IDSA News - September 2014
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Sanford Guide Releases Mobile App for Lab Diagnosis of Infectious Diseases
IDSA and the American Society of Microbiology (ASM) have teamed up with the Sanford Guide to develop a new mobile app, Lab Diagnosis of Infectious Diseases, in an effort to provide convenience and portability for physicians and lab personnel responsible for diagnosis of infectious diseases.
The app is an updated and newly organized adaptation of the 2013 Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases originally published by IDSA and ASM in Clinical Infectious Diseases. The app provides a guide for clinicians and lab personnel, specifying what tests should be used under which circumstances and how specimens should be collected and managed to achieve the most accurate results. Covering the key points related to diagnostic testing, the content of the app is organized by anatomic systems and selected pathogens for easy reference. Ideally suited for use on hospital rounds, in the examination room, and in the laboratory, the app combines portability with a wide range of functions: full-text search, bookmarks, notes, context-sensitive drop-down menus, and menu-based navigation. The new app is available for both Apple and Android devices as an annual subscription for $19.99 per year. Relevant updates will be made as necessary and appropriate throughout the subscription period.
The content of the app represents the collaborative scientific efforts of IDSA and ASM members supplying expertise in a variety of areas including infectious diseases, pathology, and microbiology. The adaptation of the original guidelines to this updated and re-organized mobile version resulted from the infectious diseases expertise and digital development experience of the Sanford Guide.
NVAC Standards for Adult Immunization: What Do They Mean for the ID Specialist?
With influenza season upon us, now is an excellent time to talk to patients and colleagues about the importance of protecting adults through immunization.
The National Vaccine Advisory Committee’s (NVAC) standards for adult immunization (PDF), which IDSA played a role in drafting, provide guidance to health care providers across the spectrum of care. IDSA recommends that all ID specialists ensure that their patients are immunized according to the Advisory Committee on Immunization Practices (ACIP) recommended schedule. In addition, all IDSA members should assume an active leadership role in improving adult immunization practices by educating other clinicians and health care system managers about the NVAC standards and by facilitating implementation of recommended measures in their own practice settings, health care systems, and communities.
IDSA recommends that all ID specialists adopt the following NVAC standards as practicable:
For all health care providers including ID specialists:
For ID specialists who normally immunize patients:
- Incorporate immunization needs assessment into every clinical encounter.
- Strongly recommend needed vaccines, and either administer vaccines or refer the patient to a provider who can immunize.
- Stay up-to-date on, and educate patients about, vaccine recommendations.
- Implement systems to incorporate vaccine assessment into routine clinical care.
- Understand how to access immunization information systems (i.e., immunization registries).
For ID specialists who are unable to immunize their patients directly:
- Ensure professional competencies in immunizations.
- Assess immunization status in every patient care and counseling encounter, and strongly recommend needed vaccines.
- Ensure that receipt of vaccination is documented in the patient medical record and immunization information system.
- Routinely assess the immunization status of patients, recommend needed vaccines, and refer the patient to an immunizing provider.
- Establish referral relationships with immunizing providers.
- Follow up to confirm patient receipt of recommended vaccines.
For additional resources on the standards and adult immunization, see:
-National Adult and Influenza Immunization Summit
-Centers for Disease Control and Prevention
-IDSA Policy and Advocacy on Immunization
HCV Treatment Guidance Now Includes Information on Prioritizing Patients
HCVguidelines.org recently released a new section, “When and in Whom to Initiate HCV Therapy.” The website was developed by IDSA and The American Association for the Study of Liver Disease (AASLD) in collaboration with the International Antiviral Society-USA (IAS-USA) to assist clinicians treating patients with hepatitis C virus (HCV).With the addition of the new section, www.hcvguidelines.org now offers clinicians information on how to prioritize treatment for those patients who will derive the most benefit or will have the greatest impact on limiting further HCV transmission. According to the guidance, highest priority should be given to patients with advanced fibrosis with compensated cirrhosis and liver transplant recipients and high priority given to patients at high risk for liver-related complications and severe extra-hepatic HCV complications. The guidance provides further detailed information on additional conditions that warrant prioritization of treatment.
The website, developed by a panel of 27 liver disease and infectious diseases specialists and a patient advocate, provides recommendations based on the latest evidence and on consensus of the panelists. It is updated regularly to keep pace with improved diagnostic tools and new drug options as they become available.
“The benefits of curing HCV are clear from the standpoint of individual patients as well as that of the health and welfare of our society. This new guidance will help clinicians determine the best course of therapy for each patient given their unique condition,” said Barbara Murray, MD, FIDSA, president of IDSA.
The three organizations will continue to work together to provide future sections of the guidance website as well as timely updates. Upcoming sections will cover monitoring patients following treatment and management of acute HCV infection.
New Resources on Co-management Agreements and Antimicrobial Stewardship Now Available
Valuable new resources are now available to help IDSA members establish co-management agreements with a hospital or healthcare system for antimicrobial stewardship, infection control and prevention services. These resources, including a guide to co-management agreements and two studies examining ID physician executive hourly rates and maximum annual incentive compensation, provide background, rationale, and sample contract language. These can be found in IDSA’s Value of the ID Specialists’ Toolkit (member login required).
The toolkit also has valuable Antimicrobial Stewardship Resources to help IDSA members implement an antimicrobial stewardship program (ASP) at a healthcare facility, including materials from the Centers for Disease Control and Prevention, The Joint Commission, Agency for Healthcare Research and Quality, and the Veterans Health Administration. Additionally, the ASP Policy & Procedure Template offers a customizable program outline that provides language for ASP policy, procedure, personnel composition, interventions, surveillance, and a list of suggested restricted antimicrobials.
IDSA, HIVMA Appeal Medicaid Restrictions on Who Treats HCV
In response to action taken by some state Medicaid programs to restrict the types of providers who can prescribe drug therapies to treat hepatitis C virus (HCV), IDSA and HIVMA have developed an appeals letter template recommending that infectious diseases specialists and other HIV providers be covered prescribers of all HCV medications.
The letter provides succinct evidence points as well as a link to IDSA/HIVMA’s appeals letter to the Center for Medicare and Medicaid Services (CMS), which expresses the rationale for inclusion of ID specialists and HIV providers in HCV medication coverage in further detail. Among other points, the letter notes that IDSA, in collaboration with the American Association for the Study of Liver Diseases, is leading the way in providing timely guidance on HCV to clinicians (see www.hcvguidelines.org). IDSA members can insert their contact information and send the personalized appeals letter to a pharmacy director urging for a change in coverage.
HIVMA also issued a statement along with the American Academy of HIV Medicine expressing concerns about these restrictions and the adverse effects on patient care.
IDSA Convenes New National Stakeholder Group on Antimicrobial Resistance
IDSA has convened a new national stakeholder group to create awareness and mobilize the public to respond to the crisis of antimicrobial resistance. The new group, the U.S. Stakeholder Forum on Antimicrobial Resistance, or “S-FAR,” was convened on the principle that any U.S. government strategy to address antimicrobial resistance should involve sustained and meaningful engagement with non-government experts and stakeholders throughout the policy development and implementation process.
More than 70 national health organizations, representing medical and allied health professionals, hospitals and other healthcare facilities, patients and consumers, public health, research and advocacy, industry, and international health, have joined the partnership thus far. S-FAR partners will convene for an inaugural meeting in Philadelphia on Oct. 9 during IDWeek2014.
Federal Funding Process Stalled Just Weeks Ahead of New Fiscal Year
Congress has yet to approve bills to fund domestic and global health programs beyond the start of the new fiscal year, October 1. Policy differences between leaders in both the House and Senate have largely hobbled the annual appropriations process.
