IDSA News - January 2010
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Haiti Disaster Response Resources
Following the devastating earthquake in Haiti, IDSA encourages members to contribute to disaster relief efforts. As ID specialists, we are especially aware of the vital need to not only aid the disaster recovery but also prevent the spread of infectious diseases from becoming yet another terrible result of the earthquake.
Following the devastating earthquake in Haiti, IDSA encourages members to contribute to disaster relief efforts. Please check the Society’s website for links to global relief and response resources. Our thoughts and prayers continue to go to the victims in Haiti.
As ID specialists, we are especially aware of the vital need to not only aid the disaster recovery but also prevent the spread of infectious diseases from becoming yet another terrible result of the earthquake. Several members have generously expressed a desire to help and encouraged the Society to be involved. IDSA will continue to monitor opportunities for members to volunteer their services and update our website as these arise.
To date, however, calls for immediate help have targeted primarily those with experience in responding to disasters, including those with trauma and surgical experience. As these needs change during the recovery effort, IDSA will alert members to opportunities to volunteer their service and expertise that complement the experienced relief organizations already on the ground in Haiti.If you are aware of venues for relief or aid that you think would be useful to IDSA members, please e-mail us.
IDSA Updates Guideline for Management of Cryptococcal Disease
An updated IDSA guideline on cryptococcal disease addresses cryptococcal meningoencephalitis in HIV and organ transplant patients, as well as patients who do not have these risk factors. Specific recommendations are made for other unique risk populations.
An updated IDSA guideline on cryptococcal disease will appear in the Feb. 1 issue of Clinical Infectious Diseases and is now available online.
The update addresses cryptococcal meningoencephalitis in HIV and organ transplant patients, as well as patients who do not have these risk factors. Specific recommendations are made for other unique risk populations, such as children, pregnant women, persons in resource‐limited environments, and those with Cryptococcus gattii infection.
The guideline addresses three key management principles:
- induction therapy for meningoencephalitis using fungicidal regimens
- the importance of early recognition and treatment of increased intracranial pressure and/or immune reconstitution inflammatory syndrome (IRIS)
- the use of lipid formulations of amphotericin B regimens in patients with renal impairment
“Risk groups are categorized, complications are examined, and special risk groups are addressed,” said John R. Perfect, MD, FIDSA, lead author. “We hope that these guidelines will provide the informational infrastructure for the care of patients with this deadly and increasing mycosis,” he added, noting that “guidelines are great starting points but cannot always accommodate for the nuances of clinical practice.”
The guideline addresses the role that highly active antiretroviral therapy (HAART) has played in the management of cryptococcal disease. Although HAART has helped in reducing the incidence of cryptococcosis in well-developed countries, it has not been as effective in areas where HIV rates are much higher due to reduced availability and monitoring of HAART or need for earlier diagnosis of HIV infection.
Tables and figures provide detailed regimens for treatment of cryptococcosis, such as appropriate dosage and duration.
Several performance measures for internal performance improvement are also suggested within the guideline. Most notably, patients should receive a polyene at the onset of treatment for cryptococcal meningoencephalitis. When a relapse occurs, the patient should be carefully monitored to determine if it is a result of fungal growth or represents IRIS (negative consequences from therapeutic advances). Also, patients with cryptococcosis or meningoencephalitis should be tested for HIV infection.
The guideline is available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our website.
New Guideline for Intra-Abdominal Infection Released
Updated guidelines from IDSA and the Surgical Infection Society incorporate new recommendations for managing intra-abdominal infection in children and provide guidance for treating appendicitis in patients of all ages and for necrotizing enterocolitis in newborns.
An updated guideline for the diagnosis and management of complicated intra-abdominal infection in adults and children is now available. Developed by IDSA and the Surgical Infection Society, the guideline appears in the Jan. 15 issue of Clinical Infectious Diseases and can be found online.
Replacing those published in 2002 and 2003, the updated guideline incorporates new recommendations for managing intra-abdominal infection in children, particularly in cases where this guidance differs from that for adults. The guideline also provides recommendations for treating appendicitis in patients of all ages and for necrotizing enterocolitis in newborns.
The guideline notes that the management of these infections has evolved considerably.
“There have been substantial changes in diagnostic methods, approaches to non-operative management—including aggressive antimicrobial therapy and radiographically guided percutaneous drainage—staged surgical management, use of antimicrobials, and heightened awareness of the value of locally developed practice pathways and stewardship programs,” said Joseph S. Solomkin, MD, FACS, FIDSA, co-chair of the expert panel that prepared the updated guidelines.
“The latest recommendations are intended to provide a framework that encompasses these issues, including an expansion into pediatric infections, especially appendicitis,” said John E. Mazuski, MD, panel co-chair.
The document addresses more than 20 clinical questions related to intra-abdominal infections, including:
- appropriate diagnostic procedures for evaluating patients with suspected intra-abdominal infection
- initiation of antimicrobial therapy
- appropriate dosing and duration of therapy
- requirements for effective source control, including operation and/or percutaneous drainage
- when and how microbiological specimens should be taken and processed, and when culture results should be used to adjust therapy
Tables outline available agents and regimens for empiric treatment of community- and health care-associated infections and provide both pediatric and adult dosages for antibiotic treatment. The document also addresses managing suspected treatment failure.
