IDSA News - July/August 2011
(Print All Articles)

CDC Offers Guide on Infection Control for Outpatient Settings

Adherence to standard infection prevention practices may be lacking in many outpatient settings (for an example, see “EIN Update in this issue). To address this, the Centers for Disease Control and Prevention (CDC) has released a new, concise guide and checklist for providers.

The Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care is based on existing, evidence-based CDC guidelines that are widely used in hospitals. The guide includes supporting materials such as a free continuing medical education course on unsafe injection practices.

According to the guide, outpatient facilities and practices should:

  • Develop and maintain infection prevention and occupational health programs
  • Ensure that at least one individual with training in infection control is employed by or regularly available to the facility. This person should be responsible for overseeing the facility's infection prevention program.
  • Develop written infection-prevention policies and procedures appropriate for the services provided by the facility and based upon evidence-based guidelines, regulations, or standards
  • Provide job- or task-specific infection prevention education and training to all health care personnel
  • Make sure sufficient and appropriate supplies necessary for adherence to standard precautions are available
  • Perform regular audits and competency evaluations of staff's adherence to infection prevention practices
  • Utilize CDC's infection prevention checklist for outpatient settings to assess infection control practices
  • Adhere to local, state, and federal requirements regarding surveillance of health care-associated infections, reportable diseases, and outbreak reporting

The guide, checklist, and supporting materials can be found on the CDC website.

Gonorrhea Susceptibility to Cephalosporins May Be Declining, CDC Reports

An analysis of 10 years’ worth of gonorrhea samples from patients across the U.S. suggests that the pathogen’s susceptibility to cephalosporins may be declining, according to a July report in the Centers for Disease Control and Prevention (CDC)’s Morbidity and Mortality Weekly Report (MMWR).

The report describes trends in cephalosporin susceptibility among Neisseria gonorrhoeae isolates from male patients in 30 U.S. cities. The analysis found that minimum inhibitory concentrations (MICs) to cephalosporins are increasing, suggesting that susceptibility to cephalosporins might be declining. The prevalence of isolates with elevated MICs remains low overall, CDC said.

From 2000 to 2010, the percentage of isolates exhibiting elevated MICs rose from 0.2 percent to 1.4 percent of isolates for cefixime, and from 0.1 percent to 0.3 percent for ceftriaxone, according to the report. No treatment failures have been observed in the U.S.

“Health care providers should use ceftriaxone and azithromycin for treatment of gonorrhea, remain vigilant for gonorrhea cephalosporin treatment failures, and report treatment failures to their local or state health departments,” the CDC report said. “Local and state health departments should promote the maintenance of local gonococcal culture capacity, establish options for local gonococcal antibiotic susceptibility testing, consider enhancing surveillance for cephalosporin-resistant gonorrhea, and report gonorrhea cases with cephalosporin treatment failure to CDC.”

The full MMWR report is available online. Additional information on the topic can be found on CDC’s website.

EIN Update: GNR Bacteremia Following Urologic Surgery

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 EIN. The reader assumes all risks in using this information.

EIN members recently discussed cases of Gram-negative rod (GNR) bacteremia following urologic surgery and infection control steps for prevention.

A member in Florida shared a recent statement from the American Urology Association (AUA) noting that “the rates of infectious complications, including sepsis, after transrectal prostate needle biopsy may be increasing” and that urologists should be aware of the issue.

The notice also referenced AUA’s best practice statement for antimicrobial prophylaxis. The antimicrobial of choice before a prostate needle biopsy is a fluoroquinolone or a second- or third-generation cephalosporin, according to AUA. Alternative agents include an aminoglycoside plus metronidazole or clindamycin. Oral fluoroquinolones are the most commonly used agents in clinical practice, AUA says.

“We have seen a few cases of GNR bacteremia with sepsis after prostate biopsy or external radiation therapy (XRT) brachytherapy implants despite quinolone prophylaxis and plan on publishing our experience of several cases with a literature review,” an EIN member in Florida wrote. “Has anyone in our ID community seen similar cases?”

Seven EIN members from five different states (California, New York, Ohio, Pennsylvania, and Texas) reported seeing such cases.

A respondent in Texas described a recent patient with a fever and chills 48 hours after a prostate biopsy, despite being given levofloxacin, cefixime, and metronidazole prophylaxis by a urologist. The patient’s blood and urine culture grew extended-spectrum beta-lactamase (ESBL) E. coli. “The patient did well on ertapenem,” the member wrote, “and I am treating as possible prostatitis.”

An EIN member in California also reported seeing higher rates of these cases than usual, “usually ciprofloxacin-resistant E. coli,” the member noted. “We are working with our urologists on prophylaxis modification.”

It is important to ensure that urologists are using a single-use, sterile needle guide, or following meticulous cleaning and disinfection methods for re-processing, a respondent with the Centers for Disease Control and Prevention (CDC) wrote. “These procedures are often done in an outpatient setting where rigorous infection control oversight may be lacking.”

The CDC respondent cited a May 2007 study in the journal Urology describing an outbreak of Pseudomonas aeruginosa infections after transrectal ultrasound-guided prostate biopsies. The outbreak resulted from a contaminated needle guide.

Emphasizing the importance of infection control, an EIN member from Missouri recalled a series of three patients who were admitted “with very peculiar multi-drug resistant GNR (E. coli, I believe) symptomatic and clinically significant urinary tract infections immediately (within days) following outpatient transrectal prostate biopsies.” All of the cases came from the same urologist, had had biopsies taken at the same outpatient office, and presented within 30 to 90 days of each other.

Hospital infection control (IC) staff visited the urologist’s office. The IC team “felt that there were significant irregularities in the sterilization practices used by this specific busy urologist’s office, and they reviewed basic standard sterile procedure with the doctor and the doctor’s staff,” the Missouri member wrote. “We immediately saw a complete disappearance of these types of cases after the IC team visit.”

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 email 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.

Income for ID Physicians Up in 2010

Infectious disease physicians saw their income increase in 2010, according to data from the Medical Group Management Association. The median income for infectious disease physicians was $219,556 in 2010, compared with $201,543 in 2009.

ID physicians who practice in single-specialty groups (median = $226,283) fared better than their colleagues in multi-specialty groups (median = $214,999). ID physicians in the South (median = $261,515) did better than ID physicians in other parts of the country.

The data is available on the IDSA website, along with guidance on how to negotiate equitable compensation arrangements for infection control and other ID services. You must be logged in to access this content.

Medicare Payment Cuts Again Looming for 2012

Additional proposed changes will affect how ID physicians will be paid

Unless Congress acts before the end of the year, physicians will see a 29.5 percent cut in their Medicare payments starting in 2012. Lawmakers avoided cuts in 2011 with several short-term fixes, but the cuts, called for by the flawed Medicare physician payment formula, are part of the 2012 Physician Fee Schedule Proposed Rule, released in July. The payment cuts are one of several changes in the rule that could significantly affect how ID physicians and their practices are paid.

Separately, physicians may face additional cuts resulting from the recent agreement to increase the federal debt ceiling (see related article), including a 2 percent across-the-board Medicare payment cut if an additional $1.2 trillion in debt reduction is not identified by the end of the year.

Medicare’s Proposed Rule for next year includes several incremental changes to the Physician Quality Reporting System (PQRS) and E-Prescribing (eRx) Incentive Program. Under PQRS, physicians will be able to boost their Medicare payments by only 0.5 percent, down from 1 percent in 2011. eRx incentive payments will hold steady at 1 percent in 2012. However, eligible professionals (EPs) who did not report at least 10 separate eRx events on their Medicare claims during the first six months of 2011, or did not claim an applicable exemption, will see their payments cut by 1 percent in 2012  (see May 2011 IDSA News). The IDSA website has a schedule of PQRS and eRx incentive payments and penalties. (You must be logged in to access this content.)

