IDSA News - April 2011
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Uncomplicated Cystitis and Pyelonephritis Guideline Now Available for Mobile Devices

IDSA’s practice guideline for the diagnosis, prevention, and treatment of acute uncomplicated cystitis and  pyelonephritis in women is now available in a format designed for iPhones and other mobile devices. Visit IDSA’s website for instructions for downloading and using this guideline and others on your mobile device.

Also, don’t forget about Pocketcard versions of the guidelines, which are also available on the IDSA website. IDSA members are eligible for a 35 percent discount when ordering these 4x7-inch quick-reference tools that feature essential diagnostic and treatment recommendations in a brief format.  Use discount code DCIDSA09.

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.)

*Note: This vaccine does not prevent infection with serogroup B Neisseria meningitidis, which is the most common serogroup in infants.


Is Your Facility Experiencing Antibiotic Shortages?
Report these to FDA and IDSA.

Electronic Health Record Incentives Program: Online Attestation Now Open

Eligible physicians may now start reporting their use of electronic health records (EHRs) to the Centers for Medicare and Medicaid Service (CMS), a step required for physicians to qualify for Medicare incentive payments for adopting certified EHR technology and demonstrating “meaningful use.”

During this process, called attestation, eligible providers and hospitals that have registered for the Medicare incentive program may report the results of their meaningful use objectives and attest that they have met the requirements to receive inventive payments. (For more about the EHR incentive program and how to participate, see the February 2011 IDSA News and the January 2011 HIVMA enews.)

To learn more about the web-based attestation system, which launched April 18, visit the CMS website. CMS plans to hold a phone call with eligible providers on Thursday, May 5, from 1:30-3 p.m. EDT to explain how to navigate the process and answer questions.  Click here to register for the conference call.  The agency also offers an online calculator to help providers determine if they have met all of the requirements before using the attestation system.

For those participating in the Medicaid EHR incentive program, the date when physicians can begin reporting their meaningful use of EHRs varies by state.

Important general reminders about the EHR incentive programs:

  • Figuring out whether you are eligible for incentive payments is easy.  Complete the online registration, which takes only a few minutes, to determine your eligibility.
  • Only physicians who provide 90 percent or more of their services in a hospital inpatient (Place of Service code 21) or emergency room (Place of Service code 23) setting will be defined as hospital-based eligible professionals and, thus, ineligible for incentive payments.
  • Eligibility for incentive payments one year does not necessarily mean that you will be eligible the next year (or vice-versa). This is because CMS recalculates your percentage of hospital-based services each year to determine eligibility.
  • Even if you are not eligible for these incentives, you need to begin the process of EHR implementation. Practices without EHRs will be at a competitive disadvantage as more health care providers record and transmit information electronically. Your service mix also could change: lack of eligibility for incentive payments may not exempt you from payment penalties beginning in 2015 if you lose your “hospital-based” status.

A schedule of EHR payment incentives and penalties is available online. CMS has a listserv about the EHR incentive program to provide updates on registration, attestation, and the payment process. Click here to join. IDSA’s practice management listserve is another resource for Society members to discuss clinical practice-related issues, including incentive programs. To subscribe, visit IDSA’s website.

CMS Reconsiders Physician Signature Requirement for Lab Services

Certifying home health services under Medicare still requires face-to-face visit

Federal officials are reconsidering a potentially burdensome paperwork rule that would have required physicians to provide their signatures on requisitions for laboratory tests. The Centers for Medicare and Medicaid Services (CMS) is now taking another look at the policy and considering next steps, according to recent reports in Inside Health Policy and American Medical News

The signature requirement was included in Medicare’s 2011 physician fee schedule but has never been enforced by CMS. Several lawmakers had asked the agency to change or delay the rule, while the American Medical Association called for CMS to abolish it permanently, citing the additional and unnecessary administrative burden it would impose.

Another 2011 fee schedule change, which may affect ID physicians with patients receiving home health services, such as home antibiotic infusion therapy, remains in place. Certifying that a patient is eligible for these services under Medicare now requires a face-to-face visit by the physician or a non-physician practitioner working in collaboration with the physician. This visit and how the patient’s condition supports the need for home health services must be documented. The visit must occur within the 90 days prior to the start of home health care or within 30 days after the start of care.

For more information, see this one-page summary (PDF) of the visit requirement prepared by CMS. IDSA’s website also offers a physician guide for certifying and recertifying patients for home care, including details about coding and allowable reimbursement. (You must be logged in to access this page.)



