IDSA News - July 2008
Volume 18, Number 7
(Print All Articles)

New Encephalits Guidelines Published

Vita Washington

IDSA has published its first set of guidelines for the management of encephalitis.

 

IDSA has published its first set of guidelines for the management of encephalitis.

The guidelines state that the best approach to management of a patient with encephalitis is early recognition of the syndrome, appropriate diagnostic evaluation based on likely etiologic agents, neuroimaging, and cerebrospinal fluid (CSF) analysis with specialized tests to attempt to identify the cause.  However, despite extensive testing to identify an etiologic agent, most cases of presumed infectious encephalitis remain unexplained.  Identifying epidemiologic and clinical clues is recommended and may suggest the likely cause. Such clues may include geographic locale, season, insect or animal contacts, prevalence of the disease in the local community, rash, or upper respiratory findings. 

The guidelines emphasize that one of the key components in managing patients with encephalitis is to perform proper diagnostic tests.  Appropriate diagnostic evaluation includes, but is not limited to, evaluation of blood and CSF by serologic studies and nucleic acid amplification tests (such as PCR), and neuroimaging.

Once the diagnosis of encephalitis is suspected, the guidelines recommend empirical therapy with acyclovir, pending results of diagnostic studies.  Other empirical therapy should be initiated based on epidemiologic or clinical factors, including therapy for presumed bacterial meningitis (if clinically indicated) and administration of doxycycline, during the appropriate season, for possible rickettsial or ehrlichial infection. 

The guidelines’ performance measures emphasize that if the etiologic agent of encephalitis is identified, antimicrobial therapy should be targeted to the infectious agent or discontinued if treatment against the etiologic agent is not available.

The encephalitis guidelines are available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our web site.

HIV Opportunistic Infections Guidelines Updated

Steve Baragona
Updated guidelines for the prevention and treatment of opportunistic infections in HIV-infected patients—one on adults and adolescents, one on children—have been published by the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and HIVMA.

Updated guidelines for the prevention and treatment of opportunistic infections in HIV-infected patients—one on adults and adolescents, one on children—have been published by the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and HIVMA. The new documents revise and combine separate prevention guidelines and treatment guidelines published earlier.

The adult and adolescent guidelines include up-to-date information on new diagnostics such as interferon-gamma release assays for latent tuberculosis infection, new antifungal therapies, and new sections on malaria and hepatitis B. Rifamycin drug interactions affecting tuberculosis prevention and treatment are covered.

The adult and adolescent guidelines also include new information on the confounding issue of immune reconstruction inflammatory syndrome (IRIS). IRIS is challenging to manage because it is poorly defined and difficult to distinguish from worsening of an existing OI, development of a new OI, drug toxicity, or unrelated organ problems.

New emphasis is placed on the importance of antiretroviral therapy (ART) in the prevention of OI. “While preventing and managing OI is important, the overall public health message is that early identification of HIV and active management with antiretrovirals will avoid many of these problems,” said Henry Masur, MD, FIDSA, co-chair of the guidelines panel, chief of the Critical Care Medicine Department at NIH, and former IDSA president.

The pediatric guidelines include new sections on malaria, bartonella, aspergillosis, human herpesviruses 6, 7, and 8, and progressive multifocal leukoencephalopathy, and also cover IRIS—all of which previously were only covered in the adult guidelines.

Pediatric guidelines working group member Anne Gershon, MD, FIDSA, director of the Columbia University Pediatric Infectious Disease Division and IDSA president elect, said the new guidelines contain “much more information on safety and effectiveness of vaccines in HIV-infected children, including those against hepatitis A and B, varicella, rotavirus, and MMR, as well as meningococcal, and pneumococcal vaccines.”

In addition to this and other added content, “There are changes related to readability, such as new subsections on monitoring and adverse events and

IRIS, and management of treatment failure,” said Lynne Mofenson, MD, executive secretary of the pediatric guidelines core working group and chief of the National Institute of Child Health and Human Development’s Pediatric, Adolescent and Maternal AIDS Branch. “Much of this information was in the prior document but now is in separate sections and therefore is easier to find.”

The guidelines currently are available from the AIDSinfo website. They have been submitted for publication in CDC’s Morbidity and Mortality Weekly Report.

IDSA Journal Club, July 2008

A panel of IDSA members identifies and critiques important new infectious diseases studies in the current literature that have a significant impact on the practice of infectious diseases medicine.

In this feature, a panel of IDSA members identifies and critiques important new infectious diseases studies in the current literature that have a significant impact on the practice of infectious diseases medicine.


 Antibiotic Prophylaxis Does Not Reduce Pyelonephritis Recurrence

Jason Weinberg, MD

In the June issue of Pediatrics, Pennesi and colleagues demonstrate that continuous antibiotic prophylaxis does not reduce the rate of pyelonephritis recurrence or the incidence of renal damage in young children with vesicoureteral reflux.

Long-term antibiotic prophylaxis is frequently prescribed for young children with reflux despite the lack of good data showing that this intervention reduces the incidence of recurrent acute pyelonephritis or prevents renal scarring.  In this multicenter, randomized, controlled trial, 100 children with grade II, III, or IV vesicoureteral reflux were randomized either to receive prophylaxis or no intervention for two years; all children were then followed for an additional two years without prophylaxis.  There were no differences between groups in the risk for having pyelonephritis recurrence or renal scarring.

While not particularly large, the study has the benefit of focusing on the at-risk population of children between 1 and 30 months.  The investigators used a standardized agent (sulfamethoxazole/trimethoprim) for prophylaxis; unfortunately, no placebo was used in the control group.  Patients and investigators were not blinded to the treatment assignment, but objective follow-up with renal ultrasound, voiding cystourethrogram and DMSA scans was performed by radiologists who were blinded to treatment condition.  The microbiology of recurrent pyelonephritis episodes was well-defined, leading to the interesting finding that recurrences in the prophylaxis group tended to be associated with bacteria resistant to multiple antibiotics, whereas all recurrences in the control group were caused by bacteria sensitive to all antibiotics tested.

The jury is still out on prophylaxis for children with grade V reflux, but it is increasingly clear that long-term antibiotics are not necessary for most young children who have reflux diagnosed after an episode of pyelonephritis.  (Pennesi et al.  Pediatrics 2008;121:e1489-94.)

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 Sequential Therapy Superior Against H. pylori

Sara Cosgrove, MD

Ten-day sequential therapy, in which patients receive five days of a proton pump inhibitor (PPI) and one antibiotic followed by five days of a PPI and two other antibiotics, appears superior to standard seven-to-10 day triple therapy for Helicobacter pylori infection in treatment-naïve patients, according to a meta-analysis published in the June 17 Annals of Internal Medicine

The meta-analysis examined 10 randomized controlled trials that included 1,363 patients who received sequential therapy and 1,384 who received standard therapy.  All patients had not received agents used to treat H. pylori in the preceding month; had the diagnosis of H. pylori made via histologic evaluation, biopsy urease test, fecal antigen test, or urea breath test; and had a test of cure using one of these tests at least one month following therapy. Pooled crude eradication rates were 93.4 percent in the sequential therapy group and 76.9 percent in the standard therapy group. Reported adherence rates in both groups were greater than 90 percent in eight of 10 studies.