An important goal of this guideline was to provide template information that should be considered in developing clinical pathways to standardize diagnosis and management of appendicitis, based upon the frequency of this disease. Performance measures related to appendicitis are included as well. The guideline emphasizes the role of antimicrobial stewardship programs in implementing the recommendations.
The update also highlights areas needing more research. These include appropriate specimen processing and the effects of delaying appendectomy. There also remains a pressing need for more study of the appropriate duration of antimicrobial therapy and the potential impact of prolonged therapy on the development of resistant organisms, the authors note.The guideline is available online now. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our website.
IDSA Journal Club
This month: Antibiotic prophylaxis for dental procedures and prosthetic joint infection, epidemiology of bacterial colonization and infections in long-term care facilities and ICUs, adjunctive therapy in pediatric meningitis, virological outcomes and incidence of HIV-1 drug resistance, and chlorhexidine-alcohol vs. povidone-iodine for the prevention of surgical site infections.
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.
No Association Between Antibiotic Prophylaxis for Dental Procedures and Prosthetic Knee or Hip Infection
Reviewed by Christopher J. Graber, MD, MPH
Dental procedures, and the lack of antibiotic prophylaxis prior to them, were not associated with increased risk of prosthetic joint (knee or hip) infections (PJI) in a case-control study published in the Jan. 1 issue of Clinical Infectious Diseases. The study enrolled 339 case patients hospitalized at the Mayo Clinic in Rochester, Minn., with PJI from 2001 to 2006 and 339 control patients with prosthetic knees or hips who were hospitalized on the orthopedic service for non-infectious issues. Researchers collected putative clinical risk factors for infection and dental records up to two years prior to admission, along with data that controlled for the propensity that each particular patient would visit a dentist.
Among dentate patients, 57 percent of PJI cases and 47 percent of controls underwent low-risk dental procedures; 48 percent and 34 percent, respectively, underwent high-risk dental procedures. Lack of antibiotic prophylaxis among procedures performed in the six months (OR 1.1, p=0.77 for low-risk; OR 0.8 p=0.60 for high-risk) or two years (OR 0.6, p=0.11 for low-risk; OR 0.8, p=0.56 for high risk) prior to admission was not associated with PJI. Only 35 patients (10.3 percent) had infection due to organisms of potential oral origin; no association was seen between low-risk or high-risk dental procedures or antibiotic prophylaxis in this subset. Notably, a trend for lower risk of PJI was seen for patients having at least one dental hygiene visit (OR 0.7, p=0.07).
This study does not support the expansive recent statement by the American Academy of Orthopedic Surgeons that “clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia,” and instead suggests that maintenance of adequate dental hygiene may be of benefit in preventing PJI.
(Berbari, et al. Clin Infect Dis 2010;50:8-16.)
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The Epidemiology of Bacterial Colonization and Infections in Long-Term Care Facilities and ICUs
Reviewed by Rachel Simmons, MD
Two recent point-prevalence studies increase our understanding of the epidemiology of bacterial colonization and infection in two important settings: long-term facilities and intensive care units (ICUs).
In the first study, published in the December 2009 issue of Infection Control and Hospital Epidemiology, researchers obtained bacterial cultures from residents, residents’ rooms, surfaces in common rooms, and health care workers at a Boston long-term care facility. Of 161 residents, 37 (22.8 percent) were colonized with gram-negative bacteria resistant to three or more antibiotics. Approximately 19 percent of the multidrug-resistant (MDR) gram-negative isolates were resistant to meropenem. Several identical MDR gram-negative strains were found in multiple residents on different wards. These bacteria were also isolated from three surfaces (1.7 percent)—two in a common room—and from the hands of one health care worker (7.7 percent). Colonization with MDR gram-negative bacteria was associated with resident stays longer than four years, fecal incontinence, and antibiotic exposure.
The high rate of carbapenem resistance among drug-resistant gram-negative isolates is concerning and underscores the importance of antibiotic stewardship. The presence of MDR gram-negative bacteria in shared spaces and on the hands of a worker, and the identification of the same strain on different wards highlight the importance of infection control measures at these facilities.
The second study, from the Dec. 2 issue of the Journal of the American Medical Association, examined the prevalence of infections in 1,265 ICUs in 75 countries on one day in 2007. Just over half of the 13,796 adult patients were considered by their treating physicians to be infected. Seventy percent of the infected patients had positive cultures. Sixty-two percent of the isolates were gram negative, 47 percent were gram positive, and 19 percent were fungi. Staphylococcus aureus was the most commonly isolated microorganism (20.5 percent of total).
