BREAK POINT 2015 - ISSUE 15 FROM THE NEWSLETTER EDITOR S DESK In this issue, antimicrobial stewardship takes on the perspective in the form of stewardship in the General Practitioner and community setting (see article by Minyon Avent, University of Queensland). New treatments for Clostridium difficile infection have also been in the forefront of recent major Infectious Diseases and Gastroenterology meetings alike (summarized within In the News ). As always suggestions towards improving the Newsletter are very welcome. Sharon Chen ASA Breakpoint Editor
BREAKPOINT CONTENTS ASA Subscription... Page 02 In the News... Page 02 Antimicrobial Stewardship in General Practice... Page 03 Antimicrobials 2016... Page 11 Proposed Program... Page 12 Meeting Calendar... Page 13 ASA SUBSCRIPTION Payment of ASA Subscription renewals can be performed on-line in the Members Area of the website (http://www.asainc.net.au/members) Alternatively subscription renewal forms can be downloaded from the Members Area (http://www.asainc.net.au/members) and: Faxed: 08 9450 8853 Emailed: info@asainc.net.au Posted: Australian Society for Antimicrobials PO Box 8266, Angelo Street, South Perth, Western Australia 6151 ASA Application Membership Forms can be downloaded from the ASA website (http://www.asainc.net.au/membership) IN THE NEWS New pharmacology treatments for Clostridium difficile infection have we arrived? The results in print form of the MODIFY I and II phase III clinical trials are awaited eagerly with the integrated results of both trials presented at various scientific meetings include ICAAC 2015 and ID weeks 2015. Both Bezlotoxumab (human IgG 1 monoclonal antibodies which targets toxin B) and Actoxumab (which targets toxin A) were studied in combination and as a single agent with the primary endpoint being recurrence of C. difficile infection (CDI). Both were given as an addition to standard of care therapy. In brief, Bezlotoxumab, Page 02
2015 - Issue 15 IN THE NEWS CONT D but not Actoxumab, was identified as conferring benefit compared with placebo. It was also efficacious in key subgroups at risk of CDI. Other drugs with promising potential include Cadazolid (currently completed phase II clinical trials) which demonstrated favourable cure rates and recurrence rates compared with vancomycin, whilst administration of nontoxigenic (NTG) C. difficile spores has been studied for prophylaxis against recurrent CDI. Further Reading: 1. Debast SB et al. Clin Microbiol Infect 2014; 20(Suppl 2): 1-26. 2. Wilcox M et al. ID week San Diego, CA, Oct 7-11 (available at ID week website) 3. Gerding DN et al, JAMA 2015: 313:1719-27 4.Loiue T et al, Antimicrob Agents Chemother 2015; 59: 6266-73. ANTIMICROBIAL STEWARDSHIP IN GENERAL PRACTICE Avent ML 1 The University of Queensland, School of Public Health and UQ Centre for Clinical Research, & Faculty of Medicine + Biomedical Sciences, Herston, Brisbane, Australia Summary Antibiotic resistance inevitably follows antibiotic use. Significantly reducing antibiotic prescribing (the pressure that drives resistance to appear and then persist) results in resistant bacteria to disappear overtime. The vast majority of antibiotics in Australia are prescribed by general practitioners (GPs), and the most common indication is for acute respiratory infections (ARIs). Evidence shows that antibiotics are largely ineffective for the management of ARIs. Thus GPs have the potential to be the most effective health care professionals to address the problem of antibiotic resistance. Since 2008 there has been a steady increase in antibiotic prescriptions in the general practice setting in Australia with Queensland having a higher prescribing rate compared to other states. Continued improvements in prescribing practice and a positive influence on clinician and community beliefs will be essential to reduce antibiotic resistance. There are a number of interventions that are effective, or have shown promise, at decreasing antibiotic prescribing for acute respiratory infections (ARIs) in primary care. Many of these strategies have not been adopted in Australia. Page 03
