2010 Conference on Antimicrobial Resistance

Transcription

1 Table of Contents Conference Objectives... 2 Acknowledgments... 4 Conference Committee Members... 4 NFID Staff... 5 Invited Presenters... 6 Accreditation and Continuing Education... 7 Disclosures... 7 General Information... American with Disabilities Act... Conference Information Desk... Conference Location... Messages... No Smoking Policy... Poster Session... Meet the Experts Breakfast Session... Program and Abstracts... 2 Registration Fees and Hours... 2 Verification of Attendance... 2 Affiliated Events and Other Meetings... 3 Hotel Floor Plan... 4 Program At-A-Glance... 5 Program Agenda... 6 Note-taking Outlines Poster Session Program Meet the Experts Biographies Abstracts Abstracts of Invited Presentations Abstracts of Submitted Oral Presentations Abstracts of Submitted Poster Presentations Author Index... 86

2 2 200 Conference on Antimicrobial Resistance Conference Objectives Overall Conference Objectives At the conclusion of this conference, participants should be able to meet the following objectives: Discuss the science, prevention and control of antimicrobial resistance Define issues and potential solutions to the problem of antimicrobial resistance Symposium Objectives: Keynote Address Review and discuss the current situation of antimicrobial resistance worldwide and ways in which its evolution can be contained so that you can participate in the global effort of containing the evolution of antimicrobial resistance; implement more prudent use of anti-infective drugs in day to day management of patients; improve the quality of life of patients by using anti-infective drugs only when necessary, and in the long term preventing the need for second and third line anti-infectives that may be associated with higher cost and greater side-effects Symposium : The Economic and Public Policy Aspects of Antibiotic Resistance and Antibiotic Development Review components of the economic burden of antibiotic resistance; describe the challenges involved in deriving an estimate of the cost of resistance in the United States, with examples of several approaches to the costing of resistance; discuss the results of two different costing studies; from the two studies, discuss an estimate of the overall cost of resistant infections in US hospitals; and review the economic and social/psychological costs of resistance to patients themselves, particularly the uninsured, with reference to MRSA infection Review economic and behavioral factors that influence the development of new antimicrobial agents or other products that could delay the emergence and spread of resistance, and conservation of antibiotic effectiveness Discuss the policy issues regarding the production and conservation of antimicrobial effectiveness Symposium 2: Susceptibility Issues Review the most threatening types of antibiotic resistances occurring and increasing in the USA and around the world; recognize the patterns of resistance and provide in vitro susceptibility monitoring services (reference-quality in vitro tests) to guide interventions to minimize greater expansion in the practice environment; implement accurate, practical in vitro methods in clinical microbiology facilities to focus optimal treatment and prevention of on-going epidemic occurrences of difficult to treat, multidrug-resistant pathogens (CLSI or EUCAST methods and interpretations) Describe the role of PK-PD data, bacterial population distribution, and clinical response data on setting susceptibility breakpoints for antimicrobial agents; list the reasons why knowing just the resistance mechanisms may not predict clinical outcome in vivo; identify regulatory, manufacturing, and clinical hurdles for implementation of new susceptibility breakpoints Discuss the overlap of resistance reservoirs in food producing animals with human clinical settings via contamination of food and water and how these resistance phenotypes and genotypes add to the burden of antimicrobial resistance in human medicine

3 SCIENCE - PREVENTION - CONTROL 3 Symposium 3: Implications of Rapid Diagnostic Testing Describe the strengths and limitations of latent class statistical methods for evaluation of test accuracy (sensitivity and specificity) for chronic infectious diseases Understand the challenges facing diagnosis of 2009 HN influenza cases early in the pandemic; review updates on emerging antiviral resistance; and know the benefits and limitations of available diagnostic tests for public health surveillance and clinical management Symposium 4: Antiviral Drug Resistance Describe resistant profiles of currently approved drugs against HBV; review management strategies to prevent and treat resistance; discuss future problems of HCV drug resistance Review drug resistance monitoring methods and surveillance data for FDA-approved anti-influenza antiviral drugs in order to facilitate the understanding of influenza drug susceptibility and treatment options available in clinical settings; implement CDC recommendations and interim guidance on the use of antivirals for the treatment of patients with influenza infections based on trends detected through influenza resistance surveillance and to improve the likelihood of successful treatment; encourage the proper use of antivirals as treatment option to reduce morbidity and mortality from complications that may arise from influenza infection Describe the clinical consequences of antiviral resistance in pandemic and seasonal HN viruses; determine effective antiviral options for prevention and treatment of oseltamivir-resistant influenza infections Symposium 5: Methicillin-resistant Staphylococcus aureus (MRSA) Discuss MRSA epidemiology in context of livestock production and its implications for occupational and public health as well as food safety Describe the components necessary to implement an active surveillance program for MRSA in a tertiary-care healthcare institution; review the outcome measures by which the success or failure of active surveillance programs for MRSA may be judged; identify factors that might contribute to reduced efficacy of active surveillance programs for MRSA; recognize opportunities for ongoing improvement of established infection control programs to control MRSA Review the typical and unusual clinical manifestations of CA-MRSA infections in children to identify infections that may be caused by this organism; describe the importance of the USA300 MRSA clone as a cause of healthcare associated infections; review the diagnostic approaches for suspected CA-MRSA infections in children so that the appropriate laboratory and imaging studies can be utilized; list the most appropriate antibiotics for empiric treatment of suspected MRSA infections in children as well as indications for surgical intervention Symposium 6: Stewardship and Policy Describe the multiple applications of antimicrobials in veterinary species and how the veterinary profession is addressing stewardship of these uses; interpret and assess accuracy of literature and press which applies to veterinary stewardship of antimicrobials

