IDSA News - April 2010
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From the President: Working with our Federal Partners to Address Antibiotic Resistance

IDSA supports a broad strategic framework to address antibiotic resistance—one that encompasses drug development, surveillance, prevention and control, research, appropriate antibiotic use in food animals, and effective antimicrobial stewardship programs for human patients.

IDSA supports a broad strategic framework to address antibiotic resistance. In addition to our new 10 x ’20 initiative, calling for the development of 10 new antibiotics by 2020, IDSA also supports:

  • passage of the Strategies to Address Antimicrobial Resistance (STAAR) Act, which will strengthen surveillance, prevention and control, and research efforts
  • an end to inappropriate antibiotic use in food animals
  • implementation of effective antimicrobial stewardship programs
  • the development of a global strategy to address antibiotic resistance

We have expanded significantly our outreach to Congress to highlight the problem and potential solutions. (For more about this outreach, see the April issue of IDSA’s Antibiotic Resistance Policy Update.)

As these initiatives more forward, the Society increasingly is teaming up with leading federal agencies that are critical to addressing antibiotic resistance, including the National Institute of Allergy and Infectious Diseases (NIAID), the Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC). Patients, ID physicians, scientists, and public health officials rely on these agencies every day. Each has shown a willingness to work with IDSA on important issues that affect members, patients, and public health.

For example, NIAID is considering IDSA’s concerns about regulatory burdens slowing needed research, which the Society highlighted in a 2009 policy statement and in a letter to NIAID Director Anthony S. Fauci, MD (see related IDSA News article). Officials are examining as well the possibility of expanding the purview of NIAID’s clinical trials networks, a proposal IDSA supported in another letter to the agency (see related IDSA News article.)

In addition, NIAID has begun to offer valuable services for conducting basic and clinical research, including genetic sequencing and genotyping, and preclinical services that will be valuable to industry and academe in the development of new treatments for infectious diseases. (For more information about available resources, visit NIAID’s website and IDSA’s website.)

NIAID, FDA, and IDSA are currently in the process of planning a public workshop focusing on four important research topics:

  • scale of the current antibiotic-resistance problem
  • science and mechanisms of bacterial resistance
  • rapid diagnostics
  • science of antibacterial drug development

The goal is to bring together key researchers, regulators, scientists, clinicians, and government officials to discuss how to advance research in these critical areas. IDSA and FDA have also co-sponsored successful workshops focused on clinical trial designs for antibiotics to treat community-acquired pneumonia (CAP), in 2008, and hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), in 2009 (see related IDSA News article). FDA is now working on guidance documents in these and other areas to provide pharmaceutical companies with a viable pathway to drug approval. 

IDSA has been a strong advocate for funding research on antibacterial resistance, and it is encouraging that NIAID is again offering funding this year for targeted clinical trials to reduce the risk of resistance and preserve the effectiveness of existing antimicrobial drugs. The agency is currently seeking proposals for studies related to pneumonia, bacteremia, tuberculosis (TB), and non-TB mycobacterial lung infections in non-HIV-infected people. For more information about these funding opportunities (proposals are due July 30), visit NIAID’s website.

In congressional testimony submitted earlier this month, IDSA called on Congress to substantially increase NIAID’s funding for antibacterial resistance and drug discovery and development research, to a total of $500 million in fiscal year (FY) 2011 (see IDSA’s testimony).

IDSA also asked lawmakers to provide at least a $36.25 million boost in FDA’s budget for the agency’s antimicrobial resistance and antibacterial drug review programs, part of a recommended overall increase of $495 million for the agency (see IDSA’s testimony). The increase would include additional funding for FDA’s new regulatory science initiative and for the National Resistance Monitoring System, a national public health surveillance system—both important parts of a comprehensive approach to addressing resistance.

Of course, IDSA also values our collaborative efforts with CDC in the areas of infection control and antimicrobial stewardship, which we have reported on in the past and plan to highlight again in the near future. IDSA has requested that Congress increase CDC’s antibiotic resistance funding to $40 million. IDSA looks forward to further strengthening our partnerships with NIAID, FDA, and CDC and other stakeholders to address the complex, multi-cause antibiotic resistance problem. Working together, we can preserve the lifesaving gift of antibiotics for future generations. 