BREAKPOINT ANTIMICROBIAL STEWARDSHIP IN GENERAL PRACTICE CONT D Australia is one of the highest users of antibiotics in the developed world, with around 22 million prescriptions written every year in primary care. The defined daily dose in Australia is nearly 23/1000 population/day compared with less than 15/1000 for Denmark, the Netherlands and Sweden combined (figure 1). 1 General Practitioners (GPs) have the potential to be the most effective health care professionals to address the problem of antibiotic resistance as the majority of antibiotics are prescribed in the general practice setting and antibiotics remain the most common class of medicine prescribed. 1 Continued improvements in prescribing practice and a positive influence on individual and community beliefs are essential to limit the spread of antibiotic resistance. 2 Research shows that up to half of antimicrobials prescribed in Australian hospitals are discordant with guidelines or microbiological results and hence are considered inappropriate, 3 however, little is known about what happens in the primary care setting. Inappropriate use of antimicrobials is thought to contribute to an increased risk of antibiotic-resistant pathogens. 4 Patients with infections caused by antibiotic-resistant organisms have an increased mortality compared with those infected with antibiotic-susceptible organisms. 5, 6 Unfortunately, new antimicrobials are not being developed at a pace that comes anywhere close to meeting the urgent need; therefore, the healthcare system needs to undertake efforts that save one of medicine s most precious and long-standing resources. 7 This was summarised by the World Health Day 2011 slogan Combat antibiotic resistance: no action today, no cure tomorrow. Reducing the inappropriate use of antimicrobials has been shown to improve patient outcomes and reduce adverse consequences of antibiotic use (including antibiotic resistance, toxicity and unnecessary costs). 8 Figure1. Comparison of Australian and European antibiotic use in the community in 2009 1 Page 04
2015 - Issue 15 ANTIMICROBIAL STEWARDSHIP IN GENERAL PRACTICE CONT D There is a strong link between antibiotic consumption and the rate of antibiotic resistance. 9 In Australia antibiotic resistance in common pathogens causing acute respiratory tract infections (ARIs) has increased over the past 20 years. 10 For example, resistance of Streptococcus pneumoniae to macrolide antibiotics has increased from 8.7% in 1994 to 20.4% in 2007, and this trend is continuing. 11 Prescribers are well placed to convey the importance of informing patients that they are twice as likely to carry resistant bacteria after a course of antibiotics as someone who has not taken them. 12-14 These resistant bacteria can persist for up to 12 months after antibiotic use in primary care; but with no further exposure to antibiotics they will disappear overtime. 14 Therefore we must reduce antibiotic use in primary care in order preserve the miracle of antibiotics. Evidence from general practice demonstrates that patient satisfaction is linked more with good communication than a prescription for an antibiotic. 15 Several studies have demonstrated that GPs trained in communication skills prescribed antibiotics significantly less than GPs without training. 16, 17 The benefits of patients managed by a GP trained in enhanced communication skills can persist for at least 3 years, and do not appear to compromise repeat consultation rate, patient recovery or patient satisfaction. 16-19 Figure 2: Distribution for percent of respiratory tract infection consultations with antibiotics prescribed for adults aged 18 59 years at 568 UK General Practices 20 Page 05
BREAKPOINT ANTIMICROBIAL STEWARDSHIP IN GENERAL PRACTICE CONT D Recently surveys of Antimicrobial Stewardship (AMS) in Australian hospitals have identified areas for improvement: reviewing antimicrobial prescribing with feedback to the prescriber, auditing and training and education in antimicrobial use. In addition, there appears to be a lack of resources to support an AMS programs in some facilities. 21-23 Other barriers were also identified: doctors reluctant to change their prescribing practices; high level of transient and/or seconded staff; lack of leadership to promote AMS; lack of support from senior clinicians as well as insufficient training and education in antimicrobial use provided to clinicians. 21-23 However, little is known about what happens in the primary health care setting in Australia. There are a number of interventions that have shown promise at decreasing antibiotic prescribing for ARIs in primary care. None of these strategies or interventions on their own will greatly improve the use of antibiotics (figure 3). However, used in concert, combinations are likely to enable clinicians and health care systems to implement the strategies that will reduce antimicrobial resistance in the future. 24 In addition, professional colleges and collaborations between industry and professional bodies could be used to promote and increase the uptake of, and compliance with, antimicrobial Figure 3: Overview of strategies to minimize antibiotic use in primary care at each stage of the path from healthy person to antibiotic prescription for acute respiratory infection 24 Page 06
