IDSA News - February 2009
Volume 19 Issue 2
(Print All Articles)
Candidiasis Guidelines Updated
New guidelines for the management of candidiasis are now available online. The guidelines provide updated data on the appropriate use of echinocandins and expanded spectrum azoles in the management of candidemia and mucosal candidiasis.
New guidelines for the management of candidiasis provide updated data on the appropriate use of echinocandins and expanded spectrum azoles in the management of candidemia and mucosal candidiasis.
The guidelines recommend echinocandin for patients with moderate to severe illness or those who have had recent azole exposure. However, azoles should not be used for empirical therapy in patients who have received an azole for prophylaxis.
Early initiation of effective antifungal therapy is crucial in the successful treatment of candidemia. Fluconazole continues to be the standard therapy for patients with candidemia and should be considered as the first-line of treatment for mild to moderate conditions.
Preferred treatments for osteoarticular, CNS, vulvovaginal, and urinary tract infections candidiasis were also addressed throughout the document.
The guidelines’ performance measures emphasize that all patients with candidemia should undergo dilated ophthalmological evaluation. This process helps determine whether or not patients with endophthalmitis need surgery or local therapy. Antifungal therapy should also be performed on all patients with candidemia within 24 hours after a positive blood culture followed by systemic antifungal therapy. Blood cultures should be obtained daily until the condition is no longer present.
The candidiasis guidelines are available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of IDSA's website.
IDSA Journal Club
In this issue: caution advised for use of linezolid for catheter-related bloodstream infections; flu is associated with GBS and not the flu vaccine; no benefit of steroids for virus-induced wheezing in children; and using hair to monitor therapeutic drug levels.
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.
Linezolid for Catheter-Related Bloodstream Infections? Caution Advised.
Linezolid was reported to be non-inferior to vancomycin when treating catheter insertion-site and catheter-related bloodstream infections (CRBSI ) in a randomized, open-label, phase III study published in the January 15 issue of Clinical Infectious Diseases. However, the study has significant limitations.
This multicenter study recruited 739 patients with suspected catheter-related infection. Of 164 patients with catheter-site infections treated with linezolid, 89.6 percent achieved successful microbiological outcomes one to two weeks after therapy, compared to 89.9 percent of 151 patients in the vancomycin group. Of those patients with CRBSI, 86.3 percent of the 95 patients treated with linezolid and 90.5 percent of the 74 treated with vancomycin achieved successful outcomes. These results met non-inferiority criteria. There was a trend for increased mortality in the linezolid group. Side-effects related to bone-marrow toxicity were similar in both groups.
Clinicians should be aware that the linezolid package insert states that it should not be used for the treatment of patients with catheter-related bloodstream infections or catheter-site infections. Aside from that fact, this study had several limitations that must be taken into account. Most significantly, the power to detect a clinically meaningful difference between the two arms was very limited given the small sample size in the CRBSI populations. This is a crucial point because the risk of making a Type II error is high (i.e. saying that no difference exists when it does). Efficacy of linezolid for Staphylococcus aureus CRBSI cannot be inferred from this study because only a quarter of patients had S. aureus infection.
Given the long clinical experience we have with vancomycin, it should still be the primary agent to treat gram-positive CRBSI. This study offers data to suggest that linezolid may be an alternative in salvage situations.
(Wilcox et a., Clin Infect Dis. 2009;48:203-212.)
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Flu—Not Flu Shot—Associated with GBS
Seasonal influenza vaccination is not associated with an increased risk of Guillain-Barre syndrome (GBS) but recent influenza-like illness (
ILI) is significantly associated with GBS, according to a study in the February 1 edition of the American Journal of Epidemiology.
The authors studied data recorded in the General Practice Research Database in the United Kingdom, one of the world’s largest primary care databases, holding data on 5.7 percent of the
UK population. The study employed a self-controlled case series methodology: Cases act as their own controls, contributing time to both the control and risk periods depending on whether and when they receive an influenza vaccine or have an
ILI. This design overcomes some of the usual problems with a cohort study such as cofounding due to essential differences between patients who receive vaccinations and those who do not.