4 4 200 Conference on Antimicrobial Resistance Acknowledgments (as of January 20, 200) This conference is supported, in part, through unrestricted educational grants from: Astellas Pharma US, Inc. BD Diagnostics Cubist Pharmaceuticals, Inc. Forest Research Institute, Inc. GangaGen Inc. Pfizer Inc. Schering-Plough Corporation 3M Healthcare NFID recognizes the following individuals for their support and contributions in planning this event Lisa Becton, DVM Conference Organizing and Scientific Program Committees American Veterinary Medical Association National Pork Board Harris, MO Stuart H. Cohen, MD Conference Organizing and Scientific Program Committees Infectious Diseases Society of America University of California, Davis Medical Center Sacramento, CA Neil Fishman, MD Conference Organizing Committee Society for Healthcare Epidimiology of America University of Pennsylvania School of Medicine Philadelphia, PA Taja L. Blackburn, PhD Conference Organizing and Scientific Program Committees US Environmental Protection Agency Washington, DC Kathryn M. Edwards, MD NFID CME Committee Vanderbilt University Medical Center Nashville, TN Gayle K. Gilmore, RN, MA, MIS, CIC Conference Organizing and Scientific Program Committees Association for Professionals in Infection Control and Epidemiology Duluth, MN John S. Bradley, MD Conference Organizing and Scientific Program Committees American Academy of Pediatrics Children s Hospital, San Diego San Diego, CA Mitchell L. Cohen, MD, USPHS Conference Organizing and Scientific Program Committees Centers for Disease Control and Prevention Atlanta, GA George M. Eliopoulos, MD Scientific Program Committee Beth Israel Deaconess Medical Center Boston, MA Paula J. Fedorka-Cray, PhD Scientific Program Committee US Department of Agriculture Athens, GA Thomas M. File, Jr., MD NFID CME Committee Summa Health System Akron, OH John F. Fisher, MD NFID CME Committee Medical College of Georgia Augusta, GA Debra A. Goff, PharmD NFID CME Committee The Ohio State University Medical Center Columbus, OH George C. Hill, PhD NFID CME Committee Vanderbilt University School of Medicine Nashville, TN Marguerite Jackson, PhD, RN, FAAN NFID CME Committee University of California, San Diego School of Medicine San Diego, CA

5 SCIENCE - PREVENTION - CONTROL Jane M. Knisely, PhD Conference Organizing Committee National Institute for Allergies and Infectious Diseases/NIH Bethesda, MD Stuart B. Levy, MD Conference Organizing Committee Alliance for the Prudent Use of Antibiotics Tufts University School of Medicine Boston, MA Sasha Madison, MPH, CIC NFID CME Committee Stanford Hospital and Clinics Stanford, CA Donna Mazyck, RN, MS NFID CME Committee Maryland State Department of Education Baltimore, MD Renee P. McLeod, PhD, APRN, BC NFID CME Committee Bradman University School of Nursing & Health Professionals San Diego, CA George A. Pankey, MD NFID CME and Scientific Program Committees Ochsner Clinic Foundation New Orleans, LA Georges Peter, MD NFID CME Committee Warren Alpert Medical School of Brown University Brookline, MA John H. Powers, III, MD, FACP, FIDSA Conference Organizing Committee George Washington University School of Medicine Washington, DC Susan J. Rehm, MD Conference Co-Chair, Conference Organizing, Scientific Program, and NFID CME Committees National Foundation for Infectious Diseases Bethesda, MD Mary E. Singer, MD Conference Organizing and Scientific Program Committees US Food and Drug Administration Silver Spring, MD 5 Vincent H. Tam, PharmD Conference Organizing and Scientific Program Committees Society of Infectious Diseases Pharmacists University of Houston College of Pharmacy Houston, TX Alan D. Tice, MD NFID CME Committee John A. Burns School of Medicine University of Hawaii Honolulu, HI Mary E. Torrence, DVM, PhD Conference Organizing and Scientific Program Committees US Department of Agriculture Beltsville, MD J. Todd Weber, MD Conference Co-Chair, Conference Organizing and Scientific Program Committees Centers for Disease Control and Prevention Stockholm, Sweden Richard K. Zimmerman, MD, MPH NFID CME Committee University of Pittsburgh Pittsburgh, PA NFID Staff, Bethesda, MD KerryAnn Bolton Education Coordinator Sharon Cooper-Kerr Director, Events Planning Lauren Ero Director, Continuing Medical Education Charlotte Lazrus Executive Assistant Len Novick Executive Director

6 6 200 Conference on Antimicrobial Resistance Invited Presenters* Michael Apley, DVM, PhD, DACVCP Director, PharmCATS Bioanalytical Laboratory Kansas State University Manhattan, KS Ronald N. Jones, MD CEO/President JMI Laboratories North Liberty, IA Peter Davies, PhD, BVSc Professor, Veterinary Population Medicine University of Minnesota St. Paul, MN Sheldon L. Kaplan, MD Professor & Vice Chairman for Clinical Affairs Head, Pediatric Infectious Disease Section Baylor College of Medicine Chief, Infectious Disease Service Head, Department of Medicine Texas Children s Hospital Houston, TX Michael N. Dudley, PharmD, FIDSA Senior Vice President, Research and Development & Chief Scientific Officer Mpex Pharmaceuticals, Inc. San Diego, CA Neil Fishman, MD Associate Professor of Medicine University of Pennsylvania School of Medicine Philadelphia, PA Susan D. Foster, PhD Director of Public Policy and Education Alliance for the Prudent Use of Antibiotics Boston, MA Ian Gardner, MPVM, BVSc, PhD Professor of Epidemiology University of California Davis, California Larisa V. Gubareva, MD, PhD Team Leader, Molecular Epidemiology Centers for Disease Control & Prevention Atlanta, Georgia Frederick G. Hayden, MD Stuart S. Richardson Professor of Clinical Virology and Professor of Medicine and Pathology University of Virginia Health Systems Charlottesville, VA David L. Heymann, MD Chair Health Protection Agency London, UK Daniel B. Jernigan, MD, MPH Deputy Director, Influenza Division Centers for Disease Control & Prevention Atlanta, Georgia John A. Jernigan, MD, MS Deputy Chief, Prevention and Response Branch Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta, Georgia *Speakers and presentations subject to change Ebbing Lautenbach, MD, MPH, MSCE Associate Professor of Medicine and Epidemiology Associate Director, Clinical Epidemiology Unit Director of Research, Department of Healthcare Epidemiology and Infection Control University of Pennsylvania School of Medicine Philadelphia, PA Ramanan Laxminarayan, PhD, MPH Senior Fellow Resources for the Future Washington, DC M. Kevin Outterson, JD, LLM Associate Professor Boston University School of Law Boston, MA Robert C. Owens, Jr., PharmD Co-Director Maine Medical Center Portland, ME George Sakoulas, MD Assistant Professor University of California, San Diego School of Medicine Sharp Memorial Hospital San Deigo, CA Usha Stiefel, MD Assistant Professor Case Western Reserve University School of Medicine Chief, Infectious Diseases Section Louis Stokes Cleveland Department of Veterans Affairs Medical Center Cleveland, OH Heiner Wedemeyer, MD, PhD Research Group Leader Hannover Medical School Hannover, Germany David G. White, Ph.D. Director, Office of Research US Food and Drug Administration Laurel, MD