Health Reform Will Affect How ID Physicians Are Paid

Several provisions will link quality measures and payments, test new models

The health reform bill that passed in March will affect ID clinicians and their patients in many different ways in the coming years. Several provisions will link quality measures and physician payments, while others will test new payment models. 

The health reform bill that passed in March will affect ID clinicians and their patients in many different ways in the coming years. While the legislation contains several provisions related to IDSA’s priorities, including those involving prevention and wellness (see related IDSA News article), it also includes measures that will affect how physicians are paid in the future. These include tests of new payment models and the use of quality measures to determine payments.

An outline of these measures is below:

  • In 2015, physicians who do not report accountability measures through the Physician Quality Reporting Initiative (PQRI) will have their Medicare payments reduced by 1.5 percent for the first year and 2.0 percent each year thereafter. Currently, this reporting is voluntary; physicians are eligible for bonus payments if they participate. For more information about the PQRI program, visit IDSA’s website.
  • The bill allows the Centers for Medicare and Medicaid Services (CMS) to pay physicians differently based on their quality and cost of care using a value-based modifier to determine payments under Medicare’s physician fee schedule. This could result in lower payments to physicians who achieve the same patient outcomes as their peers but use more resources. The new modifier will be phased in over two years starting in 2015.
  • Another provision may help ID clinicians who negotiate infection control contracts with their hospitals secure higher payments for achieving certain quality benchmarks. Starting in 2015, hospitals in the top 25 percent nationwide for certain high-cost and common health care-associated conditions will face a 1 percent payment penalty under Medicare.

The health reform legislation also authorizes testing of several new payment models through a newly established Center for Medicare and Medicaid Innovations (CMI) within CMS. Demonstration and pilot programs, which could be implemented nationally if they improve quality of care and reduce costs, will test:

  • Shared savings through accountable care organizations (ACOs), which would allow groups of providers to share in savings generated by providing more efficient care for Medicare patients, beginning in 2012. Savings payments would be in addition to Medicare’s usual fee-for-service reimbursements.
  • Bundling providers’ payments around episodes of care that include certain conditions, starting no later than January 2013. Acute inpatient care, inpatient and outpatient physicians’ services, outpatient hospital services, home health, skilled nursing services, inpatient rehabilitation, and long-term care facility services would all be part of the payment bundles.
  • Adjusting hospital payments for avoidable readmissions beginning this year. Initially, the adjustments will be based on each hospital’s percentage of potentially preventable Medicare readmissions for acute myocardial infarction, pneumonia, and heart failure. The policy may be expanded to other conditions in future years.

The reform bill also will create the Independent Payment Advisory Board (IPAB). Beginning in 2014, the board will present proposals to Congress to reduce rising Medicare costs and improve quality of care. IPAB’s recommendations will take effect automatically, without congressional approval, in years when Medicare costs are projected to exceed target growth rates. Some recommendations, however, such as rationing care or raising taxes or premiums, are prohibited.

In addition to potential payment changes for physicians, two other health care reform provisions may provide at least a limited benefit for antibacterial drug development, an important area of clinical need and an IDSA priority. These include:

  • A new two-year, temporary tax credit, subject to an overall cap of $1 billion, to encourage investments in new therapies to prevent, diagnose, and treat acute and chronic diseases.
  • Creation of the Cures Acceleration Network within the National Institutes of Health (NIH) to award grants and contracts to help move discoveries from the lab into the next generation of cures and treatment therapies for diseases. IDSA has called for funding of at least $500 million in the 2011 fiscal year for this new initiative (see IDSA’s congressional testimony).

IDSA will continue to monitor the implementation of these and other provisions of health care reform. For a summary of key provisions of the new law of particular importance to HIV providers and their patients, please see this document prepared by the HIV Medicine Association (HIVMA) and related article

IDSA Journal Club

This month: Studies investigating ivermectin therapy for recalcitrant head lice, protease inhibitors and pre-term birth, the use of commonly prescribed cephalosporins, invasive fungal infections (IFIs) in solid organ transplant recipients, and bacterial meningitis and spinal procedures.

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.