The rate of infection, particularly with S. aureus, Acinetobacter, Pseudomonas, and Candida species, increased with length of stay in the ICU. Both ICU and hospital mortality rates were significantly higher in infected patients (25.3 percent and 33.1 percent respectively) compared to uninfected patients (10.7 percent and 14.8 percent respectively). Infection was independently associated with hospital mortality in a multivariable logistic regression. These results show that globally, infections are highly prevalent in the sickest patients and are associated with significant excess mortality.
(O'Fallon et al. Infect Control Hosp Epidemiol 2009; 30(12): 1172-1179 and Vincent et al. JAMA 2009; 302(21): 2323-2329.)
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Adjunctive Therapy in Pediatric Meningitis: Back to the Drawing BoardReviewed by Christian B. Ramers, MD
Bacterial meningitis is a devastating disease that inflicts substantial morbidity and mortality, especially in children. Hearing impairment is an important sequelae of this condition with long-lasting developmental effects. A study in the January 2010 issue of Pediatrics examines the use of adjunctive therapy—in addition to appropriate antimicrobial therapy—to prevent this outcome.
The authors conducted a randomized, double-blind, placebo-controlled trial in Latin America including 383 children age 2 months to 16 years with bacterial meningitis. In addition to ceftriaxone, children were randomized to receive IV dexamethasone (n = 101), PO glycerol (n = 95), IV dexamethasone + PO glycerol (n = 92), or placebo (n = 95). Hearing impairment at different levels (40dB, 60dB, and 80dB) was assessed and validated by an external audiologist.
Most children had a bacteriologically confirmed diagnosis (72 percent), and of these, Haemophilus influenzae type B was most common (52 percent), followed by S. pneumoniae (25 percent) and N. meningitidis (19 percent). Regardless of the threshold of hearing impairment used, no adjunctive treatment improved hearing outcomes above placebo. The only factors predictive of poorer hearing outcome were young age and low Glasgow coma scale on presentation.
As one of the largest randomized controlled trials of adjunctive therapy for bacterial meningitis ever conducted in children, this study adds considerably to the debate in this area. Although trials in adults have demonstrated a mortality benefit and decreased hearing sequelae with the adjunctive use of dexamethasone, the benefit in children is less clear. A meta-analysis concluded that corticosteroids showed a protective effect on severe hearing loss in children in high-income countries, but no single trial has demonstrated this benefit. The results of the present study suggest that no currently available adjunctive therapy helps prevent hearing impairment from bacterial meningitis. Rather, the most predictive clinical variables are age and mental status on presentation to care.
(Peltola et al. Pediatrics 2010; 125(1):e1-e8.)
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Virological Outcomes Improve As Incidence of HIV-1 Drug Resistance Decreases
Reviewed by Ed Dominguez, MD
The success of highly active antiretroviral therapy (HAART) in reducing morbidity and mortality from HIV-1 infection is well-documented. However, the effects of HAART on the incidence of antiviral drug resistance and on HIV viral load in a population are not well-established. The results of such a study, from researchers in British Columbia, appear in the Jan. 1 issue of Clinical Infectious Diseases.
In this province-wide study, plasma viral loads and genotypic resistance were determined in patients receiving treatment since 1992. Because resistance testing didn’t start routinely in the program until July 1996, annual incidence was reported only from 1996 through 2008. In all, 24,652 resistance tests were performed from 5,422 participants. The primary outcome was resistance to one or more of the three categories of antiretroviral drugs (protease inhibitors, nucleoside/nucleotide reverse-transcriptase inhibitors, and non-nucleoside reverse-transcriptase inhibitors) that developed during the surveillance period.
In 1996, resistance was identified in 571 cases during 39,188 cumulative person-months of exposure per year. By 2008, there were only 71 cases identified during 52,638 cumulative person-months of exposure per year. Expressed as incidence rate, the overall rate decreased about 12-fold, from 1.73 cases per 100 person-months to 0.13 cases per 100 person-months. This represented an exponential decline and was seen in all three drug classes when analyzed individually. Concomitantly, investigators saw an increase in the proportion of people with undetectable viral loads, from 64.7 percent in 2000 to 87.0 percent in 2007 (P<.001). By 2007, the median lowest plasma viral load recorded was below the limit of detection of the assay (i.e., < 50 copies/ml).
Although this observational study cannot confirm a causal relationship between decreased antiviral resistance and decreases in viral load, it does suggest that improved accessibility to HAART may reduce HIV-1 viral load in a population without incurring drug resistance.
(Gill et al. Clin Infect Dis. 2010; 50:98-105.)
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Pre-Operative Skin Preparation With Chlorhexidine-Alcohol Prevents More Surgical Site Infections Than Povidone-Iodine
Reviewed by Sara Cosgrove, MD
Surgical skin preparation with chlorhexidine-alcohol reduces the risk of subsequent surgical site infection by 41 percent compared to povidone-iodine, according to a study published in the Jan. 7 issue of the New England Journal of Medicine. In the study, patients at six university-affiliated hospitals undergoing clean contaminated gastrointestinal, biliary, thoracic, gynecologic, and urologic procedures were randomized to receive chlorhexidine-alcohol or povidone-iodine skin prep.