Researchers analyzed 775 episodes of GBS in 690 patients; 169 had at least one influenza vaccine, 69 had at least one pneumococcal vaccine, and 99 had at least one
ILI. The relative incidence of GBS within 90 days of influenza vaccination was 0.76 (95% confidence interval 0.41-1.40), while the relative incidence of GBS within 90 days of an
ILI was 7.35 (95% confidence interval 9.37-29.54). Results were similar when the analysis was repeated using a subset of validated cases.
This study provides important data to refute the notion that influenza vaccine increases risk of GBS and to support the association between GBS and antecedent respiratory illness. In addition, it provides a possible explanation for the perception of a relationship between influenza vaccination and GBS: Influenza vaccination season coincides with ILI season; thus, patients who develop GBS after receiving influenza vaccine are also at risk for having had an
ILI prior to exposure, which may represent the true risk factor.
(Stowe et al., Am J Epidemiol. 2009;169:382-388.)
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No Convincing Benefit of Steroids for Virus-Induced Wheezing in Children
Oral prednisolone treatment of children with virus-induced wheezing did not provide any clear benefit according to a study in the January 22 issue of The New England Journal of Medicine.
In this randomized, double-blind study, 687 young children with virus-induced wheezing who presented to an emergency department or were referred to a hospital received a 5-day course of either oral prednisolone or placebo. Although well tolerated, steroid treatment was not associated with significant differences in the time to hospital discharge, use of a bronchodilator, or severity of symptoms. No differences emerged when results were stratified by symptom severity or when the analysis was limited to patients classified as being at high risk for having asthma later in life, although this was a very small subgroup in the study. Of note, diagnostics were not performed to document the presence of a virus in these patients and allow the investigators to determine whether steroids would provide benefit for patients infected with a specific virus.
In a separate article in the same issue, Ducharme and colleagues report on the preemptive use of an inhaled steroid or placebo in 129 young children beginning at the onset of a respiratory illness. The use of high-dose fluticasone reduced the use of rescue oral steroids (8 percent of the fluticasone group vs. 18 percent of the placebo group) and was associated with small reductions in symptom severity and duration. However, children with virus-induced wheezing who received steroids were noted to have smaller gains in height and weight.
Some controversy still remains regarding the use of steroids in patients with virus-induced wheezing. Together, though, these studies suggest that steroids provide little clear benefit for patients with mild or moderate disease and can be associated with concerning side effects.
(Panickar et al. N Engl J Med. 2009;360:329-38 and Ducharme et al. N Engl J Med. 2009; 360:339-53.)
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Using Hair to Monitor Therapeutic Drug Levels
Examining hair samples may provide a useful, non-invasive way to monitor antiretroviral drug concentrations, particularly in the developing world, according to a study published ahead of print in AIDS.
The Women’s Interagency HIV Study (WIHS), a prospective cohort of HIV-infected women, found that protease inhibitor (PI) levels in small hair samples were the strongest independent predictor of virologic success, defined as a viral load (VL) less than 80 copies/mL or a 2 log or more drop in VL from when starting antiretrovirals (ARV).
Drug levels in hair offer an advantage of providing an estimate of an average level of medication exposure rather than a single plasma drug concentration. Also, hair is easy to collect, store, and ship.
The authors set out to examine the relationship between concentrations of lopinavir (LPV)/ritnoavir (RTV) and atazanavir (ATV) in hair and initial virologic outcomes. Between October 2003 and October 2006, 224 participants at several sites in the
United States had hair samples collected and analyzed for levels of the target new PI at the semiannual WIHS visit.
The study revealed that participants initiating LPV/RTV who had hair levels in the top tertile were 40 times more likely to have virologic success compared to the bottom tertile. Variables such as adherence, age, race, starting viral load and CD4 count, and prior PI experience were controlled at the time of analysis. In women starting ATV, virologic suppression was 8 times more likely for those with hair concentrations in the top tertile compared to the bottom tertile.
This non-invasive approach for assessing ARV exposure may be most useful in resource-limited settings, but can be considered in situations where specimen collection is difficult such as in pediatrics, or when drug exposure is unpredictable such as pregnancy.
(Gandhi et al., AIDS 2009;23, published ahead of print.)
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Vaccine Science Prevails
Science and public health won an important court victory this February when the U.S. vaccine court rejected the link between autism and certain vaccines.