The current standoff comes just as promising spending levels were proposed for some ID and HIV programs. After much advocacy by IDSA, HIVMA and other health groups, important funding increases were proposed for the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Health Resources and Services Administration (HRSA), and the United States Agency for International Development (USAID).
For ID, a Senate subcommittee identified $30 million in new funding for the CDC to increase its efforts to address antimicrobial resistance, provided an increase to $32 million for the National Healthcare Safety Network (NHSN), continued support at $30 million for Advance Molecular Detection (AMD), sustained funding at $611 million for the Section 317 immunization program, continued support for the Biomedical Advanced Research and Development Authority (BARDA), and provided a marginal increase to the National Institute of Allergy and Infectious Diseases (NIAID) to $4.452 million.
In HIV, flat funding was provided for most HIV/AIDS-related programs with the exception of small increases for the AIDS Drug Assistance Program ($5 million). HIVMA was able to help secure favorable report language supporting the role of the NIH’s Office of AIDS Research and the subcommittee report also includes helpful language exempting scientific meetings from restrictions that have been placed on federal participation in conferences. In addition, the bill contains report language that would lift the ban on the use of federal funding to support syringe access programs. These developments would be erased if Congress fails to proactively move the FY2015 funding bills and reverts to the status quo, which would also entail additional across the board cuts.
IDSA and HIVMA will continue to advocate for robust federal funding for domestic and global ID and HIV/AIDS programs in FY 2015 and beyond. With just weeks until the start of the new fiscal year, it is now critically important that Congress be urged to complete the FY 2015 appropriations process. IDSA and HIVMA members are encouraged to take three minutes to email their members of Congress through the online Action Center.
Health Groups Share Federal Funding Experiences with Congress
IDSA and HIVMA joined several other groups under the umbrella of the Coalition for Health Funding to produce a report, Faces of Austerity: How Budget Cuts Hurt America’s Health, which features stories from researchers, practitioners, and public health officials from across the country whose work has been negatively affected by recent federal funding reductions. IDSA and HIVMA contributed a story from a member that captures the real-world implications of declining support to the National Institute of Allergy and Infectious Diseases (NIAID). The report was covered in the media and utilized during an advocacy day on Capitol Hill to highlight the need to restore funding to federal health programs. The goal of the report is to help shape decisions on federal spending that will occur over the next few months. Tweet your representatives and senators #CutsHurt and the report link to keep the discussion alive.
Advocacy on New Antibacterial Drug Pathway Continues in the House
A bipartisan group of 37 members of the House of Representatives have co-sponsored the Antibiotic Development to Advance Patient Treatment (ADAPT) Act, H.R. 3742, which has been promoted by IDSA. The ADAPT Act would permit a new antibiotic’s safety and effectiveness to be studied in smaller, more rapid clinical trials. In return, the drug would be narrowly indicated for use in a limited population of patients. ADAPT includes provisions to help guide the appropriate use of these drugs including: requiring the label to state the drug’s limited indication, granting the Food and Drug Administration authority to pre-review the drug’s promotional materials, and directing the Centers for Disease Control and Prevention (CDC) to monitor the drug’s use. IDSA is also advocating for the inclusion of a visual element on the drug’s label to clearly mark the drug as different from traditional antibiotics.
IDSA is urging additional members of the House to cosponsor the legislation so that it might be advanced this fall. IDSA members can support this effort in just a few minutes by emailing their representative through the IDSA Action Center today.
IDSA Submits Comments to FDA on Draft Guidance on Diagnostics
The Food and Drug Administration (FDA) recently issued draft guidance important to the development of new diagnostic tests. IDSA submitted comments to the first FDA draft guidance that calls for an expedited approval process for medical devices that can meet unmet medical needs. IDSA praised the agency's new provisions for diagnostic device trials, such as the use of banked samples from previous studies as well as contrived samples to test the clinical effectiveness and safety of diagnostics for rare diseases. IDSA believes this guidance will greatly facilitate the rapid development and review of innovative diagnostics and significantly impact patient care.
IDSA also submitted comments (PDF) to a second FDA draft guidance that allows small clinical studies in the approval process of diagnostics that address unmet medical needs. Acknowledging that smaller trials may leave more uncertainty about the risks and benefits of these tests, the guidance indicates that additional data can then be collected post-approval to provide information about the diagnostic’s efficacy and appropriate use in real-world settings. IDSA supports the provisions for post-market data collection that will allow novel tests to reach patients more rapidly.
Highlights from 20th International AIDS Conference
As clinicians and researchers gathered in Melbourne for the 20th International AIDS Conference, Science Speaks, the blog of the IDSA Center for Global Health Policy, provided extensive coverage.Science Speaks also offered a tribute to the lives and legacies of Joep Lange, Jacqueline van Tongeren, Glenn Thomas, Lucie van Mens, Martine de Schutter, and Pim deKuijer, who, conference-bound, lost their lives aboard MH 17.
Former President Bill Clinton invited delegates to define the terms of an interdependent world that had seen the loss of 298 people, including six global HIV leaders, on Malaysian Airlines Flight 17, but has also seen more than 13 million people receiving life-saving antiretroviral treatment.
More coverage included:
Concerns Regarding Changes to MOC Requirements Shared with ABIM
Since the introduction of major changes to its Maintenance of Certification (MOC) requirements in January, the American Board of Internal Medicine (ABIM) has received a great deal of feedback from physicians and medical specialty groups, including IDSA. IDSA has been working in collaboration with 26 other medical societies to express its concerns about these changes and to encourage ABIM to make appropriate alterations.
The changes in requirements for the ABIM MOC program centered around moving to a more continuous model, requiring physicians to meet standards set by peers on an ongoing basis rather than the previous 10-year cycle. Specifically, the program now requires:
In response to written concerns submitted in May by a coalition of medical societies including IDSA, ABIM made a number of adjustments to the MOC program and convened a summit meeting with representatives of the societies to further discuss concerns. To date, ABIM has put plans in place to make the following adjustments:
- All diplomats must meet the requirements.
- Diplomats must earn 100 points every five years.
- Some activity is required every two years.
- Diplomats must complete new modules on patient safety and survey their patients.
ABIM has not provided details regarding the timing of these updates; however, IDSA will continue to work with other medical societies to provide feedback to ABIM and to inform members as we learn more.
- Increase flexibility on deadlines.
- Add transparency of information on ABIM governance and finances.
- Broaden the range of CME options for medical knowledge and skills self-assessment.
- Provide more feedback on individual test scores.
- Evolve the “patient survey” requirement to a “patient voice” requirement.
- Reduce the data collection burden for the practice assessment requirement.
IDSA Education and Research Foundation Launches New Website
The IDSA Education and Research Foundation has provided educational and research opportunities for medical students, fellows, and infectious diseases specialists since its inception in March 2000. The Foundation continues to play a critical role in engaging future infectious diseases specialists through scholarships and fellowships, complementing the activities of the Center for Global Health Policy, thanks to the continued support of many IDSA members and friends. The Foundation is excited to unveil its newly designed website. The new website will better raise awareness among the infectious diseases community of Foundation-supported programs, recipients’ achievements, and supporters’ contributions, both individuals and organizations. Two important components of the new website are a feature box using testimonials, photos, and videos to highlight research and project activities, and a donor acknowledgement section that identifies those who have gone above and beyond to support the Foundation.
IDSA members are encouraged to visit www.idsafoundation.org and donate today.
Sign Up for OFID Table of Contents Alerts
Open Forum Infectious Diseases (OFID), IDSA’s new open access journal, now offers free electronic table of contents (e-TOC) alerts. OFID is fully peer-reviewed and freely accessible to the public. As an open access journal, OFID relies primarily on author fees to support the peer review and publishing processes. IDSA and HIVMA members receive a discount on author fees.Sign up to receive the e-TOC alerts at http://services.oxfordjournals.org/cgi/alerts/etoc. Read the journal online at www.ofid.oxfordjournals.org.
