IDSA News - April 2012
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Rhinosinusitis Guideline Podcast Now Online

A free audio podcast featuring Anthony W. Chow, MD, chair of the IDSA rhinosinusitis guideline panel, discussing the recently published guideline can be found through the Apple iTunes Store (to access the podcast through the iTunes Store, search for “IDSA guideline”). Dr. Chow talks about how to distinguish between viral and bacterial causes of rhinosinusitis, why the guidelines panel came up with new recommendations for first-line therapy, what to do if first-line therapy doesn’t work, and when to consider referral to a specialist. The discussion is hosted by Neil S. Skolnik, professor of family and community medicine at Temple University School of Medicine in Philadelphia.

New Guideline Pocketcard: Treating CAP in Children

A practice guideline developed by IDSA and the Pediatric Infectious Diseases Society on the diagnosis, prevention, and treatment of pediatric community-acquired pneumonia (CAP) is available as a Pocketcard. 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 DCIDSA12.

Don’t forget about guidelines in a format designed for iPhones and other mobile devices. Visit IDSA’s website for instructions for downloading and using guidelines on your mobile devices.

MRSA Guidelines Slide Set Available

A slide set focusing on the management of methicillin-resistant Staphylococcus aureus (MRSA) in adult patients, with accompanying notes, created by Catherine Liu, MD, lead author of IDSA’s first-ever MRSA practice guidelines, can be downloaded online (PPT) from IDSA’s website.

IDSA welcomes feedback on the slides at idsaguidelines@idsociety.org.

Fever and Neutropenia Guideline Now in Japanese

IDSA’s updated guideline for the use of antimicrobial agents in neutropenic cancer patients with fever, published in February 2011, is available in a Japanese translation (PDF). Additional IDSA practice guidelines in languages other than English are available on the Society’s website. Volunteer members of the IDSA Translation Bureau review all translations to ensure the accuracy and quality of each translation.

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. (To subscribe, check the appropriate boxes to receive CDC’s Health Alert Network (HAN) messages and/or alerts from FDA, and provide your email address and name where indicated.)

Is Your Facility Experiencing Antibiotic Shortages?

IDSA members are urged to report drug shortages directly to FDA and to copy IDSA staff at schang@idsociety.org.

IDSA, Physician Groups Urge CMS to Re-Evaluate Penalty Timelines

The Society and several physician groups, including the American Medical Association, recently urged the Centers for Medicare and Medicaid Services (CMS) to re-evaluate the timelines for several programs, including the value-based payment modifier, and penalties under the electronic prescribing program, the physician quality reporting system, and electronic health record incentive programs. In a letter (PDF), the groups urged CMS to synchronize these programs to minimize the administrative and financial burdens on physician practices.

WHO Issues New Guidance to Prevent HIV in Discordant Couples, Infants

The World Health Organization (WHO) recently released new guidelines on HIV testing, counseling, treatment, and prevention for couples in which one partner is infected with HIV and the other is not. Learn more on Science Speaks, the blog of the Center for Global Health Policy. WHO also issued updated HIV treatment guidelines for pregnant women and for preventing HIV infection in infants.

More recent news from Science Speaks:

NIH Launches Initiative to Mentor Young Global Health Researchers

A $20 million initiative announced by the National Institutes of Health earlier this month is designed to foster the next generation of global health scientists by providing mentored research experience in developing countries. Read more on Science Speaks.

More recent news from Science Speaks:

Interview Series: CDCís Role in Global HIV and TB

A series exploring the role of the Centers for Disease Control and Prevention in HIV and tuberculosis-related global activities continues with an interview with Bess Miller, MD, MSc, on Science Speaks, the blog of the Center for Global Health Policy.