2015 - Issue 15 ANTIMICROBIAL STEWARDSHIP IN GENERAL PRACTICE CONT D resistance related training and initiatives. For example, in the UK, educational and guidance material has been developed in association with professional bodies and industry alliances to aid and promote the appropriate use of antibiotics in both human and animal health. Examples include: a GP toolkit, Treat Antibiotics Responsibly, Guidance and Education Tool (TARGET), developed by the Antimicrobial Stewardship in Primary Care Collaboration and hosted on the Royal College of General Practitioners website; and a similar initiative, Stemming the Tide of Antibiotic Resistance (STAR), which provides resources for GPs to provide to patients during consultations. Currently in Australia an exciting research project is underway to evaluate the uptake and effectiveness of a number of interventions for the management of ARIs entitled General Practitioner Antimicrobial Stewardship Programme Study (GAPS). This trial is funded by the Department of Health and being conducted by The University of Queensland, Bond University and QUT. The study aims to reduce antibiotic resistance in Australia, by reducing the antibiotic prescribing rates for ARIs. Twenty-eight urban general practices in Queensland (20 in Brisbane and 8 in the Gold Coast) are participating: 14 are intervention practices; their performance in antibiotic prescribing will be compared with 14 control practices. The rate of antimicrobial prescribing will be compared with the preceding year s rates, in the same time period, as an internal control/comparison. Semi-structured interviews will be conducted with the practice staff from the intervention group by the investigators. Questions will be about the acceptability and feasibility of the interventions. In addition, health economic data will be used to estimate the costs of implementing the package and determine cost-effectiveness The interventions include: 1. a delayed prescribing protocol: which is a poster-sized commitment letter that is displayed in the GPs waiting room and/or examination room. Each GPs photograph and signature will be inserted as endorsement on the letters. The posted commitment letter, written at the eighth grade reading level and displayed in English emphasises GP commitment to guidelines, i.e. Therapeutic Guidelines: Antibiotic, for appropriate antibiotic prescribing and explains why antibiotics are not appropriate in many cases. 2. Patient information leaflet: which consists of an information leaflet that will provide more information to the patient about the poster-sized commitment letter in the GPs waiting room and/or examination room. 3. Delayed antibiotic prescribing: the GP can choose to provide the patient with a delayed antibiotic prescription with advice to the patient to only have the prescription filled at a pharmacy after a few days if symptoms are not starting to settle or become more severe. A sticker will be applied to the prescription labelling it as a delayed prescription Page 07
BREAKPOINT ANTIMICROBIAL STEWARDSHIP IN GENERAL PRACTICE CONT D 4. Patient Decision Aids: which is a brief summary of evidence for the management of a number of ARI conditions. The decision aids have been developed to assist the patient to make an appropriate decision about their condition in conjunction with the GP. 5. Online communication training package: which is offered in combination with background information on the problem of antimicrobial resistance in primary care and the effectiveness of antibiotics for most commonly presenting ARIs 6. Point of care test C-reactive protein (CRP): which is performed on a finger prick blood sample and the result is available during patient consultation and can, therefore, guide antibiotic use. 7. Infection Control strategies. there are very few data about effective Infection control strategies in the GP setting. Surveillance anterior nasal and throat swabs will be taken from General Practice staff and patients to define rates of transmission in staff and community members attending the GP practice for consultation with non-infectious complaints. This will help define what ICP protocols need to be implemented in GP settings. More information about the project can be obtained from the website http://gaps.uq.edu.au/ References 1 Mc Kenzie D, Rawlins MD, Del Mar C. Antimicrobial stewardship: what s it all about? Australian Prescriber. 