IDSA News - May 2015
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IDSA Members Named to PCORI Panel

Two members of IDSA’s Diagnostic Task Force, Robert A. Bonomo, MD, and Ann MacIntyre, MD, have been elected to the Patient Centered Outcomes Research Institute’s (PCORI) Advisory Panel for the Assessment, Prevention, and Treatment of Disease. PCORI is an independent organization that examines the relative health outcomes, effectiveness, and appropriateness of various medical treatments, focusing on including a patient voice during the process. The Advisory Panel for the Assessment, Prevention, and Treatment of Disease will help to identify critical research questions to prioritize funding for PCORI’s comparative effectiveness research.  Infectious disease has long been under-represented in PCORI research funding, and the perspectives of these two members will raise awareness of the many ID issues that impact patients.

Over 300 applications were submitted for the four primary and four alternate slots on the panel, and Drs. Bonomo and MacIntyre were the only two physicians selected. Dr. Bonomo, elected to a primary spot on the panel, is chief of the medical service at the Louis Stokes Cleveland Department of Veterans Affairs (VA) Medical Center, and is professor of medicine, pharmacology, molecular biology, and microbiology at Case Western Reserve University (CWRU) School of Medicine.  Dr. MacIntyre has been selected as an alternate to the panel, and is a private practice physician, clinical associate professor in the Department of Internal Medicine at Nova Southeastern University, and the director of the Infectious Diseases Fellowship Program at Palmetto General Hospital in Florida.

Sustained Advocacy Yields Win on Medicare Reimbursements

Following many years of advocacy by medical societies, including IDSA, Congress approved and President Obama signed legislation to promote seniors’ access to high-quality healthcare by repealing the Medicare Sustainable Growth Rate (SGR), a mechanism established in 1997 to control Medicare costs in part by cutting physician reimbursements. In the last year, IDSA members sent nearly one thousand messages to Capitol Hill urging repeal of the SGR. This outreach, combined with similar efforts by members of partner organizations, can be credited with pressuring Congress to act. Since the establishment of SGR, Congress has passed 17 temporary patches to prevent significant cuts to reimbursements.  

The Medicare Access and CHIP Reauthorization Act permanently replaces the SGR with a program that emphasizes quality while containing costs and providing increased certainty for patients and providers. Beyond repealing the SGR, the new law consolidates the three existing quality reporting programs into one merit-based incentive payment system. Medicare providers will be given a five-year period of 0.5 percent updates to transition to the new system. Physicians who participate in alternative payment models and meet certain thresholds will be eligible for incentive payments. Participation in alternative payment models is voluntary, as the new law retains the Medicare fee-for-service model.

In the months ahead, IDSA will work with Congress and the Center for Medicare and Medicaid Services to encourage proper implementation of the law and address issues of particular importance to the ID specialty. An analysis of the legislation is available on the House Energy & Commerce Committee website.

Medicare to Cover Routine HIV Screening

In an important step forward for widespread implementation of routine HIV screening, the Centers for Medicare and Medicaid Services’ (CMS) announced  that Medicare will now cover routine HIV testing for its beneficiaries.  Medicare has previously covered HIV testing only for people who are at increased risk of HIV infection and for pregnant women. HIVMA and IDSA advocated for CMS to make this change to bring Medicare’s coverage in line with other payers so that Medicare beneficiaries with HIV can be identified and connected to care and treatment earlier. Under the Affordable Care Act, routine HIV screening is now covered at no cost to enrollees by most health plans and under the Medicaid expansion coverage. 

Ryan White Medical Providers Take to the Hill

Members of the Ryan White Medical Providers Coalition Steering Committee visited Capitol Hill on April 9 and 10 advocating for continued robust Ryan White funding as well as urging Congress to lift the ban on federal funding for syringe exchange programs. Ten clinician leaders representing seven states participated in nearly 40 congressional office visits. In addition, the group met with key Administration officials:  the Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation; the Director of the Office of National Drug Control Policy; and the Director of the Office of National AIDS Policy (ONAP). HIVMA created the Coalition to support Ryan White medical providers in delivering quality care to their patients.