More recent news from Science Speaks:

FDA Announces Voluntary Plan to Limit Antibiotic Use on the Farm

The Food and Drug Administration (FDA) this month announced a voluntary strategy to promote the judicious use of antibiotics in food-producing animals, a goal IDSA supports. FDA’s approach includes:

  • guidance for industry for phasing out the use of medically important drugs in animal agriculture and phasing in veterinary oversight of the remaining therapeutic uses of these drugs
  • draft guidance to assist drug companies in voluntarily removing production uses of antibiotics from their drug labels; adding scientifically supported uses where appropriate; and changing the marketing status to include veterinary oversight
  • a draft regulation outlining ways veterinarians can authorize the use of certain drugs in animal feed

IDSA is reviewing FDA’s documents and will submit comments. The plan could be a step forward in protecting public health and patient care, if the animal drug industry and food production industry follow through on voluntary commitments to comply with FDA’s guidance. The voluntary nature of the approach will require close monitoring by organizations like IDSA and others.

Additional Information

CDCís Antimicrobial Resistance Working Group Announces New Members

Several IDSA members have been selected by the Centers for Disease Control and Prevention (CDC) to serve as members of CDC’s Antimicrobial Resistance Working Group (ARWG). This group will provide advice and recommendations to support CDC’s efforts in the prevention and control of antimicrobial resistance.

Chair

  • Robert A. Weinstein, MD, FIDSA
    Chairman, Department of Medicine, Cook County Health and Hospitals System, Chief Operating Officer, Ruth M. Rothstein CORE Center, The C. Anderson Hedberg MD Professor of Internal Medicine, Rush University Medical Center, Chicago, IL; Member, IDSA Nominations Committee

Co-Chair

  • Andrew Pavia, MD, FIDSA
    George and Esther Gross Presidential Professor, Chief, Division of Pediatric Infectious Diseases, University of Utah Health Sciences Center, and Primary Children's Hospital, Salt Lake City, UT; Member, IDSA Board of Directors; Member, IDSA Seasonal and Pandemic Influenza Program Committee; Chair, IDSA Pandemic Influenza Task Force

CDC Lead

  • Steve Solomon, MD
    Director, Office of Antimicrobial Resistance, CDC, Atlanta, GA

Members

  • Sara E. Cosgrove, MD, MS, FIDSA, FSHEA
    Associate Professor of Medicine and Epidemiology Director, Antimicrobial Stewardship Program, Associate Hospital Epidemiologist, Johns Hopkins Medical Institutions, Baltimore, MD
  • Michael N. Dudley, PharmD, FIDSA
    Senior Vice President, Research & Development and Chief Scientific Officer, Rempex Pharmaceuticals, San Diego, CA
  • Neil O. Fishman, MD
    Associate Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA
  • Donald E. Low, MD
    Medical Director, Ontario Public Health Laboratories, Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
  • Ruth Lynfield, MD, FIDSA
    State Epidemiologist and Medical Director, Minnesota Department of Health, St. Paul, MN; Chair, IDSA National & Global Public Health Committee; Chair, IDSA Antimicrobial Resistance Work Group
  • Joshua P. Metlay, MD, PhD, FIDSA
    Professor of Medicine, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
  • Richard B. Thomson Jr., PhD
    Medical Microbiologist and Director, Microbiology Laboratories, Evanston Hospital and NorthShore University Health System, Evanston, IL
  • Theoklis Zaoutis, MD
    Associate Professor of Pediatrics and Epidemiology, University of Pennsylvania School of Medicine, Associate Chief, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA

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.

Click here to view new IDSA members!

IDSA, HIVMA Can Help with ABIM Recertification

Four Maintenance of Certification (MOC) modules, developed by panels of experts from IDSA and the HIV Medicine Association (HIVMA), are available online. Each module consists of 25 multiple-choice questions; each is worth 10 points toward the American Board of Internal Medicine’s MOC program and offers two Category 1 CME credits. The modules are available at idsa.knowledgedirectweb.com.

Two new modules are under development—Adult Vaccines and Infections in the Non-HIV Immunocompromised Host—and will be introduced at workshops at IDWeek 2012 in October in San Diego. Register now for these workshops at www.idweek.org.

CDC Webcast: Multidrug-Resistant Gonorrhea and Public Health

Watch a free webcast from 1 to 2 p.m. EDT on May 15 exploring the development of antibiotic resistance in Neisseria gonorrhoeae as a growing public health concern. Part of the Public Health Grand Rounds series offered by the Centers for Disease Control and Prevention (CDC), the webcast will feature presentations on gonorrhea infections and antimicrobial treatment, the molecular basis of resistance and the importance of the laboratory in detecting resistance, and tools to combat multidrug resistance.