 

IDSA, HIVMA Members Urge Against Global Health Cuts

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the National Institutes of Health (NIH), and other global health programs will see funding cuts following the budget deal reached earlier this month for the remainder of the 2011 fiscal year. (See related article this issue.) Op-eds written by IDSA and HIVMA members, who encouraged members of Congress to preserve global health funding this year and beyond, were published in several newspapers prior to the budget agreement: “Global health a worthy cause,” by Jose Hagan, MD, in the Columbia (Mo.) Daily Tribune; “America's health aid saves others, helps us,” by Sandra Gonzalez Gompf, MD, FIDSA, in the St. Petersburg Times; and “Don't cut global health care,” by Ellen Chadwick, MD, FIDSA, in the Chicago Tribune.

To learn more about how you can speak up for global health and become involved, please contact the Center for Global Health Policy.

Center Asks President Obama to Attend UN Meeting, Show U.S. Leadership on HIV/AIDS

The Center for Global Health Policy and HIVMA joined 50 global health, human rights, and religious organizations in an April letter (PDF) calling on President Barack Obama to attend the United Nations (UN) High-Level Meeting on AIDS in early June in New York City. At the meeting, UN member states are expected to adopt a new declaration reiterating current commitments and agreeing to additional actions to combat global HIV/AIDS. The letter also encourages the president and his fellow U.S. delegates to echo important messages aimed at achieving the following outcomes: 

  • ensuring HIV treatment for 13 million people globally, with the U.S. raising its commitment to treat 6 million people globally by 2013
  • reducing the sexual transmission of HIV by 50 percent, including among key populations; eliminating all new infections associated with drug use; and scaling up evidence-based prevention in the highest burden countries
  • eliminating HIV transmission from mother-to-child through a bold U.S. pledge to ensure interventions for women to prevent vertical transmission
  • reducing tuberculosis (TB) deaths in people living with HIV by 50 percent, ensuring access to TB screening, preventive therapy and treatment, and antiretroviral therapy for all HIV-infected individuals suffering or at risk of TB

The recommendations reiterate many of the global AIDS targets in a recent report by UN Secretary-General Ban Ki-moon. For more information about the report, visit the Center’s blog, Science Speaks.

Grant Renewal to Fund Global Center Through November 2011

The Bill & Melinda Gates Foundation has awarded the Center for Global Health Policy a grant supplement that will fund the Center’s activities through the end of November 2011. The grant includes funding for the Center to host another set of congressional delegates on a tour of U.S.-supported HIV/AIDS and tuberculosis (TB) programs in Africa this summer (see September 2010 IDSA News). These trips give congressional staff members a firsthand view of the important strides these programs are making and the areas where additional support is needed.

The Center was created by IDSA and HIVMA in 2008 to support and promote U.S. efforts to combat HIV/AIDS and TB around the world (see March 2011 IDSA News). To learn more about the Center and how you can get involved, please visit www.idsaglobalhealth.org and the Center’s blog, Science Speaks.

IDSA Lays Out Policy Plan to Address Antimicrobial Resistance

IDSA released a new paper this month outlining specific policy steps and research activities needed now to address the serious threat posed by antimicrobial resistance and the lack of new antibiotic development.

Published in Clinical Infectious Diseases and available online, "Combating Antimicrobial Resistance: Policy Recommendations to Save Lives," was released at a press conference in Washington, D.C., on World Health Day, April 7. (See “From the President” in this issue and IDSA’s website for more about IDSA’s activities for World Health Day, which this year focused on antimicrobial resistance.)

A one-page summary of IDSA’s paper is available online (PDF). Key recommendations focus on strengthening U.S. approaches to new drug and related diagnostic development and public health and research efforts.  

Many policymakers are not aware of this public health crisis and the need for action to address this complex problem. IDSA urges members to contact their members of Congress to help raise awareness and to highlight the need to pass legislation to spur antibiotic discovery and address other areas necessary to combat antibiotic resistance. Visit IDSA’s website to learn how to contact federal lawmakers.

“IDSA has a comprehensive, multifaceted plan to address this crisis, but time is running out,” IDSA President James M. Hughes, MD, FIDSA, said in a press release announcing the Society’s policy paper. “If such measures are not implemented now by Congress, federal agencies, and health care providers across the country, an increasing number of lives will be devastated and lost.”