2013; 36: 116-20. 2 Antibiotic resistance: a problem for everyone. NPS news 77 2012 3 Ingram PR, Seet JM, Budgeon CA, Murray R. Point-prevalence study of inappropriate antibiotic use at a tertiary Australian hospital. Intern Med J. 2012; 42: 719-21. 4 Gottlieb T, Nimmo GR. Antibiotic resistance is an emerging threat to public health: an urgent call to action at the Antimicrobial Resistance Summit 2011. The Medical journal of Australia. 2011; 194: 281-3. 5 van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB. Predictors of mortality in Staphylococcus aureus Bacteremia. Clinical microbiology reviews. 2012; 25: 362-86. 6 Spellberg B, Blaser M, Guidos RJ, Boucher HW, Bradley JS, Eisenstein BI, et al. Combating antimicrobial resistance: policy recommendations to save lives. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2011; 52 Suppl 5: S397-428. 7 Carlet J, Collignon P, Goldmann D, Goossens H, Gyssens IC, Harbarth S, et al. Society s failure to protect a precious resource: antibiotics. Lancet. 2011; 378: 369-71. Page 08
2015 - Issue 15 ANTIMICROBIAL STEWARDSHIP IN GENERAL PRACTICE CONT D 8 MacDougall C, Polk RE. Antimicrobial stewardship programs in health care systems. Clinical microbiology reviews. 2005; 18: 638-56. 9 Goossens H, Ferech M, Vander Stichele R, Elseviers M, Group EP. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005; 365: 579-87. 10 Australian Group on Antimicrobial Resistance (AGAR). AGAR surveys: schedule and overview. 2011. 11 Barry C, Krause VL, Cook HM, Menzies RI. Invasive pneumococcal disease in Australia 2007 and 2008. Commun Dis Intell Q Rep. 2012; 36: E151-65. 12 Nasrin D, Collignon PJ, Roberts L, Wilson EJ, Pilotto LS, Douglas RM. Effect of beta lactam antibiotic use in children on pneumococcal resistance to penicillin: prospective cohort study. BMJ. 2002; 324: 28-30. 13 Chung A, Perera R, Brueggemann AB, Elamin AE, Harnden A, Mayon-White R, et al. Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study. BMJ. 2007; 335: 429. 14 Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010; 340: c2096. 15 Welschen I, Kuyvenhoven M, Hoes A, Verheij T. Antibiotics for acute respiratory tract symptoms: patients expectations, GPs management and patient satisfaction. Fam Pract. 2004; 21: 234-7. 16 Cals JW, Scheppers NA, Hopstaken RM, Hood K, Dinant GJ, Goettsch H, et al. Evidence based management of acute bronchitis; sustained competence of enhanced communication skills acquisition in general practice. Patient education and counseling. 2007; 68: 270-8. 17 Cals JW, de Bock L, Beckers PJ, Francis NA, Hopstaken RM, Hood K, et al. Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial. Annals of family medicine. 2013; 11: 157-64. 18 Altiner A, Brockmann S, Sielk M, Wilm S, Wegscheider K, Abholz HH. Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study. J Antimicrob Chemother. 2007; 60: 638-44. 19 Cals JW, Butler CC, Hopstaken RM, Hood K, Dinant GJ. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ. 2009; 338: b1374. Page 09
BREAKPOINT 20 Gulliford MC, Dregan A, Moore MV, Ashworth M, Staa T, McCann G, et al. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open. 2014; 4: e006245. 21 Avent ML, Hall L, Davis L, Allen M, Roberts JA, Unwin S, et al. Antimicrobial stewardship activities: a survey of Queensland hospitals. Australian health review : a publication of the Australian Hospital Association. 2014; 38: 557-63. 22 James RS, McIntosh KA, Luu SB, Cotta MO, Marshall C, Thursky KA, et al. Antimicrobial stewardship in Victorian hospitals: a statewide survey to identify current gaps. The Medical journal of Australia. 2013; 199: 692-5. 23 Bryant PA, Australasian Stewardship of Antimicrobials in Paediatrics g. Antimicrobial stewardship resources and activities for children in tertiary hospitals in Australasia: a comprehensive survey. Med J Aust. 2015; 202: 134-8. 24 Hansen MP, Hoffmann TC, McCullough AR, van Driel ML, Del Mar CB. Antibiotic Resistance: What are the Opportunities for Primary Care in Alleviating the Crisis? Frontiers in public health. 2015; 3: 35. Page 10
