ICAAC Nostalgia

Like many other antibiotic researchers, I was absent from ICAAC this year.  Of course, in my case, I have a good excuse – I’m retired and don’t really go to meetings anymore unless someone is paying my way. But I admit that I miss ICAAC with a nostalgia that is difficult to describe. I feel a great sadness when I think of all those colleagues who are no longer with us. I miss my colleagues and I miss discussing the latest developments in antibiotic discovery and development. I especially miss the posters where I used to wander, read, absorb and discuss and question to my heart’s content. Those interactions with young (and sometimes not so young) investigators were so stimulating.

Looking back on all those years of ICAACs, though, I remember the increasing drought of the most recent meetings.  In the beginning of my years at ICAAC – dating back to the early 1980s – I focused tightly on the science of antibiotic resistance and the epidemiology of resistance.  ICAAC back then was so busy and complicated (it used to be combined with IDSA meetings) that if you didn’t focus, you were confused and lost for a week.  Later, as my career evolved (or devolved) to antibiotic discovery and development, I focused on new molecules in addition to trying to keep abreast of key, relevant developments on the resistance front. My favorite session became the Saturday morning review of new antimicrobial agents.  I would look forward to discovering which posters the organizers had identified as being the most interesting new discoveries being presented at ICAAC.  For many years, I was not disappointed.  There were always at least a few posters that peaked my interest and curiosity and that promised a future of new therapies.

Over the years between say 2005 and 2013 (my last ICAAC), though, the Saturday morning poster review had become depressing rather than invigorating.  The organizers were obviously struggling more and more to come up with interesting new agents to highlight. The lack of new agents in the pipeline was never more apparent than at those ICAAC meetings. By 2013, knowing that I would retire in a few months, I even felt a sense of relief that I would not have to relive the Saturday morning disappointment again. I had become a little lost in the great halls of the meeting.  Even the exhibitions were faltering.  There were so few pharmaceutical companies trying to sell so few new products that even the pens and candies being provided seemed somehow sad and worn. If it weren’t for the occasional poster, I probably would have packed my bags and left on the Saturday before the meeting even really had gotten started.

This year, I looked over the abstracts and presentations.  There were a few promising, potentially exciting new developments on the B-lactamase inhibitor front, but that seemed to be about it for small molecules.  Eravacycline was the subject of a great number of abstracts demonstrating its potent activity against large global collections of resistant pathogens, but these findings were overwhelmed by the news that it failed to achieve its primary endpoint in a clinical trial of complicated urinary tract infection. I was, of course, thrilled with the findings on the clinical trials of the Merck antibody against C. difficile toxin B.

So while I look back on ICAAC meetings of the past with yearning and nostalgia, I’m afraid that 2015 would have been another disappointing year for the antibiotic pipeline.