FY 2011 Budget Deal Includes Severe Cuts to Health Agencies

The budget agreement reached in April by Congress and President Obama for the remainder of the 2011 fiscal year (FY) includes major cuts to several key federal health agencies from their FY 2010 funding levels. Among the affected health agencies and programs relevant to IDSA members:

  • Centers for Disease Control and Prevention (CDC): $730 million cut (11.4 percent) from the FY 2010 funding level.  This represents CDC’s lowest funding level since 2003, when adjusted to include anti-terrorism funding, which is now part of CDC’s base budget. It is currently unknown whether specific centers or programs will bear the majority of the cuts or whether reductions will be applied across the entire CDC budget.
  • National Institutes of Health (NIH): $260 million cut (0.8 percent) from FY 2010 level.
  • The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR): $23.2 million reduction from FY 2010. The Global Fund to Fight AIDS, Tuberculosis, and Malaria was also cut by $2.1 million compared to FY 2010.  Global family planning and reproductive health services were reduced by $85 million from current funding levels.
  • While the Prevention and Public Health Fund created under the health care reform law remains intact for FY 2011, it continues to be at risk as some lawmakers view the fund as a way to offset other budgetary cuts rather than as a supplement to the base funding for public health agencies and programs, as the fund was intended.

Among the few spending increases in the budget outside of defense is funding for the Food and Drug Administration (FDA), which will see an increase of $107 million (4 percent) from FY 2010 levels. The AIDS Drug Assistance Program (ADAP) will also receive an additional $25 million over what was allocated in FY 2010.

For more on the budget’s impact on domestic HIV/AIDS and global health funding, see the April 2011 issue of HIVMA enews and Science Speaks, the blog of the Center for Global Health Policy. Several op-eds written by IDSA and HIVMA members encouraging Congress to preserve global health funding were also recently published in several newspapers (see related article in this issue).

In related budget news, earlier this month, IDSA provided testimony (PDF) on the federal budget for the 2012 fiscal year to the House Appropriations Committee covering CDC, NIH, and the Biomedical Advanced Research and Development Authority. IDSA noted the Society’s support for strong funding levels for ID efforts within each of the agencies—particularly on antibiotic resistance.

Members on the Move

Judith A. Aberg, MD, FIDSA, has been named director of the Division of Infectious Diseases and Immunology in the Department of Medicine at New York University School of Medicine. A professor of medicine and the principal investigator of the AIDS Clinical Trials Unit at NYU, Dr. Aberg is also director of virology at Bellevue Hospital in New York City. As a member and chair of several panels, Dr. Aberg has been instrumental in developing national, state, and local guidelines. In addition, she currently serves as chair-elect of the HIV Medicine Association (HIVMA) Board of Directors. Dr. Aberg is also an editor for HIV Clinical Trials and serves on editorial boards and as an ad hoc reviewer for multiple biomedical journals.

Kenneth H. Mayer, MD, FIDSA, has received the Congressman Gerry E. Studds Award, an award that is given annually at the Fenway Health Institute’s “The Men’s Event” fundraiser in Boston to honor individuals of integrity and selflessness who embody the spirit of service and provide positive leadership for the lesbian, gay, bisexual, and transgender community. Dr. Mayer currently serves as medical research director and co-chair of the Fenway Institute. He is also director of the Brown University AIDS Program and professor of medicine and community health. Dr. Mayer currently serves as co-chair of the Center for Global Health Policy and has served on the boards of the HIV Medicine Association (HIVMA), the Gay Lesbian Medical Association (GLMA), amfAR, The Foundation for AIDS Research, and is currently a member of the Governing Council of the International AIDS Society.

Allan R. Ronald, MD, FIDSA, has been awarded the Association of Medical Microbiology and Infectious Disease (AMMI) Canada Lifetime Achievement Award for 2010. The award recognizes Dr. Ronald’s over 40-year career focused on preventing and treating infectious diseases, as well as educating future physicians. In addition to the award, he will be inducted into the Canadian Medical Hall of Fame this month. Dr. Ronald officially retired in 2000 after a 32-year career as a professor and researcher with the University of Manitoba but has continued to foster the comprehensive HIV/AIDS Care and Prevention Program in Uganda.

Are you a member on the move? Do you know someone who is? Contact Stephanie Cox at scox@idsociety.org so that we can announce it to our membership.

Welcome, New Members!