Georgina Osorio, MD, MPH; Byrd Quinlivan, MD; Michelle Ogle, MD, FAAP;
and Jim Raper, PhD, CRNP, JD, travel to Capitol Hill to meet with their legislators.

Antibiotics Incentives and NIH Funding Boost in 21st Century Cures Draft Bill

An important congressional committee has released a second bipartisan draft of its comprehensive 21st Century Cures bill, which is aimed at accelerating the discovery, development, and delivery of promising new treatments to patients. Much of the bill is still being negotiated, but it contains several key IDSA priorities, including: the limited population antibacterial drug (LPAD) approval pathway, funding increases for the National Institutes of Health (NIH), and quicker Food and Drug Administration (FDA) review of diagnostic tests and other medical devices that do not have sufficient alternatives.

At a recent House committee hearing to discuss the draft bill, several members of Congress expressed the importance of addressing antibiotic resistance and spurring the development of urgently needed new antibiotics. LPAD champions, Reps. John Shimkus (R-IL) and Gene Green (D-TX), discussed the need for the LPAD proposal to allow antibiotics and antifungals that treat serious or life-threatening infections with an unmet medical need to be studied in smaller, more rapid clinical trials, given that the targeted infections currently occur in a relatively small number of patients. The draft Cures bill also contains safeguards to help guide appropriate use of the drugs, as well as provisions to speed the updating of antimicrobial susceptibility breakpoints and to increase reimbursement for new antibiotics and antifungals that treat serious or life-threatening infections with an unmet medical need.

Help IDSA Support LPAD

Please take two minutes to email your representatives through this simple link to encourage them to support LPAD. Constituent support is critical to make sure LPAD continues to advance. 

The new draft Cures legislation includes new provisions aimed at strengthening NIH funding. Specifically, the bill would authorize $31.8 billion for NIH for 2016, $33.3 billion for 2017, and $34.8 billion for 2018 (although these amounts would still be subject to annual the annual appropriations process). The bill would also establish an NIH Innovation Fund to provide an additional $2 billion per year for specific initiatives including supporting emerging young scientists, precision medicine, and other priorities yet to be specified. The draft also includes new language indicating that Congress is supportive of federal scientists participating in scientific conferences and meetings.

Help IDSA Support NIH Funding

To effectively advocate for increased NIH funding, IDSA needs more stories from members about how funding cuts in recent years have impacted your work. If you are willing to share your story, please contact Jonathan Nurse, IDSA’s Director of Government Relations, at jnurse@idsociety.org or (703) 299-0202.

The draft bill contains some provisions of concern to IDSA.  With regard to vaccines, the bill contains a provision that we believe seeks to micromanage the Advisory Committee for Immunization Practices (ACIP) process and requires Centers for Disease Control and Prevention (CDC) to meet with any vaccine manufacturer within 90 days of a request without providing CDC any additional resources to support such activities.  The draft bill retains provisions that raised concern among many in the scientific community about congressional micromanagement of NIH, including requiring detailed strategic plans from NIH institutes. All of these provisions remain under negotiation, and IDSA will continue to work with other medical and scientific societies, public health groups, patient groups and other key stakeholders to advocate for our priorities.

Lessons from Tanzania: Controlling HIV and TB

When staff from IDSA’s Center for Global Health Policy visited Tanzania in October, responses to HIV and tuberculosis there and in other hard-hit countries had reached a turning point. With evidence that treatment could turn the trajectory of the twin pandemics, international health leaders were calling for targeted efforts: Doing the right things in the right places at the right time.

With funding from Capital for Good, the Center hosted five congressional staff members on a tour of three regions facing both unique and common challenges, traveling to:

  • Tanzania’s capital city, where health and human resources are outmatched by issues fueling the spread of HIV and tuberculosis, including a growing epidemic of injecting drug use;

  • The remote rural southern highlands, where HIV rates are among the highest in the country

  • The semi-autonomous archipelago of Zanzibar, where rates of HIV and tuberculosis are relatively low but concentrated among criminalized and vulnerable populations.

The tour highlighted the impact and advances that evidence-based action has yielded so far.