In three separate, sometimes strongly worded rulings, judges for the U.S. Court of Federal Claims ruled against those who claimed the measles-mumps-rubella (MMR) vaccine, thimerosal, or the combination of the two had caused autism in their children. The judge in one of the cases affirmed what the research has been telling us for years: “The numerous medical studies concerning these issues, performed by medical scientists worldwide, have come down strongly against the petitioners’ contentions.”
As a mother as well as a pediatrician, with family members who are on the autism spectrum, I understand the heartbreak that parents of autistic children face. More research is needed to determine why the number of cases has grown and what the true causes of autism are. Although many studies have been carried out, none has shown that vaccines cause autism. More funding for vaccine safety research and monitoring also is important, particularly as new vaccines are introduced.
The evidence has shown us how effectively vaccines have banished or reduced once-common diseases and the suffering and death they cause. Furthermore, recent outbreaks amply demonstrate that these diseases are still a threat, and that anti-vaccine misinformation is doing real harm. Vaccine refusals are partly responsible for the recent San Diego, CA measles outbreak and cases of measles in many other states, including New York and Illinoiis, and the cases of Haemophilus influenzae type b in Minnesota, for example. The unfortunate children struck by these preventable diseases may serve as a warning to parents who believe it is safer not to immunize.
Despite the overwhelming evidence against a connection between thimerosal and autism (summed up nicely in a recent article in Clinical Infectious Diseases), advocates periodically convince lawmakers to introduce legislation banning its use. IDSA believes strongly that science must guide public health policy and responds to these threats accordingly. Most recently, the Society wrote to the Indiana state legislature explaining the facts about thimerosal and the consequences of mandating thimerosal-free vaccines. Efforts in other state legislatures are on our radar.
IDSA also frequently speaks out when media reports raise undue fears about vaccines. For example, CBS News recently aired a story alleging that the human papilloma virus (HPV) vaccine is associated with unusually high levels of adverse reactions. The Society wrote to CBS News highlighting flaws in the report, which relied on an analysis put out by an anti-vaccine advocacy group.
In addition, IDSA seeks to provide health professionals, parents, and the media with up-to-date and scientifically accurate information about vaccines and the diseases they prevent through the National Network for Immunization Information (NNii), of which IDSA is a founding affiliate. A newly updated article on thimerosal and autism can be found on the NNii website, www.immunizationinfo.org. The website also contains information on other vaccine controversies such as mitochondrial disorders and downloadable slideshows to help health professionals communicate about vaccine safety.
The vaccine court’s resounding rejection of the MMR/thimerosal hypotheses injects a welcome dose of science into the vaccines-autism controversy. It is my hope that, primed with accurate information and boosted by the sad reality that vaccine-preventable diseases are still with us, more parents will acquire immunity to the influence of an unscientific few. Vaccination’s achievements are too important to be undone by a chorus of misguided voices.
EIN Considers Alternatives to Acyclovir During Shortage
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.
A shortage of acyclovir for injection has EIN members considering alternatives for treating neonatal herpes simplex virus (HSV) or varicella zoster virus (VZV) infections and other pediatric central nervous system (CNS) infections.
Several respondents reported that their institutions were almost out of IV acyclovir and were placing restrictions on orders. A respondent in
Alabama noted that the
Academy of Pediatrics (AAP) Committee on Infectious Diseases recommends conserving intravenous (IV) acyclovir for immunocompromised patients.
Alabama respondent said AAP recommends that, “When parenteral acyclovir is not available, intravenous ganciclovir should be substituted. This recommendation is based on in vitro susceptibility data and the relatively more manageable toxicities of ganciclovir as compared with foscarnet and cidofovir. Additionally, cidofovir does not cross the blood-brain barrier, further limiting its utility in central nervous system infections.”
The respondent continued, “Since there is a lack of clinical experience with ganciclovir in treatment of these diseases, close monitoring for therapeutic effect is warranted, including follow-up sampling of cerebrospinal fluid for HSV or VZV DNA PCR when central nervous system disease is present. Adverse events relating to use of an antiviral medication other than acyclovir should be reported to MedWatch.”
An article in AAP News describes the recommendations and the shortage in more detail.
