Group A streptococcal (GAS) pharyngitis: food-borne outbreak Hussein A. ECCMID 2014 abs. P1802 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 Reporter comments: It is remarkable that the patients in this study did not have diarrhoea, despite the food-borne transmission of GAS. EBV: Eppstein-Barr virus iv: intravenous(ly) PCR: polymerase chain reaction RSV: respiratory syncytial virus WBC: white blood cell Transmission via contaminated food may cause GAS tonsillitis outbreaks Data from poster

1 of 2 Adults hospitalised with respiratory syncytial virus (RSV) infection: characteristics and outcomes Volling C. ECCMID 2014 abs. eP070 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 AECOPD: acute exacerbation of chronic obstructive pulmonary disease ED: emergency department ICU: intensive care unit PCR: polymerase chain reaction resp.: respiratory Data from poster

2 of 2 Adults hospitalised with respiratory syncytial virus (RSV) infection: characteristics and outcomes Volling C. ECCMID 2014 abs. eP070 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% AECOPD: acute exacerbation of chronic obstructive pulmonary disease ED: emergency department ICU: intensive care unit PCR: polymerase chain reaction resp.: respiratory 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 Data from poster

1 of 2 Clarithromycin for sepsis and ventilator-associated pneumonia (VAP): long-term impact on hospitalisation cost Tsaganos T. ECCMID 2014 abs. O259 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 ICU: intensive care unit iv: intravenous(ly) mechan.: mechanical RCT: randomised controlled trial NI: not indicated

2 of 2 Clarithromycin for sepsis and ventilator-associated pneumonia (VAP): long-term impact on hospitalisation cost Tsaganos T. ECCMID 2014 abs. O259 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 ICU: intensive care unit iv: intravenous(ly) mechan.: mechanical RCT: randomised controlled trial Addition of clarithromycin to SOC may considerably reduce the long-term hospitalisation cost in pts with sepsis and VAP

1 of 2 β-lactam + macrolide vs β-lactam monotherapy in pts hospitalised for community-acquired pneumoniae (CAP) Garin N. ECCMID 2014 abs. eP064 Multi-centre, open-label, rater-blinded, randomised non-inferiority study (Switzerland) in adults hospitalised for moderately severe CAP (Pneumonia Severity Index (PSI) ≤IV) confirmed on X-ray (mean age: 76 yr; mean PSI: ±84) Mono Tx: amoxicilline/clavulanate or cefuroxime: N=291 Combi Tx: amoxicilline/clavulanate or cefuroxime + clarithromycine: N=289 Primary endpoint: % of pts not reaching clinical stability* at day 7 Reporter comments: This conclusion is in contrast with the conclusion of a non-inferiority cluster-randomised cross-over trial by Van Werkhoven H. ECCMID 2014 abs. P1342a. The latter study showed that empirical β-lactam monotherapy is non-inferior to combination therapy of β-lactam + macrolide or fluoroquinolone monotherapy in patients hospitalised with clinically suspected CAP in a non-ICU ward. However, the primary endpoint in the latter study was 90-day mortality and the study design was different from the current study. This topic was also discussed in Sligl WI et al. Crit Care Med 2014;42:420-32, discussed during the ECCMID 2014 symposium ‘Carbapenemases from prevention to treatment’ by Yehuda Carmeli, Patrice Nordmann, Timothy R Walsch and Maria Virginia Villegas. CI: confidence interval combi Tx: combination therapy HR: hazard ratio ICU: intensive care unit IQR: interquartile range mono Tx: monotherapy *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

2 of 2 β-lactam + macrolide vs β-lactam monotherapy in pts hospitalised for community-acquired pneumoniae (CAP) Garin N. ECCMID 2014 abs. eP064 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) Reporter comments: This conclusion is in contrast with the conclusion of a non-inferiority cluster-randomised cross-over trial by Van Werkhoven H. ECCMID 2014 abs. P1342a. The latter study showed that empirical β-lactam monotherapy is non-inferior to combination therapy of β-lactam + macrolide or fluoroquinolone monotherapy in patients hospitalised with clinically suspected CAP in a non-ICU ward. However, the primary endpoint in the latter study was 90-day mortality and the study design was different from the current study. This topic was also discussed in Sligl WI et al. Crit Care Med 2014;42:420-32, discussed during the ECCMID 2014 symposium ‘Carbapenemases from prevention to treatment’ by Yehuda Carmeli, Patrice Nordmann, Timothy R Walsch and Maria Virginia Villegas. CI: confidence interval combi Tx: combination therapy HR: hazard ratio ICU: intensive care unit IQR: interquartile range mono Tx: monotherapy Non-inferiority of β-lactam mono Tx vs macrolide combi Tx could not be demonstrated in pts hospitalised for moderately severe CAP Data from poster