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.

Ivermectin Effective Therapy for Recalcitrant Head Lice
Reviewed by Jason Weinberg, MD

Oral ivermectin is an effective treatment alternative to topical insecticides in patients with difficult-to-treat head lice. The finding comes from a study published in the March 11 issue of The New England Journal of Medicine.

A total of 812 infested patients from 376 households were included in this multicenter, cluster-randomized, double-blinded, placebo-controlled trial. All patients, who were at least 2 years old and weighed at least 15 kg, came from households in which at least one household member had failed a recent course of topical insecticide therapy. On days 1 and 8, patients from randomized households received either oral ivermectin (400 micrograms/kg) plus placebo lotion, or malathion lotion plus placebo tablet.

Oral ivermectin was both noninferior and superior to malathion lotion in achieving the primary outcome, with 95.2 percent of patients receiving ivermectin versus 85.0 percent of patients receiving malathion being free of head lice at day 15. Oral ivermectin was also superior with regard to the secondary outcomes: absence of head lice at early (days 2 and 8) and later (days 22 and 29) times. Adverse events were infrequent and occurred at a similar rate in the two study groups.

More patients preferred oral ivermectin (78.3 percent) than topical malathion (13.0 percent) in this study, suggesting that increased compliance in a non-study setting may further enhance ivermectin’s efficacy. There is some concern that the increased use of ivermectin could lead to the emergence of resistance in head lice. Limiting its use to patients who have failed topical therapy, as the authors of this study advocate, should limit this risk. In general, it is refreshing to see solid evidence for a simple and effective therapy for difficult-to-treat head lice infestations, which remain frustrating for patients and physicians alike.  

(Chosidow et al. NEJM 2010; 362:896-905.)

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Some Protease Inhibitors Not Associated with Pre-Term Birth
Reviewed by Khalil Ghanem, MD, PhD

The use of certain protease inhibitors (PIs) to treat HIV-infected pregnant women was not associated with increased risk of pre-term birth, according to a report in the April 1 issue of The Journal of Infectious Diseases. The finding comes from a large prospective cohort study designed to assess the risks of antiretroviral therapy in pregnant women and their infants.

The association between the use of PIs and pre-term birth has been controversial. The issue is critical because the current U.S. guidelines recommend combined antiretroviral therapy (cART) during pregnancy to decrease vertical transmission of HIV. No randomized controlled trials have been conducted; a common limitation of previous observational studies was confounding by indication: the possibility that women who were started on cART were sicker and thus at increased risk of pre-term birth.

In this study, among 777 HIV-infected pregnant women who were not receiving cART at conception and were enrolled in the prospective cohort, 558 received a PI-containing regimen. The most commonly used PIs included nelfinavir and the combination of lopinavir and ritonavir. Using logistic regression models to adjust for potential confounders, PI use was not associated with pre-term birth (OR 1.22, 95 percent CI: 1.70-2.12) compared with regimens that did not include a PI. The major limitations of the study were the relatively small sample size, which may have missed a small but clinically significant increased risk of pre-term birth, and the limited number of PIs that were assessed.

 The ideal antiretroviral regimen to use during pregnancy is unknown. This study suggests that some PIs (namely lopinavir/ritonavir) may be safe to use during pregnancy. Clinicians should always refer to the latest guidelines when treating pregnant women as this area is in constant flux.

(Patel et al. J Infect Dis. 2010 201(7):1035-44.)

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An Update on Cephalosporins
Reviewed by Sara Cosgrove, MD

Two recent studies published in Antimicrobial Agents and Chemotherapy provide additional information about two commonly prescribed cephalosporin antibiotics, ceftriaxone and cefepime.

The first study, published in the journal’s April issue, provides additional support for the Food and Drug Administration (FDA)’s 2009 decision to modify a warning from 2007 regarding the potential risk of precipitation and organ damage when ceftriaxone and calcium containing products are co-administered.  Investigators searched the FDA Adverse Event Reporting System (AERS) for cases who received ceftriaxone and calcium as well as for controls who received ceftazidime and calcium between 1998 and 2007.  Adverse events were classified based on the possibility that they were associated with an embolic event causing pulmonary or renal failure.