Other EIN members discussed different options. For infections other than neonatal HSV, a member in
Florida wrote, valacyclovir might be a good option. “Data in adults suggest that valacyclovir at 1 g Q 8 hours gives levels similar to IV acyclovir 5 mg/kg Q 8 hours. We might actually be using foscarnet for other pediatric CNS infections due to HSV or VZV after we run out [of acyclovir], since the pharmacokinetics look better than for ganciclovir.” A respondent in
California agreed with these suggestions, citing a 2007 Medical Letter article (Abramowicz M, Ed. “Drugs for non-HIV viral infections.” Treatment Guidelines from The Medical Letter. 2007 Jul;5(59):59-70.)
However, a member in
Georgia asked, “Can high dose oral valacyclovir be used in patients with HSV meningitis/meningoencephalitis? I thought that the bioavailability of acyclovir and valacyclovir were not adequate for CNS penetration.”
A respondent in California answered, “The problem with treatment of HSV CNS infections with oral therapy is that we are never completely sure how much drug is absorbed for a particular patient, with each particular dose; given that CNS levels are a function of levels in serum, we should attempt to achieve a high and reliable plasma AUC following each antiviral dose. Therefore, given the serious nature of CNS infection (suspected or documented), it seems prudent to use IV therapy. Ganciclovir is IT!”
More information on the shortage can be found on the Food and Drug Administration’s (FDA) drug shortages website. An EIN respondent from FDA noted that the manufacturer, APP Pharmaceuticals, is currently distributing emergency supplies to meet patient needs until they are able to return to normal distribution, expected in March.
E-mail the Emerging Infections Network.
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.
Updated Rotavirus Recommendations Include New Vaccine
A second choice of rotavirus vaccine has been added to the childhood immunization schedule. Rotarix oral rotavirus vaccine (RV1) has been added to updated recommendations from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention for prevention of rotavirus gastroenteritis. ACIP does not express a preference for Rotarix or RotaTeq oral vaccine (RV5), which was approved earlier. The complete, updated recommendations were published February 6 in Morbidity and Mortality Weekly Report.
ACIP Changes Recommendations for Anthrax, Hepatitis A Vaccines
Members of the
U.S. military and others who receive anthrax immunizations are likely to receive fewer injections because of a unanimous vote taken by ACIP at its February meeting. The vaccine also will likely be administered intramuscularly instead of subcutaneously as it has been up until now because the IM injection gives fewer local reactions.
The ACIP endorsed a schedule of intramuscular injections at 0 and 4 weeks and 6, 12, and 18 months. The previous regimen called for subcutaneous injections at 0, 2, and 4 weeks and 6, 12, and 18 months. Annual booster shots are recommended.
Also at the February meeting, ACIP recommended that people who have close contact with children adopted from countries with high rates of hepatitis A should be vaccinated within 60 days of the child's arrival. Parents and caregivers should receive their first dose of vaccine as soon as the adoption process begins or at least two weeks before the child arrives in the
ACIP also discussed influenza prevention, making no changes to the list of groups who should receive annual flu vaccine.
ACIP recommendations become final once they are approved by the director of the Centers for Disease Control and Prevention and the secretary of Health and Human Services. For more information, see ACIP’s home page at www.cdc.gov/vaccines/recs/acip/default.htm.
Drug Approvals, Recalls, Adverse Events Update
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:
IDSA members can sign up for these services online. (You must be logged in to have access to this link.)
In addition, FDA has given notice that it is reviewing safety data for drotrecogin alfa (activated), marketed as Xigris, following a study (Gentry et al., Crit Care Med 2009;37:19-25) that reported an increased risk of serious bleeding events and death in patients with sepsis and baseline bleeding risk factors who received this product.
FDA notes the findings in this study are consistent with the information in the current product label and the agency is not recommending any changes in practice at this time. The agency will communicate its conclusions and any resulting recommendations to the public when the review is completed, which may take several months. FDA urges both health care professionals and patients to report side effects from the use of drotrecogin alfa to the FDA's MedWatch Adverse Event Reporting program.
Is Your Facility Experiencing Antibiotic Shortages?
Report these to FDA and IDSA.
CMS Sending Clinicians Reports on their Medicare Costs
Infectious diseases (ID) clinicians in designated cities will soon receive reports showing how their Medicare costs compare with those of their peers. ID is among 13 specialties targeted by the Centers for Medicare and Medicaid Services (CMS) to be the first to receive the reports because they treat high-cost conditions including community-acquired pneumonia, urinary tract infections, congestive heart failure, and others.