The primary endpoint of the study was the occurrence of a surgical site infection in the 30 day post-operative period using definitions from the Centers for Disease Control and Prevention (CDC). Site investigators who were blinded to study arm determined when these infections occurred. Four hundred and nine patients who received chlorhexidine-alcohol and 440 who received povidone-iodine were included in the intent-to-treat analysis. Surgical site infections developed in 39 patients (9.5 percent) who received chlorhexidine-alcohol and 71 (16.1 percent) who received povidone-iodine. The difference was seen with superficial and deep incisional infections, but not with organ space infections.
This is the first randomized trial to demonstrate the greater efficacy of chlorhexidine-alcohol compared to the more commonly used povidone-iodine in reducing surgical site infections after clean contaminated surgery. A potential limitation of the study is the apparent lack of assessment of the techniques used to apply the agents to the skin at the different study sites. Historically, there has been a tendency to fail to allow povidone-iodine to dry or to wipe it off, rendering it less effective; it is possible that if it were more fastidiously applied that the difference in efficacy may be smaller. In addition, external validation of surgical site infection cases would have strengthened the conclusions. Finally, the efficacy of newer povidone-iodine plus alcohol skin prep agents relative to chlorhexidine-alcohol remains to be studied.
(Darouiche et al. NEJM 2010; 362:18-26.)
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Novel Influenza Strain Raises Questions for Care of HIV Patients
More research is needed, but data thus far do not indicate that people living with HIV are at substantially greater risk than others for infection with the 2009 novel H1N1 influenza strain. These patients, however, may have a greater risk for more severe illness if they do become infected with H1N1. These were two of the takeaway points presented by a panel of experts at a briefing on H1N1 and HIV/AIDS held in December by amfAR, The Foundation for AIDS Research, in Washington, D.C.
The few available data have not indicated an increased susceptibility to influenza infection, including H1N1, among persons living with HIV, said John T. Brooks, MD, leader of the clinical epidemiology team at the Centers for Disease Control and Prevention (CDC)’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. However, the prevalence of HIV-positive patients among those hospitalized for H1N1 does suggest a higher risk for severe influenza-related illnesses, said Dr. Brooks, who highlighted the need for prospective, observational studies of patients hospitalized with confirmed cases of H1N1.
Several ongoing U.S. studies should help answer questions about how different HIV populations, such as pregnant women and children, respond to the H1N1 vaccine, according to Sharon Nachman, MD, FIDSA, professor of pediatrics, chief of pediatric infectious diseases, and associate dean for research at Stony Brook University Medical Center in New York. Because of HIV patients’ reduced immune response to vaccines in general, these studies are examining the safety and immunogenicity of double the H1N1 vaccine dose recommended for others.
These research findings, however, may not be applicable in other parts of the world, such as Africa, where CD4 cell counts among those living with HIV are typically not as high as in developed countries with better access to antiretroviral treatment, noted Dr. Nachman, who also serves on HIVMA’s Board of Directors as the Pediatric Infectious Diseases Society liaison.
Another panelist, Adriana Weinberg, MD, FIDSA, professor of pediatrics, medicine, and pathology, and director of the Clinical Virology Laboratory at University of Colorado in Denver, outlined treatment questions raised by H1N1. It’s not known if the antiviral treatment doses and intervals typically used to treat H1N1 are appropriate for HIV patients, Dr. Weinberg said. Potential interactions among these treatments and antiretroviral drugs are another area needing more study.
Additional research is also needed to explore how immunosuppressed patients, such as those with HIV, shed the H1N1 virus. These patients may shed the H1N1 virus longer than others who are infected with the novel influenza strain, raising concerns for potential increased transmission of H1N1 virus by HIV-positive individuals with H1N1 infection, Dr. Weinberg said.
Slides from the briefing and a consumer fact sheet are available on amfAR’s website. Updated information for physicians about seasonal and H1N1 influenza is also available on IDSA’s website.
Spiraling Empiricism: When in Doubt, Put on Blindfold and Shoot
The following is a brief excerpt from a recent online article written by Abraham Verghese, MD, FIDSA, a regular contributor to TheAtlantic.com.
There are so many instances in infectious diseases where a rapid and precise diagnosis can be made by directly examining sputum, wound drainage, blood smears, skin lesions, and the like. Over two decades I can still remember those “eureka” moments; it made all the difference in the care of the patient by finding precisely what was causing the problem, short circuiting what was otherwise blind therapy with many drugs, hoping one was treating the cause of the infection. Diagnosis matters—surely that’s something we can all agree on.
Perhaps not. Some years ago, OSHA closed down our wet labs. These historic rooms—where interns and residents in the night or at any time could look at urine, use a Gram stain to look for bacteria in various specimens, and do other simple tests—were gone. Admittedly, they were messy rooms, and I suppose there was some potential for exposure to unsafe pathogens. But it was also the place where a generation of interns and residents learned bread and butter tricks that made them better diagnosticians. We lost that battle.
To read the full article, click here.
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). Content normally includes a range of topics, including new drug approvals and warnings. Recent alerts have included:
IDSA members can sign up for these services online. (You must be logged in to have access to this link.)