Although the 104 patients in the ceftriaxone-calcium group had more probable associated embolic events than the 99 patients in the ceftazidime-calcium group (7.7 percent vs. 4 percent), they had had fewer possible associated embolic events (20.2 percent vs. 30.3 percent).  These results suggest that the current FDA recommendation that patients more than 28 days old can receive both agents as long as the infusion line is flushed between administrations is reasonable.

A second study, published in the journal’s March issue, suggests that cefepime doses of 2 grams every 8 hours may optimize outcomes in patients with normal renal function and non-urinary tract Pseudomonas aeruginosa infections.  The authors evaluated 56 patients with respiratory (66 percent), skin and skin structure (25 percent), and bloodstream (9 percent) infections in which microbiological success was achieved in 57 percent of patients. As noted in other studies, the percentage of the dosing interval that the free drug concentration remains above the MIC of the infecting organisms (ƒT > MIC) was associated with microbiologic success; the failure rate was 78 percent if the ƒT > MIC was ≤ 60 percent in the entire cohort and 100 percent among patients with respiratory infections or bacteremia.

Using a Monte Carlo simulation, the authors estimated that at the current Clinical and Laboratory Standards Institute (CLSI)-defined breakpoint of 8 µg/ml for P. aeruginosa, a cefepime dose of 2 grams every 8 hours or as a 30-minute or 3-hour infusion has a ≥ 82 percent likelihood of achieving a ƒT > MIC of at least 60 percent in patients with normal renal function. Standard doses of cefepime were much less likely to achieve adequate pharmacodynamic targets. P. aeruginosa isolates with MICs < 8 µg/ml may not require such aggressive dosing; however, most microbiology laboratories do not report the actual MIC of the isolate. Thus, for serious infections caused by P. aeruginosa, clinicians may want to consider using cefepime at a dose of 2 grams every 8 hours.

(Steadman et al. Antimicrob. Agents Chemother. 2010;54(4):1534-1540 and Crandon et al. Antimicrob. Agents Chemother. 2010;54(3): 1111-1116.)

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Invasive Fungal Infections (IFIs) in Solid Organ Transplant Recipients
Reviewed by George R. Thompson III, MD

The Transplant-Associated Infection Surveillance Network (TRANSNET) conducted a prospective evaluation of invasive fungal infections (IFIs) in organ transplant recipients. The results of their observational study, which will likely affect future research and possibly the development of new treatment and prevention strategies, were published in the April 15 issue of Clinical Infectious Diseases.  

In prior studies, the incidence and etiology of fungal infections has varied by the type of organ transplant and by the individual transplant center. TRANSNET was established in 2001 to perform prospective surveillance among geographically diverse U.S. organ transplant centers to better define the true burden of IFIs in these patients.

Only proven and probable IFIs were included as cases in this study. There were 1,208 proven (42 percent) and probable (58 percent) IFIs among 1,063 organ transplant recipients during the surveillance period (March 2001 to March 2006). Invasive candidiasis (53 percent), aspergillosis (19 percent), cryptococcosis (8 percent), non-Aspergillus-molds (excluding Zygomycetes) (7 percent), and endemic mycoses (5 percent) were the most common.  Proven zygomycosis and Pneumocysts jiroveci infection were uncommon (<3 percent). 

The time to diagnosis of infection varied by organism. Early infection (<90 days post transplantation) was predominantly due to Candida and Aspergillus species. However, the majority of all infections occurred >90 days after transplantation with a substantial number occurring more than three years after transplant. These late infections were most commonly due to cryptococcosis, non-Aspergillus molds, and endemic mycoses.

In the incidence cohort, the 12-month cumulative incidence of infection was 3.1 percent. Small bowel transplant recipients were at the highest risk (12 percent), followed by heart-lung (9 percent), liver (5 percent), pancreas and kidney-pancreas (4 percent), heart (3 percent), and kidney (1 percent) recipients. 

These findings will undoubtedly have a significant impact on future studies examining organ-specific risk factors for post-transplant IFI and may lead to new strategies for diagnosis, prophylaxis, and/or treatment in this highly vulnerable population. 

(Pappas et al. Clin Infect Dis. 2010;50:1101-1111.)