The live webcast will be available on CDC’s website. An archived version will also be available on the site.

From the President:
Supporting the Next Generation of Our Field

Young ID specialists are the future of our field, and nurturing their development is an important priority for IDSA. One of the key ways the Society pursues this mission is through the support we offer to fellows in training.

IDSA Continues Push for Antibiotic Incentives, Members Can Help

Legislation to stimulate antibiotic development is heating up on Capitol Hill, and IDSA members can help during this critical time by contacting their members of Congress.

Young ID specialists are the future of our field, and nurturing their development is an important priority for IDSA. It’s also a responsibility all of us share. One of the key ways the Society pursues this mission is through the support we offer to fellows in training.

Held annually for more than 10 years, IDSA’s Clinical Fellows’ Meeting provides an opportunity for fellows to learn about clinical practice strategies from leading practice-based ID physicians. The meeting allows fellows to learn about various clinical practice opportunities and key issues and skills to help them succeed in clinical practice. The informal setting encourages interaction among fellows and experienced faculty.

To help foster the next generation of ID physician scientists, IDSA and the National Institute of Allergy and Infectious Diseases (NIAID) have organized a new meeting with a research focus, to be held for the first time this May. Fellows and medical students will hear from leading ID researchers, learn about the practical aspects of developing a successful research career, visit NIAID facilities, present their own research, and interact with experienced investigators.

At IDWeek 2012, several premeeting workshops will highlight timely topics for fellows: the Fellows’ Day Workshop, organized by IDSA’s Training Program Directors Committee, the Pediatric Fellows’ Day, co-organized by the Pediatric Infectious Diseases Society and IDSA, and the Vincent T. Andriole ID Board Review Course. IDWeek will also offer opportunities for fellows to present their own research and learn about the latest advances in the field. (A limited number of Trainee Awards are available to support travel for fellows in training to attend IDWeek.)

For the past five years, the HIV Medicine Association (HIVMA) has annually awarded grants to support a year of HIV clinical training for up to two fellows through the Minority Clinical Fellowship Program. The goal is to boost the population of minority HIV physicians and strengthen the commitment to provide HIV care in minority communities. As a local scientific partner of the International AIDS Society’s AIDS 2012 conference, July 22-27, in Washington, D.C., HIVMA is also offering a limited number of travel grants to fellows or residents training in the United States who have had accepted abstracts.

This is not a complete list of efforts to support the next generation of ID and HIV specialists. In February of this year, for instance, more than 750 fellows—in 16 countries—completed IDSA’s Annual Fellows’ In-Training Exam, which helps fellows identify areas in which they need to learn more. But these examples help demonstrate our strong commitment to this mission.

Mentors provided crucial support to many of us early in our careers, and we all share a responsibility to prepare today’s fellows for the next step in theirs. Providing support and guidance for the young ID physicians and investigators of the next generation will remain a key Society priority in the years ahead. The future of our field depends on it.

IDSA Continues Push for Antibiotic Incentives, Members Can Help

Legislation to stimulate antibiotic development is heating up on Capitol Hill, and IDSA members can help during this critical time by contacting their members of Congress. IDSA continues to strongly advocate for the creation of a new antibiotic approval pathway to spur new antibiotic research and development (R&D) as part of the Food and Drug Administration Prescription Drug User Fee Act (PDUFA) reauthorization legislation.

The Society’s proposed Limited Population Antibacterial Drug (LPAD) pathway would provide an important new approval option for companies interested in developing drugs for serious resistant infections with few or no existing treatment options. Fourteen drug companies and 23 health and medical groups have come out in support of the proposal (see IDSA press release).

IDSA also recommends that PDUFA:

  • designate a lead federal agency to explore opportunities for public private collaborations to spur antibiotic R&D
  • direct the National Institute of Allergy and Infectious Disease to explore the feasibility of establishing a clinical specimen repository to ease diagnostics R&D

View the latest Antibiotic Resistance Policy Newsletter to see what IDSA is saying to members of Congress on this critical issue, and take action today.