For individual ID physicians, PQRS claims and registry-based reporting requirements will remain roughly the same. The biggest changes are that Medicare proposes to eliminate the six-month reporting period (except for measures groups reported through a PQRS registry) and to modify the electronic health record (EHR) reporting option to align with the EHR Incentive Program’s clinical quality measures (CQM) reporting requirements. A new pilot program will allow EPs to fulfill their PQRS reporting requirement and complete the CQM component of the EHR Incentive Program. IMPORTANT:  EHR technology must be certified to report PQRS measures, which is not the same as “meaningful use” certification under the EHR Incentive Program.

No big changes are planned for the eRx Incentive Program. Similar to 2011, EPs must report 25 separate eRx events (specified by the numerator code G8553) during the 2012 and 2013 calendar years to qualify for incentive payments. However, to avoid the eRx payment penalties in 2012 and 2014, Medicare proposes allowing eRx reporting of the G8553 code regardless of whether the eRx event is associated with a denominator-eligible encounter code. This means ID physicians who electronically prescribe a medication in conjunction with an inpatient encounter or outpatient infusion can avoid the 2013 and 2014 eRx payment penalty. Additionally, two reporting periods—6 months and 12 months—will be available for EPs to avoid the penalty moving forward.

Medicare also proposes a PQRS and eRx Group Practice Reporting Option (GPRO) for practices of at least 25 EPs. This is a change from 2011, when practices of two or more EPs could report via a separate GPRO (referred to as GPRO II). Interested group practices must self-nominate to report via the group option. The quality reporting requirements will vary by group size. 

In addition to the PQRS and eRx Incentive Program, the Proposed Rule outlines how Medicare will begin to pay physicians for their performance. The Value-Based Payment modifier, which will be rolled out over two years beginning in 2015, will pay physicians differently based on the risk-adjusted cost and quality of their care compared to their local, regional, and national peers. The initial quality and cost of care measures will be published by Jan. 1, 2012.

Last December, Medicare launched a Physician Compare website that includes names and demographic information for physicians and whether they submitted quality data for the 2009 PQRS. Over the long term, Medicare will publicly report physicians’ performance information, including their quality and cost of care and patients’ experience of care. As a first step, Medicare plans to report 2012 performance information for GPRO participants on the site as early as 2013.

Lastly, Medicare has proposed a review of 91 Evaluation and Management (E&M) services codes to ensure their values are appropriate relative to other services and procedures paid under the Physician Fee Schedule. This is part of an ongoing effort to incentivize primary care and other cognitive specialties, particularly those focused on coordinating care for patients with multiple chronic conditions. Several outpatient infusion codes commonly used by ID physicians also are proposed for review and potential revaluation. IDSA will monitor this process to ensure that the concerns of ID physicians are considered.

The Proposed Rule is open for public comment until Aug. 30, and IDSA will be providing feedback. The Final Rule is expected by Nov. 1.

Note: Medicare has issued separate proposals that would expand the number of exemptions available under the eRx Incentive Payment Program and withdraw the physician signature requirement for lab tests. This latter requirement, originally scheduled to take effect earlier this year, was postponed due to significant opposition from physicians (see June 2011 IDSA News).

Physicians Must Start EHR Reporting Soon to Earn 2011 Incentive Payments

A key date is approaching for eligible providers wanting to earn a Medicare incentive payment for adopting certified electronic health records (EHRs) and demonstrating “meaningful use.” Providers must begin their 90-day reporting period by Oct. 3 to be eligible for the incentive payment for the 2011 calendar year.

Through Medicare’s EHR Incentive Program, eligible physicians can earn $18,000 for adopting EHRs and demonstrating meaningful use during 2011, and as much as $44,000 in total incentives if they successfully participate in the program over the next five years. To earn the incentive payment for this year, however, physicians must demonstrate meaningful use—by reporting 15 core objectives, five menu objectives, and six clinical quality measures—for a continuous 90-day period starting no later than Oct. 3.

While physicians who wait until 2012 to adopt a certified EHR system can still maximize their incentive payments, the payment amounts will decline slightly each year thereafter. Eligible physicians who do not adopt EHRs will face Medicare payment penalties starting in 2015. A schedule of incentive payments and penalties is available on IDSA’s website. (You must be logged in to access this link.)

Key reminders about the EHR incentive program:

  • 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. You must complete this process yearly.
  • 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 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 Medicare recalculates your percentage of hospital-based services each year to determine eligibility. 

Note: IDSA has asked Medicare to clarify whether physicians who are determined to be hospital-based in any year will be subject to payment penalties beginning in 2015 for failing to become a “meaningful user.” This question will be critical for ID physicians whose proportion of inpatient to outpatient services could make them eligible for the incentive one year but not the next.

Once registered, providers can start reporting the results of their EHR meaningful use objectives and attest that they have met the requirements to receive incentive payments, a process called attestation. The Centers for Medicare and Medicaid Services (CMS) has helpful resources on its website, including a user guide and a video.

Other resources include the EHR Information Center, available at 888-734-6433, from 7:30 a.m. to 6:30 p.m. Central Time, Monday through Friday. CMS also has a listserve to provide updates on registration, reporting and 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.

For physicians still considering an EHR system, it is important to take the time to select the appropriate one and plan ahead for future changes, such as selling your practice to a hospital, which may affect how much you wish to invest in an EHR system. To help IDSA members compare EHRs and learn about meaningful use requirements, IDSA has partnered with the American College of Physicians and other medical specialty societies on a free interactive website, AmericanEHR Partners.

Research Highlights from the International AIDS Conference

Researchers and scientists presented many exciting new findings at the 2011 International AIDS Conference, held in Rome in July and organized by the International AIDS Society (IAS). The Center for Global Health Policy was there with live coverage on Science Speaks, the Center’s blog.

Highlights include:

  • WHO moves forward but does not release new guidance for HIV-discordant couples: A premeeting session originally expected to feature long-anticipated World Health Organization (WHO) guidance on HIV counseling, testing, and access to antiretroviral therapy for sero-discordant couples—where one partner is HIV-infected and the other is not—instead highlighted the work in progress in clinical trials confirming the efficacy of HIV treatment and pre-exposure prophylaxis (PrEP) using antiretrovirals.

  • IAS 2011: Where we go from here: In an exclusive video interview with Science Speaks, the director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, MD, FIDSA, spoke about treatment as prevention, PrEP, and the way forward.

  • Male circumcision curbs spread of HIV over time, risky behavior does not increase: Three years after the voluntary medical male circumcision campaign began in the Orange Farm Township in South Africa, the first real-world results show a marked reduction of HIV acquisition among circumcised adult men, a drop in HIV incidence of 76 percent among men in the community, and HIV prevalence among circumcised men that is 55 percent lower.

  • PrEP works for heterosexual couples too: Preliminary results from two large studies have now shown that a daily antiretroviral tablet taken by people who do not have HIV reduces their risk of contracting the virus by up to 73 percent.

For all of the IAS 2011 coverage from the Global Center’s blog, Science Speaks, including new details released by the HPTN 052 “HIV treatment is prevention” study team, please visit

Hill Staff to Tour HIV and TB Programs in Kenya with Global Center

Joined by House and Senate staffers who work on global health funding issues, the Center for Global Health Policy in August will tour HIV and tuberculosis programs in Kenya that receive U.S. funding. The trip will give Hill staff a first-hand view of these programs, the progress they are making, and why U.S. support is needed. The congressional delegation will spend two days in Nairobi visiting hospitals and clinics that serve the Kibera slums (some of the world’s largest), meeting with key Ministry of Health officials, and participating in a roundtable with civil society organizations. The trip will also include clinical site visits in the more rural parts of the country: Kisumu, Kericho, and Eldoret. Stay tuned to the Global Center’s blog, Science Speaks, for posts from the trip!