In Memoriam: Gene H. Stollerman, MD, FIDSA (1920-2014)
IDSA founder, Gene Stollerman, MD, FIDSA, passed away on August 1, 2014 at age 93 at his home in Hanover, NH, after an extended illness with heart failure. Dr. Stollerman’s stellar career began in the early 1940s upon graduating from Dartmouth College and receiving his MD from Columbia University.
Upon returning from military service as a captain in the US Army Medical Corps, Dr. Stollerman served as chief resident in medicine at Mount Sinai Hospital and then went on to become director of New York University’s Irvington House for Children with Heart Disease, where he received national recognition for his research on the use of penicillin for the prevention of rheumatic fever. This led to an endowed professorship at Northwestern University for research in rheumatic, immunologic, and infectious diseases.
In the mid-1960s, as chair of the Department of Medicine at the University of Tennessee, he became a national leader in infectious diseases, clinical research, and preventive medicine. Dr. Stollerman went on to become a professor at Boston University Medical Center, where he promoted research and clinical training in geriatrics, preventive medicine, health services research, and primary care. In 1986 he was appointed Distinguished Physician of the Department of Veterans Affairs, where he pioneered health services research in the care of the aging veteran. He retired in 1995 to his home in Hanover, NH, where he continued to edit journals, write, and teach.
Throughout his career, Dr. Stollerman served on numerous councils and committees including serving as president of the Association of Professors of Medicine, president of the Central Society for Clinical Research, and as a member of the executive committee of the American Board of Internal Medicine.
Among his many honors and awards, Dr. Stollerman received the Bruce Medal for Preventive Medicine from the American College of Physicians, the Thulis Award from the American Geriatrics Society, and the Mentor Award of IDSA.
Dr. Stollerman is survived by his son, John Stollerman, and daughter, Anne DiZio.
IDSA Announces 2014 Fellows
Fellowship in IDSA honors those who have achieved professional excellence and provided significant service to the infectious diseases profession. Applicants for IDSA fellowship must be nominated by their peers and meet specified criteria, including national or local recognition and publication of their work. Nominees are reviewed and elected by the IDSA Board of Directors.
“IDSA Fellows are known in their hospitals, clinics, research labs, institutions, and communities as leaders and experts in the field of infectious diseases,” said IDSA President Barbara Murray, MD, FIDSA. “Fellowship in IDSA is our way of recognizing these accomplished physicians, researchers, and scientists and their contributions to our field. We congratulate this year’s Fellows.”
The following individuals have been elected for IDSA Fellowship:
Bradley L. Allen, MD, FIDSA
Richard L. Roudebush VAMC, Indianapolis, IN
Deverick Anderson, MD, MPH, FIDSA
Duke University Medical Center, Durham, NC
David R. Andes, MD, FIDSA
University of Wisconsin Hospital, Madison, WI
Jared M. Baeten, MD, PhD, FIDSA
University of Washington, Seattle, WA
Ben J. Barnett, MD, FIDSA
University of Texas-Houston Medical School, Houston, TX
William Bishai, MD, PhD, FIDSA
Johns Hopkins University, Baltimore, MD
Anne J. Blaschke, MD, FIDSA
University of Utah, Salt Lake City, UT
Willem H. Boom, MD, FIDSA
Case Western Reserve University, Cleveland, OH
Dale W. Bratzler, DO, MPH, FIDSA
University of Oklahoma Health Sciences Center, Oklahoma City, OK
Carrie L. Byington, MD, FIDSA
University of Utah, Salt Lake City, UT
Miriam L. Cameron, MD, FIDSA
Kaiser Permanente, Silver Spring, MD
Anuradha Chowdhary, MD,PhD, FIDSA
Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
John Cmar, MD, FIDSA
Sinai Hospital of Baltimore, Baltimore, MD
Valerie A. Creswell, MD, FIDSA
Infectious Disease Consultants, Wichita, KS
Benjamin T. Davis, MD, FIDSA
Massachusetts General Hospital, Boston, MA
John A. Davis, MD, PhD, FIDSA
Ohio State University, Columbus, OH
Del J. DeHart, MD, FIDSA
Michigan State University, Saginaw, MI
Mark J. DiNubile, MD, FIDSA
Merck & Company Inc., North Wales, PA
Dimitri M. Drekonja, MD, FIDSA
Minneapolis Veterans Affairs Medical Center, Minneapolis, MN
Daniel S. Fierer, MD, FIDSA
Mount Sinai School of Medicine, New York, NY
Lisa K. Fitzpatrick, MD, MPH, FIDSA
Centers for Disease Control and Prevention, Washington, DC
Timothy J. Friel, MD, FIDSA
Lehigh Valley Health Network, Allentown, PA
Yoav Golan, MD, FIDSA
Tufts Medical Center, Boston, MA
Ram Gopalakrishnan, MD, MRCP, FIDSA
Apollo Hospitals, Chennai, India
Stefan Hagmann, MD, MSc, FIDSA
Bronx Lebanon Hospital Center, Bronx, NY
Joshua D. Hartzell, MD, FIDSA
Walter Reed National Military/Medical Center, Bethesda, MD
Rayhan Hashmey, MD, FIDSA
Tawam Hospital, Al Ain, United Arab Emirates
Ali Hassoun, MD, FIDSA
Alabama ID Center, Huntsville, AL
Dora Y. Ho, MD, PhD, FIDSA
Stanford University, Stanford, CA
W. C. Huskins, MD, MSc, FIDSA
Mayo Clinic, Rochester, MN
Erica N. Johnson, MD, FIDSA
Brooke Army Medical Center, Baltimore, MD
Ravi K. Kamepalli, MD, FIDSA
Regional Infectious Disease and Infusion Center Inc., Lima, OH
Tetsuro Kato, MD, FIDSA
Jikei University School of Medicine, Tokyo, Japan
Mark G. Kortepeter, MD, FIDSA
Uniformed Services University of the Health Sciences, Bethesda, MD
Andrea A. Kovacs, MD, FIDSA
Keck School of Medicine of USC, Los Angles, CA
Paul M. Lantos, MD, FIDSA
Duke University Medical Center, Greensboro, NC
Scott P. Layne, MD, FIDSA
Private Practice, Los Angeles, CA
Ethan G. Leonard, MD, FIDSA
Case Western University, Cleveland, OH
