Group A streptococcal (GAS) pharyngitis: food-borne outbreak

1. Group A streptococcal (GAS) pharyngitis: food-borne outbreak • Case study: outbreak of tonsillopharyngitis in 42 soldiers (Israel) • Signs/symptoms at presentation: fever, sore throat, headache • Physical examination: exudative pharyngitis • Final diagnosis: acute tonsillitis • Transmission: via food stored outdoors (unrefrigerated) for several hours and consumed the day before clinical presentation • Treatment: iv penicillin V + iv fluid replacement during hospitalisation Hussein A. ECCMID 2014 abs. P1802 Transmission via contaminated food may cause GAS tonsillitis outbreaks Data from poster

2. 1 of 2 Adults hospitalised with respiratory syncytial virus (RSV) infection: characteristics and outcomes Multi-centre, retrospective cohort study (09/2012-06/2013; 4 tertiary care teaching hospitals; Canada): N=86 hospitalised adults with RSV infection diagnosed by PCR (exluding pts with nosocomial RSV infection or whose RSV infection was not the cause of hospital admission) Median age: 74 yr (range: 19-102: 34% <65 yr); 56% females Most common reasons to attend ED: shortness of breath, productive cough Volling C. ECCMID 2014 abs. eP070 Data from poster

3. 2 of 2 Adults hospitalised with respiratory syncytial virus (RSV) infection: characteristics and outcomes • Median time to death: 6 days (range: 2-52) • Median hospital length of stay in survivors: 6 days (range: 1-140) • Complications/outcomes: • Pts receiving antibiotics: 78% − anti-influenza therapy: 36% In hospitalised adults with chronic underlying conditions, RSV infection seems to be associated with substantial morbidity, extended hospital stay, ICU care and mortality. The majority of pts received antibiotics Volling C. ECCMID 2014 abs. eP070 Data from poster

4. 1 of 2 Clarithromycin for sepsis and ventilator-associated pneumonia (VAP): long-term impact on hospitalisation cost Multi-centre, double-blind RCT (2004-2005) (NCT00297674) N=200 pts with sepsis and VAP (new consolidation in lung radiography + purulent tracheobronchial secretions + clinical pulmonary infection score >6 + ≥2 signs of systemic inflammatory response syndrome): Standard of care (SOC) + placebo: N=100 SOC + clarithromycin (CLR) 1 g iv for 3 consecutive days: N=100 Short-term results: Giamarellos-Bourboulis EJ et al. Clin Infect Dis 2008;46:1157-64 Tsaganos T. ECCMID 2014 abs. O259 NI: notindicated

5. 2 of 2 Clarithromycin for sepsis and ventilator-associated pneumonia (VAP): long-term impact on hospitalisation cost • Cumulative hospitalisation cost up to day 45 after diagnosis of VAP (including imaging tests, interventions e.g. catheterisations, haemodialysis, consumables, lab tests, drugs, iv fluid, (par)enteral nutrition):CLR < placebo: P<0.05 starting from day 25 after study enrolment Addition of clarithromycin to SOC may considerably reduce the long-term hospitalisation cost in pts with sepsis and VAP Tsaganos T. ECCMID 2014 abs. O259

6. 1 of 2 β-lactam + macrolide vs β-lactam monotherapy in pts hospitalised for community-acquired pneumoniae (CAP) Multi-centre, open-label, rater-blinded, randomised non-inferioritystudy (Switzerland) in adultshospitalisedformoderately severe CAP (PneumoniaSeverity Index (PSI) ≤IV) confirmed on X-ray(meanage: 76 yr; mean PSI: ±84) Mono Tx: amoxicilline/clavulanate or cefuroxime: N=291 Combi Tx: amoxicilline/clavulanate or cefuroxime + clarithromycine: N=289 Primaryendpoint: % of ptsnotreachingclinicalstability* at day 7 Garin N. ECCMID 2014 abs. eP064 *Heart rate <100 bpm, systolic blood pressure >90 mmHg, temperature <38.0°C, respiratory rate <24/min, oxygen saturation >90% on room air Data from poster

7. 2 of 2 β-lactam + macrolide vs β-lactam monotherapy in pts hospitalised for community-acquired pneumoniae (CAP) • Predictors of delayed clinical stability: • Infection with atypical pathogens: HR=0.33; 95% CI: 0.13-0.85; P=0.02 • PSI category IV: HR=0.81; 95% CI: 0.59-1.10; P=0.18 (trend)(vs PSI category I-III: HR=1.06; 95% CI: 0.82-1.36; P=0.66) Non-inferiority of β-lactam mono Tx vs macrolide combi Tx could not be demonstrated in pts hospitalised for moderately severe CAP Garin N. ECCMID 2014 abs. eP064 Data from poster

8. 1 of 2 β-lactam + macrolide vs β-lactam or fluoroquinolone monotherapy in pts hospitalised for community-acquired pneumoniae (CAP) Multi-centre, non-inferiority, cluster-randomised cross-over trial (the Netherlands; 2011-2013) N=2,283 ptshospitalisedwithclinicallysuspected CAP in non-ICU wardandreceivingempiricalantibioticTxfor CAP (meanage: 67 yr; mean PSI: 85; 76% radiologically proven CAP) Secondaryendpoints Shorter time tooralTxwith FQL (median: 3 days) vs BL (median: 4 days): HR=1.29; 95% CI:1.15-1.46 Longerlength of hospitalstaywith BLM vs BL (both: median: 6 days): HR=0.87; 95% CI: 0.78-0.97 Complicationrate: no significant ≠ betweenTx arms Van Werkhoven CH. ECCMID 2014 abs. P1342a Data from poster

9. 2 of 2 β-lactam + macrolide vs β-lactam or fluoroquinolone monotherapy in pts hospitalised for community-acquired pneumoniae (CAP) Empirical Tx with BL for pts hospitalised to non-ICU wards with clinically suspected CAP was non-inferior to BLM or FQL for 90-day mortality Van Werkhoven CH. ECCMID 2014 abs. P1342a Data from poster

10. 1 of 2 Impact of macrolide use on mortality in ICU pts with community-acquired pneumoniae (CAP) Systematic literature review + meta-analysis: 28 observational studies (no RCTs) comparing macrolide Tx with other regimens in ICU pts with CAP N=9,850 pts: mean age: 58-78 yr; ♀: 14-49% Sligl WI et al. Crit Care Med 2014;42:420-32

11. 2 of 2 Impact of macrolide use on mortality in ICU pts with community-acquired pneumoniae (CAP) In critically ill pts with CAP, macrolide use seems to be associated with a significant reduction in mortality compared with non-macrolide Tx Sligl WI et al. Crit Care Med 2014;42:420-32