7 SCIENCE - PREVENTION - CONTROL 7 Accreditation and Continuing Education Continuing Medical Education The National Foundation for Infectious Diseases (NFID) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide Continuing Medical Education (CME) for physicians. NFID takes responsibility for the content, quality, and scientific integrity of this CME activity. NFID designates this educational activity for a maximum of 7 AMA PRA Category credits TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. Continuing Nursing Education NFID is an approved provider of continuing nursing education by the Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation. This educational activity has been approved for 7 contact hours. To earn contact hours, each participant must attend the entire conference, sign in daily, and complete the conference evaluation form. Designated Continuing Education Activities Sessions designated with a symbol have been approved for credit. No other sessions are eligible for credit hours. CME and Nursing Certificates In order to ensure that you receive the credits to which you are entitled, please complete and return the Continuing Education and Evaluation form to conference staff at the Conference Information Desk, or mail to: NFID, Office of CME 4733 Bethesda Avenue, Suite 750 Bethesda, MD 2084 FOR NURSES ONLY: you must also sign in daily and attend the entire conference to receive credit for attendance. Disclosures As a sponsor accredited by the ACCME, NFID must ensure balance, independence, objectivity, and scientific rigor in its educational activities. All individuals in a position to influence the content of this activity have disclosed: () any relevant financial interest or other relationship with the manufacturer(s) of any commercials product(s) and/or provider(s) of commercial services discussed in an educational presentation and/or with any commercial supporters of the activity; (2) any intention to discuss off-label uses of regulatedsubstances or devices. Disclosure information is reviewed in advance to manage and resolve any conflict of interest that may affect the balance and scientific integrity of an educational presentation. The intent of this disclosure is not to prevent a speaker or program planner with a relevant financial or other relationship from making a presentation or assisting in conference organization. The intent is to provide listeners with information on which they can make their own judgments. It remains for the audience to determine whether the speaker s interests or relationships have influenced the presentation.

8 8 200 Conference on Antimicrobial Resistance Individuals in a Position to Control the Content: Michael Apley (Faculty) received grants for clinical Kathryn M. Edwards (NFID CME Committee)received research from Elanco Animal Health; and served as an grants for clinical research from sanofi pasteur, CSL, advisor, consultant or speaker for Elanco Animal Health Wyeth and Novartis. and Pfizer Animal Health. Lisa Becton (Conference Organizing and Scientific George M. Eliopoulous (Conference Scientific Program Committee) served as an advisor or consultant Program Committees) has no relevant financial for Cubist, Arpida, Theravance, Achaogen, LEAD relationships. Therapuetics, and Bayer Schering. He received grants Taja L. Blackburn (Conference Organizing and Scientific Program Committees) has no relevant financial relationships. KerryAnn Bolton (NFID Education Coordinator) has no relevant financial relationships. John S. Bradley (Conference Organizing and Scientific Program Committees) served as an advisor or consultant for Johns & Johnson, Pfizer, Bayer, and Cubist. He or contracts for clinical research from Theravance, Pfizer and Novexel. Lauren Ero (NFID Director, Continuing Medical Education) has no relevant financial relationships. Paula J. Fedorka-Cray (Conference Scientific Program Committee) served as an advisor or consultant for and received grants for research from Intervet/Schering. Thomas M. File, Jr. (NFID CME Committee) served received grants for clinical research from Johnson & as an advisor, consultant or speaker for Advanced Life Johnson, Cubist and Pfizer. Sciences, Astellas/Theravance, Cerexa/Forest, Ortho- Cindy R. Cisar (Presenter) has no relevant financial relationships. Mitchell L. Cohen (Conference Organizing and Scientific Program Committees) has no relevant financial relationships. Stuart H. Cohen (Conference Organizing and Scientific Program Committees) served as a speaker or member of a speakers bureau for Cubist, Pfizer, Merck, and Astellas. Sharon Cooper-Kerr (NFID Director, Events) has no relevant financial relationships. Peter Davies (Faculty) has no relevant financial relationships. David M. Donovan (Presenter) has no relevant financial relationships. Michael N. Dudley (Faculty) is employed by and has stocks, stock options, and/or bond holdings from Mypex Pharmaceuticals. McNeil, Protez, Merck, Nabriva, Pfizer, Schering Plough, Targanta and Wyeth; received grants for clinical research from Cerexa, Ortho-McNeil, Protez, Pfizer, Boehringer Ingelheim, Gilead and Tibotec. John F. Fisher (NFID CME Committee) served as an advisor, consultant or speaker for Pfizer, Wyeth and Astellas. Neil Fishman (Conference Organizing Committee and Faculty) has no relevant financial relationships. Susan D. Foster (Faculty) has no relevant financial relationships. Ian Gardner (Faculty) has no relevant financial relationships. Gayle K. Gilmore (Conference Organizing andscientific Program Committees) has no relevant financial relationships.