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Improving Infection Control: Bacterial Meningitis and Spinal Procedures
Reviewed by Kathryn E. Stephenson, MD, MPH

Two small clusters of bacterial meningitis among healthy women who received intrapartum spinal anesthesia were reported in the U.S. between September 2008 and May 2009, raising the possibility that infection control measures for spinal procedures may not be widely followed. The report, which first appeared in the Centers for Disease Control and Prevention (CDC)’s Morbidity and Mortality Weekly Report (MMWR) in January, was also published in the March 17 issue of the Journal of the American Medical Association.

In four of the five cases, Streptococcal salivarius, a common organism in the mouth, was found in the women’s blood and/or cerebral spinal fluid. All cases were marked by the rapid onset of symptoms after spinal procedures; one of the women died. Each cluster – one in New York, the other in Ohio – was associated with a single anesthesiologist. CDC investigators concluded that the two clusters of meningitis were most likely due to breaches in aseptic technique allowing droplet transmission of S. salivarius from the oropharynx of the anesthesiologists to the patients.  In other words, the doctors did not wear surgical masks.

The Healthcare Infection Control Practices Advisory Committee (HICPAC) recommends that surgical masks be worn by spinal procedure operators to prevent infections, but this recommendation, issued in June 2007, is not yet in widespread practice. It applies to many diagnostic and therapeutic spinal procedures, including lumbar puncture, myelography, and spinal anesthesia, and is particularly important for procedures that involve placing a catheter or injecting material into the spinal canal or epidural space. The authors advise that health care facilities where these procedures are performed should raise awareness of HICPAC recommendations and reinforce adherence to infection-control guidelines among staff.

(JAMA. 2010:303:1026-8.)

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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:

May 15

  • Cerebral Emboli in Endocarditis: More Frequent than You Might Think
  • Climbing Fish and Mononucleosis
  • Delusional Parasitosis

May 1

  • Genetic Determinants of Outcomes in Chronic Hepatitis C Virus (HCV) Infection
  • Extreme Leukocytosis



Special Review Panel Upholds IDSA’s 2006 Lyme Disease Guidelines

After spending more than a year reviewing the evidence relating to Lyme disease, a special independent Review Panel has unanimously agreed that no changes need to be made to IDSA’s 2006 Lyme disease guidelines. The panel determined that the guidelines were based on the best evidence available at the time and also supported by the evidence that has been published since. Released April 22, the Review Panel’s final report is available on IDSA’s website.

The special review was conducted following a voluntary agreement with Connecticut Attorney General Richard Blumenthal, who challenged the process used to develop IDSA’s 2006 Lyme disease guidelines on behalf of a group of patients and advocates and a small group of physicians who support a different treatment model. The Attorney General never questioned the scientific validity of IDSA’s guidelines but alleged conflicts of interest and a failure to consider divergent points of view. IDSA maintains that these assertions were unfounded. However, IDSA voluntarily agreed to a special, one-time review, confident that the guidelines and the process behind them would be validated. 

EIN Update: Invasive Group A Streptococcal (GAS) Infections

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 (CDC), which funds the EIN. The reader assumes all risks in using this information. 

Two recent EIN discussions featured widespread comments from members in a number of states and a Canadian province about invasive streptococcal infections, including cases requiring hospitalization.

“Has anyone seen clusters of invasive group A streptococcal (GAS) infections recently?” an EIN member from Virginia asked. “We have had four severe cases in the last two weeks.” None of the patients were contacts with one another, and appropriate infection control measures were used. Two patents died in the emergency room, one with bacteremia and sepsis, the other with sepsis and a facial wound. “We have been in discussion with our local and state health departments about this,” the member wrote.

A respondent in South Carolina reported three cases of invasive GAS skin and soft tissue infections in the last month, including two involving toxic shock syndrome. “Fortunately, they have all done well,” the respondent noted. “Again, they were all from the community with no recent health care exposure. No common contacts.”

Members in New York, Michigan, and Tennessee shared reports of cases as well. A California respondent highlighted an excerpt from a recent editorial in The Journal of Infectious Diseases, which attributed the “resurgence of invasive disease by GAS” partly to “the emergence and global spread of a new strain of M-type 1 (M1) organisms over the past 20–30 years.” The editorial refers to an accompanying article.