CMS says the reports are part of an effort to help clinicians improve performance using “meaningful, actionable, and fair measures of Medicare resource use,” according to letters sent to clinicians ahead of the reports.
These reports are likely to play a part in the coming movement toward pay-for-performance.
Clinicians who receive the reports are encouraged to provide feedback to CMS.
ID clinicians’ costs are likely to be higher than, for example, primary care physicians because ID clinicians frequently care for higher-risk patients. IDSA has urged CMS to take these factors into account when evaluating the resource use data.
More on the Medicare Resource Use Measurement Plan is available on the CMS website.
How to Put Health IT to Work in Your Practice
Are you struggling to figure out how to implement health information technology solutions in your ID practice? Thanks to a special arrangement with the
College of Physicians (ACP), several practical resources are now available to IDSA members and their office staff, even if you’re not an ACP member.
On IDSA’s Health Information Technology web page (you must be logged in to access this link), you’ll find these helpful ACP tools:
Electronic Health Records (EHR)
Information and guides on how to research various EHR products, select the right one for your practice, and integrate it into your practice environment. Also available for purchase: Electronic Health Records, 2nd Edition is a guide and workbook for evaluating, selecting, implementing, and using an electronic health records system.
Electronic Prescribing (eRx)
A compilation of guides and publications designed to assist physicians and their staff in integrating e-prescribing into their practice environment.
Practice Management Systems
Online guide designed to provide physicians and their staff with a practical list of considerations in planning and evaluating a computerized practice management system.
Communicating with Patients Electronically
Online guide that discusses the issues surrounding the provision of non-face-to-face care to patients and how electronic communication can be used to improve your practice.
In addition to these ACP tools, the IDSA web page also includes a list of EHR products approved by the Certification Commission for Healthcare Information Technology and health IT-related presentations from IDSA’s 2007 Clinical Practice Meeting.
You can also sign up for IDSA’s Practice Management Listserve, where you can connect with colleagues who may have faced similar IT challenges.
Federal HAI Prevention Plan is “Important First Step”
Federal plans to reduce health care-associated infections (HAIs) are a good first step but fall short, according to IDSA and the Society for Healthcare Epidemiology of America (SHEA). SHEA and IDSA on February 6 submitted joint comments to the Department of Health and Human Serivces (HHS) on the Action Plan to Prevent Healthcare-Associated Infections.
The HHS Action Plan establishes a set of five-year national prevention targets for enhancing and coordinating HHS-supported efforts to prevent and reduce HAIs, as well as metrics to assess progress toward these targets. These targets include development of national benchmarks, prioritized recommended clinical practices, a coordinated research agenda, an integrated information systems strategy, and a national messaging plan. The plan also identifies opportunities for collaboration with national, state, tribal, and local organizations.
SHEA and IDSA support efforts to improve coordination among agencies—for example by developing standard terms and measures to ensure quality data, sharing best practices, engaging partners, coordinating research activities, and disseminating information.
But although the HHS plan is an "important first step," SHEA and IDSA believe that the Action Plan falls short in a number of ways: It does not contain well-defined action items with defined deliverables. It includes a set of metrics with associated targets, but no clear roadmap for each agency as to how the specific targets are to be achieved. It references alignment among agencies, but it is not clear how alignment will be attained. Finally, it does not include a summary of progress to date, which would allow agencies to build on efforts already underway.
Given the critical need to engage providers, state health departments, and consumers in any effort to reduce HAIs, SHEA and IDSA urged HHS to provide additional, timely opportunities for stakeholder input and involvement.
Links to the proposed national action plan and the joint SHEA/IDSA response can be found online.
Stimulus Funding May Go Toward ID Research, HIV/AIDS Prevention
The federal economic stimulus package signed into law this month includes a $650-million fund for prevention and wellness programs aimed at chronic diseases. HIVMA will be working with partners to include funding for HIV prevention. The package also includes $10.4 billion for the National Institutes of Health (NIH) for grant-making and infrastructure projects. Funding for research grants will prioritize those that can show achievement within two years.
As Congress worked to pass the stimulus bill, HIVMA and IDSA urged lawmakers to include funding for health care provisions and opposed the removal of funds for HIV and sexually transmitted diseases (STD) prevention.