EIN Update: Vancomycin and Acute Renal Toxicity

EIN members discussed vancomycin, acute renal toxicity, and a recent Food and Drug Administration statement providing new information for clinicians.

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.

Last summer, several EIN members discussed vancomycin and acute renal toxicity, a topic raised again recently on the forum when the Food and Drug Administration (FDA) issued a statement, providing new information and study results for clinicians.

A member in Indiana started the initial discussion in August 2011. “We seem to be seeing patients with rapid onset of acute renal failure on IV vancomycin again (and also piperacillin-tazobactam),” the member wrote. “We had wondered about intermittent ‘bad lots’ of vancomycin but were unable to pin it down. Pharmacy monitoring has not changed. Anyone else noting the same?”

A respondent in New York also reported several similar cases. “My three patients required hemodialysis and prolonged hospitalization. All patients were young and on no other nephrotoxic medications,” the member wrote. “Is there any formulation of generic vancomycin or manufacturing process that has changed?”

The cases appeared to be unrelated to age, sex, weight, or underlying illness, noted a member in Florida. “My theory is that there is a certain genetic polymorphism that causes this renal insufficiency that is not seen with other combination antibiotics,” the member noted. “Maybe in the future we can predict who should not get this combination if there truly is a predisposition from a genetic basis as the field of pharmacogenetics is finding new genetic polymorphisms that lead to drug toxicity.”

A member in Iowa described two recent outpatient parenteral antimicrobial therapy patients who experienced a rapid change in renal function (creatinine > 4) “within a span of one weeks duration,” with no good explanation. From Michigan, another respondent wrote of a “34-year-old patient who developed increase in serum creatinine, which kept escalating along with nonoliguric renal failure within 48 hours of starting vancomycin. It was held, but the creatinine continued to increase up to10. There was one trough at 24.”

“Did you recently change your trough levels to coincide with the new recommendations of troughs 15-20 for most indications?” an EIN member in California asked. “If so, that’s the issue. We almost never saw toxicity with levels 5-10, or even 10-15. As soon as we instituted 15-20 for serious infections, we saw renal toxicity.”

“Part of the equation is the purity of generic vancomycin,” a member in Oregon wrote, noting that manuscripts on the subject recently had been submitted for publication. “Back in the 1980s, we had a reliable animal model of aminoglycoside nephrotoxicity,” the member continued. “In that model, the Eli Lilly drug, even in enormous dosage, did not cause any evidence of nephrotoxicity. Low dose vancomycin greatly amplified gentamicin nephrotoxicity, as was later validated clinically.”

In March 2012, one of the original respondents posted an update, referencing FDA’s recent statement, which cited two new FDA studies published online in February:

“Additional studies are underway to determine efficacy of generic vancomycin preparations in animals,” the member added. “I am unaware of any animal nephrotoxicity studies.”


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.

IDSA Journal Club

April 2012

This month, studies investigating: a novel approach in using facility antimicrobial resistance data to provide decision support for empiric antimicrobial prescription; the effect of highly active antiretroviral therapy on tuberculosis in HIV-infected patients from Western Europe and the U.S.; perinatal hepatitis B trends; and C. difficile infections in hematopoietic stem cell transplant recipients.

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.


The WISCA: Flipping the Traditional Antibiogram on its Head
Reviewed by Christopher J. Graber, MD, MPH

An article published in the April 2012 issue of Infection Control and Hospital Epidemiology describes a novel approach in using facility antimicrobial resistance data to provide decision support for empiric antimicrobial prescription. Most facilities typically publish an antibiogram that reports antimicrobial resistance according to organism. However, the infecting organism is typically not known at the time when empiric antimicrobial therapy is prescribed, limiting the antibiogram’s usefulness.