Members

Archbald-Pannone, Laurie, MD, MPH
Chowdhary, Anuradha, MD, MBBS
Courtney, Thomas, MD
Enriquez, Maithe, PhD
Fangman, John, MD
Farquhar, Carey, MD, MPH
Kitt, Therese, MD
Martin, Emily, MPH, PhD
Paul, Maneesh, MSc, PhD
Slezinger, Albert, MD

Associates

Arauz, Ana, MD
Barry, Darlene, PharmD
Boteler, Diane, MD, DTM&H
Bourbia, Amine, MD
Chkhartishvili, Nikoloz, MD, MS
Evans, Jason, MS, RN
Gomez, Isabel, MD
Grint, Paul, MBBS
Higgins, Brian, PhD
Kelly, Ruth, PhD
Kishel, Joseph, PharmD
Laguerre, Marianne, MD
Luiz, Andre, MD
Mithani, Harsha, MD
Neumann, Mark, MD
Prentice, Elizabeth, MD
Radix, Anita, MD, MPH
Raeder-Devens, Jennifer, MS, BCh
Sacarny, Bonnie
Sanchez, Mitchel, PharmD
Sarabia, Alicia, MD
Smits, Nicole, PhD
Suksompoth, Kanokrat, MD
Thurman, Karen, MSc
Uthman, Blane, MSc
Vance, Graham, BSN
Vassar, Jack, MS
Verma, Indu, PhD
Wang, Wen, DO
Youssef, Mohamed, MD
Zimmermann, Judith

Members-in-Training

Ali, Sajjad, MBBS
Campbell, Jennifer, PharmD
Chung, Christina, PharmD, RPh
Colburn, Nora, MD
Geisinger, Edward, MD, PhD
Hovenic, Thomas, MD
Kim, Dong Hyun, MD
Kwak, Byung Ok, MD
Maurtua-Neumann, Paola, MD
Newman, Jessica, DO
Sears, Jennifer, MPH
Wolf, Joshua, MBBS

In Memoriam

Kilbourne, Edwin, MD
Pollack, Matthew, MD

IDSA Influenza Conference Available Online, with CME Credit

IDSA members can register for free to view sessions from IDSA’s Seasonal and Pandemic Influenza 2011 conference online. Sessions from the conference, which took place Jan. 27-28, are available to view on-demand, with CME credit available.

This year’s program featured an array of topics including epidemiology, cross-cutting issues like communication, antiviral deployment, and infrastructure and surge. Speakers addressed:

  • the international impact of pandemic and seasonal influenza
  • new pandemic and seasonal influenza planning strategies, including the role of state and public health officials
  • the improvement of public-private sector coordination efforts, particularly related to vaccine developments

Participants included members of the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), state and local health officials, and ID professionals.

For more information, visit www.idsalive.com.

IDSA Lyme Disease Online Course Offers CME Credit

Tick season is now upon us. Prepare yourself and your practice with IDSA’s online case study course for the clinical assessment, treatment, and prevention of Lyme disease. Using cases written by expert faculty members, participants will be better able to:

This course is intended for clinicians with patients who are either at risk for, or are being treated for, Lyme disease. The audience includes physicians and other health care professionals.

Each case is accredited for .25 CME credits. To receive CME credit, you must complete at least four of the six cases, score 70 percent correct or higher on the post-test, and complete the evaluation. A letter of completion is also available for non-physicians.

Learn more and register for the course at lymecourse.idsociety.org.

From the President: Combating Antimicrobial Resistance

Ricky Lannetti, a star college football player, was only 21 years old when a methicillin-resistant Staphylococcus aureus (MRSA) infection cut his life short in 2003. I had the honor of meeting Ricky’s mother, Theresa Drew, as she shared her son’s story earlier this month at two IDSA events highlighting the serious public health threat posed by antimicrobial resistance.

Ricky Lannetti, a star college football player, was only 21 years old when a methicillin-resistant Staphylococcus aureus (MRSA) infection cut his life short in 2003. I had the honor of meeting Ricky’s mother, Theresa Drew, as she shared her son’s story earlier this month at two IDSA events highlighting the serious public health threat posed by antimicrobial resistance and the need for action to address this global public health crisis before more lives like Ricky’s are lost.

On World Health Day, April 7, which focused on antibiotic resistance, IDSA brought together government officials, lawmakers, physicians, industry representatives, and those whose lives have been forever altered by drug-resistant infections to speak about this complex issue at a press conference and a congressional briefing in Washington, D.C. I thank all of the speakers for their participation and their ongoing commitment to solving this problem.

