Combating Multidrug-resistant Organisms: Strategic Considerations for Optimal Clinical Outcomes COMBATING MULTIDRUG-RESISTANT ORGANISMS: STRATEGIC CONSIDERATIONS FOR OPTIMAL CLINICAL OUTCOMES ©2016 Paradigm Medical Communications, LLC, except where noted. Content may not be reproduced in whole or in part without the express written consent of Paradigm Medical Communications , LLC. WELCOME AND INTRODUCTION Thomas M. File Jr, MD, MSc, MACP, FIDSA, FCCP (Chair) Chair, Division of Infectious Disease Summa Health Akron, OH Professor, Internal Medicine Master Teacher and Chair, Infectious Disease Section Northeast Ohio Medical University Rootstown, OH ©2016 Paradigm Medical Communications, LLC, except where noted 1 Combating Multidrug-resistant Organisms: Strategic Considerations for Optimal Clinical Outcomes Faculty Thomas M. File Jr, MD, MSc, MACP, James S. Lewis II, PharmD, FIDSA FIDSA, FCCP (Chair) ID Clinical Pharmacy Supervisor Chair, Division of Infectious Disease Oregon Health and Science University Summa Health Departments of Pharmacy & Infectious Diseases Akron, OH Portland, OR Professor, Internal Medicine Master Teacher and Chair, Infectious Disease Section Hans H. Liu, MD, FACP Northeast Ohio Medical University Director, Antimicrobial Stewardship Rootstown, OH Bryn Mawr Hospital George H. Karam, MD Mainline Health System Bryn Mawr, PA Paula Garvey Manship Chair of Medicine Department of Medicine Professor of Medicine Louisiana State University School of Medicine in Sidney Kimmel School of Medicine New Orleans Thomas Jefferson University Baton Rouge Branch Campus Philadelphia, PA Baton Rouge, LA 3 Disclosures Thomas M. File, Jr, MD, MSc, MACP, FIDSA, FCCP (Chair) Grant/Research Support: Nabriva Therapeutics AG; Pfizer Inc Retained Consultant: Bayer HealthCare; Cempra Pharmaceuticals, Inc.; Melinta Therapeutics, Inc.; MotifBioSciences, Inc.; Nabriva Therapeutics AG; Paratek Pharmaceuticals Inc; Tetraphase Pharmaceuticals, Inc. George H. Karam, MD Retained Consultant: Philips Healthcare Non-Speakers Bureau Activities: Merck & Co, Inc James S. Lewis II, PharmD, FIDSA Retained Consultant: Accelerate Diagnostics, Inc; Achaogen, Inc; Astellas Pharma US, Inc; The Medicines Co.; Merck & Co, Inc; Paratek Pharmaceuticals, Inc Hans H. Liu, MD, FACP Retained Consultant: Cempra Pharmaceuticals, Inc. Speakers Bureau: Daiichi Sanyko Co., Ltd Paradigm Medical Communications, LLC, staff members have no financial relationships to disclose. Educational Review Systems, Inc., staff members have no financial relationships to disclose. Independent peer reviewer has no financial relationships to disclose. 4 ©2016 Paradigm Medical Communications, LLC, except where noted 2 Combating Multidrug-resistant Organisms: Strategic Considerations for Optimal Clinical Outcomes Accreditation Physician Accreditation Statement Paradigm Medical Communications, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Physician Credit Designation Statement Paradigm Medical Communications, LLC designates this live activity for a maximum of 2.0 AMA PRA Category 1 Credits ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Pharmacist Accreditation and Designation Statement Educational Review Systems is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 2.0 hours (0.2 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks for participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. (Universal Activity Number 0761-9999-16-233-L01-P) This is a knowledge-based activity. This activity is jointly provided by Educational Review Systems, Inc., and Paradigm Medical Communications, LLC. 5 Disclosure of Commercial Support This activity is supported by educational grants from Allergan, Inc; Cempra Pharmaceuticals, Inc; Tetraphase Pharmaceuticals, Inc; and The Medicines Company 6 ©2016 Paradigm Medical Communications, LLC, except where noted 3 Combating Multidrug-resistant Organisms: Strategic Considerations for Optimal Clinical Outcomes How to Obtain Your CME/CPE Credit • Attend the live activity. • At the conclusion of the activity, complete the post-survey and evaluation in the Evaluation section on your iPad. • Provide your name, email address, and select the credit hours you will be claiming. A certificate of participation/statement of completion will be issued 2 to 3 weeks following the meeting. Please note: to claim CPE credit , please make sure you include your date of birth and NABP number. All credit information will be uploaded into CPE Monitor within 30 days . 