Michael K. Leonard, Jr., MD, FIDSA
ID Consultants Charlotte, Charlotte, NC
Emil P. Lesho, DO, FIDSA
Walter Reed Army Institute of Research, Silver Spring, MD
Catherine Liu, MD, FIDSA
University of California, San Francisco, San Francisco, CA
Anurag Malani, MD, FIDSA
St. Joseph Mercy Health System, Ann Arbor, MI
Lisa K. Maragakis, MD, FIDSA
Johns Hopkins University School of Medicine, Baltimore, MD
Trini A. Mathew, MD, MPH, FIDSA
University of Connecticut Health Center, Farmington, CT
Ryan C. Maves, MD, FIDSA
Naval Medical Center San Diego, Chula Vista, CA
Nkechi E. Mbanefo-Azie, MD, FIDSA
Astellas Pharma US Inc., Northbrook, IL
Aaron Milstone, MD, FIDSA
Johns Hopkins University, Baltimore, MD
Daniel Morgan, MD, FIDSA
University of Maryland School of Medicine, Baltimore, MD
Brian S. Murphy, MD, FIDSA
Medpace, Cincinnati, OH
Gerard J. Nau, MD, PhD, FIDSA
Rhode Island Hospital, Providence, RI
Andrew Nevins, MD, FIDSA
Stanford University, Stanford, CA
Viseth Ngauy, MD, FIDSA
Tripler Army Medical Center, APO, HI
Richard M. Novak, MD, FIDSA
University of Illinois, Chicago, IL
Stephen K. Obaro, MD, FIDSA
University of Nebraska Medical Center, Omaha, NE
Christopher A. Ohl, MD, FIDSA
Wake Forest University, Winston-Salem, NC
Saad Omer, PhD, FIDSA
Emory University/Rollins School of Public Health, Atlanta, GA
Belinda Ostrowsky, MD, FIDSA
Montefiore Medical Center/Albert Einstein Medical Center, Bronx, NY
Robert M. Paris, MD, MPH, FIDSA
Walter Reed Army Institute of Research, Silver Spring, MD
Steven W. Parker, MD, FIDSA
Sierra Infectious Disease, Reno, NV
Atul K. Patel, MD, FIDSA
Vedanta Institute of Medical Science, Ahmedabad, India
Steven A. Pergam, MD, MPH, FIDSA
Fred Hutchinson Cancer Research Center, Seattle, WA
Paul S. Pottinger, MD, FIDSA
University of Washington, Seattle, WA
Moti N. Ramgopal, MD, FIDSA
Associates in Infectious Diseases, Fort Pierce, FL
J. Trees Ritter, DO, FIDSA
Central Coast ID Consultants, San Luis Obispo, CA
Mitchell B. Rosenfeld, MD, FIDSA
Memorial Regional Hospital, Hollywood, FL
Vincent O. Rotimi, MD, MSc, PhD, FIDSA
Kuwait University, Safat, Kuwait
Michael Rubin, MD, PhD, FIDSA
University of Utah, Salt Lake City, UT
Marco A. Ruiz, MD, FIDSA
Louisiana State University Health Sciences Center, New Orleans, LA
Cassandra D. Salgado, MD, MS, FIDSA
Medical University of South Carolina, Charleston, SC
Edsel M. Salvana, MD, FIDSA
National Institutes of Health, University of the Philippines Manila, Manila, Philippines
Priya Sampathkumar, MD, FIDSA
Mayo Graduate School of Medicine, Rochester, MN
Mark H. Sawyer, MD, FIDSA
University of California, San Diego School of Medicine, San Diego, CA
Christina Schofield, MD, FIDSA
United States Air Force, Olympia, WA
Irene G. Sia, MD, FIDSA
Mayo Clinic, Rochester, MN
Martin S. Siegel, MD, FIDSA
University of Washington, Bellevue, WA
Kari Simonsen, MD, FIDSA
University of Nebraska Medical Center, Omaha, NE
Dawd Siraj, MD, FIDSA
East Carolina University Brody School of Medicine, Greenville, NC
Muhammad R. Sohail, MD, FIDSA
Mayo Clinic, Rochester, MN
Emilia M. Sordillo, MD, PhD, FIDSA
St Lukes-Roosevelt Hospital Center, New York, NY
Barry Statner, MD, FIDSA
Robles Hospital & Medical Center, Thousand Oaks, CA
Timothy R. Sterling, MD, FIDSA
Vanderbilt University School of Medicine, Nashville, TN
Raymond A. Strikas, MD, FIDSA
Centers for Diseases Control and Prevention, Atlanta, GA
Aruna K. Subramanian, MD, FIDSA
Stanford University, Stanford, CA
Keipp Talbot, MD, FIDSA
Vanderbilt University Medical Center, Nashville, TN
Jeffrey M. Tessier, MD, FIDSA
Texas Health Care, Keller, TX
John R. Ticehurst, MD, FIDSA
Johns Hopkins Hospital, Baltimore, MD
Robin Trotman, DO, FIDSA
CoxHealth, Springfield, MO
George M. Varghese, MD, FIDSA
Christian Medical College, Vellore, India
Anilrudh Venugopal, MD, FIDSA
Loyola University Medical Center, Chicago, IL
Maria Virginia Villegas, MD, FIDSA
CIDEIM Research Center, Cali, Valle, Colombia
Mary A. Vogler, MD, FIDSA
Weill Cornell Medical College, New York, NY
Paige Waterman, MD, FIDSA
Walter Reed National Military Medical Center, Silver Spring, MD
Jason Weinberg, MD, FIDSA
University of Michigan, Ann Arbor, MI
Mark P. Wilhelm, MD, FIDSA
Mayo Clinic, Rochester, MN
Timothy J. Wilkin, MD, FIDSA
Weill Medical College of Cornell University, New York, NY
John W. Wilson, MD, FIDSA
Mayo Clinic, Rochester, MN
Alan J. Wright, MD, FIDSA
Mayo Clinic-Rochester, Rochester, MN
Vijay V. Yeldandi, MD, FIDSA
University of Illinois Chicago, Chicago, IL
Najam A. Zaidi, MD, FIDSA
Roger Williams Medical Center, Providence, RI
Richard K. Zimmerman, MD, FIDSA
University of Pittsburgh, Pittsburgh, PA
Members on the Move
Demetre Daskalakis, MD, has been named assistant health commissioner for the New York City Bureau of HIV/AIDS Prevention and Control. In 2006, he founded the Men’s Sexual Health Project, which involved testing men for HIV and other sexually transmitted diseases in sex clubs and bathhouses. Dr. Daskalakis serves on the board of Gay Men’s Health Crisis and on the antiviral advisory committee for the U.S. Food and Drug Administration.
Dale Bratzler, DO, MPH, has been named senior policy advisor at the Office of the Associate Director for Policy at the Centers for Disease Control and Prevention. Dr. Bratzler also serves as chief quality officer-OU Physicians Group and professor and associate dean of the College of Public Health at the University of Oklahoma Health Sciences Center. Dr. Bratzler previously served as president and CEO of the Oklahoma Foundation for Medical Quality and director of medical education at Oklahoma State University.
Are you a member on the move? Do you know someone who is? Contact Jennifer Morales at email@example.com so we can announce it to our membership.