Illinois Health Providers Urge Support for Domestic and Global AIDS Programs

Led by HIVMA/IDSA members Robert Murphy, MD, and Renslow Sherer, MD, 37 health care professionals in Illinois urged Sens. Mark Kirk (R-IL) and Richard Durbin (D-IL) in a July letter to defend longstanding, bipartisan efforts to fund domestic and global AIDS programs. The programs are poised to lose funding in fiscal year 2012, and as lawmakers with authority over funding for domestic and global AIDS programs, Sens. Kirk and Durbin can influence the U.S. response to HIV/AIDS. The letter (PDF) can be found on the Center for Global Health Policy’s website.

To learn more about how you can speak up for global health, please contact the Global Center.

Restriction on AIDS Funding Violates First Amendment, Court Rules

A U.S. policy that denies federal funding to any AIDS organization that does not explicitly oppose prostitution and sex trafficking is unconstitutional, according to a ruling (PDF) issued by the U.S. Court of Appeals for the Second Circuit in July. The U.S. government had required that organizations seeking government funds publicly announce their opposition to prostitution and sex trafficking. The ruling applies to the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, which authorizes billions of dollars of U.S. aid that targets the three diseases. The majority opinion contended that the provision is unconstitutional because “compelling speech as a condition of receiving a government benefit cannot be squared with the First Amendment.” The ruling upholds an injunction blocking the government’s enforcement of the policy. Visit the Center for Global Health Policy’s blog, Science Speaks, for the full story.

HHS Seeks Input on Major Changes to Rules Protecting Human Research Subjects

The Department of Health and Human Services (HHS) proposed sweeping changes (PDF) in late July to regulations that govern research on human subjects, and federal officials are seeking input on several issues. Often referred to as the Common Rule, the regulations have not been substantially revised since they were established in 1991 to guide federally funded research involving human subjects.

HHS’ goal is to strengthen protections for subjects while also modernizing and simplifying the current system. The research landscape has changed dramatically in the past 20 years, and the proposed changes are an attempt to keep pace and improve gaps and inconsistencies in federal regulations, HHS says. A government FAQ document explains the proposal, and a related table compares existing regulations with the changes, many of which address issues IDSA has raised about the increasing regulatory burden on research (see IDSA’s related policy statement). The government’s proposal is the first step in a months-long process during which HHS plans to gather input widely.

The proposed changes include:

  • revising the existing risk-based framework to more accurately calibrate the level of review to the level of risk

  • using a single Institutional Review Board review for all domestic sites of multi-site studies

  • extending federal regulatory protections to all research conducted at U.S. institutions receiving funding from the 15 Common Rule federal agencies

  • implementing a systematic approach to collecting and analyzing adverse events data across all trials to harmonize the complicated array of definitions and reporting requirements

IDSA plans to submit comments on the proposed changes and encourages IDSA members to do so as well. Comments are due Sept. 26. Visit the HHS website for instructions. For more information, or to share comments with IDSA, contact Audrey Jackson, PhD, at IDSA.

In related news, IDSA urged federal officials to exempt research from the Health Insurance Portability and Accountability Act (HIPAA) and create a new privacy protection framework for research, in response to a separate HHS proposal to exempt research from one requirement of HIPAA (see related article).

Additional Resources:

Advance Notice of Proposed Rulemaking: Human Subjects Research Protections: Enhancing Protections for Research Subjects and Reducing Burden, Delay, and Ambiguity for Investigators (PDF)

HHS website (links to proposal, FAQ, press release, and comment submission instructions)

IDSA policy statement:  Grinding to a Halt: The Effects of the Increasing Regulatory Burden on Research and Quality Improvement Efforts

Commentary by Ezekiel J. Emanuel, MD, and Jerry Menikoff, MD: Reforming the Regulations Governing Research with Human Subjects, New England Journal of Medicine 

IDSA, HIVMA Urge Balanced Approach to Reducing Deficit that Protects Health

President Obama in early August signed a bill into law that raises the nation’s debt limit ceiling, reduces the deficit by over $900 billion over 10 years through caps on spending, and creates a special congressional committee tasked with identifying an additional $1.2 trillion in deficit reduction by the end of the year. It is not yet clear how the spending caps will impact funding for critical ID programs at the National Institute of Allergy and Infectious Diseases, the Centers for Disease Control and Prevention, and other agencies.

IDSA will continue to work with Congress during the upcoming appropriations process and deficit reduction debates to underscore the value of investments in public health and research, and the need for a balanced approach to reducing the deficit. This will include new ways for IDSA members to get involved and advocate for needed funding.

Earlier in the deficit debate, IDSA and the HIV Medicine Association (HIVMA) urged President Obama in a letter (PDF) to apply three principles in developing strategies to reduce the deficit while ensuring public health and the health care system are protected:

  • Support an equitable and balanced approach that incorporates reductions in federal spending and revenue generation and does not disproportionately rely on spending cuts to programs that are not related to defense and homeland security.

  • Do not impose rigid spending caps that force across-the-board cuts that eliminate the opportunity to consider priorities.

  • Consider programs protecting public health, biomedical research, and vulnerable populations a “last resort” when evaluating spending cuts.

In addition, HIVMA joined 11 HIV/AIDS advocacy groups in urging President Obama and congressional leaders in a July statement (PDF) to consider the impact on vulnerable populations, including people living with HIV/AIDS, from cuts in funding. HIVMA and Ryan White Medical Providers Coalition also called on lawmakers to use a balanced approach in implementing the budget legislation and to consider the impact of cuts on patients (see the statement online).

IDSA opposed a separate debt reduction proposal that would have cut payments for Part B drugs, including intravenous antibiotics, administered to Medicare beneficiaries in the outpatient setting. Even a small reduction in payments for these cost-effective treatments could have a devastating impact on patients with serious infections, IDSA said in a July letter (PDF).

In other policy and advocacy news:

  • IDSA responded to a draft federal action plan to combat antimicrobial resistance. In its June comments (PDF), the Society highlighted the need for greater leadership, coordination, input from non-government experts, accountable measures, and resources to address antimicrobial-resistant infections. The draft plan (PDF) was published by the federal Interagency Task Force on Antimicrobial Resistance. 

  • IDSA urged federal officials to exempt research from the Health Insurance Portability and Accountability Act (HIPAA) and create a new privacy protection framework for research. Until that can be done, IDSA called on the Department of Health and Human Services (HHS) to take steps to limit the negative impact of HIPAA on research by exempting research activities from the accounting of disclosures requirement; redefining protected health information in the context of research; and clearly delineating quality improvement efforts from research activities. IDSA’s comments (PDF) were in response to an HHS proposal (see June 2011 IDSA News). In a related development, HHS in late July also proposed sweeping changes to regulations, known collectively as the Common Rule, that govern all federally funded research on human subjects (see related article).