This meta-analysis has some limitations. Most notably, all of the studies were performed in Italy, which may affect generalizability. Only one of 10 studies was double-blinded. Also, some guidelines consider standard therapy to be a 14-day course rather than 10 days.  However, given the declining rates of H. pylori eradication in the United States using standard therapy, alternative approaches such as sequential therapy should be seriously considered and studied. (Jafri et al., Ann Intern Med. 2008;148:923-31.)

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 Single-tier Lyme Disease Test May Reduce Misdiagnosis

Melinda Pettigrew, PhD

In the first prospective study of two diagnostic tests for Lyme disease, the single-tier IgG VlsE C6 peptide ELISA test performed as well as the CDC-recommended two-tiered IgM and IgG ELISA and Western blot method in patients with symptoms of disseminated or late Lyme disease. An accompanying editorial notes that given the frequency with which the two-tier test is misinterpreted in clinical practice, the single-tier test has the potential to reduce misdiagnoses of Lyme disease. The study and editorial appear in the July 15 issue of Clinical Infectious Diseases,

Steere and colleagues prospectively examined the performance of the two-tiered test and the C6 peptide ELISA among patients with different stages of Lyme disease, patients with other illnesses, and in healthy controls. The sensitivity of both tests was very low among patients with the erythema migrans rash, which is present in a majority of early Lyme patients. Both tests performed well among patients in the later stages of disease.

The two-tiered test had slightly higher specificity and when used correctly can potentially provide information regarding the estimated duration of infection. However, problems persist with the correct interpretation and appropriate use of the two-tiered test in clinical practice. The C6 peptide ELISA may allow for ease of use and standardization of testing. Thus, this test has the potential to decrease the number of misdiagnosed cases of Lyme disease. This study was conducted in a controlled research laboratory setting. It remains to be seen how the C6 peptide ELISA would perform in clinical practice.

(Steere et al., Clin Infect Dis. 2008; 47:188-95; commentary by Weinstein, Clin Infect Dis. 2008;47:196-7.)

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 Waiting-room Video May Help Prevent Sexually Transmitted Diseases

Melinda Pettigrew, PhD

An STD prevention intervention that involved playing a short video containing safe sex messages to patients in the waiting rooms of public STD clinics resulted in a 10 percent decrease in the incidence of new STDs, as described in the June 24 issue of PLoS Medicine. The “Safe in the City” intervention video was played in STD clinic waiting rooms on alternate months. The control group consisted of the usual waiting room environment, without the video. Incident cases of laboratory-confirmed STDs were determined during the follow-up period by medical record review and county surveillance registries. Subjects were assigned to the intervention or control group based on whether their first clinic visit took place during an intervention or control four-week period. The intervention was most effective among men, older patients, and those who had an STD at their first visit.

A video intervention should be simple and affordable to implement, and has the potential to reach a large number of people. These data are likely to be generalizable since the study was conducted under real-world waiting room conditions. More research is needed to identify the specific aspects of the video that are most effective and to identify interventions that will be effective in preventing STDs in women. (Warner et al., PLoS Medicine. 2008;5:e135.)

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 Acyclovir Does Not Prevent HIV Acquisition in HSV-2-infected Patients

Khalil Ghanem, MD

Two recent randomized controlled trials demonstrated that acyclovir did not reduce HIV acquisition among herpes simplex virus 2 (HSV-2)-infected patients. This is disappointing news given the high prevalence of HSV-2 infection around the world and the strong epidemiologic data linking HSV-2 with increased acquisition of HIV.

In the first trial, published in the April 10 issue of the New England Journal of Medicine, 821 women who were HIV-negative and HSV-2-seropositive were randomized to receive 400 mg of acyclovir twice daily or placebo. The women were followed for 12 to 30 months. Despite a median adherence of 90 percent to the study drug, there was no overall effect of acyclovir on the incidence of HIV (rate ratio for the acyclovir group: 1.08; 95 PE confidence interval: 0.64 to 1.83).  Of note, acyclovir did not decrease the rates of genital ulcer disease in the intervention group. (Watson-Jones et al., NEJM. 358:1560-1571.)

The second study, published in the June 21 issue of the Lancet, recruited 1,814 men and 1,358 women. The study design was similar to the first study. Again, despite 94 percent adherence to the study drugs, there was no overall effect of acyclovir on the incidence of HIV (hazard ratio for the acyclovir group: 1.16; 95 percent confidence interval, 0.83 to 1.62). In the latter study, however, acyclovir did decrease the rates of genital ulcers by 47 percent. (Celum et al., Lancet. 2008;371:2109-2119.)

After the success of circumcision in reducing HIV acquisition in men and the recent disappointment in a preventive HIV vaccine, there was great hope that HSV-2 suppression using a relatively inexpensive drug such as acyclovir might provide an additional means to decrease the spread of HIV (especially in resource-limited settings). Despite strong epidemiologic data linking HSV-2 to HIV acquisition, the reason for the failure of acyclovir to protect against HIV acquisition is still unclear. There is an ongoing study to evaluate the efficacy of acyclovir therapy in preventing HIV transmission from HSV-2/HIV co-infected patients to their uninfected partners.

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In the IDSA Journals

Steve Baragona

Racial Disparities in Kidney Disease Progression

The results of this study suggest that disparities in end-stage renal disease (ESRD) between HIV-positive whites and African Americans is more likely a result of faster disease progression from chronic kidney disease (CKD) than a higher incidence of CKD in African Americans.  In this study of more than 3,000 African Americans and more than 1,000 whites in Baltimore, MD, African Americans were somewhat more likely than their white counterparts to develop CKD.  But progression to ESRD was much more rapid in the African Americans who developed CKD. (Lucas et al., J Infect Dis. 2008;197:1548-1557; commentary by Wyatt, J Infect Dis. 2008;197:1490-1492.)

CMV Vaccine Shows Promise

In this phase I clinical trial, an adjuvanted DNA vaccine encoding two cytomegalovirus (CMV) antigens, phosphoprotein 65 (pp65) and glycoprotein B (gB), was well tolerated and generated antibody or cellular immune responses in 45 percent of CMV-seronegative subjects and 25 percent of seropositive subjects.  Cellular immune responses were stronger than antibody responses. Sixty-eight percent of seronegative subjects showed memory T cell responses at 32 weeks. (Wloch et al., J Infect Dis. 2008;197:1634-1642; commentary by Go and Pollard, J Infect Dis. 2008;197:1631-1633.)