9 SCIENCE - PREVENTION - CONTROL Debra A. Goff (NFID CME Committee) served as an advisor, consultant or speaker for Merck, Cubist and Schering; received a grant for clinical research from Cepheid. Mary Joy N. Gordoncillo (Presenter) has no relevant financial relationships. Larisa V. Gubareva (Faculty) has no relevant financial relationships. Elizabeth Hamilton (Presenter) has no relevant financial relationships. 9 Emil Lesho (Presenter) has no relevant financial relationships. Stuart B. Levy (Conference Organizing Committee) served as an advisor or consultant for, owns stock, stock options or bonds from and holds a patent for and/or royalties from Paratek Pharmaceuticals. Sasha Madison (NFID CME Committee and Content Reviewer) has no relevant financial relationships. Donna Mazyck (NFID CME Committee) has no relevant financial relationships. Frederick G. Hayden (Faculty) served as an advisor or Renee P. McLeod (NFID CME Committee) served as an consultant for Roche, GlaxoSmithKline, Biocryst, 3-V advisor, consultant or speaker for GlaxoSmithKline. Biosciences, NexBio, MedImmune and Merck. Michael J. Hearn (Presenter) has no relevant financial relationships. David L. Heymann (Faculty) owns stock, stock options or bonds from GlaxoSmithKline. George C. Hill (NFID CME Committee) has no relevant financial relationships. Marguerite Jackson (NFID CME Committee) owns stock, stock options or bonds from Cellestis, Inc. Daniel B. Jernigan (Faculty) has no relevant financial relationships. Ronald N. Jones (Faculty) owns stock, stock options or bonds from GlaxoSmithKline, Merck and Novartis. Sheldon L. Kaplan (Faculty) received grants for clinical research from Pfizer and Cubist. Jane M. Knisely (Conference Organizing Committee) has no relevant financial relationships. Munawwar A. Khan (Presenter) has no relevant financial relationships. Ramanan Laxminarayan (Faculty) has no relevant financial relationships. Yoko Miyasaki (Presenter) has no relevant financial relationships. Len Novick (NFID Executive Director) owns stock, stock options or bonds from Viropharma, Pfizer, Novavax and Cubist. M. Kevin Outterson (Faculty) has no relevant financial relationships. Jeannette Ouyang-Latimer (Presenter) has no relevant financial relationships. Robert C. Owens (Faculty) has no relevant financial relationships. George A. Pankey (NFID CME and Conference Scientific Program Committees) has no relevant financial relationships. Georges Peter (Chair NFID CME Committee) served as an advisor, consultant or speaker for Merck, Noravax, Novartis and Wyeth; owns stock, stock options or bonds from Bristol Myers Squibb.

10 0 200 Conference on Antimicrobial Resistance John H. Powers, III (Conference Organizing J. Todd Weber (Conference Co-Chair, Conference Committee) served as an advisor or consultant for Organizing and Scientific Program Committees) has Acureon, Advanced Life Sciences, Astellas, Astra- no relevant financial relationships. Zeneca, Basilea, Centegen, Cerexa, ConCERT, Cubist, Destiny, Forest, Gilead, Great Lakes, Johnson & Johnson, LEO, Merck, Methylgene, Mpes, Octoplus, Pharming, Takeda, Theravance, and Wyeth. Susan J. Rehm (NFID Medical Director, Conference Co-Chair, Conference Organizing, Scientific Program and NFID CME Committees) served as an advisor, consultant or speaker for Pfizer; served as a speaker or a member of a speakers bureau for Cubist, Roche and Wyeth; and received grants for clinical research from Cubist. George Sakoulas (Faculty) served as an advisor or consultant for Cubist, Pfizer, Ortho-McNeil, and Astellas; served as a speaker or member of a speakers bureau for Cubist, Pfizer, and Astellas. Mary E. Singer (Conference Organizing and Scientific Program Committees) has no relevant financial relationships. Gary E. Stein (Presenter) received grants for clinical research from Schering Plough. Usha Stiefel (Faculty) has no relevant financial relationships. Vincent H. Tam (Conference Organizing and Scientific Program Committees) served as a speaker or member of a speakers bureau for Merck; and received grants for clinical research from Astra-Zeneca, Merck, ScheringPlough, and Achaogen. Alan D. Tice (NFID CME Committee) served as an advisor, consultant or speaker for Cubist and Merck; received grants for clinical research from Human Genome Sciences, Roche and 3 Rivers. Mary E. Torrence (Conference Organizing and Scientific Program Committees) has no relevant financial relationships. Heiner Wedemeyer (Faculty) served as an advisor or consultant for, served as a speaker or member of a speakers bureau for, and received grants for clinical research from Roche, BMS, Gilead, Schering-Plough, and Novartis. He also served as an advisor or consultant for Abbott. David G. White (Faculty) has no relevant financial relationships. Richard K. Zimmerman (NFID CME Committee) received grants for clinical research from MedImmune and Merck; and served as an advisor, consultant or speaker for Merck.

11 SCIENCE - PREVENTION - CONTROL General Information Americans with Disabilities Act The Hyatt Regency Bethesda is fully accessible to the public in accordance with the Americans with Disabilities Act guidelines. If you have any special meeting needs or requirements, please contact either Sharon Cooper-Kerr or a member of the hotel staff. Conference Information Desk The Conference Information Desk is located in the Waterford Lobby area outside the Crystal Ballroom. Conference staff will be available at the desk throughout the conference. Conference Language The official language for the conference is English. Conference Location All sessions of the conference will be held at: Hyatt Regency Bethesda One Bethesda Metro Center Wisconsin Avenue at Old Georgetown Road Bethesda, Maryland 2084 (30) Messages All sleeping rooms in the Hyatt Regency Bethesda are equipped with a voice mail system. This system is accessible via the hotel operator using the house phone. In case of emergencies requiring immediate attention, your party should call the general hotel number listed below and instruct the switchboard to deliver a message to Sharon Cooper-Kerr or Lauren Ero at the Antimicrobial Resistance Conference Information Desk outside of the Crystal Ballroom. The general hotel number is No Smoking Policy The Hyatt Regency Bethesda is a non-smoking facility. No smoking is allowed in any of the sleeping rooms, session rooms, coffee break area, or in the foyer adjoining the session rooms. Poster Session The Poster Session and Reception will be held on Monday, February, 4:45 pm in Waterford/Lalique. Presenters will be at their posters to answer questions and discuss their research. The Posters will continue to be on display throughout the conference. Meet the Experts Breakfast Session The Meet the Expert discussions are in a small group format focusing on interaction between faculty members and attendees. The format is conducive to informal interaction led by introductory remarks from the leader followed by questions and answers from the participants. The session is open to all attendees, however, seating capacity is limited and on a first-come, first-served basis. Please be sure to take advantage of this networking opportunity to meet with faculty for a thoughtful exchange of ideas among peers, mentors, and colleagues.