IDSA also released an important new paper by IDSA leaders outlining specific public policy strategies and research activities to address resistance and the lack of new antibiotic development. "Combating Antimicrobial Resistance: Policy Recommendations to Save Lives" is published in Clinical Infectious Diseases and is available online. (Visit IDSA’s website and see the related article in this issue for more information on our recommendations.)

Our speakers included Food and Drug Administration (FDA) Commissioner Margaret Hamburg, MD, who described FDA’s efforts to facilitate antibiotic approvals. (You can read her remarks on FDA’s website.) Dr. Hamburg noted that several important FDA guidances for industry will be published later this year to provide a clearer approval pathway for antibiotics needed to treat key infections.

In addition to clearer FDA guidances, there is a need for statutorily-defined incentives and stronger and better-coordinated public health and research efforts to combat resistance.  Focusing on these issues, two members of Congress also spoke: Rep. Phil Gingrey, MD (R-GA), lead sponsor of the Generating Antibiotic Incentives Now (GAIN) Act, and Rep. Jim Matheson (D-UT), lead sponsor of the Strategies to Address Antimicrobial Resistance (STAAR) Act.

Minnesota State Epidemiologist Ruth Lynfield, MD, FIDSA, gave an update on the spread of antibiotic resistance in her state and elsewhere; Paul Miller, PhD, vice president and chief scientific officer in the antibacterials research unit at Pfizer, summarized challenges in antibiotic drug discovery from the pharmaceutical industry’s perspective; Brad Spellberg, MD, FIDSA, a member of IDSA’s Antimicrobial Availability Task Force, outlined key recommendations from IDSA’s new policy paper; and Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs at the Centers for Disease Control and Prevention (CDC), provided an additional perspective on antimicrobial resistance and CDC’s efforts.

At a congressional briefing featuring several of the same presenters, Rima Khabbaz, MD, deputy director of infectious diseases at CDC, and Neil Fishman, MD, FIDSA, immediate past president of the Society for Healthcare Epidemiology of America, spoke about the growing threat of resistance and the importance of antibiotic stewardship in addressing the problem. As the activities above illustrate, confronting antimicrobial resistance and the market failure represented by the broken antibiotic development pipeline are important priorities for the Society, and we will maintain our focus on this issue.

The Department of Health and Human Services (HHS) Interagency Task Force on Antimicrobial Resistance recently issued a draft public health action plan to combat antimicrobial resistance. IDSA is reviewing the plan, which is available online. We will respond to HHS with comments, drawing upon the recommendations in the Society’s latest policy paper. In the coming months, a report is also expected from the joint U.S./European Union Transatlantic Task Force, established in 2009 to encourage global research and development of new antibiotics and to address antimicrobial resistance.

Other recent developments include the National Institute of Allergy and Infectious Diseases’ (NIAID) plan for a new clinical trials network primarily focused on bacterial antibiotic resistance, but also providing the ability to rapidly address emerging infectious diseases. An NIAID town hall meeting in March provided more information, and the meeting presentations and other updates are available on NIAID’s website. IDSA will continue to communicate with members as these plans progress.

Finally, in the next few weeks, IDSA members will be receiving a survey seeking input on what the Society’s priorities should be in the coming years. Your responses will be invaluable as the Board of Directors engages in strategic planning discussions at its June meeting. Thank you in advance for your participation in this brief survey.

 

 


 

Updated Guidelines for the Prevention of IV Catheter-Related Infections

Released by the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC), updated guidelines for the prevention of intravascular catheter-related bloodstream infections are now available online.

Updated guidelines for the prevention of intravascular catheter-related bloodstream infections are now available online. Released in April by the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC), the guidelines were developed by a working group led by scientists from the National Institutes of Health (NIH) along with 14 other professional organizations, including IDSA, which also endorsed the guidelines.

Published in the May 1 issue of Clinical Infectious Diseases, the guidelines replace those issued in 2002. Major areas of emphasis include:

  • educating and training health care personnel,
  • using maximal sterile barrier precautions during catheter insertion,
  • cleaning skin with chlorhexidine,
  • and avoiding routine replacement of certain catheters.

“Catheter-related bloodstream infections—like many infections in health care—are now seen as largely preventable," said Naomi O'Grady, MD, FIDSA, lead author of the guidelines and medical director of procedures, vascular access, and conscious sedation services at the NIH Clinical Center Critical Care Medicine Department, in a CDC/NIH press release. "Implementation of these critical infection control guidelines is an important benchmark of health care quality and patient safety."