The California member also shared a comment from a physician with the Centers for Disease Control and Prevention (CDC), who wrote that “clusters of severe GAS infections are often part of a community-wide temporal increase in cases, often related to influx of a strain to which the community at large does not have much immunity. They are rarely point source and, unfortunately, cannot be easily prevented.” Clusters may also occur “because of an increase in the underlying at risk population,” such as accompanying some virus outbreak, like influenza, the CDC physician added.

A 1997 article in the Journal of the American Medical Association may be relevant, according to an Illinois respondent. The article describes the migration of virulent GAS strains and dissemination through school-age children.

A Florida EIN member, meanwhile, asked if others were seeing a recent increase in hospitalizations related to invasive GAS infections. The question generated responses from 10 states and a Canadian province, including several reporting specific recent cases.

A respondent in Oregon noted three cases within the last six to eight weeks: a 17- year-old boy from a youth camp who started with untreated pharyngitis and progressed to bilateral pneumonia and empyemas, requiring two decortications and three weeks in the hospital; a severely handicapped 14-year-old boy with primary pneumonia, sepsis, respiratory failure, and prolonged assisted ventilation; and a 60-year-old man with mitral valve (MV) endocarditis.

“All survived but were critically ill,” the respondent wrote. “We usually get one or two cases a year like this, so I would consider this a bit of a ‘cluster.’ ”

Another member in Florida asked if any isolates from this cluster had been typed. “The apparent increase in occurrence of invasive GAS cases could be due to the introduction of a particularly virulent GAS strain—likely M1 or M3—into your community. Admittedly, this information won't have immediate clinical relevance to you, but it may confirm a true cluster and further alert local docs to be on the lookout for such cases.”

Several members reported invasive GAS disease from somewhat unusual sterile sites, including a case of jugular venous thrombosis combined with transverse sinus thrombosis, one case of mycotic aneurysm, and another of mitral valve endocarditis. There were also two cases of otomastoiditis and three cases of empyema reported.

The ability to search electronic medical records or discharge diagnostic codes to look for past trends in GAS disease over time may be useful, noted a respondent in Washington state who reported no suspected increases in GAS disease locally. 

An Illinois respondent also cited a recent report about transmission of GAS infection in the operating room setting presented at the Fifth Decennial International Conference on Healthcare-Associated Infections in March. Two surgeons became ill, one with pharyngitis and one with a severe and ultimately fatal case of fasciitis, after performing extensive debridement on a patient with severe necrotizing fasciitis caused by GAS.

“The latter case [was] related, apparently, to contamination of [the surgeon’s] socks in surgery,” the respondent wrote. The surgeon had athlete's foot, which may have served as a portal of entry for the infection, and he didn't change his socks after the surgery.

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) with funding from the Centers for Disease Control and Prevention (CDC), EIN tracks emerging infectious diseases and keeps the public-health community up to date with new disease trends, difficult cases, and other issues affecting 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. Click here for more information or to join EIN.

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 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 Again Postpones Physician Payment Cuts

Earlier this month, Congress passed another short-term fix averting a 21 percent across-the-board cut in physicians’ Medicare payments. This current fix expires May 31. This means that physicians will once again face the threat of significant cuts on June 1 unless Congress acts. 

Although the previous short-term fix passed by Congress expired April 1, Medicare had instructed its contractors to hold claims for two weeks, providing more time for lawmakers to take action. This current extension will also be applied retroactively to all physician services provided to Medicare patients in April. While few if any claims were processed at the reduced rates, Medicare will automatically reprocess any claims paid that reflected the 21 percent cut.

For more updates and additional information, including how you can urge Congress to adopt a permanent fix to the Sustainable Growth Rate (SGR) under Medicare, visit IDSA’s website.

New Medicare ID Utilization Data Now Available

The 2008 Medicare utilization rates for relevant current procedural terminology (CPT) codes used by ID specialists are now available on the IDSA website as a downloadable PDF. Previous years’ utilization data is also available on the website (log-in required for both pages). Additional information is available for free or for purchase from Medicare’s Research, Statistics, Data, and System’s website.