2015 - Issue 15 ANTIMICROBIALS 2016 On behalf of the Australian Society for Antimicrobials I would like to invite you to the Society s 17 th Annual Scientific Meeting Antimicrobials 2016 to be held at the Melbourne Convention Exhibition Centre, Melbourne, on Thursday 25 th - Saturday 27 th February 2016. I am pleased to announce Robin Patel, Mayo Clinic, USA; Neil Woodford, Imperial College London, UK; and Chris Baggoley (Chief Medical Officer) and Mark Schipp (Chief Veterinary Officer) will be participating at the meeting. Robin will be presenting the plenary Biofilm Associated Implant Infections, and Neil will be presenting Gram Negative Susceptibility/Resistance Epidemiology. Chris and Mark will be providing an update on the Australian Response to the Antimicrobial Resistance Crisis with particular reference to the recently released The Australian National Antimicrobial Resistance Strategy (www.health.gov.au/amr). The 2016 Howard Florey Oration will be delivered by Lyn Gilbert from the Institute of Clinical Pathology and Medical Research, New South Wales. Lyn will be presenting the talk Reflections on 50 Years of Antimicrobial Resistance Will Science and Technology or Social Science win the Next 50 Years? The programme s symposia cover many different aspects on antimicrobials and sessions include One Health, Resistant Epidemics - KPCs, ICU Related Infections: Does one Size Fit All?, Infective Endocarditis and Mycobacterium tuberculosis. In addition we have two pharmacy symposia on Saturday afternoon titled Monitoring Outcomes of Antimicrobial Therapy and Using Antimicrobials Better. The scientific symposia it titled Whole Genome Sequencing: Embracing New Technologies. Six proffered papers and two poster sessions are also planned for the meeting. To promote discussion and interaction between delegates and the invited speakers the meeting s registration includes lunches, morning and afternoon teas and admission to the Howard Florey Reception and the Industry Reception. I am confident that you will find the meeting s programme both scientifically stimulating and informative and we look forward to meeting you in Melbourne. The meeting s website, Antimicrobials2016.com, will be available soon IMPORTANT DATES Abstract Submission Deadline Friday 11 th December 2015 Abstract Notification Friday 18 th December 2015 Early Bird Registration Friday 8 th January 2016 Kind regards Thomas Gottlieb President ASA Page 11
BREAKPOINT PROPOSED PROGRAM THURSDAY 25 FEBRUARY FRIDAY 26 FEBRUARY SATURDAY 27 FEBRUARY INDUSTRY BREAKFAST SYMPOSIUM 0700 0845 0900 0915 Presentation of ASA Awards Thomas Gottlieb ASA President 0915 1015 Plenary 1 The Australian Response to the Antimicrobial Resistance Crisis Chris Baggoley, Department of Health, Australian Capital Territory Mark Schipp, Department of Agriculture, Australian Capital Territory 1045 1245 Symposium 1 One Health MORNING TEA 1015 1045 Salmonella Zoonosis: Epidemiology and Source Tracking Nigel French, Massey University, New Zealand E. coli ST131 Darren Trott, Adelaide University, South Australia Antimicrobial Resistance Surveillance: A Veterinary and Agriculture Perspective David Jordan, Department of Primary Industries, New South Wales Antimicrobial Stewardship: A Veterinary and Agriculture Perspective Glenn Browning, Melbourne University, Victoria PROPOSED INDUSTRY LUNCH SYMPOSIUM 1245 1415 1415 1545 Proffered Paper Sessions 1-3 (Three concurrent sessions) INDUSTRY BREAKFAST SYMPOSIUM 0700 0845 0900 1000 Plenary 2 Gram Negative Susceptibility/Resistance Epidemiology Neil Woodford, Imperial College London, United Kingdom MORNING TEA 1000 1030 1030 1200 Symposium 3 ICU Related Infections: Does one Size fit all? Sepsis Pathway: Have we got it Right and Implications for Antibiotic Use? Simon Finfer, The George Institute for Global Health, New South Wales What is the Role of MRO Screening in the 2016 ICU? Allen Cheng, Alfred Hospital, Victoria Topical Antiseptics in the ICU: Are we Hexed - What is the Role for Antiseptic and Disinfectant Use? Caroline Marshall, Royal Melbourne Hospital, Victoria PROPOSED INDUSTRY LUNCH SYMPOSIUM 1200 1330 1330 1500 Proffered Paper Sessions 4-6 (Three concurrent sessions) INDUSTRY BREAKFAST SYMPOSIUM 0700 0845 0900 1000 Plenary 3 Biofilm Associated Implant Infections Robin Patel, Mayo Clinic, USA MORNING TEA 1000 1030 1030 1230 Symposium 5 Mycobacterium tuberculosis Update on Mtb Treatment Ivan Bastian, SA Pathology, South Australia WGS for Tracking Mtb Transmission Grant Hill-Cawthorne, University of Sydney, New South Wales Susceptibility Testing: Beyond the Dark Ages John Turnidge, Australian Commission on Safety and Quality in Health Care, New South Wales Rapid Diagnostics: Practical Application of Resistance Gene Testing Chris Coulter, Pathology Queensland, Queensland 1315 1445 Scientific Symposium I WGS: Embracing New Technologies LUNCH 1230 1315 1315 1445 Pharmacy Symposium I Monitoring Outcomes of Antimicrobial Therapy AFTERNOON TEA POSTER SESSION 1 (AUTHORS IN ATTENDANCE) 