12 2 200 Conference on Antimicrobial Resistance The breakfast session is scheduled for Tuesday, February 2, 7:5 am 7:45 am, in Waterford/Lalique. Discussion leaders and topics (please refer to the Table of Contents for biographical information): Incentivizing New Antibiotics Ramanan Laxminarayan, PhD, MPH The Implications of the Emergence of MRSA in Livestock Peter Davies, PhD, BVSc Antimicrobial Use in Food Animals Michael Apley, DVM, PhD, DACVCP Prevention and Management of Drug Resistance in HBV Infection Heiner Wedemeyer, MD, PhD Influenza Clinical Management Issues Frederick G. Hayden, MD Legal issues in Healthcare Associated Infections M. Kevin Outterson, JD, LLM Program and Abstract Book and Handouts Each registered participant will receive one complimentary copy of the Final Program and Abstract Book as part of his/her registration fee. Additional copies, if available, may be purchased for $25. Orders for additional copies can be taken at the Conference Information Desk and after the conference, by to or by calling (30) , ext 9. Please note that we are unable to replace lost or stolen programs. Handouts of the presentations will not be provided. Notetaking outlines may be found immediately after the Program Agenda, beginning on page 6. With the permission of each faculty member, note-taking details and the actual slides presented at the conference will be posted on NFID s website after the conference. Registered attendees will be notified by when the slides are posted, and they will be available for one month. Please use this resource to find slides that may have been updated since the abstract book was printed. Registration Fees and Hours The onsite registration fee: US $550 (Non Member) and $495 (NFID Supporting Member) The registration fee includes a program and abstract book, continental breakfast on each day of the conference, all scheduled coffee breaks, and the reception on Monday. Accommodations and additional meals are not included. Individuals interested in registering onsite may do so at the Conference Information Desk between the following times: Sunday, January 3 6:00 pm - 7:30 pm Monday, February 7:30 am - 4:45 pm Tuesday, February 2 7:00 am - 4:45 pm Wednesday, February 3 7:00 am - 8:00 am Verification of Attendance Attendees may obtain a letter of attendance verification from the staff at the Conference Information Desk during registration hours.

13 SCIENCE - PREVENTION - CONTROL 3 Affiliated Events and Other Meetings Tuesday, February 2, 200 5:00pm 8:00pm., Congressional Room Conference on Antimicrobial Resistance Organizing and Scientific Program Committee Meeting (Closed meeting) Wednesday, February 3, 200 2:00pm-:00pm., Crystal Ballroom Interagency Task Force on Antimicrobial Resistance Sponsored by the Centers for Disease Control and Prevention, US Food and Drug Administration, and the National Institutes of Health The Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and National Institutes of Health (NIH), co-chairs of the Interagency Task Force on Antimicrobial Resistance, will hold an open meeting to present the annual report of progress by Federal agencies in accomplishing activities outlined in, A Public Health Action Plan to Combat Antimicrobial Resistance (Part I: Domestic Issues) and solicit comments from the public regarding the annual report. The Action Plan serves as a blueprint for activities of Federal agencies to address antimicrobial resistance. The agenda will consist of welcome and introductory comments, an executive summary, and brief reports in four focus areas: Surveillance, Prevention and Control, Research, and Product Development. The meeting will then be open for general discussion. The Action Plan and Annual Report are available at The public meeting is sponsored by the CDC, FDA, and NIH in collaboration with seven other Federal agencies and departments that were involved in developing and writing A Public Health Action Plan to Combat Antimicrobial Resistance (Part I: Domestic Issues).

14 4 200 Conference on Antimicrobial Resistance FLOOR PLAN CONFERENCE LEVEL CRYSTAL BALLROOM LEVEL

15 SCIENCE - PREVENTION - CONTROL PROGRAM AT A GLANCE Sunday, Jan 3 Monday, Feb Tuesday, Feb 2 7:00 am Registration 7:5 am Meet the Experts Breakfast Session 7:30 am Registration Poster Set-up Continental Breakfast 8:00 am 8:5 am Welcome and Introductions 8:30 am Keynote Address Continental Breakfast Symposium 4: Antiviral Drug Resistance Submitted Presentations: Epidemiology and Clinical Consideration Coffee Break 9:30 am Coffee Break 9:45 am Symposium : The Economic and Public Policy Aspects of Antibiotic Resistance and Antibiotic Development Symposium 7: Late Breaking Issues: Impact of Antimicrobial Resistance on Healthcare Settings 0:00 am Coffee Break 0:5 am Symposium 5: Methicillin-resistant Staphylococcus aureus (MRSA) Lunch (on your own) Adjournment/ Conference Evaluation Meeting of the Interagency Task Force on Antimicrobial Resistance 2:00 pm Lunch (on your own) 2:5 pm :00 pm Symposium 2: Susceptibility Issues :30 pm Submitted Presentations: Mechanisms and Drug Discovery 2:30 pm Coffee Break 2:45 pm Symposium 6: Stewardship and Policy 3:00 pm Coffee Break 3:5 pm Symposium 3: Implications of Rapid Diagnostic Testing 4:45 pm Poster Session and Reception 6:00 pm Early Registration Registration Continental Breakfast 9:5 am :45 pm Wednesday Feb 3 Adjournment 5

16 6 200 Conference on Antimicrobial Resistance FINAL PROGRAM Sunday, January 3, 200 6:00 pm 7:30 pm Registration Crystal Ballroom Foyer Monday, February, 200 7:30 am 4:45 pm Registration Crystal Ballroom Foyer 7:30 am Poster Set-Up Waterford/Lalique 7:30 am Continental Breakfast Crystal Ballroom Foyer 8:5 am Welcome and Introductions Susan J. Rehm, M.D. National Foundation for Infectious Diseases Bethesda, MD Crystal Ballroom Keynote Address CE Crystal Ballroom Moderator: J. Todd Weber, MD Centers for Disease Control and Prevention CDC Liaison at the European Centre for Disease Prevention and Control Stockholm, Sweden 8:30 am. The Globalization of Antimicrobial Resistance David L. Heymann, MD Health Protection Agency London, United Kingdom 9:5 am Questions and Answers 9:30 am Coffee Break Crystal Ballroom Foyer Symposium. The Economic and Public Policy Aspects of Antibiotic Resistance and Antibiotic Development CE Crystal Ballroom Moderator: John H. Powers, III, MD George Washington University School of Medicine Washington, DC 9:45 am 2. Economic Consequences of Antibiotic Resistance Susan Foster, PhD Alliance for the Prudent Use of Antibiotics Boston, MA