A focus on preventing these infections, and specifically central line-associated blood stream infections, has proven to be effective in improving patient safety, according to CDC. A recent CDC report found that rates of bloodstream infections in ICU patients with central lines decreased by 58 percent in 2009 compared to 2001, representing up to 27,000 lives saved and $1.8 billion in excess health care costs (see March 2011 IDSA News).

Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our website.

IDSA Journal Club

April 2011

This month, studies investigating: protease inhibitor therapy for chronic HCV infection, bacterial contamination of physician uniforms vs. infrequently washed white coats, alcohol prep pads contaminated with Bacillus, and an update on tuberculosis in the United States.

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

Click here for the previous edition of Journal Club. 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.


Protease Inhibitor Therapy for Chronic HCV Infection
Reviewed by Jason Weinberg, MD

Chronic hepatitis C virus (HCV) infection is common worldwide, but outcomes are unsatisfactory with the current standard therapy of peginterferon and ribavirin.  The addition of boceprevir, an HCV-specific protease inhibitor, was associated with improved sustained virologic response in two studies in the March 31 edition of The New England Journal of Medicine.

The first study examined the safety and efficacy of boceprevir when used in conjunction with peginterferon and ribavirin for patients with untreated chronic HCV infection.  Following a four-week lead-in period in which all patients were treated with peginterferon and ribavirin, patients treated with 44 weeks of triple therapy had a significantly better rate of sustained virologic response (66 percent) than did patients treated with only peginterferon and ribavirin (38 percent).  A similar rate of sustained virologic response (63 percent) was seen in a third group that received 24 weeks of triple therapy, after which all treatment was discontinued if HCV RNA was undetectable at weeks eight through 24 (response-guided therapy).  A poor initial response to the four-week peginterferon-ribavirin lead-in period was associated with lower rates of sustained virologic response and higher rates of boceprevir resistance.

The second study describes the results of a trial with a similar design, using boceprevir in patients who previously failed standard therapy for chronic HCV infection.  Boceprevir again improved outcomes, with overall sustained virologic response in 66 percent of patients receiving 44 weeks of triple therapy and 59 percent of patients receiving response-guided therapy compared to 21 percent of patients receiving 44 weeks of standard therapy.  This benefit was seen in both patients who had not responded to previous therapy and patients who had had a relapse after previous therapy.  Rates of sustained virologic response were again lower in patients who had a minimal response to a four-week peginterferon-ribavirin lead-in period, although boceprevir still provided some benefit.

In both studies, anemia was more common in patients receiving boceprevir, sometimes prompting dose reductions and the use of transfusions and erythropoietin in boceprevir recipients.  It is also important to note that boceprevir is active only active against HCV genotype 1, limiting its usefulness to patients infected with that genotype.  Despite caveats such as these, boceprevir and telaprevir, a similar HCV-specific protease inhibitor that has also been used in recent clinical trials, appear to provide welcome additions to otherwise limited treatment options for chronic HCV infection.

(Poordad et al.  New Engl J Med. 2011;364:1195-206 and Bacon et al.  New Engl J Med. 2011; 364:1207-17.)

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Bacterial Contamination of Physician Uniforms vs. Infrequently Washed White Coats 
Reviewed by George R. Thompson III, MD

In recent years, British health officials have mandated that health care workers abandon their traditional white coats in favor of daily laundered short-sleeve uniforms.  Although well intentioned, this attempt to reduce bacterial contamination of health care worker clothing has been based on supposition alone.  A prospective, randomized controlled trial published in the April issue of the Journal of Hospital Medicine compared the extent of bacterial contamination of physicians’ white coats with that of newly laundered standardized short-sleeved uniforms.

One hundred physicians were randomized to the white coat group or the physician uniform group.  Cultures were obtained using an imprint method of each participants’ breast pocket, sleeve cuff (long-sleeved for white coats, short-sleeved for uniforms) and from the volar surface of the wrist eight hours after beginning the workday.  A subset additionally had cultures obtained two-and-a-half, five, and eight hours after they donned the uniforms.  