Aguilar Salinas, Pedro, MD
Alawdah, Laila, MBBS
Alexander, Elizabeth, MD, MSc
Bagasra, Alexander, MD
Cane, Michael, MD
Davids, Abby, MD, MPH
Dhakal, Bidur, MD
Dobre, Paul, DO, PHD
Edden, Michelle, PharmD
Evangelio, Costanza, MD
Georgiades, Benjamin, PharmD
Grunwald, Jenny, PA-C
Hamula, Caille, PhD
Hernandez, Maria, MD
Holzbauer, Stacy, DVM, MPH
Ide, Louis, MD
Iglesias, Antonio, PharmD
Irabor, Iziegbe, MBBS
Jolivet, Marie, MD
Kaleko, Michael, MD, PhD
Keeshin, Susan, MD
Koenke, Debra, MSN
Lehman, Laura, PhD
Lyrene, George, MD
Marino, Kaylee, PharmD
Meddings, Jennifer, MD, MSc
Miller, David, MD, MPH
MuÃƒÂ±oz de Benito, Rosa Maria, MD
Nowak, Michael, PharmD
Ostfeld, Iris, MD
Parker, Eric, MSN, NP, RN
Racino, Ryan, PharmD
Randlemon, Julianne, DNSc, NP, RN
Sabbagh, Wissam, MD
Sawler, Daniel, MD
Schoenbachler, Lauren, PharmD
Sharma, Navneet, MBBS, MD
Sikich, Kaitlin, PA-C
Smith, Bradley, MD
White, Margaret, BSN, MPH, MSN, NP
Worley, Marylee, PharmD
Yoke, Leah, PA-C
Ahrens, John, MD
Alsan, Marcella, MD, MPH, PhD
Baldwin, Kelly, MD
Buckel, Whitney, PharmD
Jasrotia, Davinder, MBBS, MD
Juretschko, Stefan, PhD
Kallstrom, George, PhD
Kociolek, Larry, MD
Lee, Daniel, PharmD
Nachega, Jean, MD
Norizuki, Masataro, MD
Varghese, Sunil, MD
Vega, Vivian, MD
Vervaeke, Steven, MD
Villagroy Gomez, Javier, MD
Watson, Douglas, MD
Yasin, Sami, MD
Abd El Gadir, Ghussai, MBBS
Abdulmassih, Rasha, MD
Achebe, Loraine, MBBS
Ahmed, Sohail, MD
Akhtar, Lisa, MD, PhD
Alame, Diana, MD
Al-Shaikh, Layla, MD
Arguello, Sara, MD
Arguello Perez, Esther, MD
Arif, Nida, MD
Atri, Nipun, MD
Baghdadi, Jonathan, MD
Banzon, Jona, MD
Barbosa, Felipe, MD
Barnes, Erin, MD
Berlanga, Gemma, MD
Bgoya, Kaneza, MD
Bhat, Supriya, MD
Blanco Gueman, Merilda, MD
Bontempo, Gilda, MD
Brady, Adam, MD
Briant, Judith, MD
Brown, Lillian, MD, PhD
Bukhari, Imran, MBBS
Caroff, Daniel, MD
Castro Pena, Norys Alexandra, MD
Censullo, Andrea, MD
Chang, Yeh-Chung, MD
Chatfield, Peggy, MPH
Chaudhary, Manu, MD
Cheruranky, Anita, MD
Choi, Byungwoo, MD
Chu, Jacqueline, MD
Claeys, Kimberly, PharmD
Collins, Matthew, PhD
Cotter, Aoife, PhD
Covelli, Vincent, DO
da SIlva, Juliana, MD
Daniel, Krupa, DO
Dare, Ryan, MD
Dave, Apara, MD
Dbeibo, Lana, MD
Delgado, Alejandro, MD
Devraj, Vinay, MD
Duke, Elizabeth, MD
Dunn, Jessica, MD, MPH
Dysangco, Andrew, MD
Eastment, McKenna, MD
El Boghdadly, Zeinab, MD
El Chaer, Firas, MD
El Chakhtoura, Nadim, MD
El-sayed, Dena, MD
Enemchukwu, Chubuzo, MD
Epstein, Rachel, MD
Epstein, David, MD
Feinstein, Addi, MD
Fernandes, Priyanka, MBBS
Figueroa, Danisha, MD
Foo, Cheryl, MD
Ford, Emily, MD
Foster, Clayton, MD
Fox, Jarod, MD
Francis, Ekezie, MD
Frasca, Katherine, MD
Furuichi, Munehiro, MD
Galbraith, Ronald, MD
Gancher, Elizabeth, MD
Gervacio, Benclement, MD
Ghimire, Rabindra, MD
Gill, Navneet, MD
Godshall, Casey, MD
Gomez, Gabriel, MD
Gomez-Alvarez, Carlos, MD
Greene, Matthew, MD
Groner, Mordechai, MD
Haidar, Ghady, MD
Hamad, Yasir, MBBS
Hamdan, Manal, MD
Haque, Javeria, MD
Harrington, Whitney, MD, PhD
Harris, Meghan, MD
Harris, Nadine, MD
Hatahet, Dania, MD
Hopkins, Mary, MD
Hough-Telford, Catherine, MD
Hussain, Cory, MD
Igbinosa, Osamuyimen, MD
Ippolito, Matthew, MD
Jagga, Shirish, MD
Jain, Aabha, MD
Jamali, Layli, MD
Jaspal, Sunjit, MD
Jessani, Laxman, MD
Johnson, Jessica, DO
Kaewpoowat, Quanhathai, MD
Kandel, Christopher, MD
Kanjilal, Sanjat, MD, MPH
Kapadia, Shashi, MD, PhD
Kaplan-Lewis, Emma, MD
Katz, Morgan, MD
Kaur, Ishminder, MD
Keaton, Amelia, MD
Kenechukum, Obiokoye, MD
Khatib, Samara, MD
Klinger, Frederick, DO
Kouma, Marcus, PharmD
Kynaston, Kelly, DO
Labuda, Sarah, MD, MPH
Lakshmi, Seetha, MD
Langlier, Charles, MD, PhD
LaVie, Katherine, MD
Leahey, Peter, MD
Lederer, Philip, MD
Lewis, James, MD
Lim, Rex, MD
Lisco, Andrea, MD
Longworth, Sarah, MD
Lowenstein, Hayden, MD
Lucar Lloveras, Jose, MD
Luk, Alfred, MD
MacKenzie, Lauren, MD
Madeo, Jennifer, DO
Makadia, Jina, MD
Malik, Farida, MD
Maloule, Ossama, MD
Manning, Nyla, MD
Manohar, Akshay, MBBS
Marcelin, Jasmine, MD
Markley, John, DO
Marsh, Ketzela, MD
Mattar, Caline, MD
Mawas, Isam, MD
Medzihradsky, Oliver, MD, MPH, MS
Mendoza, Neil, MD
Mikulca, Janelle, PharmD
Miller, William, MD
Milligan, Patrick, MD
Morales, Megan, MD
Moritz, Donna, MD
Mueller, Daniel, MD
Mullin, Katherine, MD
Nachimuthu, Nagakrishnal, MD
Nadiger, Shrivatsa, MD
Nagendran, Kokila, MD
Natarajan, Mukilan, MD
Nazinitsky, Allison, MD
Needles, Mark, MD
Nelson, Sara, MD
Nicholson, Erin, MD
Nicoletti, Brianne, DO
Nomura, Yosuke, MD
Non, Lemuel, MD
Novack, Amanda, MD
Odrobina, Robert, MD
Oliver, Nora, MPH
Orellana, Cesar, MD
Patwa, Tanmay, MD
Paules, Catharine, MD
Perez, Christian, MD
Perkins, Matthew, MD
Petrey, Christopher, DO
Piantadosi, Anne, MD, PhD
Quang Ho, Minh, DO
Quilter, Laura, MD
Rafeek, Hashmi, MD
Raybould, Jillian, MD
Reid, Michael, MD
Reyes Angeles, Maria, MD
Reza, Mohammed, MD
Rogers, Thomas, MD, PhD
Rosa, Rossana, MD
Rose, Michael, MD
Rutishauser, Rachel, MD, PhD
San Jose, Sergio, DO
Sanchez, Diana, MD
Shah, Ansal, MD
Sheffer, Ian, MD
Shenderov, Maryana, MD
Shevy, Laura, MD
Shibib, Dena, DO
Shimose, Luis, MD
Sim, Jean, MBBS, MRCP
Smith, Jordan, PharmD
Souder, Emily, MD
Soule, Daniel, DO
Spiess, Krystine, DO
Strnad, Luke, MD
Suazo Hernandez, Lia, MD
Sudhindra, Praveen, MBBS, MD
Syed, Javeria, MBBS
Szabela, Maria Elaine, MD
Teh, Yii Ean, MBBS, MRCP
Tewell, Chad, MD
Tirmizi, Amir, MD
Vorkas, Charles, MD
Waldman, Sarah, MD
Wang, Dingyuan, MBBS
Wang, Jeffrey, MD
Wark, Kellie, MD
Washam, Matt, MD, MPH
Woltmann, Jon, MD
Woolley, Ann, MD
Wu, Gina, DO
Yared, Nicholas, MD
Yim, Juwon, PharmD
Yoon, Inae, MD
Yoon, Hyun, MD
Young, Cynthia, MD
Young Highsmith, Heather, MD, MSc
Zanoni, Brian, MD
Zasowski, Evan, PharmD
Zhou, Hong Yuan, MD
Zmeter, Carla, MD
Zukowski, Elisabeth, MD
Arena, Roberto, MD
Isip, Jacqueline, PharmD
Jubbal, Sandeep, MD
Koroscil, Matthew, MD
Naegele, Sandra, PharmD
Sfeir, Maroun, MD
Eberly, Lauren, BCh
Omatsone, Anne, MD
Rawlings, Stephen, PhD
Presidentís Message: With the Spotlight on Drug Resistance, Itís Time for the ID Specialistís Role in Stewardship to Shine
So much has happened in the realm of antimicrobial resistance since the start of my term as president of IDSA a year ago including a seminal report from the CDC and increasing support from the President and Congress. Central to the fight against antimicrobial resistance is stewardship, and as ID specialists we are uniquely qualified to provide leadership to a multi-disciplinary team of healthcare professionals that will effectively engage physicians, nurses, and administrators in a systematic manner.