1 of 2 β-lactam + macrolide vs β-lactam or fluoroquinolone monotherapy in pts hospitalised for community-acquired pneumoniae (CAP) Van Werkhoven CH. ECCMID 2014 abs. P1342a Multi-centre, non-inferiority, cluster-randomised cross-over trial (the Netherlands; 2011-2013) N=2,283 pts hospitalised with clinically suspected CAP in non-ICU ward and receiving empirical antibiotic Tx for CAP (mean age: 67 yr; mean PSI: 85; 76% radiologically proven CAP) Secondary endpoints Shorter time to oral Tx with FQL (median: 3 days) vs BL (median: 4 days): HR=1.29; 95% CI:1.15-1.46 Longer length of hospital stay with BLM vs BL (both: median: 6 days): HR=0.87; 95% CI: 0.78-0.97 Complication rate: no significant ≠ between Tx arms Reporter comments: This conclusion is in contrast with the conclusion of a multi-centre, randomised non-inferiority study by Garin N. ECCMID 2014 abs. eP064. The latter study failed to demonstrate non-inferiority of β-lactam monotherapy vs combination therapy of β-lactam + macrolide in patients hospitalised with moderately severe CAP. However, the primary endpoint in the latter study was % of pts not reaching clinical stability* at day 7 and the study design was different from the current study. This topic was also discussed in Sligl WI et al. Crit Care Med 2014;42:420-32, discussed during the ECCMID 2014 symposium ‘Carbapenemases from prevention to treatment’ by Yehuda Carmeli, Patrice Nordmann, Timothy R Walsch and Maria Virginia Villegas. CI: confidence interval ICU: intensive care unit ITT: intention-to-treat HR: hazard ratio PSI: Pneumonia severity index Tx: treatment Data from poster

2 of 2 β-lactam + macrolide vs β-lactam or fluoroquinolone monotherapy in pts hospitalised for community-acquired pneumoniae (CAP) Van Werkhoven CH. ECCMID 2014 abs. P1342a Reporter comments: This conclusion is in contrast with the conclusion of a multi-centre, randomised non-inferiority study by Garin N. ECCMID 2014 abs. eP064. The latter study failed to demonstrate non-inferiority of β-lactam monotherapy vs combination therapy of β-lactam + macrolide in patients hospitalised with moderately severe CAP. However, the primary endpoint in the latter study was % of pts not reaching clinical stability* at day 7 and the study design was different from the current study. This topic was also discussed in Sligl WI et al. Crit Care Med 2014;42:420-32, discussed during the ECCMID 2014 symposium ‘Carbapenemases from prevention to treatment’ by Yehuda Carmeli, Patrice Nordmann, Timothy R Walsch and Maria Virginia Villegas. CI: confidence interval ICU: intensive care unit ITT: intention-to-treat HR: hazard ratio PSI: Pneumonia severity index Tx: treatment 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 Data from poster

1 of 2 Impact of macrolide use on mortality in ICU pts with community-acquired pneumoniae (CAP) Sligl WI et al. Crit Care Med 2014;42:420-32 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% Reporter comments: This publication was discussed during the ECCMID 2014 symposium ‘Carbapenemases from prevention to treatment’ by Yehuda Carmeli, Patrice Nordmann, Timothy R Walsch and Maria Virginia Villegas. This topic was also discussed in 2 randomised non-inferiority studies that gained conflicting results: Van Werkhoven H. ECCMID 2014 abs. P1342a and Garin N. ECCMID 2014 abs. eP064. Limitations of this study are the observational character of the included studies (no RCTs) and the lack of detailed information regarding patient demographics, comparator treatments, aetiology of CAP, concomitant treatment, dose regimens, etc. BLF: β-lactam/fluoroquinolone BLM: β-lactam/macrolide ICU: intensive care unit RCT: randomised controlled trial RR: risk ratio Tx: treatment

2 of 2 Impact of macrolide use on mortality in ICU pts with community-acquired pneumoniae (CAP) Sligl WI et al. Crit Care Med 2014;42:420-32 Reporter comments: This publication was discussed during the ECCMID 2014 symposium ‘Carbapenemases from prevention to treatment’ by Yehuda Carmeli, Patrice Nordmann, Timothy R Walsch and Maria Virginia Villegas. This topic was also discussed in 2 randomised non-inferiority studies that gained conflicting results: Van Werkhoven H. ECCMID 2014 abs. P1342a and Garin N. ECCMID 2014 abs. eP064. Limitations of this study are the observational character of the included studies (no RCTs) and the lack of detailed information regarding patient demographics, comparator treatments, aetiology of CAP, concomitant treatment, dose regimens, etc. BLF: β-lactam/fluoroquinolone BLM: β-lactam/macrolide ICU: intensive care unit RCT: randomised controlled trial RR: risk ratio Tx: treatment In critically ill pts with CAP, macrolide use seems to be associated with a significant reduction in mortality compared with non-macrolide Tx