PCV7 and pneumococcal meningitis

Following the introduction of routine vaccination of young children with 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, the annual mean rate of pneumococcal meningitis hospitalization decreased by 66 percent among children aged less than 2 years and by 51.5 percent among children 2-4 years of age. Among adults over 65 years of age, rates decreased by 33 percent. (Tsai et al., Clin Infect Dis. 2008;46:1664-1672; commentary by Dagan, Clin Infect Dis. 2008;46:1673-1676.)  

 

Use of active surveillance cultures for MRSA: a review

Active surveillance cultures (ASCs) are universal or targeted screening cultures of samples from patients admitted to a hospital and have been proposed to reduce the number of infections caused by multidrug-resistant organisms. This review of the literature sought evidence of the efficacy and cost-effectiveness of ASCs in the control of methicillin-resistant Staphylococcus aureus (MRSA) infection. Important gaps in the literature were identified, including a need for a clear definition of ASCs, a clear implementation protocol, and rigorous economic evaluations. Existing evidence may favor the use of ASCs, but the evidence is of poor quality, and definitive recommendations cannot be made. (McGinigle et al., Clin Infect Dis. 2008;46:1717-1725; commentary by Milstone and Perl, Clin Infect Dis. 2008;46:1726-1728.)

C. difficile infection after perioperative prophylaxis

Perioperative antibacterial prophylaxis is used to prevent surgical site infections but occasionally may lead to Clostridium difficile infection. In this study, the authors found that the risk of C. difficile infection following perioperative antibacterial prophylaxis was 0.7 cases per 1000 surgical procedures for the period 1999-2002. The rate increased to 15 cases per 1000 surgical procedures for the period 2003-2005 after the emergence of a hypervirulent strain of C. difficile. (Carignan et al., Clin Infect Dis. 2008;46:1838-1843.)

More from the literature: the IDSA Journal Club

Don’t miss this new feature to help you stay up to date on the infectious diseases literature. Each month, the IDSA Journal Club will feature brief summaries of key infectious diseases studies in the previous month’s major journals chosen by the new IDSA Literature Review Panel.

In addition, the “In This Issue” section of each issue of Clinical Infectious Diseases highlights several important studies from that journal. (Click for July 1 or July 15.)

For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, in each issue of Clinical Infectious Diseases.

July 1:

  • Get the Blood Culture before the Fever?
  • Rifampicin Prophylaxis for Leprosy
  • Nan(non)bacteria
  • Voriconazole for Scedosporium Infection

July 15:

  • Eliminating Yaws
  • An Oncogenic Polyomavirus?
  • Bon Appétit, Mon Bactérie!
  • Tuberculosis and Infliximab

ACIP Makes New Recommendations on Rabies, HPV, Pneumococcal Vaccines

Diana Olson

New recommendations and discussion from the June meeting of the federal Advisory Committee on Immunization Practices (ACIP), according to IDSA’s ACIP liaison, Samuel Katz, MD, FIDSA.

The federal Advisory Committee on Immunization Practices (ACIP) made the following recommendations at its June meeting in Atlanta, according to IDSA’s ACIP liaison, Samuel Katz, MD, FIDSA:

Rabies Pre-exposure Vaccination Discouraged: Due to the continuing shortage of rabies vaccine, pre-exposure prophylaxis is discouraged. Post-exposure prophylaxis should be initiated only on the basis of good evidence. In many states, vaccine can only be obtained through health departments. Two companies are licensed to produce rabies vaccine in the United States: Sanofi Pasteur, which is renovating its plant and may be back in production in 2009, and Novartis, which continues to produce and is building a new plant in Marburg, Germany. The companies hope to have more vaccine in the United States this summer.

HPV Vaccine Not Cost-beneficial for Women Over 26: Although there are no contraindications unique to women over age 26, the benefits of human papillomavirus (HPV) vaccine for this age group do not outweigh the costs, according to discussion at ACIP. Women may request the vaccine from their gynecologists or internists, but without ACIP’s recommendation most insurance companies will not pay for it. The vaccine costs about $500.

Pneumococcal Vaccine Recommended for Adults with Asthma: Asthma was added as a high-risk condition in the recommendations for adults age 18-64 years who should receive PPSV23 pneumococcal vaccine. ACIP also considered, but decided against, adding smoking to the list of high-risk conditions.

In other news, ACIP:

  • recommended adding two new pediatric combination vaccines—Kinrix and Pentacel—to the Vaccines for Children Program, which means the federal government will pay for them. Kinrix is a booster for diphtheria, tetanus, pertussis, and polio, and Pentacel protects against diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b.
  • harmonized the schedule recommendations for rotavirus vaccines manufactured by Merck (RotaTeq) and GlaxoSmithKline (Rotarix)
  • discussed continued shortages of some varicella products. Zoster is still obtainable; MMRV is not and may not be until early 2009.

ACIP recommendations become official once approved by the Centers for Disease Control and Prevention and published in Morbidity and Mortality Weekly Report. For more information, see: http://www.cdc.gov/vaccines/recs/acip/.

CDC Updates Recommendations on Prevention, Control of Influenza

Diana Olson

Recommendations include vaccinating all children ages 5-18 years and targeting children aged 6 months through 4 years. Live, attenuated influenza vaccine is now approved for children as young as 2 years old.

The Centers for Disease Control and Prevention has issued newly updated recommendations for the prevention and control of influenza, in advance of the 2008-2009 flu season. CDC’s Advisory Committee on Immunization Practices recommends the following:

  • Annual vaccination should be administered to all children ages 5-18 years, beginning in the 2008-2009 season, if feasible, but not no later than 2009-2010.
  • Efforts should primarily target children aged 6 months through 4 years because these children are at higher risk for influenza complications.
  • Either trivalent inactivated influenza vaccine or live, attenuated influenza vaccine (LAIV) should be used when vaccinating healthy persons aged 2-49 years (the previous recommendation for LAIV was for people aged 5-49 years)
  • Providers should use vaccines containing the 2008-09 trivalent vaccine virus strains A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2-like), and B/Florida/4/2006-like antigens.

The report includes new information on antiviral resistance. Oseltamivir-resistant influenza A (H1N1) strains have been identified in the United States and some other countries. However, oseltamivir or zanamivir continue to be the recommended antivirals for treatment of influenza because other influenza virus strains remain sensitive to oseltamivir, and resistance levels to other antiviral medications remain high.

The full report can be found in MMWR, July 17, 2008/57(Early Release);1-60.

Zoster Vaccine Recommended for All Persons Over 60

Diana Olson
Zoster vaccine is now recommended for all persons aged over 60 years who have no contraindications.