Vote for the IDSA and HIVMA Boards of Directors

Election Ballots Due Sept. 15

IDSA and HIV Medicine Association (HIVMA) members will elect new officers and Board members this summer. You will soon receive a ballot including biographical statements and personal sketches from each of the candidates. The IDSA slate is as follows:

Vice President:

  • Barbara E. Murray, MD, FIDSA
    Director, Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School-Houston; Professor, Department of Internal Medicine, University of Texas Medical School-Houston; Professor, Department of Microbiology and Molecular Genetics, University of Texas Medical School-Houston; Professor, Graduate School of Biomedical Sciences, University of Texas Health Science Center-Houston; Co-Director, Center for the Study of Emerging and Re-Emerging Pathogens, University of Texas Health Science Center-Houston

  • Michael S. Saag, MD, FIDSA
    Director, Center for AIDS Research, University of Alabama at Birmingham (UAB); Professor of Medicine in School of Medicine and Epidemiology, UAB School of Public Health; Director, William C. Gorgas Center for Geographic Medicine, Birmingham, AL

Director Slot 1:

  • Helen W. Boucher, MD, FIDSA
    Director, Infectious Diseases Fellowship Program and Staff Physician, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA; Associate Professor of Medicine, Tufts University School of Medicine, Boston, MA

  • Mary E. Klotman, MD
    R. J. Reynolds Professor of Medicine, Duke University School of Medicine; Chair, Department of Medicine, Duke University Medical Center; Assistant Attending Professor of Medicine and Infectious Diseases, Duke University Medical Center; Chief of Staff, Duke University Hospital, Durham, NC

Director Slot 2:

  • Stanley C. Deresinski, MD, FIDSA
    Clinical Professor of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University; President of Professional Staff, Sequoia Hospital, Redwood City, CA; Hospital Epidemiologist, Sequoia Hospital Redwood City, CA

  • Lawrence P. Martinelli, MD, FIDSA
    Clinical Associate Professor of Medicine, Texas Tech University School of Health Sciences; Attending Staff: University Medical Center, Covenant Medical Center, Covenant Lakeside Hospital, Covenant Specialty Hospital, Lubbock, TX

Director Slot 3:

  • Upton D. Allen, MD, FIDSA
    Chief, Division of Infectious Diseases, Professor of Pediatrics, Senior Associate Scientist, Hospital for Sick Children, University of Toronto; Professor, Department of Health Policy, Management and Evaluation, University of Toronto, Canada

  • Raul E. Isturiz, MD
    Senior Consultant, Centro Medico de Caracas and Centro Medico Docente La Trinidad, Caracas, Venezuela;  Director, Adult Vaccine Center Centro Medico Docente La Trinidad;  Interim Chair and Chair of the Clinical Subcommittee, IDMC Sanofi-Pasteur Dengue Vaccine Studies;  Medical Advisor, Embassy of the United States of America, Caracas, Venezuela

The HIVMA slate is as follows:

Vice Chair:

  • Joel Gallant, MD, MPH, FIDSA
    Professor of Medicine and Associate Director, Johns Hopkins AIDS Service, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine;  Professor of Epidemiology, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

  • Kimberly Smith, MD, MPH
    Associate Professor of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, IL; Attending Physician, Stroger Hospital and the CORE Center, Chicago, IL

Infectious Diseases Slot

  • Wendy Armstrong, MD, FIDSA
    Associate Professor of Medicine, Division of Infectious Disease; Infectious Disease Fellowship Program Director, Emory University, Atlanta, GA;  Medical Director, Infectious Disease Program (Ponce Center), Grady Health System, Atlanta, GA

  • W. David Hardy, MD
    Professor of Medicine-in-Residence, Department of Internal Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA;  Chief, Division of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, CA

  • Lisa Hirschhorn, MD, MPH, FIDSA
    Assistant Clinical Professor of Medicine, Department of Global Health and Social Medicine, Harvard Medical School; Director of Monitoring, Evaluation and Quality, Partners in Health, Boston, MA

  • Susan Koletar, MD, FIDSA
    Professor, Division of Infectious Diseases, Department of Internal Medicine; Director, Division of Infectious Diseases, Ohio State University College of Medicine, Columbus, OH

  • Karen Tashima, MD, FIDSA
    Associate Professor of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University; Director of HIV Clinical Trials and AIDS Clinical Trials Group (ACTG) Clinical Research Site Leader, The Miriam Hospital; Infectious Disease Fellowship Program Director, Warren Alpert Medical School of Brown University, Providence, RI

  • Barry S. Zingman, MD
    Medical Director, AIDS Center; Clinical Director, Infectious Diseases; Professor of Clinical Medicine; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY

Family Medicine Slot

  • Joel Ang, MD
    Clinical Assistant Professor, Family Medicine, Georgetown University; Private Practice Physician, C. A. Caceres Inc., Washington, DC

  • J. Kevin Carmichael, MD, FIDSA
    Unit Chief, El Rio Special Immunology Associates, El Rio Community Health Center, Tucson, AZ

Nurse Practitioner/Physician Assistant Slot

  • James Raper, DSN, CRNP, JD, FAANP, FAAN
    Director and Nurse Practitioner, 1917 HIV Outpatient, Research and Dental Clinics; Associate Professor of Medicine and Nursing; Scientist, Center for AIDS Research (CFAR); Scholar, Lister Hill Center for Health Policy; University of Alabama at Birmingham, Birmingham, AL

The deadline for casting your ballot is Sept 15.

Voting is easy and important for setting the priorities and future direction of IDSA and HIVMA. You will soon receive an electronic ballot by e-mail if you are eligible to vote and have an e-mail address on file. Check for a message from IDSA President James M. Hughes, MD, FIDSA, and HIVMA Chair Kathleen Squires, MD, with a subject line, “2011 IDSA and HIVMA Elections.” Paper ballots will be mailed to all members who are eligible to vote but do not have e-mail addresses on file. Members who do not receive their ballots by e-mail or mail, or who lose their ballots, may call the help desk at Election Services at 1-866-720-4357.


Congratulations, New IDSA Fellows!

Fellowship in IDSA honors individuals who have achieved professional excellence and provided significant service to the profession. The following members were elected to fellowship this year:

Carlos Alvarez, MD, FIDSA
Pontificia Universidad Javeriana, Bogota, Colombia

Africa Alvarez-McLeod, MD, MPH, FIDSA
Cobb County HIV/TB Clinics, Marietta, GA

David Aronoff, MD, FIDSA
University of Michigan Health System, Ann Arbor, MI

Lindsey Baden, MD, FIDSA
Brigham and Women’s Hospital, Boston, MA

Miriam Baron Barshak, MD, FIDSA
Harvard Medical School, Boston, MA

Robert Barthel, MD, FIDSA
Navy Medical Research Unit #3, Cairo, Egypt

Roger Baxter, MD, FIDSA
Kaiser Permanente Vaccine Study Center, Oakland, CA

Tanvir Bell, MD, FIDSA
University of Texas Health Science Center, Houston, TX

Markian Bochan, MD, PhD, FIDSA
Infectious Disease of Indiana, Carmel, IN

Helen Boucher, MD, FIDSA
Tufts Medical Center, Boston, MA

Alain Bouckenooghe, MD, FIDSA
Sanofi Pasteur, Singapore

Robert Brooks, MD, MBA, MPH, FIDSA
University of South Florida College of Medicine, Tampa, FL

D. William Cameron, MD, FIDSA
University of Ottawa at The Ottawa Hospital, Ontario, Canada

Raymond Coghlan, MD, FIDSA
Willis-Knighton Health System, Bossier City, LA

Miguel Colon-Perez, MD, FIDSA
University of Puerto Rico School of Medicine, San Juan, Puerto Rico

Cristie Columbus, MD, FIDSA
Baylor University Medical Center, Dallas, TX

Sara Cosgrove, MD, FIDSA
Johns Hopkins School of Medicine, Baltimore, MD

Patrick J. Danaher, MD, FIDSA
San Antonio Military Medical Center, Fort Sam Houston, TX

Vinod K. Dhawan, MD, FIDSA
Rancho Los Amigos National Rehabilitation Center, Downey, CA

Kevin Dieckhaus, MD, FIDSA
University of Connecticut Health Center, Farmington, CT

Amy Duckro, DO, FIDSA
Kaiser Permanente, Lafayette, CO

Joseph Duncan, MD, PhD, FIDSA
University of North Carolina-Chapel Hill, NC

Robert Duncan, MD, MPH, FIDSA
Lahey Clinic Medical Center, Burlington, MA

Steven Ebert, PharmD, FIDSA
Meriter Hospital, Madison, WI

Richard Ebright, PhD, FIDSA
Howard Hughes Medical Institute, Rutgers University, Piscataway, NJ