17 SCIENCE - PREVENTION - CONTROL FINAL PROGRAM 0:5 am 3. Economics of Antibiotic Development Ramanan Laxminarayan, PhD, MPH Resources for the Future Washington, D.C. 0:45 am 4. Assessing Incentives for Continued Antimicrobial Effectiveness Kevin Outterson, JD, LLM Boston University School of Law Boston, MA :5 am Panel Questions and Answers :45 am Lunch (on your own) Symposium 2. Susceptibility Issues CE Crystal Ballroom Moderator: George M. Eliopoulos, MD Beth Israel Deaconess Medical Center Boston, MA :00 pm 5. What s Hot in Antimicrobial Resistance and the Challenges in Resource-Limited Settings Ronald N. Jones, MD JMI Laboratories North Liberty, IA :30 pm 6. Towards Improved Susceptibility Tests: Getting the Right Answer Michael N. Dudley, PharmD, FIDSA Mpex Pharmaceuticals, Inc. San Diego CA 2:00 pm 7. Paper or Plastic? Bringing Resistance Home David G. White, PhD US Food and Drug Administration Laurel, MD 2:30 pm Panel Questions and Answers 3:00 pm Coffee Break Crystal Ballroom Foyer 7

18 8 200 Conference on Antimicrobial Resistance FINAL PROGRAM Monday, February, 200 (continued) Symposium 3. Implications of Rapid Diagnostic Testing CE Crystal Ballroom Moderator: John S. Bradley, MD Children s Hospital San Diego San Deigo, CA 3:5 pm 8. Early Detection and Containment of New Antimicrobial Resistance Clones - Rapid Diagnostics in Veterinary Medicine: Challenges and Benefits Ian Gardner, MPVM, BVSc, PhD University of California Davis, CA 3:45 pm 9. Clinical and Public Health Implications of Rapid Diagnostic Testing for Influenza Daniel B. Jernigan, MD, MPH Centers for Disease Control and Prevention Atlanta, GA 4:5 pm Panel Discussion: T he Interface between Human and Veterinary Medicine Ian Gardner, MPVM, BVSc, PhD and Daniel B. Jernigan, MD, MPH 4:45 pm Poster Session and Reception Waterford/Lalique (Posters will remain on display throughout the conference) Tuesday, February 2, 200 7:00 am 4:45 pm Registration Crystal Ballroom Foyer 7:5 am 7:45 am Meet the Experts Breakfast Session Waterford/Lalique Symposium 4: Antiviral Drug Resistance CE Crystal Ballroom Moderator: John S. Bradley, MD Children s Hospital San Diego San Deigo, CA 8:00 am 0. Resistance in Viral Hepatitis: The European Perspective Heiner Wedemeyer, MD, PhD Hannover Medical School Hannover, Germany 8:30 am. Antiviral Resistance in Influenza: Mechanisms, Detection, and Global Epidemiology Larisa V. Gubareva, MD, PhD Centers for Disease Control & Prevention Atlanta, GA

19 SCIENCE - PREVENTION - CONTROL FINAL PROGRAM 9:00 am 2. Influenza Resistance to Antiviral Drugs: Public Health and Management Implications Frederick G. Hayden, MD University of Virginia Health Systems Charlottesville, VA 9:30 am Panel Questions and Answer 0:00 am Coffee Break Crystal Ballroom Foyer Symposium 5: Methicillin-resistant Staphylococcus aureus (MRSA) CE Crystal Ballroom Moderator: J. Todd Weber, MD Centers for Disease Control and Prevention CDC Liaison at the European Centre for Disease Prevention and Control Stockholm, Sweden 0:5 am 3. MRSA in Livestock: Zoonotic Issues Peter Davies, BVSc, PhD University of Minnesota St Paul, MN 0:45 am 4. The MRSA Prevention Initiative and the VA: The Road Ahead Usha Stiefel, MD Louis Stokes Cleveland Veterans Affairs Medical Center Cleveland, OH :5 am 5. Diagnosis, Treatment and Prevention of MRSA Infections in Children Sheldon L. Kaplan, MD Baylor College of Medicine Texas Children s Hospital Houston, TX :45 am Panel Questions and Answers 2:5 pm Lunch 9

20 Conference on Antimicrobial Resistance FINAL PROGRAM Tuesday, February 2, 200 (continued) Submitted Presentations : Mechanisms and Drug Discovery Moderator: Vincent H. Tam, PharmD University of Houston College of Pharmacy Houston, TX CE :30 am S Targeting Intracellular Staphylococcus Aureus with Staphylolytic Peptidoglycan Hydrolase Fusions D. M. Donovan, S. C. Becker, J. Foster-Frey, R. Almeida2, I. Marriott3, S. Dong4, J. R. Baker4, D. G. Pritchard4, T. R. Sheen5, K. S. Doran5; Animal Biosciences and Biotechnology, ARS/USDA, Beltsville, MD, 2University of Tennessee, Knoxville, TN, 3Biology, University of North Carolina, Charlotte, Charlotte, NC, 4 Biochemistry and Molecular Genetics, University of Alabama, Birmingham, Birmingham, AL, 5Biology, San Diego State University, San Diego, CA. :45 pm S2 Evaluation of Serum Bacterial Kill of Moxifloxacin and Levofloxacin Against S. Pneumoniae Isolates With First-step Mutations G. E. Stein, C. Smith2, G. Kim, L. Dybas, W. Chung, D. Nicolau3; Medicine, Michigan State University, East Lansing, MI, 2Pharmacy, Ferris State University, Lansing, MI, 3Hartford Hospital, Hartford, CT. 2:00 pm S3 Drug Design Strategies for Combating the Rise of Resistance in Tuberculosis M. J. Hearn, M. H. Cynamon2, M. F. Chen, R. Coppins, J. Davis, H. Kang, A. Noble, B. Tu-Sekine, M. Terrot, D. Trombino, M. Thai, E. R. Webster, R. Wilson; Department of Chemistry, Wellesley College, Wellesley, MA, 2Veterans Affairs Medical Center, Syracuse, NY. 2:5 pm S4 ovel Method of Evaluating the Antimicrobial Activities of Chinese Herbal Extracts N Against Multi-drug Resistant Acinetobacter Baumannii Y. Miyasaki, W. S. Nichols2, M. A. Morgan2, J. A. Kwan2, M. M. Van Benschoten3, P. E. Kittell4, W. D. Hardy; Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 2Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 3M. M. Van Benschoten O.M.D and Associates, Reseda, CA, 4Patient Financial Services, Cedars-Sinai Medical Center, Los Angeles, CA. 2:30 pm Coffee Break Crystal Ballroom