Zoster vaccine is now recommended for all persons aged over 60 years who have no contraindications, including patients who have had a previous episode of zoster or who have chronic medical conditions. According to the Advisory Committee on Immunization Practices (ACIP), patients do not need to be asked about their history of varicella or to have serologic testing prior to administering the vaccine. ACIP’s recommendations were published in the June 6 issue of Morbidity and Mortality Weekly Report (MMWR June 6, 2008/57(05);1-30).

EIN: MAI Disease and Clofazimine

Steve Baragona

The Emerging Infections Network discusses obtaining clofazimine to treat Mycobacterium avium-intracellulare (MAI) disease, and some limitations.

The Emerging Infections Network (EIN) is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. Any diagnostic or therapeutic recommendations and all opinions presented are those of the individual contributor. They do not necessarily represent the views of EIN, IDSA (EIN's sponsor), or the Centers for Disease Control and Prevention, which funds the EIN. The reader assumes all risks in using this information.

 

An EIN member asked for suggestions for obtaining clofazimine for a patient with progressive Mycobacterium avium-intracellulare (MAI) disease who had previously been treated with standard first- and second-line medications.

Several members noted that the drug is no longer commercially available in the United States, but can be obtained for free through the Food and Drug Administration under an investigational new drug ( IND) application. Some members added that institutional review board (IRB) approval will be required. A letter from the manufacturer, Novartis Pharmaceuticals Corporation, with more information and contact details can be found at FDA’s drug shortages website.

A member in Florida who sees a large number of patients with MAI offers the following suggestions: “When progression occurs on treatment, as defined by worsening CT chest and symptoms (cough, shortness of breath, hemoptysis, weight loss, etc.), look for the following: 1) non-compliance with the regimen; 2) secondary pathogens such as rapidly growing mycobacteria (RGM), Pseudomonas, MRSA, or Aspergillus (consider bronchoalveolar lavage), or 3) truly resistant MAI. If all else fails, for extremely resistant cases you may want to consider gamma interferon for eight weeks or lung resection of large cavity or isolated lobe involvement.”

However, “This discussion misses some very important points,” added a member in California. “First, there is no evidence that conventional in vitro susceptibility test results with clofazimine correlate with clinical outcomes, and at least some evidence that indicates they do not (see, e.g., J Infect Dis. 1996;173:677-83). Furthermore, there is no evidence that clofazimine contributes to a favorable result in treating patients with Mycobacterium avium complex (MAC) infection (see, e.g., Int Conf AIDS 1992; 8:B101, abstract no. PoB 3087; Eur J Clin Microbiol Infect Dis. 1999;18:16-22; AIDS 1997;11:311-7). (It must be noted that these deal with disseminated MAC in AIDS and were likely caused by M. avium, while the patient in question has pulmonary infection and is more likely to be infected with M. intracellulare.)”

“Finally,” the member concluded, “before you go through all the trouble of getting the drug, you may wish to discuss with the patient the almost inevitable skin discoloration that occurs with prolonged use. Many patients will opt out at that point.”


The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public-health community detect trends in emerging infectious diseases.

A joint project of IDSA and the Pediatric Infectious Diseases Society (PIDS) and supported by funding from the Centers for Disease Control and Prevention.

EIN tracks emerging infectious diseases and keeps the public-health community up to date with issues that are currently affecting or may soon affect members’ clinical practices.The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. Both IDSA and PIDS members are eligible to join. The EIN listserve allows members to discuss new disease trends and difficult cases. Click here for more information or to join EIN.

Drug Approvals, Recalls, Adverse Events Update

Rebecca Dotson

IDSA offers two e-mail services to help members stay informed of updates from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).

IDSA offers two e-mail services to help members stay informed of updates from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). Recent alerts have included:

  • Drug Information Update -- Fluroquinolone Antimicrobial Drugs
    “FDA is notifying the makers of fluoroquinolone antimicrobial drugs for systemic use of the need to add a boxed warning to the prescribing information about the increased risk of developing tendonitis and tendon rupture in patients taking fluoroquinolones…”

IDSA members can sign up for this service online. (You must be logged in to have access to this link.)

Congress Stops Steep Medicare Physician Payment Cuts, For Now

Diana Olson

Congress enacted legislation this month that stops steep Medicare physician payment cuts from taking effect this year.

Congress enacted legislation this month that stops steep Medicare physician payment cuts from taking effect this year. The Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331) retroactively maintains physicians' payments at their pre-July 1 levels during the second half of 2008 and increases payments by 1.1 percent in 2009.

Although President Bush vetoed the Medicare bill (for reasons unrelated to physician payment), Congress successfully overrode the veto July 15. Had that not happened, ID practices would have seen their payments cut by nearly 11 percent.

The Centers for Medicare and Medicaid Services has instructed its contractors to implement the revised payment rates. However, since it may take up to 10 business days for contractors to implement these changes, some claims may still be paid at the lower rates that were in effect between July 1 and July 15. Claims paid at the lower rates will automatically be reprocessed.

IDSA has developed several web-based payment resources, including an interactive reimbursement calculator to help you estimate what the payment changes mean for your practice. (You will need your member log-in.)

Future Physician Payment Cuts

Congress’s action means that steep cuts have been forestalled but not prevented. Physicians face several years of future payment cuts beginning with a projected 21 percent payment cut in 2010. These cuts are due to the flawed formula, called the sustainable growth rate (SGR), used by Medicare to calculate physician payments. Please visit IDSA's Physician Payment Toolkit for information on future payment cuts and to contact Congress to support a long-term and sustainable solution to the physician-payment problem.

CMS to Launch New Website to Compare Physicians

Diana Olson
The federal Centers for Medicare and Medicaid Services (CMS) plans to launch a new Physician Compare website modeled after the agency’s Hospital Compare website, www.hospitalcompare.hhs.gov, which provides consumers with quality data related to certain conditions or procedures.

The federal Centers for Medicare and Medicaid Services (CMS) plans to launch a new Physician Compare website modeled after the agency’s Hospital Compare website, www.hospitalcompare.hhs.gov, which provides consumers with quality data related to certain conditions or procedures.

Although few details of the proposed physician website have been released yet, IDSA has already contacted the agency to express concern. While providing information about the quality of medical care is a “laudable goal,” the new project “is fraught with challenges and unintended consequences, including the likelihood that Medicare beneficiaries will misinterpret quality data,” said Michael Buckley, MD, FIDSA, chair of IDSA’s Quality Improvement Task Force, in a June 30 letter to CMS.

From an ID perspective, the biggest challenge is the lack of available accountability measures for inpatient infectious diseases consultants. In addition, patient choice does not play a role in many inpatient consultations. Patients who need an ID consult are routinely among the sickest and most complex patients and don’t have the means to access nor the ability to compare meaningful quality information before seeing an ID physician. “Absent a sound risk adjustment methodology, making such data publicly available would serve no purpose other than to provide retrospective and misleading quality information to patients,” said the IDSA letter.