F. Richard Ervin, MD, FIDSA
McLeod Health, Florence, SC

Echezona Ezeanolue, MD, MPH, FIDSA
University of Nevada School of Medicine, Las Vegas, NV

Tomas Ferguson, MD, FIDSA
Tripler Army Medical Center, Honolulu, HI

Adam Finn, MD, PhD, FIDSA
University of Bristol, United Kingdom

Michael Forgione Jr., MD, FIDSA
Keesler Medical Center, Keesler Air Force Base, MS

Susan Fraser, MD, FIDSA
Walter Reed Army Medical Center, Washington, DC

David Fredricks, MD, FIDSA
Fred Hutchinson Cancer Research Center, Seattle, WA

Khalil Ghanem, MD, PhD, FIDSA
Johns Hopkins School of Medicine, Baltimore, MD

Michael Glickman, MD, FIDSA
Memorial Sloan-Kettering Cancer Center, New York, NY

Howard Gold, MD, FIDSA
Beth Israel Deaconess Medical Center, Boston, MA

Fernando Guerena, MD, FIDSA
U.S. Army Medical Research Institute of Infectious Diseases, Frederick, MD

Nicholas Haddad, MD, FIDSA
Aleda E. Lutz VA Medical Center, Saginaw, MI

Alan Hauser, MD, PhD, FIDSA
Northwestern University, Chicago, IL

Mary Hayden, MD, FIDSA
Rush University Medical Center, Chicago, IL

C. Mary Healy, MD, FIDSA
Baylor College of Medicine, Houston, TX

David Hirschwerk, MD, FIDSA
North Shore University Hospital, Manhasset, NY

Michael Horberg, MD, FIDSA
Mid-Atlantic Permanente Medical Group, Rockville, MD

Chiu-Bin Hsiao, MD, FIDSA
University at Buffalo, State University of New York, Buffalo, NY

Rezhan Hama Ali Hussein, MD, FIDSA
Spotsylvania Regional Medical Center, Fredericksburg, VA

James Kellner, MD, FIDSA
University of Calgary, Alberta, Canada

Rudolf Kotula, MD, FIDSA
Methodist Physician Clinic, Omaha, NE

Mark Lacy, MD, FIDSA
Flagstaff Medical Center, Flagstaff, AZ

Michael Landrum, MD, FIDSA
Brooke Army Medical Center, Fort Sam Houston, TX

James Lewis II, PharmD, FIDSA
University Health Systems, San Antonio, TX

Angelike Liappis, MD, FIDSA
Veterans Affairs Medical Center, Washington, DC

Ajit Limaye, MD, FIDSA
University of Washington, Seattle, WA

John LiPuma, MD, FIDSA
University of Michigan, Ann Arbor, MI

Susan Little, MD, FIDSA
University of California, San Diego, CA

Mary MacGregor, DO, FIDSA
Travel Medicine Source, Morton Grove, IL

Anna-Pelagia Magiorakos, MD, FIDSA
European Centre for Disease Prevention and Control, Stockholm, Sweden

Prashant Malhotra, MBBS, FIDSA
North Shore LIJ Hofstra School of Medicine, Forest Hills, NY

Mammen Mammen Jr., MD, FIDSA
National Center for Medical Intelligence, Frederick, MD

Masoud Mardani Dashti, MD, FIDSA
Shahid Beheshti Medical University, Tehran, Iran

Kieren Marr, MD, FIDSA
Johns Hopkins University, Baltimore, MD

Jonathan McCullers, MD, FIDSA
St. Jude Children’s Research Hospital, Memphis, TN

Joseph McGowan, MD, FIDSA
North Shore University Hospital, Manhasset, NY

Shelly McNeil, MD, FIDSA
Dalhousie University, Halifax, Nova Scotia, Canada

Jose Montoya, MD, FIDSA
Stanford University School of Medicine, Stanford, CA

Mark Mulligan, MD, FIDSA
Emory University School of Medicine, Decatur, GA

Donald Murphey, MD, FIDSA
Cook Children’s Infectious Disease Clinic, Fort Worth, TX

Bogdan Neughebauer, MD, PhD, FIDSA
Sentara Medical Group, Norfolk, VA

Ellen Neuhaus, MD, FIDSA
Eastern Connecticut Health Network, Vernon, CT

Hari Polenakovik, MD, FIDSA
Wright State University, Dayton, OH

Kenneth Pursell, MD, FIDSA
The University of Chicago, Chicago, IL

Nalini Rao, MD, FIDSA
University of Pittsburgh Medical Center, Pittsburgh, PA

Raymund Razonable, MD, FIDSA
Mayo Clinic, Rochester, MN

Rebecca Redman, MD, FIDSA
Johnson and Johnson, San Jose, CA

Sandra Richter, MD, FIDSA
Cleveland Clinic, Cleveland, OH

Rodrigo Romulo, MD, FIDSA
ID Consultants of Hampton Roads, Norfolk, VA

Katherine Ruiz de Luzuriaga, MD, FIDSA
University of Massachusetts Medical School, Worcester, MA

Helio Sader, MD, PhD, FIDSA
JMI Laboratories, North Liberty, IA

Jorge L. Santana Bagur, MD, FIDSA
University of Puerto Rico, Guaynabo, Puerto Rico

Carlos Seas, MD, FIDSA
Universidad Peruana Cayetano Heredia, Lima, Peru

Upinder Singh, MD, FIDSA
Stanford University, Stanford, CA

Paul Spearman, MD, FIDSA
Emory University, Atlanta, GA

Jason Stout, MD, FIDSA
Duke University Medical Center, Durham, NC

Alex Studemeister, MD, FIDSA
San Jose Medical Group, San Jose, CA

Sankar Swaminathan, MD, FIDSA
University of Utah School of Medicine, Salt Lake City, UT

Kenneth Tack, MD, FIDSA
KJ Tack MD PC, Brighton, MI

Anna R. Thorner, MD, FIDSA
Brigham and Women’s Hospital, Boston, MA

Patricia Triplett, MD, FIDSA
High Point Regional Hospital Cornerstone Health Care, Greensboro, NC

James Veazey Jr., MD, FIDSA
U.S. Army Medical Materiel Development Activity, Hamden, CT

David K. Warren, MD, MPH, FIDSA
Washington University School of Medicine, St. Louis, MO

Patty Wright, MD, FIDSA
Vanderbilt University School of Medicine, Nashville, TN

Shanta Zimmer, MD, FIDSA
University of Pittsburgh, Pittsburgh, PA

Members on the Move

Naomi P. O’Grady, MD, FIDSA, has been named chair of the American Board of Internal Medicine’s (ABIM) Subspecialty Board on Critical Care Medicine. As such, she is the subspecialty board’s representative to ABIM’s Board of Directors. Dr. O’Grady has been a member of the Subspecialty Board on Critical Care Medicine since 2007. She is also a senior staff physician in the National Institutes of Health Clinical Center’s Critical Care Medicine Department and the medical director of the Clinical Center’s Vascular Access and Conscious Sedation Services. Dr. O’Grady was chair of IDSA’s Standards and Practice Guidelines Committee from 2002 to 2005.

Raymond P. Smith, MD, FIDSA, has been named the vice chairman for education in the Department of Medicine at Albany Medical College in New York. Dr. Smith recently retired from the Department of Veterans Affairs Medical Center in Albany after 34 years. He was the chief of the medical service from 2001 to 2011 and chief of the ID section from 1999 to 2011.

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

Welcome, New Members!