No differences were found between total colony counts or the rate of methicillin-resistant Staphylococcus aureus (MRSA) positivity in cultures obtained from white coats versus newly laundered uniforms at eight hours.  Additionally, despite the newly laundered uniforms demonstrating near sterility at the time they were put on, by two-and-a-half-hours hours, 50 percent of the total colonies counted at eight hours were already present. 

Although this study evaluated only total colony counts and the presence of MRSA, and did not include an assessment of Gram-negatives or other drug-resistant pathogens, it cautions against hospital policy changes in the absence of supportive data.  In fact the authors suggest that work clothes would have to be changed every few hours if the intent were solely to reduce bacterial contamination.  Their data does not support discarding long-sleeved white coats for short-sleeve uniforms changed on a daily basis.

(Burden et al.  J Hosp Med.  2011;6:177-182.)

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Alcohol Prep Pads Contaminated with Bacillus
Reviewed by Kathryn E. Stephenson, MD, MPH

The Centers for Disease Control and Prevention (CDC) reported in March that two cases of Bacillus cereus bacteremia and sepsis in children in Colorado in 2010 were most likely due to the use of contaminated alcohol prep pads during the insertion of vascular catheters.

An investigation of the two cases revealed that 40 out of 60 alcohol prep pads sampled at a Colorado children’s hospital yielded B. cereus or Bacillus spp., and that the pads were not labeled as either sterile or nonsterile on the outside of the package. The pads were supplied by a single manufacturer that subsequently recalled the product in January 2011 because of potential contamination.

It is important to be aware that not all alcohol prep pads are sterile, and that B. cereus group and Bacillus species are resistant to killing by alcohol. Contamination of the pads with Bacillus spp. can lead to health-care associated outbreaks of invasive disease as well as pseudoinfections from contaminated tissue samples. As a result of the investigation, the Food and Drug Administration warned health care providers in a news release that nonsterile alcohol prep pads should not be used to prepare the skin of patients for surgery or for sterile procedures, including catheter insertion. In addition, FDA advised that nonsterile pads not be used on patients with a depressed immune system. CDC also recommended that manufacturers do a better job of labeling their products sterile or nonsterile to avoid misuse by health care facilities and providers.

(Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. March 25, 2011:60(11):347.)

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Update on Tuberculosis in the United States
Reviewed by Jonathan Li, MD

While tuberculosis (TB) continues to be one of the leading causes of death worldwide from an infectious disease, the rates of new TB cases continue to decline in the United States. A report from the Centers for Disease Control and Prevention (CDC), published in the March 25 issue of the Morbidity and Mortality Weekly Report, provides the latest update.

In 2010, 11,181 TB cases were reported in the U.S., an incidence of 3.6 cases per 100,000 people (compared to a rate of 340 per 100,000 people in Africa). Of these cases, 40 percent were born in the U.S., a 3.7 percent decrease compared to 2009 and a 75 percent decrease compared to 1993.  The 6,707 TB cases (60 percent) from foreign-born individuals represent a 4 percent decrease since 2009 and a 47 percent decrease since 1993.  In 2010, four countries accounted for half of all TB cases from foreign-born individuals: Mexico (23 percent), the Philippines (11 percent), India (9 percent), and Vietnam (8 percent).  In 2010, Hispanics accounted for more TB cases than any other ethnic group, but Asians had the highest TB case rate (22.5 per 100,000 persons).       

A total of 113 cases of multidrug-resistant TB (1.3 percent) were identified that were resistant to at least isoniazid and rifampin (compared to a 3.6 percent rate globally in 2008).  Only one case of extensively drug-resistant (XDR) TB was reported in the U.S. in 2010. (XDR TB is defined as resistance to isoniazid, rifampin, fluoroquinolone, and at least one second-line injectable drug.)  Based on the latest data from 2007, 94 percent  of those who started treatment eventually completed treatment.

This CDC update highlights the progress that has been made in the control of the TB epidemic in the United States.  However, further progress will be hindered by the headwind of a persistent worldwide epidemic, which will likely lead to a growing gap in the rates of TB incidence between U.S.-born and foreign-born individuals.

(Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. March 25, 2011 / 60(11);333-337.)

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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:

April 15

  • Antibiotic Resistance and Bacterial Altruism
  • The Viral Portion of Our Microbiome: The Gastrointestinal Virome
  • Persisting Alteration of Gastrointestinal Bacterial Flora

April 1

  • CRP, ESR, or both?
  • Intracellular Pathogens are not Protected from Antibody
  • Anaplasma and Ixodes: Keeping warm with Snuggling and Antifreeze