In a joint letter to Congress and a press statement, IDSA and HIVMA supported funding for vaccines, health promotion, HIV/AIDS prevention, and other wellness and prevention programs. The statement emphasized the cost-effectiveness of these provisions and the potential for job creation in health departments that the stimulus funding offered. (A version of the press statement was posted in Congress Blog from The Hill, a newspaper read by members of Congress and their staffs.)
Earlier in the process, an IDSA/HIVMA statement from HIVMA Chair Arlene Bardeguez, MD, MPH, opposed the removal of funding for screening and prevention of STDs and HIV. In addition to noting the cost-effectiveness of prevention funding, the statement charged that singling out STD prevention funding for criticism was an ideological attack not rooted in public health reality.
HIVMA Urges Medicare to Cover Treatment of Facial Lipodystrophy
Reconstructive treatments for facial lipodystrophy syndrome (FLS) are reasonable, medically necessary, and appropriate for patients with HIV/AIDS who have or are undergoing antiretroviral therapy (ART), HIVMA said in a comment letter to the Centers for Medicare and Medicaid Services (CMS). CMS recently opened its national coverage determination process on Medicare coverage for the treatment. CMS plans to issue a proposed decision by July 2009 and a final decision by October 2009.
Advocacy Update: IDSA Expresses Concern About State Lyme Disease Bills
IDSA recently sent letters to legislators in several states expressing the Society’s concern over bills that would promote long-term antibiotic therapy in treating Lyme disease, despite medical and scientific evidence indicating that such treatment may do more harm than good. A
Connecticut bill would prohibit state licensing boards from disciplining physicians who prescribe such treatment. Bills in
West Virginia would mandate insurance coverage of such treatments. Long-term antibiotic therapy is not medically indicated for Lyme disease, and it can lead to potentially fatal infections of the bloodstream, as a result of intravenous administration. It can also promote the development of drug resistance among other microorganisms.
Other advocacy efforts include:
IDSA opposed an
Indiana bill (House bill 1567) that would ban the administration of influenza vaccines containing thimerosal in pregnant women and young children. The Society addressed its concerns in a letter to the Indiana House of Representatives Committee of Public Health asserting that the bill is based on flawed pseudoscience linking thimerosal in vaccines to adverse effects on children. A Feb. 12 ruling by the Special Masters of the U.S. Court of Federal Claims reaffirmed that thimerosal-containing vaccines were not causal factors in the development of autism or autism spectrum disorders.
IDSA sent comments to the Centers for Medicare and Medicaid Services in support of a gain-sharing exception that would allow infection control practitioners to share in the savings they help generate in hospitals, therefore incentivizing infection control strategies.
SHEA Offers California Epidemiology Course
A one-day specialized training course in hospital epidemiology is available for
California physicians who need to meet new state requirements.
California enacted legislation requiring physicians acting as epidemiologists or chairing a hospital infection control committee to obtain CME-accredited training by January 1, 2010.
The advisory body to the California Department of Public Health has approved a course
SHEA developed to meet this need. This one-day course will be offered on March 19 as a pre-meeting activity to the SHEA 19th Annual Scientific Meeting in
San Diego. SHEA is exploring future opportunities to offer this curriculum in other locations in
Go online for more information and to register .
Welcome New IDSA Members!
Byrnes, Matthew, MD
Endsley, Janice, PhD
Khader, Shabaana, PhD
Krug, Laurie, PhD
Kumar, Priti, PhD
Raffatellu, Manuela, MD
Chahin, Ihsan, PharmD
Crouch, Bronson, BSN
Gravenstein, Stefan, MD, MPH
Hasselbrack, Robert, MD, MS
Madon, Andrew, PharmD
Maluf, Nasib, PhD
McCown, Jerry, PA-C
Moadebi, Susanne, PharmD
Musoke, Pamela, PharmD
Patterson, Annette, RPh
Schwartz, Michael, PharmD
Yeung, Philip, PharmD
Buchanan, Ann, MD
Hoffman, Michael J., MD
Hsiang, Michelle, MD
Martinez, Jeffrey, MD
Matthews, Lynn, MD
Mayo, Lorna, MD
Russell, Marsha, MBBS
Ryscavage, Patrick, MD, MS
Stein, Tricia, MD