Bowers, Daniel, MD
Buss, Janice, PhD
Chertow, Daniel, MD, MPH
Davis, Manli, PhD
DeHaan, Elliot, MD
Kathrens, Sharon, NP
Seward, Jane, MD, MPH
Shah, Minesh, MD
Sheehan, Gerard, MD
Woodhull, Kimberly, PharmD


Benson, Susan
Challapalli, Malliswari, MD
Chaparanganda, Iryna, ChB
Dorobisz, Monica, PharmD
Dykes, Colin, PhD
Glenn, Gregory, MD
Goulart, Silvia, MD
Harding, Ian, PhD
Lopes Goncales, Eduardo, MD
Mallat, Hassan, MD
Mayer, Richard, MD
McGowan, David, MBBS
Murano, Fernando, MD
Olson, Douglas, MD
Pires de Campos, Luciana, MD, MS
Schoeman, Pierre, ChB, MSc
Smith, Geoffry
Taylor, Thomas, MD, MS
van de Beek, Diederik, MD, PhD
Vindenes, Tine, MD
Volk, Stacy, PharmD
Ward, Susan, MA
Wilson, Gregory, MD


Aduako, Cecilia, MD
Afridi, Muhammad, MD
Agarkova, Anna, MD
Almuti, Walid, MD
Anderson, Teresa, MD
Ard, Kevin, MD
Arif, Sana, MD
Atthota, Vakula, MD
Baffoe-Bonnie, Anthony, MD
Bansal, Ekta, MD
Benwill, Jeana, MD
Beydoun, Karen, MD
Boyd, Sarah, MBBS
Bruminhent, Jackrapong, MD
Camargo, Jose, MD
Chan, Brian, MD
Chaung, Jenna, MD
Chen, Ting-Yi, MD, MPH
Chien, Jaime, MBBS, MRCP
Chung, Won, MD
Cockerham, Lesie, MD
Cole, Joanna, MD
Cook, Sean, DO
Crabtree, Scott, MD
Cross, Sara, MD
Crusio, Robbert, MD
David, Alexandru, MD
Davis, Michael, MD
Decker, Brooke, MD
Dekker, John, MD, PhD
Desai, Mona, MD
Dhaubhadel, Pragya, MD
Drozd, Daniel, MD
Figueroa, Cesar, MD
Foster, Monique, MD
Ghayad, Zeina, DO
Glassman, Seth, MD
Goodloe, Neil, MD
Gupta, Ekta, MD
Haidar, Wael, MD
Hallit, Rabih, MD
Hasalla, Irida, MD
Hong-Nguyen, Yugenia, MD
Husney, Robert, MD
Hyle, Emily, MD
Iliff, Timothy, MD
Jiddou, Renee, MD
Johnson, Cynthia, MD, PhD
Jongwutiwes, Ubonvan, MD
Jose, Anita, MD
Kadri, Sameer, MD
Kamath, Deepa, DO
Karnik, Geeta, MD
Khair, Hani, MD
Khurshid, Khawar, MD
Koirala, Bibek, MD
Kutbi, Suzanne, MD, MBBS
Kyrillos, Ramona, MD
Larsen, Staci, MD
Leedy, Nicole, MD
Lobritz, Michael, MD, PhD
Mahmood, Saima, MBBS
Manrilla, Jessica, MD
Mathew, Anil, MD
Mayer, Stockton, DO
Mbang, Pamela, MD
Mdluli, Xolani, MD
Miracle, Jill, MD
Neelakanta, Anupama, MD
Neilan, Anne, MD
Nett, Jeniel, MD, PhD
Newman, Stacy, MD
Paez, Carmen, MD
Peglow, Sarah, MD
Pierre-Louis, Frantz, MD
Piracha, Nauman, MD
Pisney, Larissa, MD
Prasad, Paritosh, MD
Pulimamidi, Shipali, MD
Ramidi, Ganga, MD
Razzaq, Kanwal, MD
Reedy, Jennifer, MD, PhD
Rice, Casey, MD
Rimawi, Ramzy, MD
Rodriguez, Manuel, DO, MPH, MS
Rose, Stacey, MD
Roth, Prerana, MD, MPH
Rowe, Theresa, MD
Rubach, Matthew, MD
Ruhs, Sebastian, MD, PhD
Sadarangani, Manish, MA, BCh
Sanders, James, PharmD, PhD
Scherrer, Sara, MD
Sen, Pritha, MD
Shakil, Javeria, MD
Shor, Asaf, MD
Shwe, Thi Thi, MD
Siddiqui, Wajid, MD
Smith, Marc-Andre, MD
Statler, Victoria, MD
Struble, Kelley, DO
Suchindran, Sujit, MD
Sullivan, Richard, BSN
Vaughan, Leroy, MD
Vaz, Louise, MD
Vazquez-Rivera, Liliana, MD
Vilchez, Manuel, MD
Viray, Melissa, MD
Ward-Demo, Pamela, MD, DVM
Washburn, Taylor, MD
Wolfsohn, Joshua, DO
Yanofsky, Andrew, MD
Youngster, Ilan, MD
Yu, Brian, MD
Zahid, Sadia, MD
Zapata, Heidi, MD, PhD

From the President: Setting Priorities for IDSA’s Future

When living in challenging times, it’s wise to periodically reassess the path we are on. The IDSA Board of Directors met in June for a strategic planning session to identify the Society’s top priorities for the next two to three years.

When living in challenging times, it’s wise to periodically reassess the path we are on.

The weight of the federal budget deficit is pressing down on all of us, leading to cuts in public health and research funding, as well as efforts to control Medicare and Medicaid spending. Implementation of health care reform is creating a push toward more integrated ways of delivering health care and new payment models for providers to reward quality care and reduce health care costs.

These trends affect not only those of us who currently work in infectious diseases, but also medical students and residents who are considering their career options. The future of our field is at stake.

In this context, the IDSA Board of Directors met in June for a strategic planning session to identify the Society’s top priorities for the next two to three years. Board members drew upon a range of information, including an assessment of the changing environment, recent member surveys (summaries are available online), and strategic planning documents recently developed by the HIV Medicine Association of IDSA (HIVMA). (You must be logged in to access the survey summaries.)

 The IDSA Board identified several top priorities:

  • Advocate for regulatory and legislative action to address antimicrobial resistance, including by urging Congress to pass legislation to create incentives to stimulate the antimicrobial pipeline and the development of rapid diagnostics, strengthening surveillance programs, requiring antimicrobial stewardship efforts, and fostering research on antimicrobial resistance. This includes continuing to urge the Food and Drug Administration to complete important clinical trial guidance documents.
  • Significantly enhance the development of IDSA practice guidelines, focusing on making timely revisions, standardizing guideline formats, and ensuring that the guidelines are concise and user-friendly.
  • Assist ID physicians in understanding and coping with changes in the health care delivery system, including ongoing efforts to document the value ID specialists provide to patients and the health care system, informing members of important trends and changes related to health care reform, developing practical tools to help members respond to the changing circumstances of their practices, and assisting ID clinicians in providing care for patients with chronic hepatitis B and C virus infection.
  • Support adequate funding for critical public health and prevention programs in ID, including developing effective ways to advocate for funding for the Centers for Disease Control and Prevention and continuing to promote adult immunization.
  • Promote ID research, including influencing the direction of research by identifying critical unmet medical needs, advocating for eliminating bureaucratic barriers to research while strengthening protection of research subjects, and developing effective strategies to advocate for funding for the National Institute of Allergy and Infectious Diseases.

The Board also agreed that IDSA should have an ongoing role in advocacy on global ID issues, including antimicrobial resistance, in addition to maintaining current efforts on HIV/AIDS and tuberculosis through the Center for Global Healthy Policy (see March 2011 “From the President”). A new Board work group has been appointed to define core advocacy activities in this important area.