21 SCIENCE - PREVENTION - CONTROL FINAL PROGRAM Symposium 6. Stewardship and Policy CE Crystal Ballroom Moderator: Susan J. Rehm, MD National Foundation for Infectious Diseases Bethesda, MD 2:45 pm 6. Policy Issues Neil Fishman, MD University of Pennsylvania Philadelphia, PA 3:5 pm 7. Antimicrobial Stewardship in 200: When to Act, When to Study Robert C. Owens, Jr., PharmD Maine Medical Center Portland, ME 3:45 pm 8. Antibiotic Stewardship in Veterinary Medicine Mike Apley, DVM, PhD, DACVCP Kansas State University Manhattan, KS 4:5 pm Panel Questions and Answers 4:45 pm Adjournment Wednesday, February 3, 200 7:00 am 8:00 am Registration Crystal Ballroom Foyer 7:5 am 7:45 am Meet the Experts Breakfast Session Waterford/Lalique 7:30 am Continental Breakfast Crystal Ballroom Foyer Submitted Presentations 2: Epidemiology and Clinical Considerations CE Crystal Ballroom Moderator: Gayle K. Gilmore, RN, MA, MIS, CIC Association for Professionals in Infection Control and Epidemiology Duluth, MN 8:00 am ntibiotic Susceptibility and Resistance Among Bacterial Enteropathogens Isolated S5 A From International Travelers to Mexico, Guatemala, and India, J. Ouyang-Latimer, S. Jafri2, Z. Jiang2, H. L. DuPont3; Baylor College of Medicine, University of Texas School of Public Health, Houston, TX, 2 University of Texas School of Public Health, Houston, TX, 3University of Texas School of Public Health, St. Luke s Episcopal Hospital, Houston, TX. 8:5 am S6 T he Multidrug-resistant Organism Repository and Surveillance Network (MRSN): The Army s Response to the Antibiotic Resistance Crisis E. Lesho, D. Craft, D. Hospenthal2, K. Kester, C. Murray2, M. Vahey, B. Kirkup, A. Summers, P. Waterman3, G. Wortmann3, R. Bowden; Walter Reed Army Institute of Research, Silver Spring, MD, 2San Antonio Military Medical Center, San Antonio, TX, 3Walter Reed Army Medical Center, Washington, DC. 2

22 Conference on Antimicrobial Resistance FINAL PROGRAM Wednesday, February 3, 200 (continued) S7 I mpact of Wastewater Treatment Plant Effluent on Antibiotic Resistance in Aeromonads C. R. Cisar, S. K. Henderson, M. L. Dallis, K. M. Dixon, H. G. Moses, C. S. Paine; Natural Sciences, Northeastern State University, Tahlequah, OK. S8 WITHDRAWN 8:45 am S9 M olecular Characterization and Antimicrobial Resistance of Enterococcus Faecium and Escherchia Coli Isolated From Companion Animals and Their Health Care Providers at a Veterinary Teaching Hospital E. Hamilton, K. May, J. Hattey2, J. B. Kaneene; Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, 2Diagnostic Center for Population and Animal Health, Michigan State University, East Lansing, MI. 9:00 am S0 I nnovative Veterinary Education as a Means to Control and Prevent Emergence and Spread of Antimicrobial Resistance M. N. Gordoncillo, P. C. Bartlett; Large Animal Clinical Sciences, Michigan State University, East Lansing, MI. 9:5 am Coffee Break 8:30 am Symposium 7. Late-breaking Issues Crystal Ballroom CE Moderators: Susan J. Rehm, MD National Foundation for Infectious Diseases Bethesda, MD And J. Todd Weber, MD Centers for Disease Control and Prevention CDC Liaison at the European Centre for Disease Prevention and Control Stockholm, Sweden 9:45 am 9. Gram Positive Cocci George Sakoulas, MD Sharp Memorial Hospital San Diego, CA 0:5 am 20. Gram Negative Bacilli Ebbing Lautenbach, MD, MPH, MSCE University of Pennsylvania School of Medicine Philadelphia, PA 0:45 am 2. Reducing Antimicrobial Resistant Infections In Healthcare Settings Resistant Infections John A. Jernigan, MD, MS Centers for Disease Control and Prevention Atlanta, Georgia

23 SCIENCE - PREVENTION - CONTROL FINAL PROGRAM :5 am Panel Questions and Answers :45 am Adjournment/Participant Evaluation 2:00 pm Meeting of the Interagency Task Force on Antimicrobial Resistance Sponsored by the Centers for Disease Control and Prevention, US Food and Drug Administration, and the National Institutes of Health An open meeting to present the annual report of progress by Federal agencies in accomplishing activities outlined in A Public Health Action Plan to Combat Antimicrobial Resistance (Part I: Domestic Issues) and to solicit comments from the public regarding the annual report. The Action Plan and Annual Report are available at 23