The authors describe a method of reporting antimicrobial resistance according to presenting clinical syndrome, which they call the “Weighted-Incidence Syndromic Combination Antibiogram (WISCA).” It was applied to two clinical syndromes of community onset for which hospitalization was required at their facility from January 2006 to June 2010: urinary tract infection (UTI) and abdominal-biliary tract infection (ABI), identfied by ICD-9 codes and having a relevant positive culture within the first two (for UTI) or four (for ABI) days of admission. For each case, a determination was made based on antimicrobial susceptibility patterns as to whether the infection would have been “covered” by each of a panel of antimicrobial regimens. Results were also stratified according to demographic and clinical factors that may influence antimicrobial resistance, including age, recent emergency department visit or inpatient admission, underlying chronic disease, prior antimicrobial exposure, and prior culture positivity with a multidrug-resistant organism.

Reporting via WISCA yielded valuable information. Though their facility had a fluoroquinolone susceptibility among all E. coli isolates of 84 percent, the authors found that only 62 percent of UTI patients and 37 percent of ABI patients would have had their infections adequately treated with a fluoroquinolone. However, fluoroquinolones were adequate in 82 percent of the UTI patients with no identified risk factors for resistance. Taken together, the WISCA method can serve as a useful template for antimicrobial stewardship teams to assist providers in making individualized decisions regarding empiric antimicrobial therapy.

(Hebert et al. Infect Control Hosp Epidemiol 2012;33(4):381-8.)

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HAART Reduces Risk of TB, But in Some Cases, It’s Too Late
Reviewed by Nina Kim, MD, MSc

Tuberculosis (TB) remains a leading cause of morbidity and mortality in HIV-infected patients worldwide. Multiple studies have shown the benefit of highly active antiretroviral therapy (HAART) in reducing both TB incidence and mortality, but fewer studies have examined how the effect of HAART on TB varies over time and in different patients. One study from the May 1 issue of Clinical Infectious Diseases explored these questions in a large cohort of patients from Western Europe and the United States.

Investigators identified 65,121 HIV-infected adults who were antiretroviral naïve at baseline from 1996 to 2007. They restricted their analysis to patients who did not have an AIDS-defining condition, including a TB diagnosis, during their first month to ensure that events reflected incident rather than prevalent TB. During a median follow-up of 28 months, 712 individuals were diagnosed with TB with an overall incidence of three cases per 1,000 person-years. TB incidence was greatest in patients with CD4 counts <50 cells/mm3 and those older than 50. HAART reduced TB incidence overall by 44 percent, but this reduction was not observed in the high-risk subsets of patients older than 50 or in those with CD4 counts <50 cells/mm3. The risk of TB varied by time from the start of HAART and actually increased by 36 percent within the first three months after HAART initiation, particularly in men, older individuals, and those with lowest baseline CD4 counts. The risk of Pneumocystis pneumonia, in contrast, declined immediately after HAART in this cohort, and remained low even during the first three months.

Increased TB incidence early in HAART has also been reported in another very large cohort from North America and suggests the “unmasking” of TB with HAART-mediated immune reconstitution inflammatory syndrome. These findings underscore the need to improve TB screening and case identification in HIV-infected patients. Clinicians should maintain suspicion for TB even in high-income countries where TB is not endemic, particularly in patients with advanced disease during the first few months of starting HAART.

(HIV-CAUSAL Collaboration, Clin Infect Dis 2012;54(9):1364-72.)

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Perinatal Hepatitis B in the U.S.: Going, but not yet Gone
Reviewed by Christian B. Ramers, MD, MPH

Although hepatitis B incidence in the United States has declined by approximately 82 percent since the introduction of a comprehensive elimination strategy, chronic infections continue to occur, especially among immigrant populations. Chronic infection is much more likely at a younger age of exposure, with perinatally exposed newborns having a rate of 90 percent, compared with just 5 percent in exposed adults. A study in the April 2012 issue of Pediatrics describes substantial progress and a changing epidemiology of perinatal infection following the 1990 launch of the National Perinatal Hepatitis B Prevention Program (PHBPP), which strove to identify hepatitis B surface antigen (HBsAg)-positive mothers and ensure timely prophylaxis and screening of their infants. 