New MDR-TB Treatment Program Has Early Success

Disease experts working in KwaZulu-Natal, South Africa, announced last month that the first six patients treated for multidrug-resistant tuberculosis TB (MDR-TB) through an innovative community-based program were successfully cured. This marks a major medical accomplishment and a remarkable personal turnaround for both the doctors and patients involved.

This new approach to treating MDR-TB grew out of a crisis. About four years ago, health care workers in KwaZulu-Natal were faced with a burgeoning epidemic that was overwhelming the local hospital; doctors were diagnosing more than 2,000 MDR-TB cases a year but only had 500 hospital beds available for treatment. The prolonged hospitalization required to treat MDR-TB patients—about six months—was not just a major burden on the health care system; it also took a heavy toll on the patients and their families.

In response, a coalition of American and South African health professionals joined with the KwaZulu-Natal Department of Health to devise a unique solution: treating patients in their homes, with care delivered by injection teams that visit each patient on a daily basis to administer medications, monitor progress, and provide support.

The project was spearheaded, in part, by the Tugela Ferry Care and Research Collaboration (TF CARES), a group of researchers and clinicians from several U.S. medical schools, including Yale University and Albert Einstein College of Medicine, and the Nelson R. Mandela School of Medicine – University of KwaZulu Natal (UKZN) in Durban, South Africa.

“This idea came by necessity,” said Claudio Marra, MD, of the Istituto Superiore di Sanita in Italy, who also works for the KwaZulu-Natal Department of Health. “You couldn’t treat all the patients in the hospital even if you wanted to.”

Read more about this unique program and other global health news at the Center for Global Health Policy’s blog,

Other recent blog posts include:

  • A Q&A with Willard Cates Jr., MD, MPH, President, Research, Family Health International, who recently gave a provocative presentation at a Microbicides Trial Network meeting in Washington, D.C. He provided insights about the potential public health impact of microbicides if the scientific evidence demonstrates efficacy in preventing HIV transmission. Dr. Cates also spoke about the challenges of translating scientific data into real-world prevention gains.
  • An account of the growing crisis faced by HIV/AIDS patients living in post-earthquake Haiti, where less than 40 percent of Haitians who were receiving AIDS-related care prior to the earthquake are receiving it now. A Haitian delegation recently came to Washington to talk to policymakers about the need for dedicated funding to help respond to the AIDS pandemic. 
  • A compelling story about a Mississippi student’s two-year battle against MDR-TB, which he contracted on a backpacking trip through Southeast Asia. He spoke at a House of Representatives briefing to mark World TB Day on March 24. The Center for Global Health Policy released a new report, Death by Drug-Resistant TB and How to Stop It, at a companion Senate briefing that day.

FDA Advisory Committees Seek New Members

The Food and Drug Administration (FDA) has many advisory committees and panels of independent experts to advise on scientific, technical, and policy matters. FDA has asked IDSA to nominate individual members for these committees, which need to be replenished periodically. If you are interested in being nominated, please send your CV to Padma Natarajan at IDSA’s Board of Directors will consider applicants for nomination. Below is a list of relevant advisory committees with a brief description of each.  More information also can be found on the FDA Advisory Committee website.

  • Antiviral Drugs Advisory Committee: reviews and evaluates data concerning the safety and effectiveness of marketed and investigational human drug products for use in the treatment of AIDS, HIV-related illnesses, and other viral, fungal, and mycobacterial infections
  • Anti-Infective Drugs Advisory Committee: reviews and evaluates available data concerning the safety and effectiveness of marketed and investigational human drug products for use in the treatment of infectious diseases and disorders
  • Microbiology Devices Panel: reviews and evaluates data concerning the safety and effectiveness of marketed and investigational in vitro devices for use in clinical laboratory medicine including microbiology, virology, and infectious diseases
  • Vaccines and Related Biological Products Advisory Committee: reviews and evaluates data concerning the safety, effectiveness, and appropriate use of vaccines and related biological products used in the prevention, treatment, or diagnosis of human diseases, and, as required, any other product for which the FDA has regulatory responsibility

Welcome, New Members!