1545 1630 1630 1800 Symposium 2 Resistant Epidemics - KPCs Killer KPCs Worldwide Neil Woodford, Imperial College London, United Kingdom Victorian KPC Experience Jason Kwong, MDU, Doherty Institute, Victoria A Coordinated National Response Mike Richards, The Royal Melbourne Hospital, Victoria 1800 1845 Howard Florey Oration Reflections on 50 Years of Antimicrobial Resistance Will Science and Technology or Social Science win the next 50 Years? Gwendolyn Gilbert, Institute of Clinical Pathology and Medical Research, New South Wales 1845 2015 Howard Florey Reception AFTERNOON TEA POSTER SESSION 2 (AUTHORS IN ATTENDANCE) 1500 1545 1545 1715 Symposium 4 Infective Endocarditis Laboratory Diagnosis Robin Patel, Mayo Clinic, USA Streptococcal/Enterocccal Infective Endocarditis Eugene Athan, Melbourne University, Victoria Is there a Role for TDM in Endocarditis? Jason Roberts, University of Queensland, Queensland 1715 1745 Annual General Meeting 1745 1915 Industry Reception Current and Future WGS Platforms for the Diagnostic Laboratory Robin Patel, Mayo Clinic, USA Bioinformatic Tools for the Diagnostic Laboratory Torsten Seemann, MDU, Doherty Institute, Victoria 1500 1630 Scientific Symposium II WGS: Embracing New Technologies cont. Phenotype from Genotype Neil Woodford, Imperial College London, United Kingdom Using Genomics to Understand Resistance Ben Howden, MDU, Doherty Institute, Victoria Infection Biomarkers: Predictors of Clinical Response Pat Charles, Austin Health, Victoria Using the MIC in Predicting Clinical Outcomes of Antibiotic Treatment Jason Roberts, University of Queensland, Queensland AMS Programs: Measuring the Impact on Patient Care Matthew Rawlins, Fiona Stanley Hospital, Western Australia AFTERNOON TEA 1445 1500 1500 1630 Pharmacy Symposium II Using Antimicrobials Better The National Antimicrobial Prescribing Survey: Are we Getting Better? Karin Thursky, Melbourne University, Victoria The Role of the Laboratory: Lessons from AMS Sue Benson, PathWest Laboratory Medicine-WA, Western Australia Hepatitis C: Changing Paradigm of Use of Direct Acting Antivirals Joseph Torresi, Melbourne University, Victoria Page 12
2015 - Issue 15 2016-2017 MEETING CALENDAR 2016 ESCMID postgraduate course: diagnosis and management of Drug-resistant TB 18-19 January, Cape town, RSA Website: www.escmid.org ASA Annual Meeting 25-27 February, Melbourne Website: www.asainc.net.au Pathology Update 26-28 February, Melbourne Website: www.rcpa.edu.au 17th International Congress of Infectious Diseases 2-5 March, Hyderabad, India Website: www.isid.org 11th International Meeting on Microbial epidemiological markers (postgraduate course) 9-12 March, Estoril,Portugal Website: www.escmid.org British Society for Microbiology Annual Meeting 21-24 March, Liverpool, UK Website: www.microbiologysociety.org Population modeling and dose optimization with Pmetrics and BestDose: antimicrobial approaches 13-16 April, Lyons, France Webiste: www.escmid.org ASID 20-23 April, Launceston, Tasmania Website: www.asid.net.au 26th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2015) 9-12 April 2016, Amsterdam, The Netherlands Website: http://escmid.org/dates_events/ American Transplant Congress (ATS congress) 11-15 June, Boston, MA Website: https://www.myast.org In 2016, the ASM general meeting and ICAAC will be co-located in Boston, June 2016. New * ASM Microbe 2016 (Inaugural combined ASM general meeting with ICAAC) 16-20 June 2016, Boston, MA Website: www.asm.org/microbe2016 Virulence and Resistance in Staphylococcus aureus: 2016 State of the Art, ESCMID Postgraduate Education Course 28 June 1 July, Lyons, France Website: www.escmid.org ASM conference on sterptococcal genetics July 31-August 3 2016, Washington DC Website: www.asm.org 21st International AIDS Conference 17-20 July, Durban, SA Website: www.aids2016.org/ ASM conference on sterptococcal genetics July 31-August 3 2016, Washington DC Website: www.asm.org 10th International Transplant Infectious Diseases Conference Aug 17-19, Hong Kong, China Website: www.tts.org/ IMED 2016: International Meeting on Emerging Diseases and Surveillance 4-7 November, Vienna, Austria Website: http://imed.isid.org 16th Asia Pacific Conference on Clinical Microbiology and Infection (APCCMI) 30 Nov- 3 Dec, Melbourne, Australia Website: http://www.asainc.net.au 2017 ASA Annual Meeting, in conjunction with the StaphPath Meeting 23-25 February, TBD Website: www.asainc.net.au 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2017) 22-25 April 2017, Vienna, Austria Website: http://escmid.org/dates_events/ Page 13