24 Conference on Antimicrobial Resistance NOTE-TAKING OUTLINES NOTE-TAKING OUTLINES

25 SCIENCE - PREVENTION - CONTROL 25 NOTE-TAKING OUTLINES The Globalization of Antimicrobial Resistance David L. Heymann, MD Monday, February at 8:30 am Influenza A (HN), reported geographic distribution Oseltamivir resistance, pandemic HN Adamantine Resistance, seasonal influenza, Antibiotic use: evolution of penicillin resistance of Staphylococcus aureus Leading Causes of Mortality in Low-income Nations (2004) Leading infectious causes of death in low-income countries 2005 (estimates) Antimicrobial resistance: bacterial, viral, and parasitic infections Global Spread of Chloroquine-Resistant Strains of P. falciparum, 950s-980s Malaria transmission areas and reported drug resistance, 2004 Proportion of tuberculosis cases with first-line drug resistance, UK, Percent MDR TB among new cases Antibiotic over-use: Lack of simple diagnostics for human infections Penicillin resistant Gonorrhoea, 990s Antimicrobial over-use: medical workers Antibiotic use: outpatient penicillin usage correlated with penicillin resistance, Europe, 2005 Total antibiotic use in the outpatient setting (vertical axis) versus prevalence of penicillin-nonsusceptible Streptococcus pneumoniae (horizontal axis)

26 Conference on Antimicrobial Resistance NOTE-TAKING OUTLINES Association between annual human consumption of macrolides (in tons) and frequency of macrolide resistance among group A streptococci in Japan Antibiotic consumption in animals, 2005 Antibiotic use: indiscriminate use in plants, fish and animals Percentage of Multidrug-resistant Definitive Type (DT) 04 Salmonella Typhimurium, Europe Hospital Acquired Infections and antimicrobial resistance Proportion of MRSA isolates, Europe, Reported MRSA, worldwide, 2006 Spread of multi-resistant pneumococcus first identified in Spain Failing research and development: 90/0 gap Discovery of antibiotics: a faltering pipeline Use of second and third generation antimicrobials increases costs WHO Global strategy for containment of resistance, 200 The five key areas for containment of antimicrobial resistance Continuing the action Vaccines, a definitive solution to antimicrobial resistance

27 SCIENCE - PREVENTION - CONTROL NOTE-TAKING OUTLINES 2 Economic Consequences of Antibiotic Resistance Susan D. Foster, PhD Monday, February at 9:45 am The direct costs of drug resistance The indirect economic costs The Massachusetts Hospital Discharge Study ICD9 V09 Codes for Drug-Resistant Infections Average hospital LOS and hospital charge per discharge (inflation adjusted) for drug-resistant infections and drug-susceptible infections in Massachusetts, Age Distribution of Hospital Discharges with Drug-Resistant Infections in Massachusetts, 2000 and 2007 Age distribution of cases in Massachusetts, 2000, 2006 and 2007 Payer Distribution of Hospital Discharges with Drug-Resistant Infections in Massachusetts Drug resistant cases by payer, Massachusetts, Destination of discharges, 2000 and 2006 The Chicago Cook County (Stroger) Hospital Study Patient characteristics of the sample Mean cost by type of infection Overall resistant infections by type, Chicago Cook County Hospital (2000) Contribution to total cost by infection, Chicago Cook County Hospital (2000) The national burden Study of impact of MRSA on patients and households Impact of MRSA on individuals Impact on individuals: another example Reported out of pocket expenditures by MRSA patients (preliminary data) Insurance status of respondents Conclusions 27

28 Conference on Antimicrobial Resistance NOTE-TAKING OUTLINES 3 Economics of Antibiotic Development Ramanan Laxminarayan, PhD, MPH Monday, February at 0:5 am Health Care Consequences Economic Burden of Resistance Why is resistance increasing? Market failure? Dealing with resistance Why intervene? Commonly cited reasons Incentives for Pharma Challenges with incentives What kind of innovation would be helpful? Incentives Overview of policy options

29 SCIENCE - PREVENTION - CONTROL NOTE-TAKING OUTLINES 4 Assessing Incentives for Continued Antimicrobial Effectiveness Kevin Outterson, JD, LLM Monday, February at 0:45 am Conventional view ABX & Rivalry Mismatched incentives What is the goal? Conservation 20th Century Model Preserving the common pool ACE incentives I ACE incentives II Reimbursement Social value of the ABX common pool Other reimbursement models Discussion ABX Prizes Infections of interest New therapies 29

30 Conference on Antimicrobial Resistance NOTE-TAKING OUTLINES 5 What s Hot in Antimicrobial Resistance and the Challenges in Resource-Limited Settings Ronald N. Jones, MD Monday, February at :00 pm Bad Bugs, No Drugs A Changing Landscape for Approval of Antibacterial Agents: FDA Approvals Over Time Carbapenem Usage Continues to Rise Dramatically ( USA) Regional Trends in MRSA Rates Trends in MRSA Rates in SENTRY Program Medical Centers (Bacteremias in USA, ) Comprehensive Evaluation of Vancomycin and Daptomycin MIC Creep Real Issues of Compromised Glycopeptide Action Regional Trends in Blood Culture VRE Rates (SENTRY Program, [2 years]; >35,000 Isolates) Progression of Vancomycin Resistance among E. faecium Bacteremias in North America and Europe Progression of Penicillin and Macrolide-Resistant Rates among S. pneumoniae Current Susceptibility Patterns of Newer Antimicrobials Vancomycin versus Daptomycin MIC Trends from Linezolid (Oxazolidinone) Resistance Surveillance Programs Worldwide Resistance to Selected Antimicrobials ( ) Regional Trends in Enterobacter Derepressed AmpC Resistances (SENTRY Program, ) Changes in Ceftazidime (CAZ) Resistance Mechanisms among CAZ-Resistant Enterobacters (SENTRY Program, versus 2005) Klebsiella Outbreak in NYC Eight-year Trends in Carbapenem Resistances in the MYSTIC Program (USA; )a Worldwide Resistance to Selected Antimicrobials ( ) Resistance Mechanisms Occurring in 50 Meropenem-Resistant P. aeruginosa Isolatesa Acinetobacter Cumulative Percent of Acinetobacter spp Isolates Inhibited at Increasing MIC Values Correlation between Vancomycin Broth Dilution MIC and Disk Zone Diameter How is Vancomycin Susceptibility Determined (Data from the CAP Sample, D-2, 2007)?a The Future of Infectious Disease Practice