Board members also recommitted to ensuring the success of IDWeek. A new venture of IDSA, the Society for Healthcare Epidemiology of America, HIVMA, and the Pediatric Infectious Diseases Society, IDWeek 2012 will involve the first-ever combined meeting of these leading ID groups next fall in San Diego. (As a reminder, the 49th Annual Meeting of IDSA and HIVMA, Oct. 20-23, 2011, in Boston is rapidly approaching. See the related article in this issue for more information, including how to register.)

The strategic planning process was invaluable in refining the Society’s short-term priorities. I was pleased to see that the priorities identified by our Board and our members are, for the most part, consistent with current activities, reinforcing my belief that we are on the right path.

The process also reinforced the challenges IDSA faces in serving its diverse membership (see May 2011 IDSA News). It was incredibly gratifying to read the comments from members responding to the surveys who wrote in passionate terms about why they belong to IDSA in these challenging times.

Said one: “IDSA is one of the most progressive and active professional organizations and is dedicated to improving patient care.” Said another: “I believe in what [IDSA] stands for and want to help out in any way I can.”  I hope that you share these views.

IDSA 2011: See You in Boston!

It’s not too late to register for the pre-eminent meeting in infectious diseases—IDSA’s 49th Annual Meeting, Oct. 20-23, 2011, in Boston.

It’s not too late to register for the pre-eminent meeting in infectious diseases—IDSA’s 49th Annual Meeting, Oct. 20-23, 2011, in Boston. Learn more at Keynote speakers include:

Opening Plenary
Michael S. Saag, MD, FIDSA, University of Alabama
Thirty Years of HIV/AIDS: Where Have We Been...Where Are We Going?

Opening Plenary
Keiji Fukuda, MD, MPH, World Health Organization
Global Emerging Infectious Disease Issue

Maxwell Finland Lecture
Julie Parsonnet, MD, FIDSA, Stanford University
Infectious Diseases Epidemiology and Chronic Disease

John F. Enders Lecture
Angela Caliendo, MD, PhD, FIDSA, Emory University Hospital
Molecular Diagnostics: Promises Realized and Lessons Learned

Joseph E. Smadel Lecture
William Schaffner, MD, FIDSA, Vanderbilt University School of Medicine
The Media and Infectious Diseases

Edward H. Kass Lecture
Larry Pickering, MD, FIDSA, Centers for Disease Control and Prevention
The Science of Vaccines: Research, Subjectivity or Speculation

Embedded between the two named lectures on Friday will be a featured oral abstract presentation that was specially selected by the Program Committee as the top abstract submitted to IDSA 2011:

Mahmoud Ghannoum, PhD, Case Western Reserve University
Oral Mycobiome and Bacteriome Analysis of HIV-Infected Patients and Healthy Individuals: Identification of Pichia as a Candida Antagonist

Several other promising investigators will discuss their research during special “mini-lectures” at Friday’s and Saturday’s oral abstract sessions:

MRSA Screening and Prevention—Where We Stand
Frank Lowy, MD, Columbia University
88. Staph aureus: Screening and Prevention
Oct. 21, 2:15-4:15 p.m.

Title TBD
Michael Glickman, MD, Memorial Sloan Kettering Cancer Center
112. Innate and Adaptive Immunity to Infections
Oct. 22, 8:15-9:45 a.m.

Emergence and Evolution of KPC
Barry Kreiswirth, PhD, University of Medicine and Dentistry of New Jersey
175. The Menace of Klebsiella pneumoniae Carbapenemase (KPC)-Producing Organisms
Oct. 22, 1:45-3:15 p.m.

Pediatric Respiratory Infections in the Current Vaccine Era
Krow Ampofo, MD, University of Utah
174. Respirator Infections in Children
Oct. 22, 1:45-3:15 p.m.

If you’re preparing for recertification by the American Board of Internal Medicine, you won’t want to miss the pre-meeting session on Thursday morning that will feature two new IDSA maintenance of certification modules—one on general ID and the other on HIV.

Be sure to stay for Sunday morning’s special Presidential Plenary Session, which will feature IDSA President James M. Hughes, MD, FIDSA, giving an IDSA update and three lectures on cholera by Stephen J. Calderwood, MD, FIDSA, of Massachusetts General Hospital; Jean Pape, MD, of GHESKIO; and Scott F. Dowell, MD, MPH, of the Centers for Disease Control and Prevention. 

For a complete listing of current speakers and topics, check out the Interactive Program Planner.  Abstracts will be online in the fall. 

Register now to take advantage of the best deals on registration and housing.

Important Dates

 Deadline for Late Breaker Abstracts

 Friday, Aug. 12*

 *5:00 p.m. Eastern Daylight Time

 Regular Registration Deadline

 Friday, Sept. 23

 49th Annual Meeting of IDSA

 Thursday, Oct. 20 – Sunday, Oct. 23

As Anti-Infective Shortages Continue, GAO to Study Problem

IDSA provides input on shortages’ impact on patient care and public health
Drug shortages, including those of key antibiotics, continue to cause concerns among health care providers and, increasingly, some policymakers in Washington. The Government Accountability Office (GAO) is now studying the problem, at the request of Congress.

Drug shortages, including those of key antibiotics, continue to cause concerns among health care providers and, increasingly, some policymakers in Washington.

At the request of Congress, the Government Accountability Office (GAO) is now studying the problem. The government watchdog recently sought IDSA’s input on the cause of the shortages, what effects antibiotic shortages have, and how the Food and Drug Administration (FDA) has responded to them. At GAO’s request, IDSA identified the following four critical anti-infective sterile injectable drug shortages since 2009 that have had a significant impact on patient care and public health:

  • amikacin
  • intravenous (IV) trimethoprim-sulfamethoxazole (TMP/SMX)
  • IV acyclovir
  • IV clindamycin

In addition, IDSA shared a list of 16 other relevant anti-infective shortages with GAO.

On Capitol Hill, several lawmakers have called for hearings on the issue. A bill introduced in the House of Representatives in July would require FDA to notify health providers of drug shortages and work with manufacturers to fill supply gaps. Similar legislation was introduced earlier this year in the Senate.

Two recent surveys underscore the scope of the problem. Nearly 100 percent of hospitals surveyed by the American Hospital Association reported a drug shortage in the previous six months, and nearly half reported 21 or more shortages. Among the 820 hospitals in the survey (PDF), 82 percent have had to delay treatment, and more than half were not able to provide a patient with the recommended treatment.

Labor costs associated with managing these shortages translates to an estimated annual impact of $216 million nationally, according to a nationwide survey of 353 pharmacy directors, conducted by the American Society of Health-System Pharmacists (ASHP).

Several IDSA members have contacted the Society about the availability of certain drugs, and members of the Emerging Infections Network (EIN) recently discussed the current shortage of amikacin (see May 2011 IDSA News). IDSA members are urged to report drug shortages directly to FDA and to copy IDSA staff at

FDA provides information and e-mail alerts about drug shortages and how physicians can obtain available emergency supplies. ASHP’s website offers information about shortages, including current and resolved shortages, as well as bulletins on drugs that are no longer available.

IDSA continues to work with FDA and Congress to keep the issue on their radar.

IDSA Journal Club

July-August 2011

This month, studies investigating: the effects of surgical vs. N-95 masks and evidence for transocular entry of seasonal influenza; antibiotic overuse and acute pediatric visits for asthma; the E. coli outbreak in Germany; and dexamethasone in community-acquired pneumonia and the length of hospital stays.

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.

Effects of Surgical vs. N-95 Masks and Evidence for Transocular Entry of Seasonal Influenza
Reviewed by Christopher J. Graber, MD, MPH

A recent study in The Journal of Infectious Diseases raises important issues regarding transmission of seasonal influenza, most notably that transocular entry may play a role in transmission.