IDSA’s letter to CMS can be found online.

U.S. Global AIDS Program Expands

Steve Baragona
Congress has passed a 5-year, $48 billion expansion of the U.S. global HIV/AIDS initiative known as the President’s Emergency Fund for AIDS Relief (PEPFAR).

Congress has passed a 5-year, $48 billion expansion of the U.S. global HIV/AIDS initiative known as the President’s Emergency Fund for AIDS Relief (PEPFAR).

The new legislation targets $5 billion for malaria and $4 billion for tuberculosis (TB). The broader focus makes a lot of sense, noted HIV Medicine Association (HIVMA) board member Eric Goosby, MD, CEO and chief medical officer of Pangaea Global AIDS Foundation and Professor of Clinical Medicine at UCSF Global Health Science Department of Medicine, because, “It’s often the same patient who gets all three diseases.” Making the funds available for malaria and TB can also help to build a country’s public health infrastructure, he added. “You have a huge influx of resources coming into a country. Since that country can decide to use these resources for TB and malaria, it’s going to benefit the larger population that’s not (HIV-)infected as well, hopefully, all boats rise.”

As significant as what the new version of PEPFAR includes is what it leaves out. It strikes down the long-standing ban on travel to the United States for those living with HIV. HIVMA has long argued against the ban, which has no medical basis, stigmatizes those with HIV, and has kept the International AIDS Society’s major biannual meeting out of the United States.

“For many of us, this ban has been an embarrassment,” said HIVMA Vice Chair Michael S. Saag, MD, FIDSA, director of the Center for AIDS Research at the University of Alabama at Birmingham. Dr. Saag was in close contact with the office of Alabama Senator Jeff Sessions (R), who led objections to lifting the ban. Dr. Saag and others were instrumental in persuading Sen. Sessions to drop his objection, and Sen. Sessions on the Senate floor praised Dr. Saag’s work in Zambia and elsewhere.

Also conspicuous in their absence are many of the earmarks and restrictions that restricted how countries may spend PEPFAR funds. Requirements have been relaxed on spending fixed percentages on antiretroviral drugs and prevention programs emphasizing sexual abstinence. “Flexibility is absolutely required because of the dramatic differences in need from one country to another, and even within a country from one setting to another,” Dr. Saag said. According to Dr. Goosby, relaxing these restrictions also will encourage countries to take ownership of the programs.

The enlarged PEPFAR program includes funding to strengthen health systems and the health care workforce, including a goal to train at least 140,000 new health care workers. Dr. Goosby is helping to implement HIV/AIDS programs in several countries currently receiving PEPFAR funding and has first-hand knowledge of the severity of the health care workforce crisis in many developing countries affected by HIV/AIDS.  In many countries more physicians are needed, but in the meantime, he said, “Diagnosis and treatment decisions need to be shifted from exclusively an MD decision  to an RN or NP in consultation with a physician. Without the midlevel provider expansion of role,it won’t work.”

Also included in the PEPFAR package are resources for monitoring, evaluation, and operational research. These funds will help to establish what interventions and methods of delivery work best in individual settings.

HIVMA has written several letters to Congress regarding this legislation, which can be found on in the “Public Policy” section of the HIVMA website, www.hivma.org, under “Global.” 

Federal ID Budgets Likely to See Small Increases

Steve Baragona

Current 2009 budget proposals for federal infectious diseases programs give modest increases to the Centers for Disease Control and Prevention (CDC) and the National Institute for Allergy and Infectious Diseases (NIAID).

Current 2009 budget proposals for federal infectious diseases programs give modest increases to the Centers for Disease Control and Prevention (CDC) and the National Institute for Allergy and Infectious Diseases (NIAID).

The Senate Appropriations Committee has approved a bill increasing funding for NIAID by $128 million and CDC by $133 million. Meanwhile, the equivalent bill in the House of Representatives includes a funding increase of $156 million for NIAID and $157 million for CDC. (See chart, below.)

Congressional reports—recommendations to agencies accompanying the bills—include IDSA-backed suggestions such as:

  • encouraging CDC to explore the use of sentinel surveillance networks to describe and confirm regional outbreaks of resistant infections

  • encouraging NIAID to strengthen clinical, translational, and basic research to address antimicrobial resistant infections

  • encouraging NIAID to accelerate research to advance the understanding of mechanisms of resistance and how resistant microbes impact human health

  • encouraging CDC to enhance 317 Program activities to support efforts to strengthen adolescent and adult immunization coverage 

Neither bill has made it past the committee level yet. It appears unlikely that a final budget will be approved before a new president takes office.

Details of the appropriations proposals are below:

HHS Program

2008 Final 

2009 President's Budget Request (change from 2008)

Senate Committee bill (change from 2008)

House Subcommittee bill (change from 2008)

Centers for Disease Control Total

$6,375.00

$5,900.67
(-7.44%)

$6,507.80
(+2.08%)

$6,531.88
(+2.46%)

Infectious Diseases Total

$1,891.74

$1,857.18
(-1.83%)

$1,909.54
(+0.94%)

$1,976.11
(+4.46%)

Infectious Diseases Control

$149.90

$122.84
(-18.05%)

$154.93
(+3.35%)

$149.93
(+0.02%)

Pandemic Influenza Activities

$154.90

$160.09
(+3.35%)

$154.63
(-$0.27)

$157.46
(+1.65%)






NIH Total

$28,941.00

$29,465.00
(+1.81%)

$30,254.52
(+4.54%)

$30,379.52
(+4.97%)

NIAID

$4,560.66

$4,568.78
(+0.18%)

$4,688.83
(+2.81%)

$4,716.28
(+3.41%)

Fogarty International Center

$66.56

$66.62
(+0.10%)

$68.48
(+2.88%)

$68.91
(+3.53%)






HHS Office of the Secretary

Pandemic Influenza Preparedness

$74.80

$585.10
(+682.22%)

$585.09
(+682.21%)

$448.09
(+499.05%)

Biomedical Advanced Research and Development Authority

$102.00

$275.00
(+169.61%)

$175.00
(+71.57%)

$275.00
(+169.61%)

IDSA Advocacy Update: IDSA Opposes Federal Antiviral, Antibiotic Stockpiling Plans

Rebecca Dotson

Personal and employer antiviral stockpiles, home doxycycline stockpiles, and more IDSA advocacy.

IDSA is urging the federal government to expand the federal antiviral stockpile rather than rely upon employer purchase to ensure antiviral prophylaxis of at-risk workers in an influenza pandemic. The Society, along with the Society for Healthcare Epidemiology (SHEA), issued comments on the federal government’s June 2008 revision of two draft guidance documents, on antiviral use during a pandemic and antiviral stockpiling by employers in preparation for a pandemic.