As my term as president of IDSA comes to a close and I reflect on the past year, I recall that shortly before taking the gavel from David Relman, the Centers for Disease Control and Prevention issued a seminal report on the state of antimicrobial resistance.
So much has happened in the realm of antimicrobial resistance since then: President Obama has requested significant funding to address the problem; the President’s Council of Advisors on Science and Technology (PCAST) has embraced recommendations that closely mirror IDSA policy initiatives; support is building in Congress for legislation that would create a special path to Food and Drug Administration approval for urgently needed new antibiotics; and new antibiotics have come to market, bringing us a little closer to IDSA’s 10x20 Initiative goal. It is heartening to see that there is growing public awareness and concern around this issue. The threat of antimicrobial resistance is something that we as infectious diseases specialists and IDSA have been sounding an alarm about for years. It was a decade ago that IDSA issued its Bad Bugs, No Drugs report outlining the serious problem we face as well as the steps we believed needed to be taken toward a solution.
What should not be lost in this discussion is the critical role of antimicrobial stewardship programs in preventing drug resistance. Working with our colleagues in the Society for Healthcare Epidemiology of America, IDSA has continued to promote stewardship, most recently by calling for antimicrobial stewardship to be required as a condition of participation for hospitals in the Medicare program. IDSA will continue our important advocacy to make this policy a reality. Hospitals and health care systems may embrace stewardship as a cost-saving measure, which is also important, but we need to make the case that stewardship is about providing better patient care—both in terms of making sure that the individual patient receives the right drug (for the appropriate length of time and in the right dose) and in helping to preserve the effectiveness of antibiotics for all of our patients.
Through an ID-led antimicrobial stewardship program, we can provide peer-to-peer consultations on the prescription of antimicrobial treatments based on expert clinical judgment that cannot be provided by any other subspecialty. As ID specialists, we bring to the table a sophisticated knowledge of how antimicrobials work, as well as an in-depth understanding of the relationship between antimicrobial use and the development of drug resistance. We are uniquely qualified to provide leadership to a multi-disciplinary team of healthcare professionals that will effectively engage physicians, nurses, and administrators in a systematic manner. Furthermore, our ability to transition patients from the inpatient setting to more efficient options, employing outpatient parenteral antimicrobial therapy (OPAT), distinguishes us as providers that align patient-centered solutions with value-based care.
IDSA offers a number of helpful resources for developing a stewardship program in its Value of ID Toolkit, including a template on Antimicrobial Stewardship Policy and information on how to provide antimicrobial stewardship services to facilities under co-management or gain-sharing agreements.
IDSA will also continue to advocate for other federal policies that support and promote stewardship, including stronger data collection on antimicrobial drug use and resistance patterns, funding for research to help evaluate the effectiveness of activities to limit the development of resistance and determine best practices, and incentives to stimulate the development and clinical integration of rapid diagnostic tests—a critical tool for stewardship activities.
As stewards, our job is to keep the focus on better outcomes for our patients and the health care system. We can all agree that the most expensive antibiotic isn’t always the best option, but, if it is, cost should not prevent its use. At the same time, we must take care to preserve our antimicrobials’ effectiveness and protect our patients from future drug resistance.
IDSA Provides Ebola Resources for ID Clinicians
With the increasing numbers of those stricken by the Ebola outbreak in West Africa and increasing concern here in the U.S., IDSA has compiled several resources for our members including guidance from the CDC. Special sessions have also been added to the upcoming IDWeek schedule.
In an effort to keep our members current with the evolving Ebola outbreak in West Africa and prepared for any potential US response, IDSA has compiled numerous resources on the homepage of our website including:
IDWeek, Oct. 8-12 in Philadelphia, will include timely updates on Ebola, including perspectives from physicians and scientists who have been involved with the response in West Africa and the US.In addition to providing these resources to our members, IDSA has also coordinated responses to several media inquiries about the outbreak. Thanks to the help of members of the Public Health Committee, we have been able to provide a science-based perspective to the general public’s understanding of the outbreak, the medical response, and the likelihood of the virus appearing in the US. In a recent story appearing in Salon, Jeff Duchin, MD, FIDSA, chair of IDSA’s Public Health Committee responded to a recent Harvard School of Public Health survey showing that over a quarter of Americans fear that they or someone in their family could become infected with the virus, explaining that the chances of a US outbreak are close to zero.
Additional Resources and Requests:
Oxford University Press, publisher of IDSA journals, has a collection of journal articles on Ebola, available free of charge at: www.oxfordjournals.org/en/our-journals/medicine-and-health/ebola.html
Centers for Disease Control and Prevention Advice for Humanitarian Aid Workers Traveling to Guinea, Liberia, Nigeria, or Sierra Leone during the Ebola OutbreakDoctors Without Borders/ Médecins Sans Frontières (MSF) is actively looking for medical personnel who can assist with the Ebola crisis in West Africa. They are looking for nurses and physicians with experience working in isolation wards and infection control. To learn more about the qualifications needed or to apply visit the Doctors Without Borders website.
Sign Up for AlertsMuch of the information provided above was shared with IDSA members through the two email services offered 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. Other recent alerts have included:
Cubist Pharmaceuticals Issues Voluntary U.S. Recall Of Certain Lots Of CUBICIN
FDA approves Orbactiv to treat skin infections
IDSA members can log in to MyIDSA to sign up for these services online.
Is Your Facility Experiencing Antibiotic Shortages?IDSA members are urged to report drug shortages directly to FDA and to copy IDSA staff at firstname.lastname@example.org.
Countdown to IDWeek 2014
ID Week is just weeks away! Learn about recently added sessions addressing the Ebola outbreak, several satellite symposia, and an inaugural Donors’ Lounge for supporters of the IDSA Education and Research Foundation.
IDWeek has recently added two exciting late breaker sessions. “Emerging Outbreaks in the News” will feature talks on dengue, chikungunya and Ebola. Robert Fowler, MD, MDCM, MSc of the University of Toronto, who is currently on the ground in Sierra Leone working in some of the areas hardest hit by Ebola, will provide a brief overview of Ebola and a summary of the current outbreak, with insights on the challenges of patient management and disease control in resource-limited settings. A second late breaker, entitled “Ebola – the US Experience,” will take place immediately following the opening Special Plenary Session on Resource-Limited Health Care Issues. Please check the Interactive Program planner for updates at www.idweek.org and the Final Program Addendum (available at registration) for further details.
