This past week I attended the American Society for Microbiology’s 49^th annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) held in San Francisco.  ICAAC is the largest conference in the world dealing with infectious diseases and antimicrobial agents.  It routinely gathers over 10,000 microbiologists, infectious diseases specialists, pharmacists, etc. from all over the globe for lectures, posters, symposia dealing with all aspects of antimicrobial therapy and infectious diseases. Although I have attended the meeting many times over the past 25 years this was the first ICAAC in which I actually participated.  I was lead author of a poster on the use of daptomycin in the treatment of diabetic foot infections which was included in the Monday poster session.  I have always liked poster sessions at these meetings since you actually get to meet the author and ask questions one-on-one.  Our poster was no exception with folks coming up throughout the session to discuss diabetic foot infections.

On Tuesday afternoon I was honored to be asked to participate in a “Meet the Expert” session on the treatment of diabetic foot infections along with Dr. Tony Berendt from Oxford, UK.  Although the timing was late in the meeting and late in the day, beginning at 5:30PM, we easily had a few hundred attendees who stayed throughout the entire 75 minute session.  Tony and I decided to try an approach successfully employed for sessions like this by Dr. Ben Lipsky called the “What Do You Want to Learn Today” method.  We started by asking the audience to step to the mic and announce topics they would like to hear covered.  After a few seconds of initial reluctance the floodgates opened and attendees lined up to call out subjects.  We could have spent the entire 75 minutes just listing all of the topics!  Most revolved around the diagnosis and treatment of osteomyelitis, antibiotic selection, length of therapy and the use of “adjunctive” therapies such as hyperbaric oxygen.

Interestingly to both of us, a topic mentioned by a number of attendees seemed so basic that we were surprised that it was a concern…what to do if your surgeon refuses to do surgery? Apparently, there is some reluctance out there for surgeons to do the necessary I&D work not to mention minor amputations of the toe/foot to try to save the leg.  One very prescient question asked if by failing to perform the necessary aggressive surgery we are causing more antibiotic resistance.  I found this a particularly timely and important question since during the session I presented a current case of mine concerning a patient with osteomyelitis of the 2^nd toe and 2^nd metatarsal who adamantly refused to have her toe removed.  Instead of my podiatric surgical colleague being able to essentially “cure” the infection with a scalpel and bone saw I was left sending the patient to an SNF unit with an IV line for 4 weeks of vancomycin.  And we wonder why we have issues with MIC creep!

I will include some interesting tidbits I picked up at ICAAC in a subsequent post.

With the news of the imminent release of the 3^rd Edition tentatively scheduled for 9/25 it is time to update the blog. Over the next few days I hope to get a few more posts up covering some recent literature of interest and my experiences at the recent ICAAC meeting.  I would also like to bring your attention to the fact that we have posted a Preview of the MRSA Chapter.  This is a brand new section of the book covering a vitally important topic that, in earlier editions, only merited a few paragraphs.  MRSA has become a primary pathogen to the point that I have begun to pretty much cover virtually ALL of my hospitalized patients as if they have MRSA until proven otherwise.  This is what is known as “De-escalation therapy”.  You cover the patient broadly, as if they have MRSA, and then “de-escalate” to non-MRSA specific therapy if or when preliminary culture results (or surveillance screening) come back as being negative for MRSA. I cover more about this in the book itself.

The chapter preview includes my “History of Staph” where I review how we have come from the early days of penicillin sensitive staphylococcus, the development of penicillin, beta-lactamase forming staph, penicillinase resistant penicillins and finally MRSA…all in about a 50 year period.  The preview section also discusses the most recent classification of MRSA including the differences between CA- and HA-MRSA, clinical presentation and various virulence factors of each.  In the non-previewed section I go on to discuss the treatment approach including older and newer agents and importance of “MIC creep” amongst other subjects.

In the near future I hope to have posted the final preview section which will include the beginning of the newly revised diabetic foot infection chapter.  This section will include a discussion on the Infectious Diseases Society of America diabetic foot infection classification.

Needless to say, I am really excited about the book finally being published and ready to ship.  I hope you enjoy both the preview chapters and the new book itself.