Avdic, Edina, MBA, PharmD
Chang, Larry, MD, MPH
Jeffres, Meghan, PharmD
Kaufman, David, MD, PhD
Pasquale, Timothy, PharmD
Rahimi Shahmirzadi, Mohammad Reza, MD
Scott, Ken, MD


Babic, Maja, MD
Collis, Phillip, PharmD
Cushion, Melanie, PhD
English, Cary, MD
Esper, Frank, MD
Farshait, Nataly, MSN
Febles, Taynet, MD
Fox, Rodney, BSN, FNP, NP, RN
Guy, Stephen, MBBS
Hristea, Adriana
Jeng, Karen, PharmD
Johnson, Karmon, PHARMD, PharmD
Kelley, Susan, MD, MT(ASCP), PhD
King, Susan, MS
Kutner, Pamela, JD
Liu, Jenkuei, PhD
Mahmood, Kamran, MBBS
McConnell, Scott, PharmD
McKinnon, Jeannie, PharmD
Mendez-Vigo, Luke, PharmD
Morris, David, MD
Rodriguez Caprio, Gabriela, MD
Russo, Rene, PharmD
Sabuda, Deana, RPh
TyAgi, B., PhD
Vazquez, Maria, MD
Wiederhold, Nathan, PharmD


Cho, Eun Young, MD
Choe, Ulyee, DO
Hong, Ki Bae, MD
Njau, Modesta
Papenburg, Jesse, MD
Patel, Rattan, MD
Piggott, Damani, MD, PhD
Yun, Ki-wook, MD 

Redesigned ID/HIV Career Center Offers New Features

The ID/HIV Career Center, the official online career center of IDSA and the HIV Medicine Association (HIVMA), has been redesigned through our partnership with HEALTHeCAREERS Network to connect you with more jobs in less time. Visit the site to:

  • Find the right jobs, quicker: Look for hundreds of positions in ID and HIV medicine by location as well as specialty, keyword, and organization name.
  • Get job alerts: Register for e-mails about jobs that match your qualifications and interests.
  • Connect at events: Use the improved Conference Connection™ feature to see who is attending events and plan a time to network with potential employers.
  • Sign up for eNewsletters: Receive employment best practices and job tips in your inbox.
  • Read career advice: Access the ID/HIV Career Center for articles about résumés, interviews, and landing the right position.
  • Tie it all together: Manage your resumes, jobs, and application histories.

If you are hiring, take advantage of the 30 percent member discount when posting a physician position to put more jobs in front of more job seekers. The website redesign also makes it easier to connect with the right candidates.

See what’s new—visit the ID/HIV Career Center today! 

Revised CPT Coding Resources Coming Soon

In May, IDSA members who have indicated an interest in patient care will receive the Society’s updated inpatient and outpatient coding resources in the mail.  The updates include new information about how to maximize reimbursement by coding for prolonged service and critical care service time.  These revisions are especially important in light of Medicare’s decision to eliminate payments for consultation codes (see related IDSA News article). These resources include:

  • The inpatient correct coding pocket card, which provides evaluation and management (E&M) coding guidance related to consultations, admissions, subsequent hospital visit, prolonged services, and critical care.
  • The outpatient correct coding wall poster, which provides E&M coding guidance related to office consultations, new patient, established patient, and prolonged services.

IDSA will send more information about the updated resources in May. The current coding resources are available at (log-in required).  Please contact Jason Scull at with any questions or concerns.

Slides from Billing and Coding Webinar Now Available

In February, IDSA held a billing and coding webinar for members and their staff that answered tough questions related to Medicare's decision to eliminate payments for consultation codes and other evaluation and management (E&M) coding issues relevant to the practice of infectious diseases.

The “Hot Topics in E&M Coding for the ID Practice” webinar covered:

  • what codes to use in place of the consultation codes
  • how to bill other payers for consultative services and documentation requirements

Members can view the webinar slides on the IDSA website. (You must be logged in to access this link.) For more information about Medicare’s decision, see this earlier IDSA News article. A related article in this issue provides information about updates to IDSA’s correct coding resources. IDSA members and their staff may also send billing and coding questions to the “Ask the Coder” e-mail portal