Other advocacy items:

  • Together with the American Medical Association, American Academy of Pediatrics, and American Academy of Family Physicians, IDSA opposed a plan under consideration by the Department of Health and Human Services (HHS) to permit the public to purchase and stockpile antivirals at home ahead of a potential influenza pandemic, citing clinical and public health considerations. In a joint letter, the societies offered aid to overall national antiviral distribution and dispensing efforts.
  • Similarly, at a meeting of the National Biodefense Science Board, IDSA delivered public comments raising concerns about an HHS initiative to permit the public to stockpile doxycycline at home for use in a potential anthrax attack.
  • IDSA and SHEA opposed including methicillin-resistant Staphylococcus aureus (MRSA), among other complications, on a list of “reasonably preventable” conditions for which hospitals will not receive additional payment if the conditions are not present on admission and if they are the only co-morbidity. In joint comments to Medicare on the 2009 inpatient prospective payment system proposed rule, IDSA and SHEA also supported including surgical site infections following total knee replacement and varicose vein stripping as reasonably preventable hospital acquired conditions.
  • IDSA joined other global health groups in calling on Congress to significantly increase funding for global health research programs at the Centers for Disease Control and Prevention and the National Institutes of Health, especially at the National Institute of Allergy and Infectious Diseases and the Fogarty International Center.
  • IDSA signed a coalition letter to House Appropriations Committee Chair, David Obey, urging that the committee not adopt any amendment which would restrict the use, or limit the availability, of recommended vaccines, in particular influenza vaccine containing thimerosal.
  • IDSA and SHEA urged the federal government to emphasize the use of facemasks rather than N95 respirators by the general public as part of pandemic influenza preparedness efforts.

IDSA/SHEA Infection Control Fellows Course Available Online

Stephanie Cox

The online IDSA/Society for Healthcare Epidemiology of America (SHEA) Infection Control Fellows Course was designed to give infectious diseases fellows and others basic training and background in infection control.

 

 

 

 

The online IDSA/Society for Healthcare Epidemiology of America (SHEA) Infection Control Fellows Course was designed to give infectious diseases fellows and others basic training and background in infection control. The course consists of a 21-question pre-test, 14 lectures (approximately 12.5 hours), and a 32-question post-test. Other features include:

  • synchronized audio and searchable slides
  • printable slides
  • a searchable transcript for each lecture
  • self-pacing and "bookmarking" capabilities  

The IDSA/SHEA Infection Control Fellows Course was taped at Johns Hopkins Hospital, and includes lectures on outbreak management, bloodstream and catheter infections, antimicrobial management, and much more.

A preview of the course is available online. To register, visit www.iccourse.org and follow the instructions in the green “Registration” box on the right side of the page. To sign up a group of fellows, you can use the Group Registration Form.

If you are a training program director and have already registered your group of fellows, you can request a report on the post-test scores of these fellows by e-mailing iccourse@idsociety.org.

Looking For CME Opportunities?

Stephanie Cox

Many opportunities to receive continuing medical education (CME) credits are available through IDSA and HIVMA.

Many opportunities to receive continuing medical education (CME) credits are available through IDSA and HIVMA:

  • ICAAC/IDSA Joint Meeting (October 25-28, 2008, Washington, DC). Provides broad continuing educational courses and comprehensive educational experiences in the major facets of infectious diseases: pathophysiology, diagnosis, treatment, and prevention.
  • IDSA Clinical Practice Meeting (March 20-21, 2009, San Diego, CA). Participants will learn ways to improve practice efficiency and increase profitability so they can focus their practices on providing quality patient care.
  • HIVMA Course - HIV Prevention in the Care Setting: Implications for STD Management. This course is designed to help clinicians gain perspective on HIV prevention and STD management, including recommendations for the initial HIV screening, the relationship between acute HIV infection and the risk of transmission, and the association between rectal STD infections and HIV risk.
  • Lyme Disease Case Study Course (available Fall 2008). This interactive case-based program is based on the IDSA clinical practice guidelines, The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis
  • Seasonal and Pandemic Influenza Monograph (available Fall 2008). This educational activity is for clinicians, public health officials, and policy makers involved in planning and implementing care for patients with seasonal and pandemic influenza.

Look for new or updated CME opportunities on the IDSA Homepage. IDSA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME credits. 

 

Congratulations, New IDSA Fellows!

Fellowship in IDSA honors individuals who have achieved professional excellence and provided significant service to the profession. More information about fellowship in IDSA and an application are available online.

Murray A. Abramson, MD, FIDSA
Merck & Co, Inc, Rahway, NJ

Barbara D. Alexander, MD, FIDSA
Duke University, Durham, NC

Donald T. Allegra, MD, FIDSA
I.D. Care, Inc/I.D. Associates, P.A., Randolph, NJ

Laura H. Bachmann, MD, MPH, FIDSA
University of Alabama at Birmingham, Birmingham, AL

Andrew Badley, MD, FIDSA
Mayo Clinic, Rochester, MN

C. Keith Beck, MD, FIDSA
Harbor-UCLA Medical Center, Torrance, CA

Beth P. Bell, MD, MPH, FIDSA
CDC/NCIRD, Atlanta, GA

David L. Blazes, MD, FIDSA
Naval Medical Research Center Detachment, APO, AA

Michael Boeckh, MD, PhD, FIDSA
University of Washington, Seattle, WA

John A. Bosso, PharmD, FIDSA
College of Pharmacy Medical University of S. Carolina, Charleston, SC

William Bower, MD, FIDSA
Center for Disease Control and Prevention, Atlanta, GA

Timothy Brewer, MD, MPH, FIDSA
McGill Medical School, Montreal, QC

John D. Bullock, MD, MPH, MSc, FIDSA
Wright State University School of Medicine, Kettering, OH

Edward P. Butler, MD, FIDSA
Lawrence Memorial Hospital, Medford, MA

Christopher F. Carpenter, MD, FIDSA
William Beaumont Hospital, Royal Oak, MI

Connie Celum, MD, MPH, FIDSA
University of Washington, Seattle, WA

Oliver A. Cornely, MD, FIDSA
Uniklinik koln, Cologne

Kimberly Couch, PharmD, MA, FIDSA
Christiana Care Health System, Stevensville, MD

Nancy F. Crum-Cianflone, MD, FIDSA
Triservice AIDS Clinical Consortium, Poway, CA

William A. Davis, MD, FIDSA
Drs Kane & Davis Associates, Bethesda, MD

Maria G. Dominguez-Bello, PhD, FIDSA
University of Puerto Rico, San Juan, PR

Ann Duerr, MD, PhD, FIDSA
Fred Hutchinson Cancer Research Center, Seattle, WA

Daniel V. Ehrensaft, MD, FIDSA
Pacific Palisades, CA

Mimi Emig, MD, FIDSA
Spectrum Health Infectious Diseases, Grand Rapids, MI

Guliz Erdem, MD, FIDSA
University of Hawaii, Honolulu, HI

Mohamad G. Fakih, MD, MPH, FIDSA
St John Hospital & Medical Center, Grosse Pointe Woods, MI