Is Your Facility Experiencing Antibiotic Shortages?
Report these to FDA and IDSA.
Medicare Update: Payment Cuts for Consultation Codes Go Into Effect
IDSA online resources outline changes and financial impact
There’s good news and bad news in Medicare. The good news: Congress in late December postponed until March a planned 21 percent across-the-board cut in physicians’ Medicare payments, a delay intended to give Congress more time to address the issue. IDSA continues to advocate a long-lasting and sustainable solution to the payment problem and joined a coalition of physician groups in a December letter urging Congress to pass a permanent fix.
The bad news: Despite vigorous opposition from IDSA and other specialty societies, the decision by the Centers for Medicare and Medicaid Services (CMS) to eliminate payments for consultation codes went into effect Jan. 1 (see related IDSA News article).
The change eliminates payments for inpatient (99251-99255) and outpatient (99241-99245) consultation codes. CMS still will allow physicians to bill initial inpatient consultative visits using the hospital admission codes (99221-99223). Follow-up care will continue to be billed using the subsequent hospital visit codes (99231-99233). The financial impact on an individual physician will vary, depending on his or her service mix.
While IDSA and other groups continue to advocate against the consultation codes decision, the Society has developed several resources on IDSA’s website to help members and their staffs better understand the effects of these changes. (You must be logged in to access these resources.) These tools include:
- an interactive reimbursement calculator that estimates the financial impact of these changes on an individual practice
- information on how to bill Medicare for consultative services going forward
- an interactive webinar scheduled for Feb. 23 at noon EST to help answer questions about the changes (Click here to register.)
As Congress worked on health care reform legislation, IDSA urged lawmakers to include an amendment proposed by U.S. Sen. Arlen Specter (D-Pa.) that would delay Medicare’s consultation codes decision for one year. The Society joined more than 20 other physician organizations in a letter and related press release urging this delay to ensure that Medicare beneficiaries are not harmed by the new payment policy. Now that health care reform has stalled, however, there is no clear path forward for the Specter amendment.
IDSA continues to monitor this and other Medicare payment issues and to offer billing and coding resources, including those related to consultations, on the IDSA website.
Collaboration Provides Training in Pediatric HIV Treatment
Treating HIV/AIDS in resource-poor settings like Rwanda is hard enough, with health worker shortages, drug supply glitches, and other hurdles hindering quality care. But when the HIV-positive patient is an infant, the job is even more daunting. There are obstacles at every turn, from individual patient diagnosis to case management to weak underlying country health systems. Compounding the problem, caring for HIV-infected children is very different from treating adults, involving complications that can seem overwhelming to even the most seasoned physicians.
The South-to-South Partnership for Comprehensive Pediatric HIV Care and Treatment, the subject of the Center for Global Health Policy’s latest program profile, is trying to change that. The collaboration between Columbia University’s International Center for AIDS Care and Treatment Programs and Stellenbosch University in South Africa provides much-needed training in pediatric HIV treatment to African health professionals.This program profile is part of an ongoing effort by the Center to highlight innovative research, prevention, and treatment programs to combat global HIV/AIDS and tuberculosis. To submit information about your own research or program for future profiles, visit this page.
HIVMA, Global Center Members Decry Anti-Gay Bill in Uganda
Nearly 1,500 leading HIV physicians, nurses, and public health experts expressed deep concern this month about the implications of an anti-gay bill under consideration in the Ugandan Parliament. The bill’s provisions include penalties of life imprisonment, or even death, for same-gender consensual sex acts and threaten imprisonment of individuals who do not report suspected homosexual acts to the police.
The legislation prompted members of HIVMA and the Center for Global Health Policy to send a letter to Ugandan President Yoweri Museveni, urging him to stop the bill. These disease experts are particularly concerned that the legislation would deal a blow to Uganda’s successful AIDS treatment efforts, deterring an already vulnerable, at-risk population from seeking HIV services out of fear of severe punishment, as well as threatening the health care workers who serve these populations. HIVMA and the Center also issued a press release highlighting these concerns.
“This legislation will violate Ugandans’ human rights and will impede successful efforts in HIV prevention by promoting misinformation suggesting that HIV transmission in Uganda is primarily due to male homosexual behavior,” said Kenneth Mayer, MD, FIDSA, co-chair of the Center for Global Health Policy’s Scientific Advisory Committee and professor at Brown University, where he directs the AIDS program. “This legislation will have a chilling effect on patients’ willingness to seek HIV testing and prevention services, and jeopardizes the fragile gains Uganda has made in combating the AIDS epidemic.”
Read about the Congressional hearing on this issue, including testimony given by Christine Lubinski, IDSA’s vice president of global health, and other global health news at the Center for Global Health Policy’s blog, http://www.sciencespeaks.wordpress.com/.
Recent blog highlights include:
- Highlights of a Q&A session featuring Ann Gavaghan, a top official in the office of the U.S. Global AIDS Coordinator, who recently spoke to HIV advocates in Washington about the new five-year strategy for the President's Emergency Plan for AIDS Relief (PEPFAR).