Abstracts will be available through the Interactive Program planner and the IDWeek Mobile App. New this year, abstracts will also be published in a special online supplement to Open Forum Infectious Diseases (OFID), the new open access journal from IDSA and HIVMA.
IDWeek 2014 will play host to a number of affiliated events in Philadelphia. This year’s meeting will feature five accredited satellite symposia. These programs offer CME that is supplemental to credits offered by the Official IDWeek Program. New this year, the IDExpo Hall will feature a Learning Lounge for attendees to view 45-minute presentations from various exhibiting companies during exhibition hours (10 a.m. – 2 p.m., Thurs-Sat). Further details for these and all affiliated events will be available in early September at www.idweek.org.
IDSA Foundation Donors’ Lounge
The IDSA Education and Research Foundation is excited to launch its inaugural Donors’ Lounge at this year’s IDWeek. The lounge will provide a quiet space to relax throughout IDWeek, providing donors the opportunity to get online with a local Wi-Fi hotspot, enjoy complimentary continental breakfast, coffee and snacks, and recharge devices. Access to the donors lounge is limited to qualifying donors (a total of $500 or more given from Oct 2, 2013 to present). Only those individuals with a Donors’ Lounge Access Pass will be granted entry. Donations will be accepted at the Donors’ Lounge, room 117, or online at www.idsafoundation.org. Official invitations will be sent in early September.
IDSA Business Meeting/Posters in the Park Reception
Be sure to attend the IDSA Business Meeting and Posters in the Park Reception (6 – 8 p.m., Fri., in the Philadelphia Marriott Downtown, Grand Ballroom) for a “State of the Society” speech from IDSA President Barbara Murray, MD, FIDSA, as well as presentations by the leaders of each of the other IDWeek partnering societies—HIVMA, the Society for Healthcare Epidemiology of America, and the Pediatric Infectious Diseases Society. The wine and cheese reception will feature poster presentations that have been specially selected by the respective societies.Register now to take advantage of the best travel rates. Information about housing and travel discounts can be found at http://www.idweek.org/attendees/housing-and-travel/.
IDSA Journal Club
The Era of Interferon-Free Therapy Arrives for HIV-infected Patients with Chronic HCV; Impact of Time to Antibiotic Administration on Mortality in Patients with Febrile Neutropenia;The Good (Reduced Mortality), the Bad (One More Metric), and the Timely: Antibiotic Timing and Severe Sepsis; Cefazolin: A More Tolerable Option than Nafcillin for Outpatient Parenteral Therapy for S. aureus Disease?; Patience Matters: Reduction in Mortality with Delayed ART in Treatment-Naive AIDS Patients with Cryptococcal Meningitis; Double the Risk of Suicidality with Efavirenz-Containing ART
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, FIDSA, in each issue of Clinical Infectious Diseases.
The Era of Interferon-Free Therapy Arrives for HIV-infected Patients with Chronic HCV
Reviewed by Nina Kim, MD, MSc
Death from end-stage liver disease is a major cause of non-AIDS-related mortality among HIV-infected individuals, with an overwhelming majority of these deaths attributable to chronic hepatitis C virus (HCV) infection. However, treatment of HCV in HIV/HCV co-infected patients has historically been infrequent due to the poor efficacy as well as complexity and toxicity of interferon-based therapy. The advent of direct-acting antiviral (DAA) combination therapy for HCV has changed this history. The PHOTON-1 study of the all-oral regimen of sofosbuvir plus ribavirin, published in the July 19 HIV-themed issue of the Journal of the American Medical Association, is the first to prove the concept that interferon-free therapy is safe and efficacious in this population.In this open-label phase 3 trial, patients received sofosbuvir, a nucleotide NS5B polymerase inhibitor, with ribavirin (weight-based dosing). The majority (n=114) were treatment-naive patients with genotype 1 HCV infection who received 24 weeks of therapy. The remainder had genotype 2 or 3 infection and received either 12 weeks (treatment-naive, n=68) or 24 weeks (treatment-experienced, n=41). The median CD4 count ranged from 562 to 581 cells/mm3 and 95 percent were on antiretroviral therapy. Ultimately this regimen was safe, well-tolerated, and achieved high rates of sustained virologic response (SVR, HCV viral level <25 IU/ml 12 weeks post-treatment): 76 percent for genotype 1 and 67-94 percent for genotype 2 or 3 patients – success rates that are notably comparable to those observed in the mono-infection trials.
This study heralds the beginning of the end of the interferon era and hopefully more widespread treatment of co-infected patients. But as impressive as 76 percent may be compared with the historic 25-30 percent SVR with 48 weeks of peginterferon and ribavirin in genotype 1 co-infected patients, the promise of greater than 90 percent efficacy with multi-class DAA combinations of 12 weeks or shorter is just around the corner.
(Sulkowski et al. JAMA. 2014;312:353-61.)
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Impact of Time to Antibiotic Administration on Mortality in Patients with Febrile Neutropenia
Reviewed by Zeina Kanafani, MD, MS
Febrile neutropenia is a significant cause of mortality in patients on chemotoxic drugs. The time to antibiotic administration (TTA) is a known determinant of mortality in patients with sepsis, with current guidelines recommending a TTA of one hour or less with appropriate antibiotics. However the impact of TTA on mortality and the optimal TTA for patients on chemotherapy with febrile neutropenia is still not well established.
In the July 2014 issue of Antimicrobial Agents and Chemotherapy, researchers prospectively analyzed 307 febrile neutropenia episodes in 169 subjects. Bloodstream infections were the most common cause of fever (37.4 percent) with E. coli accounting for 41.7 percent of infections followed by coagulase negative staphylococci (31.3 percent). During the study period, 29 patients died (9.4 percent). Cox regression was used to determine predictors of mortality at 28 days. There was a statistically significant association between TTA and mortality (1.66 hours in the mortality group vs. 0.33 hours in the survival group; p < 0.001). Each hour of delay in TTA was associated with an 18 percent increase in mortality (hazard ratio, 1.19; 95 percent confidence interval, 1.10-1.26). Additional independent predictors of mortality included a relapsing underlying disease, bloodstream infection, and high-risk Multinational Association for Supportive Care in Cancer (MASCC) score.
The authors also performed a subgroup analysis comparing mortality in patients with a TTA of < 30 minutes to those with a TTA between 31 and 60 minutes. They found that 28-day mortality was significantly decreased in those with a TTA of < 30 minutes (3.0 percent vs. 18.1 percent; log-rank p = 0.0002).
The study highlights that early treatment with antibiotics in patients with febrile neutropenia significantly decreases mortality. These findings suggest that having a target TTA of less than 30 minutes could have a favorable impact on the survival rate of these patients.
(Rosa and Goldani. Antimicrob Agents Chemother. 2014;58(7):3799-3803.)
The Good (Reduced Mortality), the Bad (One More Metric), and the Timely: Antibiotic Timing and Severe Sepsis
Reviewed by Nirav Patel, MD
Timely administration of antibiotic therapy in the setting of sepsis is intuitive and evidence-based, however a large confirmatory study had not yet been performed. In the August 2014 issue of Critical Care Medicine, researchers describe a retrospective analysis of a large dataset to ascertain the association between the timing of antibiotic administration and mortality.
The study was performed using the large Surviving Sepsis Campaign (SSC) database. After excluding patients who did not receive antibiotics, who were previously on antibiotics prior to the development of sepsis, and those missing antibiotic administration time, 17,990 patients were included in the study. Investigators reviewed the time of first antibiotic dose compared to the time of presentation. The statistical analysis used risk factor modeling to determine 51 covariates considered by the investigators as possible confounders.