In April, the Center released its findings in a report detailing effective but under-resourced efforts as well as gaps that continue to slow progress against HIV and tuberculosis in resource-poor settings. The report, Redeployment – Opportunities to Control HIV and TB in Tanzania, Observations from Dar es Salaam, Mbeya, and Zanzibar, presents a picture of realities on the ground, and an argument for committed, continued, and targeted investments against infectious diseases, with no lesser goal than sustainable success.

The Center is housed within the IDSA Education and Research Foundation.

Science Speaks: Confronting Tuberculosis

As World TB Day and events commemorated the discovery 132 years ago of the bacteria that causes tuberculosis, Science Speaks, the official blog of the Center for Global Health Policy looked at current challenges in confronting the disease globally, with:

IDSA Foundation Announces 2015 Medical Scholarship Recipients

The IDSA Education and Research Foundation is pleased to announce the following participants in this year’s Medical Scholars Program. The Medical Scholars Program was established in 2002 and has awarded over 540 medical students the opportunity to pursue independent clinical or research activities to explore the field of infectious diseases. The program helps attract the best and brightest to the field by giving medical students a first-hand look at the challenges and opportunities of working in infectious disease.

Applications for next year will open early December 2015. The Foundation’s Medical Scholars Program is supported entirely by member donations. To support future medical scholars, please consider donating today!

Britt Anderson, Washington University School of Medicine, St. Louis, MO. “Differential Gene Expression in Individuals with Lymphatic Filaraisis after Treatment, and the Development of Adverse Events.” Mentor: Gary Weil, MD, FIDSA.

Brandon Berger, University of Chicago Pritzker School of Medicine, Chicago, IL. “Cost-effectiveness Analysis of Cutaneous Leishmaniasis Treatment with Meglumine Antimoniate and Miltefosine in the Pediatric Population in Colombia.” Mentor: Allison Bartlett, MD.

Sushma Boppana, University of Alabama School of Medicine, Birmingham, AL. “The Impact of HIV Adaptation on Vaccine Induced CD8 T Cell Responses.” Mentor: Paul Goepfert, MD.

Paul Bourdillon, Yale School of Medicine, New Haven, CT. “A Five-Year Retrospective Cohort Study of Delays in Diagnosis and Treatment of Tuberculosis in Three High-Burden Prisons in Mato Grosso do Sul, Brazil.” Mentor: Albert Ko, MD, FIDSA.

Nicholas Brazeau, University of North Carolina School of Medicine, Chapel Hill, NC. “Mapping Cholorquine Resistant in Plasmodium vivax.” Mentor: Jonathan Juliano, MD, MSPH, DTM&H.

Kayla Briggs, University of Missouri - Kansas City School of Medicine, Kansas City, MO. “Enterovirus D68 Illness in Hospitalized Children under 2 Years of Age.” Mentor: Jennifer Schuster, MD, MSCI.

Ignacio Cerdena, Yale School of Medicine, New Haven, CT. “Developing a Community Health Worker TB Screening Intervention and Testing its Effectiveness in a Latin American Prison: A Quasi-Experimental Trial.” Mentor: Frederick Altice, MD, MA.

Cody Cichowitz, Johns Hopkins University School of Medicine, Baltimore, MD. “Understanding the Patient Experience in HIV Care After Hospital Discharge in South Africa.” Mentor: Chris Hoffmann, MD, MPH.

Emily Coleman, Yale School of Medicine, New Haven, CT. “Effectiveness of Human Papillomavirus Vaccine in Clinical Practice: A Case-Control Study.” Mentor: Eugene Shapiro, MD, FIDSA.

Chanelle Diaz, University of Miami Miller School of Medicine, Miami, FL. “Cardiovascular Morbidity and Mortality and the Association with Antiretroviral Exposure in a Cohort of HIV-Infected Patients from Rio de Janeiro, Brazil, 2000-2010.” Mentor: Jesse Clark, MD, MSc.

Carey Downey, University of Utah, Salt Lake City, UT. “Gonorrhea Outbreak in Northern Utah – Associated Social Factors Contributing to the Epidemic.” Mentor: Claudia Goulston, MD.