Marta Feldmesser, MD, FIDSA
Albert Einstein College of Medicine, Bronx, NY

Joel T. Fishbain, MD, FIDSA
Walter Reed Army Medical Center, Silver Spring, MD

Kenneth A. Freedberg, MD, MSc, FIDSA
Massachusetts General Hospital - Havard Medical School, Boston, MA

Manjusha Gaglani, MD, MBBS, FIDSA
Scott & White Memorial Hospital and Clinic, Temple, TX

Kelly Gebo, MD, FIDSA
Johns Hopkins University School of Medicine, Baltimore, MD

William M. Geisler, MD, FIDSA
The University of Alabama at Birmingham, Birmingham, AL

Eric V. Granowitz, MD, FIDSA
Baystate Medical Center-Tufts Univesity School of Medicine, Springfield, MA

Peter G. Gulick, DO, FIDSA
Michigan State University, East Lansing, MI

Joseph I. Harwell, MD, FIDSA
Warren Alpert Medical School of kBrown University, Providence, RI

Elizabeth L. Hohmann, MD, FIDSA
Massachusetts General Hospital, Boston, MA

Gary P. Holmes, MD, FIDSA
Carl R. Darnall Army Medical Center, Ft Hood, TX

Susan S. Huang, MD, MPH, FIDSA
University of California Irvine School of Medicine, Orange, CA

Kentaro Iwata, MD, FIDSA
Kameda Medical Center, Kamogawa

Leonard B. Johnson, MD, FIDSA
St. John Hospital and Medical Center, Grosse Pointe Woods, MI

Timothy F. Jones, MD, FIDSA
Tennessee Department Of Health, Nashville, TN

M. Patricia Joyce, MD, FIDSA
Centers for Disease Control and Prevention, Tucker, GA

Niranjan Kanesa-Thasan, MD, FIDSA
Novartis Vaccines and Diagnostics, Cambridge, MA

Souha S. Kanj, MD, FIDSA
American Univesity of Beirut Medical Center, Beirut

Barbara I. Kazmierczak, MD,PhD, FIDSA
Yale University School of Medicine, New Haven, CT

Marla J. Keller, MD, FIDSA
Albert Einstein College of Medicine, Scarsdale, NY

Monina Klevens, DDS, MPH, FIDSA
Centers for Disease Control and Prevention, Atlanta, GA

Albert I. Ko, MD, FIDSA
Weill Medical College of Cornell University, Salvador, Bahia

Margaret J. Koziel, MD, FIDSA
Beth Israel Deaconess Medical Center, Boston, MA

Christopher G. Lauge, MD, PhD, FIDSA
Research Center Borstel, Borstel, Germany

Linda L. Lewis, MD, FIDSA
Food and Drug Administration, Bethesda, MD

Jason D. Maguire, MD, MPH, FIDSA
Naval Medical Center, Portsmouth, Chesapeake, VA

Steven D. Mawhorter, MD, DTM&H, FIDSA
Cleveland Clinic, Cleveland, OH

Gregory J. Moran, MD, FIDSA
Olive View/UCLA Medical Center, Sylmar, CA

David M. Mushatt, MD, MPH, FIDSA
Tulane University School of Medicine, New Orleans, LA

David Nicolau, PharmD, FIDSA
Hartford Hospital, Hartford, CT

Gary J. Noel, MD, FIDSA
Johnson & Johnson Pharm R&D, Raritan, NJ

Eli N. Perencevich, MD, FIDSA
University of Maryland School of Medicine, Baltimore, MD

Kyle Petersen, DO, FIDSA
Naval Medical Research Center, Silver Spring, MD

Randall A. Prince, PharmD, FIDSA
University of Houston, Houston, TX

Gary W. Procop, MD, FIDSA
Cleveland Clinic, Twinsburg, OH

Richard C. Prokesch, MD, FIDSA
Infectious Diseases Associates, Riverdale, GA

Stuart C. Ray, MD, FIDSA
Johns Hopkins University School of Medicine, Baltimore, MD

Luther V. Rhodes, MD, FIDSA
Lehigh Valley Infectious Diseases Services, Allentown, PA

Janice M. Rusnak, MD, FIDSA
U.S. Army Medical Research Institue, Frederick, MD

Juan C. Sarria, MD, FIDSA
University of Texas Medical Branch, Galveston, TX

Mary E. Schmidt, MD, FIDSA
Inova Fairfax Hospital, Annandale, VA

Albert C. Shaw, MD,PhD, FIDSA
Yale University School of Medicine, New Haven, CT

Kevin W. Shea, MD, FACP, FIDSA
Carolina Health Care, Florence, SC

David H. Shepp, MD, FIDSA
Gilead Sciences, Inc., Glen Cove, NY

Gary R. Skankey, MD, FIDSA
University of Nevada School of Medicine, Las Vegas, NV

Peter J. Skidmore, MD, FIDSA
Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA

William J. Steinbach, MD, FIDSA
Duke University Medical Center, Durham, NC

Stephen J. Thomas, MD, FIDSA
Armed Forces Research Institute of Medical Sciences, APO, AP

John F. Toney, MD, FIDSA
University of South Florida College of Medicine, Tampa, FL

David R. Tribble, MD, FIDSA
Unifromed Services University, Rockville, MD

Jesus G. Vallejo, MD, FIDSA
Baylor College of Medicine, Houston, TX

Meera Varman, MD, FIDSA
Creighton University Medical Center, Omaha, NE

Matthew K. Waldor, MD, PhD, FIDSA
Channing Lab, Brigham & Women's Hospital, Boston, MA

Ajay Wanchu, MD, FIDSA
PGIMER, Chandigarh

David Wheeler, MD, FIDSA
Infectious Diseases Physicians, Annandale, VA

Cynthia G. Whitney, MD, FIDSA
Centers for Disease Control and Prevention, Atlanta, GA

Marcelo J. Wolff, MD, FIDSA
University of Chile School of Medicine, Santiago

Christopher W. Woods, MD, FIDSA
Duke University Medical Center/Durham VAMC, Durham, NC

Gianna Zuccotti, MD, FIDSA
Memorial Sloan Kettering Cancer Center, New York, NY

IDSA 2008 Elections Coming Up

Stephanie Cox
IDSA members will elect new officers and Board members this summer.