- A post about how an “anti-prostitution” provision included in the law that reauthorized PEPFAR might have a chilling effect on efforts to reach vulnerable populations at high risk for HIV infection with treatment, education, and other vital assistance. The Center and HIVMA sent a letter in late 2009 to U.S. Health and Human Services Secretary Kathleen Sebelius expressing concern about the provision.
Survey Reveals Adult Immunization Practices of IDSA Members
Almost two-thirds of IDSA members who responded to a recent survey believe that ID physicians should administer to their adult patients all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). That was one of the chief findings of a 2009 survey of IDSA members who indicated they had a clinical practice. The survey was sent to more than 5,600 individuals; 568 responded.
Slightly more than two-thirds of responding members were obtaining the immunization histories for their adult patients, and one-third were administering deficient vaccines. While influenza vaccine was most frequently offered, all ACIP-recommended vaccines were being administered by one-third of respondents.
IDSA’s Immunization Work Group prepared a commentary paper on the survey, which noted two concerns:
- First, those who had most recently completed a fellowship were least likely to be immunizing, something that should be addressed by internal medicine and ID training programs.
- Second, the survey identified financial obstacles and programmatic issues (such as access to immunization records) that need to be overcome in order to achieve higher immunization rates for adults.
The survey results and commentary are accessible at: www.idsociety.org/Content.aspx?id=16086.
To view IDSA’s policy principles for strengthening adult and adolescent immunization coverage issued in 2007, visit IDSA’s website.
In Memoriam: Walter E. Stamm, MD, FIDSA (1945-2009)
By Lawrence Corey, MD, FIDSA
An icon in our field and a former president of IDSA, Walter E. Stamm, MD, FIDSA, passed away Dec. 14, 2009 in Seattle at the age of 64. Dr. Stamm made major contributions to the study of urinary tract, sexually transmitted, and nosocomial infections, not only through his research and the physician scientists he mentored, but also his work in developing new standards of care still used today.
In 1980, Dr. Stamm published the first randomized controlled trial of the safety and efficacy of low-dose antimicrobial prophylaxis of recurrent urinary tract infections (UTIs) in women. A landmark paper on the diagnosis of coliform bacteria soon followed, establishing the defining standard for UTIs currently used by clinicians around the world. In rapid succession, he defined the association between C. trachomatis and acute urethral syndrome and the association between coitus and coliform UTI. He also developed the concept of short course antimicrobial therapy for UTIs and demonstrated that two weeks rather than six weeks of therapy could successfully cure upper tract infections. Recommendations based on this research remain the standard of care 25 years later.
Dr. Stamm’s laboratory developed several rapid and sensitive methods for detecting C. trachomatis infections, and he adapted these for use in large epidemiological studies, helping to clarify the role of these infections in pelvic inflammatory disease (PID). In 1996, he published a classic article demonstrating how chlamydia screening could prevent PID, research that led to the chlamydia control programs we have today. These efforts have markedly reduced the frequency of PID and its tragic effects. He also demonstrated the effectiveness of a single dose of azithromycin in treating chlamydia.
A prolific writer, Dr. Stamm authored more than 350 research articles, 11 books, and numerous reviews and book chapters. One of the founding editors of the textbook, Sexually Transmitted Diseases, he served on editorial boards of several journals and was an associate editor of The Journal of Infectious Diseases for more than 10 years. He received multiple honors, including the Squibb Award—IDSA’s honor recognizing early achievement—and the Sanofi-Aventis Award from the American Society for Microbiology.
Born in Philadelphia and raised in Portland, Ore., Dr. Stamm graduated from Stanford University and Harvard Medical School before completing residency training at the University of Washington in Seattle. His ID career began in 1973 at the Centers for Disease Control and Prevention (CDC), where he worked as an Epidemic Intelligence Service (EIS) officer and branch chief, making his mark defining the important role vascular access devices played in hospital-acquired infections. In 1976, he returned to the University of Washington and began his work on urinary tract and chlamydial infections.
As the head of the division of allergy and infectious diseases at the university from 1994 to 2007, Walt grew the department’s faculty from 25 to more than 75 and mentored numerous students and fellows. He also served on many committees for the division, the medical school, and the university, in addition to chairing many guideline and advisory committees.
Dr. Stamm’s professional achievements reflected his ability to synthesize complex ideas, develop consensus, and listen wisely, but also act forcibly and with reason. He was unique: a builder, yet a consensus maker; a passionate advocate for academia and data-based research and clinical care; a superb physician; and a gentle, yet firm, mentor.
But these accomplishments are only part of his legacy, which includes the example he set as a husband, father, teacher, and leader. Dr. Stamm was accomplished in every field he touched: A star athlete in high school and at Stanford, he had a lifelong passion for tennis, which he shared with his wife Peggy, who passed away in June 2008. He also enjoyed fishing with his children and skiing with family and friends. Skiing in his tracks was a sure and elegant way to come down the mountain. We will miss his vibrant presence.