The investigators recruited 28 healthy volunteers to be exposed to aerosolized live attenuated influenza vaccine (2009/10 seasonal FluMist) in an airtight chamber for 20 minutes and be assigned to one of the following groups: no barrier precautions, ocular exposure only (with subjects breathing air from outside the chamber), surgical mask with and without eye protection, and N-95 respirators with and without eye protection. A nasal wash was performed immediately after exposure, from which quantitative reverse-transcriptase PCR for a portion of the M gene of influenza A was performed.

The largest amount of viral RNA was found in the nasal washes of the subjects with no barrier precautions and with surgical masks without eye protection; all participants in these groups had positive nasal washes. Three of four subjects in the ocular exposure only group had positive nasal washes, though the absolute amount of RNA present was very low. Though eye protection did not prevent anyone wearing a surgical mask from having a positive nasal wash, it did reduce the amount of RNA present approximately four-fold. In the N-95 respirator group, eye protection was associated with a lower number of subjects having positive nasal washes (one of five versus three of five subjects) and an approximately eight-fold reduction in amount of RNA present. Five- to ten-fold reductions in amount of RNA present were seen in those wearing the N-95 respirators compared to surgical masks.

While this was a small study, it adds important data to the ongoing debate of how best to protect health care workers from influenza exposure and suggests the need for further study on the role of eye protection.

(Bischoff et al. J Infect Dis 2011; 204:193-9)

back to top

Antibiotic Overuse: Spotlight on Acute Pediatric Visits for Asthma
Reviewed by Christian B. Ramers, MD, MPH

Visits to primary care providers, emergency departments, and pediatricians are often due to acute respiratory tract infections, especially in children with asthma or a prior history of wheezing.  Because most of these are caused by viruses, antibiotics are generally not recommended in the management of acute asthma. Yet this may be a unique patient population in which a large proportion of unwarranted antibiotic use occurs. Two studies in the June issue of the Journal of Pediatrics highlight this persistent problem and quantify the troublesome frequency of antibiotic use in this setting.

In the first study, American investigators analyzed data from two large nationally representative databases of ambulatory and emergency visits. Analysis was restricted to patients < 18 years of age with a primary diagnosis of asthma. Between 1998 and 2007, there were 5,198 visits in the dataset, and 15.6 percent of them involved an antibiotic prescription without a co-existing diagnosis to justify such a prescription. In a multivariate analysis, factors associated with antibiotic prescription included concomitant steroid prescription (odds ratio (OR) 2.69, 95 percent confidence interval (CI) 1.68-4.30) and visit during a winter month (OR 1.92, 95 percent CI 1.05-3.52). Patients seen in an emergency department were less likely to receive antibiotics (OR 0.46, 95 percent CI 0.26-0.89). 

In another study, investigators in Belgium used a health insurance database covering 44 percent of the country’s population. Restricting the analysis to children, the dataset included 892,841 individuals, and ambulatory visits were analyzed for one calendar year. Overall, 44.2 percent of these children received an antibiotic prescription. Children were significantly more likely to receive an antibiotic if they were prescribed an asthma drug (bronchodilator or leukotriene antagonist) on the same day (OR 1.90, 95 percent CI 1.89-1.91). Overall, among children who received an asthma drug, 34.6 percent also received an antibiotic prescription.

Both studies underscore the particular importance of acute visits for asthma symptoms in the over-prescription of antibiotics. Although unlikely to have any effect on outcomes, antibiotics are often co-prescribed with asthma medications, up to 15 to 35 percent of the time. Efforts to decrease unnecessary antibiotic prescriptions in primary and ambulatory settings should focus on this particular population.

(Paul et al. J Pediatr. 2011; 127: 1014-1021 and De Boeck et al. J Pediatr 2011; 127:1022-1026.)

back to top

E. coli Outbreak in Germany: A Preliminary Report
Reviewed by Rachel Simmons, MD

A report published online in the New England Journal of Medicine provided preliminary information on the large E. coli outbreak in Germany. As of June 18, 2011, more than 3,200 cases were reported, including 39 deaths (3.3 percent) and 810 associated cases (25.1 percent) of hemolytic uremic syndrome (HUS). HUS occurred overwhelmingly in adults (89 percent) in this outbreak, and women made up the majority of case patients with HUS (68 percent) and with Shiga-toxin producing E. coli gastroenteritis (58.8 percent). 

Bloody diarrhea (96 percent) and abdominal pain (89 percent) were the most common clinical symptoms in adults. As expected, patients with HUS had significantly higher creatinine levels (2.6 mg/dl versus 0.8) and lower platelet counts (88.3 billions/liter versus 245.3) during the illness compared to those patients who did not develop HUS. In a small prospective cohort, no features or laboratory tests were identified that could predict the development of HUS.

The outbreak strain is O104:H4, has the gene for Shiga-toxin 2 variant (stx2a), and also carries virulence-factor genes for enteroaggregative E. coli. A subset of isolates has been analyzed by pulse-field gel electrophoresis, and the bacteria are indistinguishable from each other. The outbreak strain contains both an extended-spectrum beta-lactamase (ESBL) complex and the beta-lactamase TEM-1; is resistant to beta-lactam antibiotics, third generation cephalosporins, and nalidixic acid; and is susceptible to ciprofloxacin and carbapenems.

This large outbreak has several unique features. The rate of HUS among adults was quite high, and for unclear reasons, women were overrepresented among those with gastroenteritis and with HUS. In addition, the outbreak stain not only carried a Shiga-toxin gene, but also genes typically associated with enteroaggregative E. coli. This combination may have contributed to its increased virulence. Additional information about this bacteria and its source is eagerly anticipated. 

(Frank et al. N Engl J Med. published online June 22, 2011)

back to top

Dexamethasone in CAP May Shorten Length of Hospital Stay
Reviewed by Nina Kim, MD, MSc

Community-acquired pneumonia (CAP) remains among the leading causes of death in the U.S., and hospitalization rates for pneumonia appear to be increasing, particularly in the elderly. Overwhelming inflammatory reactions can contribute to this high morbidity and mortality. Investigators from the Netherlands sought to examine whether corticosteroids added to antibiotics could accelerate recovery from pneumonia. Their results appear in the June 11 issue of the Lancet.

The double-blind trial enrolled 304 patients who met criteria for CAP and who were randomized to receive either dexamethasone 5 mg or placebo intravenously once daily for four days, initiated no later than 12 hours from admission. Individuals with known congenital or acquired immunodeficiency or who were on immunosuppressive medications including corticosteroids or chemotherapy were excluded. The primary endpoint was length of hospital stay (LOS) with time censored at discharge, death, or transfer to the intensive care unit (ICU).

The dexamethasone group had a shorter median LOS compared with the placebo group – 6.5 versus 7.5 days (95 percent confidence interval (CI) for difference in medians: 0-2 days, P=0.048) – a difference that remained after adjusting for baseline characteristics, yielding a hazard ratio of 1.46 favoring the dexamethasone group for earlier discharge (95 percent CI, 1.13-1.89). There was no difference in hospital mortality, rates of transfer to ICU, empyema or pleural effusion, or readmission.

This study is the largest randomized-controlled trial to date of corticosteroids in CAP. This modest reduction in LOS came at some cost, as hyperglycemia was not surprisingly more common among those who received dexamethasone. Gastric perforation also occurred in one dexamethasone-treated patient three days into therapy – a temporal association that is difficult to dismiss. These results may also not be generalizable, considering only 11 percent of these patients received a macrolide, an agent more widely used in the U.S. for CAP and known to have immunomodulatory properties.

(Meijvis et. al. Lancet 2011; 377:2023-30.)

back to top

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

July 15

  • PCR for Invasive Aspergillosis
  • A New Central Nervous System Syndrome in HIV-Infected Patients?
  • KSHV—A Master Manipulator

July 1

  • MRSA in the Supermarket
  • XMRV—The Answer Is In
  • Gonorrhea Is a Little Bit Human