IDSA members will elect new officers and Board members this summer. Ballots will be sent in August to all members who are eligible to vote and will be due in September. Your ballot will include biographical statements and personal sketches from each of the candidates. The slate is as follows:

Vice President:

James Hughes, MD, FIDSA
Professor of Medicine and Public Health, Rollins School of Public Health; Director, Program in Global Infectious Diseases; and Director, Center for Global Safe Water; Emory University, Atlanta, GA

David Relman, MD, FIDSA
Associate Professor of Medicine and of Microbiology and Immunology, Stanford University; and Chief, Infectious Diseases, VA Palo Alto Health Care System, Stanford, CA

Director (Three slots open):

Arturo Casadevall, MD, PhD, FIDSA
Professor and Chair, Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY

Thomas File, Jr, MD, MS, FIDSA
Chief, Infectious Disease Service and Director, HIV Research, Summa Health System; Professor of Internal Medicine, Master Teacher, and Head, Infectious Disease Section, Northeastern Ohio Universities College of Medicine, Akron, OH

Carol Kauffman, MD, FIDSA
Professor, Department of Internal Medicine, University of Michigan; and Chief, Infectious Diseases, Ann Arbor Veterans’ Affairs Medical Center, Ann Arbor, MI

Marguerite Neill, MD
Associate Professor, Infectious Diseases, Brown Alpert Medical School, Providence, RI; and Clinician, Division of Infectious Diseases, Memorial Hospital of Rhode Island, Pawtucket, RI

Andrew Pavia, MD, FIDSA
Professor and Chief, Division of Pediatric Infectious Diseases, University of Utah Medical Center; and Director, Hospital Epidemiology, Primary Children’s Medical Center, Salt Lake City, UT

William Powderly, MD, FIDSA
Professor, Medicine and Therapeutics; and Head, School of Medicine and Medical Science; University College Dublin, Dublin, Ireland

Members on the Move

Rebecca Dotson

George H. Karam, MD, and Arturo Casadevall, MD, PhD, FIDSA

George H. Karam, MD, has been elected to the American Board of Internal Medicine (ABIM) Board of Directors.  The Board of Directors guides ABIM’s overall mission and direction as it works to improve health care quality.  All ABIM directors participate in ABIM’s Maintenance of Certification program, which promotes ongoing learning and in which doctors demonstrate their commitment to the Board’s standards.  Dr. Karam is the Paul Garvey Manship Professor of Medicine at the Louisiana State University School of Medicine.

Arturo Casadevall, MD, PhD, FIDSA, has been awarded the 2008 American Society for Microbiology (ASM) Williams A. Hinton Research Training Award.  The award recognizes outstanding contributions toward fostering the research training of underrepresented minorities in microbiology.  The award was presented in June during the 108th General Meeting of the American Society for Microbiology (ASM) in Boston, MA.

Welcome, New IDSA Members!

Members

Aram, Jalal, MD
Belko, John, MD
Cassino, Cara, MD
Cobb, David, MD
Das,
Rituparna, MD
Harris, Jason, MD
Lee, Su, PharmD
Lewis, Steven, MD
Lock, John, PharmD
Ogunsakin,
Mobolaji, MD
Park, Wan Beom, MD, PhD
Pujari,
Sanjay, MD
Shrewsbury, Stephen, MD
Towner, William, MD 

Associate

Aureden, Kathy, MS, MT(ASCP)
Geissel, Kathleen, PharmD
Godkin, Susan, RPh
Hayes, Jennifer, PharmD 

Members-In-Training

Agolory, Simon, MD
Ali,
Shabnam, MD
Ariza-Heredia, Ella, MD
Baang,
Jihoon, MD
Babu, Elizabeth, MD
Balan,
Aurelia, MD
Baliga, Christopher, MD
Ballard, Yvonne, MD
Baluch, Aliyah, MD
Banerjee, Ritu, MD, PhD
Basilan, Richard, MD
Blaylock, Jason, MD
Boehringer, Christine, DO
Bolton, Michael, MD, PhD
Boukhoudmi,
Soraya, MD
Brett, Meghan, MD
Byers,
David, MD
Camacho-Gonzalez, Andres, MD
Cilley, Brian, DO
Coffee, Megan, MD, PhD
Cohen, Stephanie, MD
Cole, Phillip, MD
Collinet-Adler, Stefan, MD
Desai,
Rishi, MD
Donovan, Fariba, MD, PhD
Dutta,
Ankhi, MD
El Mortada, Mohamad, MD
Erlandson, Kristine, MD
Evens, Alexander, DO
Flores, Anthony, MD, PhD, MPH
Gaisa, Michael, MD, PhD
Ganguly,
Nivedita, MD
Golubchik, Anneta, MD
Gulati, Reena, MD
Gunter, Brian, MD
Gupta,
Vinit, MD
Haverkamp, Miriam, MD
Herbert-Grant, Mary, MD
Hiles, Jon, PharmD
Ho, Ken, MD
Ibrahim,
Lamis, MD
Jose, Jinson, MD
Kapoor, Vikas, MD
Keh, Chris, MD
Kelkar,
Dhanashree, MD
Kelly, Paul, MD
Khawcharoenporn,
Thana, MD
Kitazono, Hidetaka, MD
Klein, Nicole, MD
Ko, Pan, MD
Ku,
Tsun, MD
Kwon, Joong, MD
LaBrunda, Michelle, MD
Lai, Andrew, MD
Liu, Theresa, MD
Lopez-Marti, Maria, MD
Maher, Julie, MD
Mehta,
Tejal, MD
Meier, Cynthia, MD
Meyer,
Jaimie, MD
Minces, Lucio, MD
Missaghi, Bayan, MD
Morrison-Bryant, Maya, MD
Mues,
Mascha, MD
Nace, Heather, MD
Nakeshbandi,
Mohamed, MD
Nassour, Oima, MD
Nussbaum, Jesse, MD
Oates, Angela, MD
Ovalle,
Ilonka, MD
Paolino, Kristopher, MD
Patel,
Rupa, MD
Pfeiffer, Christopher, MD
Pokharel, Shradha
Pollack,
Margaret, MD
Preiss, Jana, MD, MPH
Priza, Erica, MD
Raual,
Brijesh, MD
Schlaudecker, Elizabeth, MD
Shah,
Neha, MD
Shattahi, Elias, MD
Shaughnessy, Gretchen, MD
Sheridan, Kathleen, DO
Sherwood, Jeffrey, MD
Shiley, Kevin, MD
Simkins, Jacques, MD
Snider,
Cynthia, MD
Sree, Aruna, MD
Stevens, Michael, MD
Temple, Brian, MD
Thabolingam,
Manju, MD
Velez, Marela, MD
Vento, Todd, MD
Volpe, Gretchen, MD
Weedon, Kathryn, MD
Woldetensaye,
Yeneneh, MD
Yared, Nada, MD
Zeimet, Anthony, DO 

In Memoriam

Hurley, Douglas L., MD

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