He is survived by his two daughters, Hillary and Lindsay, and a son, Andrew.
Members on the Move
Julie Gerberding, MD, FIDSA, has been named president of Merck Vaccines. Dr. Gerberding was the director for the Centers for Disease Control and Prevention (CDC) from 2002 to 2009. She previously served as a member of the IDSA Annual Meeting Program Committee and the IDSA Emerging Infections Network Committee. A member of the Institute of Medicine and a fellow of the American College of Physicians, Dr. Gerberding is also a clinical professor of infectious diseases at Emory University and an adjunct associate professor of medicine in infectious diseases at the University of California in San Francisco.
Richard T. Kenney, MD, FIDSA, has been appointed vice president of clinical development at Vical Inc. Dr. Kenney previously worked at GSK Biologicals as the senior director of global clinical R&D, vaccines for viral diseases. He is also a fellow of the American College of Physicians and a member of several professional organizations, including the American Federation for Medical Research and the American Society of Tropical Medicine and Hygiene.
Are you a member on the move? Do you know someone who is? Contact Stephanie Cox at email@example.com so that we can announce it to our membership.
Welcome, New Members!
Akhtar, Aamina, MD
Akhter, Shafinaz, MD
Balter, Ivana, MD
Bisson, Gregory, MD, MSc
Chavez, Jose, MD
Chuck, Erin, MD
Cox, Nancy, PhD
Curfman, Maria, MD
Doonquah, Leleka, MD
DoUmbia, Boubacar, PharmD
Edwards, Barbara, MD
Emu, Brinda, MD
Furusyo, Norihiro, DMsc
Huchko, Megan, MD, MPH
Kammeyer, Joel, MD
Kaul, Pamposh, MD
Kennedy, Leigh, DO
King, Cynthia, MD, MPH
Laing, Kerry, PhD
Lasco, Todd, PhD
Lass-Florl, Cornelia, MD
Laufer, Dagna, MD
Lynch, John, MD
Masannat, Fares, MD
Nahm, Moon, MD
Norman, Dean, MD
Pyrgos, Vasilios, MD
Reyno, Jorge, MD
Sahner, David, MD
Siegel, Lawrence, MD, MPH
Ughwanogho, Ovie, MD
Vanden Bossche, Geert, DVM, PhD
Vidal, Jorge, PhD
Yanagisawa, Naoki, MD
Cathcart, Ronald, MD
Chowdhury, Imran, MD
Fosse, Thierry, MD, PhD
Groben, William, PharmD
Hanlon, Cathleen, DVM, PhD
Harish, Belgode, MD
Hosseini, Sayyed Attallah, MD
Ingram, David, PharmD
Jones, Philip, MS
Kunz, Danielle, RPh
Lee, Vivien, MPA, MA, MSc
Li, Yong, PhD
Lieberman, John, MD
Marcheski, John, RPh
Martin, Michael, MD
McNamara, Mary, MD
Mera, Jorge, MD
Miao, Hongyu, PhD
Oguchi, Godson, MD
Ohoro, John, MD
Palenik, Charles, DDS, MBA, MS, PhD
Papermaster, Nicole, PA-C
Penaranda, Joelle, PharmD
Plotinsky, Rachel, MD
Portsmouth, Simon, ChB, MB, MD, MRCP
Psarros, Georgios, MD
Ramsay, Hope, MPH
Rogers, Dana, PharmD
Salzberger, Bernd, MD
Satterwhite, Erin, MS
Sinkaset, Vivian, PharmD
Taha, Ahmed, MRCP
Tessier, Jeanette, PharmD
Tom, Trisha, PharmD
Wilson, Thomas, PharmD
Wolf, Mark, MD
Zanella, Dennis, MD, MPH
Abbasi, Farhad, MD
Abuali, Mayssa, MD
Abubaker, Firas, MD
Alexander, Elizabeth, MD
Arbulu Guerra, Ricardo, MD
Bhowmick, Tanaya, MD
Castillo, Elvis, MD
Chavada, Ruchir, MD
Cheema, Faiqa, MD
Djigbenou, Daignon, MD
Dulek, Daniel, MD
Esbenshade, Jennifer, MD
Gallagher, David, MRCP
Gong, Tracie, MD
Gray, Erana, MBBS
Khalil, Ambreen, MD
Le, Thy, PharmD
Lerner, Polina, PharmD
Noon, Amber, MD
O'Shea, Daire, MB
Pang, Phillip, MD, PhD
Pardo, Manuel, MD
Pokharna, Hiren, MD, MPH
Rowe, Emily, MBBS
Shahzad, Asher, MD
Sukhlall, Dinesh, PharmD
Thomsen, Isaac, MD
Tykhonova, Irina, PharmD
Vittor, Amy, MD, PhD
Wiberg, Kjell, MD
Wieland, Brent, MD
Yamaki, Jason, PharmD
Cone, Lawrence, MD
Stamm, Walter, MD
Apply Now for the 2010 Joint Research Awards
The IDSA Education and Research Foundation (ERF)/National Foundation for Infectious Diseases (NFID) Joint Research Awards provide support for promising young researchers who may not otherwise find funding. Applications are now being accepted for the 2010 awards. Applicants and their sponsors must be members of IDSA unless otherwise noted.