The results showed that hospital mortality was 32 percent in the first hour, dropped to 28.1 percent in the second hour, and then increased to 39.6 percent in those receiving antibiotics after six hours. Adjusting for Sepsis Severity Score, ICU admission source, and geographic region, the odds ratio for mortality increased to 1.52 (1.36-1.70, p<0.001) if antibiotics were administered more than six hours after presentation, with a probability of mortality linearly increasing from 24.6 percent to 33.1 percent.
Clear strengths of the study include the sample size and the robust dataset, however there are concerns regarding the inclusion criteria used in the SSC as well as potentially missed confounders in the final analysis. Additionally, the focus on administration of the first antibiotic only and the lack of consideration of bug-drug mismatches is somewhat limiting to the practicing clinician. More broadly, there is concern about the use of such data to generate quality metrics that may lead to inappropriate antibiotic use. Timely use of antibiotics in patients with sepsis clearly reduces mortality; how it translates into the current quality and regulatory domains remains to be seen.
(Ferrer et al. Crit Care Med. 2014;42(8):1749–1755.)
Cefazolin: A More Tolerable Option than Nafcillin for Outpatient Parenteral Therapy for S. aureus Disease?
Reviewed by Christopher J. Graber, MD, MPH, FIDSA
The optimal antibiotic for completing treatment for complicated methicillin-sensitive Staphylococcus aureus (MSSA) infections via outpatient parenteral therapy (OPAT) is a matter of debate. Some experts suggest that the semisynthetic penicillins (e.g., oxacillin or nafcillin) should be preferred over cefazolin due to the fact that some MSSA strains produce type A β-lactamase (which degrades cefazolin more than semisynthetic penicillins) that may lead to an inoculum effect, though it is not clear if this phenomenon leads to worse outcomes clinically. Cefazolin is typically much more inexpensive, requires less frequent dosing, and is generally well-tolerated.
A recently published article in Clinical Infectious Diseases compares the tolerability of cefazolin to nafcillin in the outpatient setting in the treatment of MSSA infection. In an analysis of 509 OPAT episodes (366 nafcillin, 119 cefazolin) from 2007 to 2011, the authors found a significantly higher premature discontinuation rate with nafcillin as compared to cefazolin (hazard ratio, 2.81; 95 percent confidence interval, 1.26-3.68), although the Kaplan-Meier curves did not diverge until after about two weeks of therapy. A significantly higher proportion of patients on nafcillin developed rash (13.9 percent vs. 4.2 percent), renal dysfunction (11.4 percent vs. 3.3 percent), and liver function abnormalities (8.1 percent vs. 1.6 percent). Clinical cure rates were not specifically assessed.While this article suggests that cefazolin is more tolerable in the outpatient setting than nafcillin, semisynthetic penicillins should still be considered (at least in the initial phases of management) as primary options in cases involving a deep focus of infection and high bacterial load (e.g., endocarditis) or in cases involving the central nervous system, as cefazolin penetrates the blood-brain barrier poorly.
(Youngster et al. Clin Infect Dis. 2014;59(3):369-75.)
Patience Matters: Reduction in Mortality with Delayed ART in Treatment-Naive AIDS Patients with Cryptococcal MeningitisCurrent data generally supports early initiation of antiretroviral therapy (ART) in all HIV-infected patients. However, due to the challenge of balancing the benefits of ART with the potentially fatal risks of immune reconstitution inflammatory syndrome (IRIS), the optimal time to start ART in newly diagnosed AIDS patients with cryptococcal meningitis has been unclear. The 2010 IDSA guidelines for treatment of cryptococcal meningitis highlight the uncertainty but broadly recommend initiating ART “2–10 weeks after commencement of initial antifungal treatment (B-III).”
Reviewed by Manie Beheshti, MD
In the June 26 issue of the New England Journal of Medicine, investigators evaluated the difference between early and late ART in AIDS patients with cryptococcal meningitis. Their study included 177 treatment-naive HIV-infected adults in Uganda and South Africa with cryptococcal meningitis randomly assigned to two groups: early ART (started one-to-two weeks after diagnosis) and delayed ART (started five weeks after diagnosis). Due to the limited availability of flucytosine, all patients were treated with 14 days amphotericin B and high-dose fluconazole (800 mg), followed by consolidation fluconazole therapy.
Mortality at 26 weeks (the primary end point) was significantly higher in the early versus delayed ART group: 45 percent versus 30 percent (hazard ratio [HR], 1.73; 95 percent confidence interval [CI], 1.06-2.82; P=0.03). The gap was most notable two-to-five weeks after diagnosis (HR, 3.10; 95 percent CI, 1.37-7.00; P=0.007). In the subgroup analysis, mortality was significantly higher in patients with cerebrospinal fluid (CSF) white blood cell (WBC) counts less than 5 cells/mm3 (HR, 3.87). Due to the substantial mortality difference, study enrollment was stopped early. All other outcomes were similar between the two groups.
These findings shed light on an area of previous uncertainty and strongly support the delay of ART until five weeks after start of amphotericin B-based therapy for cryptococcal meningitis, especially in those without significant CSF pleocytosis (<5 WBCs/mm3) at the time of presentation.
(Boulware et al. New Eng J Med. 2014;370:2487-2498.)
Double the Risk of Suicidality with Efavirenz-Containing ART
Reviewed by Brian R. Wood, MD
Efavirenz, a frequent component of initial antiretroviral therapy (ART) for HIV-1 infection around the world (often as part of the single-tablet regimen tenofovir-emtricitabine-efavirenz), frequently causes central nervous side effects such as insomnia, dizziness, and vivid dreams. For most, those effects are mild and short-lived. More concerning are post-marketing reports of psychiatric adverse events, which have led to warnings about worsening depression and suicidality. New data recently published in the Annals of Internal Medicine support a causal relationship between efavirenz and suicidality and suggest caution when prescribing the medication.
Investigators pooled data from four AIDS Clinical Trials Group randomized controlled trials of efavirenz-containing versus efavirenz-free regimens (most of the efavirenz-free regimens were protease inhibitor-based). They performed a retrospective comparison of reported suicidality, defined as documented suicidal ideation, attempt, or completion. Overall, 3,241 participants were randomized to an efavirenz-containing regimen and 2,091 to an efavirenz-free regimen. Participants were primarily young men, and one-third had documented psychiatric history or pre-study psychoactive medication use. Median follow-up was 96 weeks.
The primary intent-to-treat analysis demonstrated higher likelihood of suicidality in the efavirenz group (hazard ratio, 2.28; 95 percent confidence interval, 1.27 to 4.10; P = 0.006) as well as shorter time to suicidality (highest risk occurred in the first 24 weeks after ART initiation). Eight of nine completed suicides occurred in the efavirenz group. In multivariate analysis, additional factors associated with suicidality included: history of injection drug use, psychiatric history or recent psychoactive medication use, and low body weight.
This new robust data demonstrate that suicidality, although uncommon overall, is twice as frequent with efavirenz-containing as compared to efavirenz-free ART. Ideally, efavirenz should be avoided in individuals with a history of psychiatric illness or at high risk for depression or suicidality; if other options are not readily available, close monitoring for worsening psychiatric symptoms is warranted.
(Mollan et al. Ann Intern Med. 2014;161(1):1-10.)
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:
- Rhizopus on the Linen
- Transmission of Hepatitis E Virus Infection by Transfusion
- Nebulized Colistin Treatment of Bronchiectasis Patients With Chronic Pseudomonas Infection
- Cats, Humans, and Bovine Tuberculosis
- Chronic Granulomatous Disease: A Potentially Lethal Combination of Immunodeficiency and Excess Inflammation
- Tissue Destruction in Amebiasis: Chew on It
- Streptococcus Pyogenes: The Path to Enhanced Virulence