Investigators compiled PHBPP reports from state and local health departments from 1994 to 2008 and reported on estimated births to HBsAg-positive women, the number officially managed by the PHBPP program, and details of the clinical management of exposed infants through follow-up at 12 and 24 months of age. From 1994 to 2008, the estimated number of births to HBsAg-positive women increased from 19,208 to 25,600 (p < 0.001). Over time, a greater proportion of these births were officially managed within the program (40.8 percent to 56.0 percent, p < 0.001). Overall, 94.4 percent of PHBPP-managed infants received both hepatitis B immunoglobulin and hepatitis B vaccine within one day of birth. Surprisingly, vaccination series completion rates decreased from 86.0 percent to 77.7 percent (p = 0.004), but the use of post-vaccination testing increased from 25.1 percent to 56.0 percent (p < 0.001). Perhaps most importantly, the incidence of chronic hepatitis B among tested infants decreased from 2.1 percent in 1999 to 0.8 percent in 2008 (P = 0.001).

This report describes important progress in the identification and effective management of hepatitis B-exposed infants in the United States. Interestingly, the number of births to HBsAg-positive mothers actually increased, suggesting that this situation will continue to be encountered regularly in clinical practice.

(Smith et al. Pediatrics. 2012 April; 129(4):609-616.)

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C. difficile Infections in Hematopoietic Stem Cell Transplant Recipients: Epidemiology and Outcomes
Reviewed by Ed Dominguez, MD

Clostridium difficile infection (CDI) is experiencing a global resurgence due to the hypertoxigenic strain, NAP1. Risk factors include prolonged hospitalization, prolonged antibiotic exposure, and enteric mucosal disruption, all of which are common in hematopoietic stem cell transplant (HSCT) recipients. However, the epidemiology and outcomes in this population are not well understood. The April 15 issue of Clinical Infectious Diseases contains a single-center retrospective case-control study of CDI in HSCT adult recipients.

Between January 2003 and December 2008, 92 CDI cases were seen in 999 HSCT recipients (9.2 percent). The incidence was almost twice as high in allogeneic recipients compared to autologous (12.5 percent vs. 6.5 percent). Furthermore, the median time to infection was later in allogeneic recipients (33 days vs. 6.5 days). To evaluate risk factors, controls were matched 2:1 to each CDI case. Multivariate analysis identified chemotherapy prior to HSCT conditioning; post-transplant high-risk antibiotics; gastrointestinal acute graft-versus-host disease (aGVHD); and vancomycin-resistant enterococcus (VRE) colonization as independent factors for subsequent CDI. Interestingly, receipt of a proton pump inhibitor protected against CDI (adjusted odds ratio, 0.29), contradicting some studies in non-HSCT patients.

The clinical signs of CDI were subdued in HSCT recipients. Only 29.3 percent of patients were febrile, and 2.2 percent had leukocytosis > 20,000 cells/cu mm. All patients were treated with metronidazole or vancomycin, alone or in combination. No recipients had toxic megacolon. All-cause mortality was similar between allogeneic recipients with CDI and allogeneic controls. Recurrence occurred in 21.7 percent of patients a median of 69 days after initial CDI and was strongly associated with subsequent gastrointestinal aGVHD (adjusted odds ratio, 4.23). This sequence of CDI followed by gastrointestinal aGVHD suggests that a proinflammatory cascade may be initiated by the infection. Equipped with these observations, the role of new antibiotics (e.g., fidaxomicin) and modalities (such as fecal microbiota transplant) in HSCT can be evaluated.

(Alonso et al. Clin Infect Dis. 2012;54(8):1053–63.)

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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

  • Mycobacterium abscessus Group: Dealing With Rapidly Growing Mycobacteria Has Become More Complex and Difficult
  • Adenoidectomy Does Not Prevent Recurrent Upper Respiratory Tract Infection

April 1

  • Trimethoprim-Sulfamethoxazole Dose and Methicillin-Resistant Staphylococcus aureus Infections
  • Rifaximin to Prevent Recurrent Diarrhea in Patients With Clostridium difficile Disease Treated With Vancomycin or Metronidazole
  • Oseltamivir Resistance—Does It Quack Like a Duck?