The application deadline is Feb. 12.
IDSA members-in-training are encouraged to apply for the following:
- Merle A. Sande/Pfizer Fellowship Award in International Infectious Diseases
sponsored by Pfizer Inc.
- This award is intended to encourage young physicians interested in international medicine. Note: The applicant's sponsor must be from a resource-limited country and does not necessarily have to be an IDSA member.
Junior faculty members (those who are not more than four years out of a training program) are encouraged to apply for the following:
- Association of Specialty Professors – IDSA Young Investigator Award in Geriatrics
sponsored by the Atlantic Philanthropies Inc. and the John A. Hartford Foundation
- This award provides support to infectious diseases faculty within the first four years of appointment who are interested in academic careers focused on the geriatric medicine aspects of the subspecialty.
- Astellas Young Investigator Awards
sponsored by the Astellas USA Foundation
- These awards provide funding to young investigators who have demonstrated outstanding research in any area of current interest in the field of infectious diseases.
- Wyeth Young Investigator Award in Vaccine Development
sponsored by Wyeth Vaccines Research
- This annual award provides funding for outstanding research in vaccine development, either through clinical or laboratory investigation.
These awards grow more competitive every year as the number of applicants increases. Apply now! The deadline is Feb. 12. For more information or to download an application, visit the IDSA website, call (703) 740-4788, or e-mail firstname.lastname@example.org.
2010 Medical Scholars Program: Application Deadline March 1
An important part of IDSA's mission is to promote the subspecialty of infectious diseases by attracting the best and brightest medical students to the field. To further this goal, the IDSA Education and Research Foundation (ERF) offers scholarships to medical students with mentorship by an IDSA member or fellow. IDSA members and fellows are encouraged to identify and solicit interested students and to serve as mentors.
Students in any year of medical school are eligible for this award. The scholarship activity must focus on pediatric or adult infectious diseases and may involve either clinical or research activities. Each scholarship recipient will receive $2,000.
Applications for the Medical Scholars Program must be postmarked by March 1.
For application instructions, eligibility information, and reporting requirements, please visit the IDSA website, call (703) 740-4788, or e-mail email@example.com.
New IDSA Teaching Guidelines Emphasize Active Learning
IDSA is promoting new approaches for teaching microbiology and infectious diseases in medical school. Published in the January 2010 issue of Academic Medicine and available online, a new set of IDSA guidelines emphasize ways to engage students about key concepts and principles, and offer an alternative to traditional methods that depend on PowerPoint-based lectures and short-term learning.
The members of IDSA’s Preclinical Curriculum Committee, chaired by Frederick Southwick, MD, FIDSA, explain that students can gain a deeper understanding of viruses, bacteria, and fungi through five teaching components:
- just-in-time teaching
- peer instruction
- teaching from textbooks and Internet sources
- small group discussions
- essay questions
To help reduce information overload and minimize excessive memorization, the guidelines also propose a national consensus on microbiology facts and concepts that first- and second-year medical students need to know. For more information, please visit IDSA’s website.
IDSA Enters Publishing Partnership with Oxford University Press
IDSA and Oxford Journals, a division of Oxford University Press, have announced a new publishing partnership for IDSA’s highly cited and internationally prestigious journals: Clinical Infectious Diseases (CID) and The Journal of Infectious Diseases (JID). Oxford Journals will assume publication of both journals on January 1, 2011.
Clinical Infectious Diseases, one of the most heavily cited journals in the field, publishes articles on infectious diseases, microbiology, hospital infections, public health, and HIV/AIDS. In 2009, this journal was named one of the "100 Most Influential Journals in Biology and Medicine" of the past 100 years by the Special Libraries Association. CID is edited by Sherwood L. Gorbach, MD, FIDSA.
Founded in 1904, The Journal of Infectious Diseases predates the Society’s formation in 1963, and is the premier publication for original research on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune mechanisms. JID is edited by Martin Hirsch, MD, FIDSA.
The two groups see IDSA’s twice monthly publications as an excellent fit with Oxford Journals’ strong medicine collection, which includes complementary titles in the field of infectious diseases as well as with OUP’s clinical book publishing program.
“Oxford’s academic orientation and its emphasis on scientific rigor complement the mission of IDSA,” said Richard J. Whitley, MD, FIDSA, president of IDSA. “Our two organizations are committed to the dissemination of scientific knowledge.”
Infections in Older Adults Website Now Available
IDSA’s Geriatrics Interest Group has partnered with several professional organizations to develop an interactive “Infections in Older Adults” website. The site includes resources related to:
- clinical care issues
- guidelines and consensus statements
- education and practice improvement
- research in older adults
- landmark papers
The Geriatrics Interest Group is a collaboration of academic investigators and clinicians formed to foster research on infectious disease and immunologic issues in older adults and to facilitate translation of this research into improved care for this at-risk patient population.