7 Continuing Education Information Learning Objectives Upon proper completion of this activity, participants should be better able to: • Review pathogens responsible for most multidrug-resistant organism-related infections and their appropriate treatment. • Outline the appropriate integration of new and emerging antibiotics, alongside older, more established agents. • Summarize the tenets of effective antimicrobial stewardship, including the rationale, different interventions, and approaches to measuring process and outcomes. Disclosure of Unlabeled Use This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. 10 ©2016 Paradigm Medical Communications, LLC, except where noted 4 Combating Multidrug-resistant Organisms: Strategic Considerations for Optimal Clinical Outcomes Agenda Topic Faculty Thomas M. File Jr, MD, MSc, Welcome and Introduction MACP, FIDSA, FCCP Multidrug-resistant Infections: Reviewing Common Hans H. Liu, MD, FACP Pathogens and General Treatment Strategies New and Emerging Antibiotics: Data and Practical George H. Karam, MD Recommendations Antimicrobial Stewardship: Effective James S. Lewis II, PharmD, FIDSA Implementation for Improved Clinical Outcomes Case Studies with Audience Participation All faculty 11 Impact of Drug-resistant Infection: High Morbidity and Mortality CDC Estimates on Limitations of CDC Estimates 2 US Antibiotic Resistance 1 • Based on small samplings from <10 states in 2011 • Reporting standards differ by state, not well enforced • <50% US states record deaths from prevalent superbugs 1. Centers for Disease Control and Prevention (CDC). www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf/. Accessed 10/20/16. 2. ‘Superbug’ scourge spreads as US fails to track rising human toll. www.reuters.com/investigates/special-report/usa-uncounted-surveillance/. Reuters. 9/7/16. 12 ©2016 Paradigm Medical Communications, LLC, except where noted 5 Combating Multidrug-resistant Organisms: Strategic Considerations for Optimal Clinical Outcomes CDC Antibiotic Resistance Threats • Clostridium difficile • Carbapenem-resistant Enterobacteriaceae (CRE) • Neisseria gonorrhoeae (cephalosporin resistance) • MDR Acinetobacter • Drug-resistant nontyphoidal Salmonella • Drug-resistant Campylobacter • Drug-resistant Salmonella typhi • Fluconazole-resistant Candida • Drug-resistant Shigella • ESBLs • Methicillin-resistant S aureus (MRSA) • VRE • Drug-resistant Streptococcus pneumoniae • MDR Pseudomonas aeruginosa • Drug-resistant tuberculosis • Vancomycin-resistant S aureus • Erythromycin-resistant Group A Streptococcus • Clindamycin-resistant Group B Streptococcus ESBLs, extended-spectrum beta-lactamases; MDR, multidrug resistant; VRE, vancomycin-resistant enterococci CDC. Biggest Threats. 2013. www.cdc.gov/drugresistance/biggest_threats.html. Accessed 10/20/16. 13 Antimicrobial Resistance in the News • New strain of E coli resistant to “last resort” antibiotic, colistin • Mcr-1 gene May 26, 2016 July 11, 2016 14 ©2016 Paradigm Medical Communications, LLC, except where noted 6 Combating Multidrug-resistant Organisms: Strategic Considerations for Optimal Clinical Outcomes United Nations Responds to MDROs • UN has met only 4 times in its “It is not that it may happen in the 70-y history re: health crisis 1 future. It is a very present reality— 2 • 2001: AIDS virus in all parts of the world...” • 2011: Noncommunicable diseases UN Secretary-General, Ban Ki-moon • 2014: Ebola virus • 2016: MDROs AIDS, acquired immunodeficiency syndrome; MDRO, multidrug-resistant organism 1. United Nations. www.un.org/pga/71/2016/09/21/press-release-hl-meeting-on-antimicrobial-resistance/. Accessed 10/20/16. 2. UN News Centre. www.un.org/apps/news/story.asp?NewsID=55011#.WAUDwenfOM8. Accessed 10/20/16. 15 Antibiotic Misuse in Hospitals • Increased Up to 50% of antibiotic use Antibiotic Pathogen Resistance 1 Exposure is inappropriate Risk • Consequences CRE Carbapenems 15-fold 2-4 • ESBL-producing C difficile Cephalosporins 6- to 29-fold 2-4 organisms • Increased MDR risk, prevalence increased mortality, healthcare costs, hospital LOS LOS, length of stay 1. Centers for Disease Control and Prevention. Get Smart for Healthcare. www.cdc.gov/getsmart/healthcare/evidence.html. Accessed 10/20/16. 2. Patel G et al. Infect Control Hosp Epidemiol. 2008;29:1099-1106. 3. Zaoutis TE et al. Pediatrics. 2005;114:942-949. 4. Talon D et al. Clin Microbiol Infect . 2000;6:376-384. 16 ©2016 Paradigm Medical Communications, LLC, except where noted 7 Combating Multidrug-resistant Organisms: Strategic Considerations