Robert Flick, University of Colorado School of Medicine, Aurora, CO. “Evaluating the Feasibility and Impact of Community Health Worker-driven Intensified Case Finding on Tuberculosis Case Finding and Treatment Among HIV-infected Pregnant Women Enrolled in Option B+ in Central Malawi” Mentor: Michael Herce, MD, MPH

Hilary Flippo, University of Alabama School of Medicine, Birmingham, AL. “A comparison of HSV-2 viral shedding in African Americans vs. Caucasians.” Mentor: Nicholas Van Wagoner, MD PhD.

Andrew Flynn, University of Colorado School of Medicine, Aurora, CO. “Barriers to Care Among Ugandan Patients Presenting with an AIDS-Defining Illness.” Mentor: David Boulware, MD, MPH, CTropMed.

Ayako Wendy Fujita, Emory University School of Medicine, Atlanta, GA. “Antimicrobial Resistance in Blood Isolates at a Tertiary Hospital in Uganda and the Urgent Need for Standardized Reporting and a National Surveillance Program.” Mentor: Joshua Rhein, MD.

Paul George, Washington University in St. Louis School of Medicine, St. Louis, MO. “Intimate Partner Violence, High Risk Sexual Behaviors, and HIV among Male Sex Workers in Lima, Peru.” Mentor: Jesse Clark, MD, MSc.

Jeremy Gold, Albert Einstein College of Medicine, Bronx, NY. “Bacterial Vaginosis and Mucosal Immunity in the Context of HIV & HSV-2 Infection.” Mentor: Marla Keller, MD, FIDSA.

Bryna Harrington, University of North Carolina - School of Medicine, Chapel Hill, NC. “Safety, Suppression, Second-line, and Survival among HIV+ Pregnant Women in Malawi.” Mentor: Mina Hosseinipour, MD, MPH.

John Haydek, Emory University School of Medicine, Atlanta, GA. “The Importance of Gut Flora Diversity in Treatment of Clostridium difficile Infection via Fecal Microbiota Transplant.” Mentor: Colleen Kraft, MD MSc.

Danielle Hron, University of Minnesota Medical School, Minneapolis, MN. “Effectiveness of Screening and Decolonization of Staphylococcus aureus in Surgery Outpatients.” Mentor: Susan Kline, MD, MPH.

Brooke Hyman, University of Maryland School of Medicine, Baltimore, MD. “Prevalence of HIV Infection among Children Born to HIV-Infected Women after the Implementation of Option B+ in Rwanda.” Mentor: David Riedel, MD, MPH.

Monika Jelic, University of Washington School of Medicine, Spokane, WA. “The Use of Antibiotics with Activity Against Gram Negative Bacteria in Pediatric Populations.” Mentor: Danielle Zerr, MD, MPH.

Nikeshan Jeyakumar, University of Miami Miller School of Medicine, Miami, FL. “Prevalence of Coccidioidomycosis in a Population of Organ Donors at a Single Organ Procurement Organization.” Mentor: Peter Chin-Hong, MD.

Nona Jiang, University of Virginia School of Medicine, Charlottesville, VA. “Geohelminth Infection, Systemic Cytokine Production, and Neurocognitive Development in Bangladeshi Children.” Mentor: William Petri, MD, PhD, FIDSA.

Wallace Jones, University of Colorado School of Medicine, Denver, CO. “UTIDecide: Mobile Decision Support to Reduce Overtreatment of Bacteriuria in Long Term Care Residents.” Mentor: Barbara Trautner, MD, PhD, FIDSA.

Noah Kojima, David Geffen School of Medicine at UCLA Los Angeles, CA. “Investigating Bacterial Vaginosis and Bacteriophage in Mysore, India.” Mentor: Jeffrey Klausner, MD, MPH.

Anna Kress, Columbia University College of Physicians and Surgeons New York, NY. “The Role of Bile Acids on Colonization with Carbapenam-Resistant Enterobacteriaceae (CRE) After Liver Transplantation.” Mentor: Anne-Catrin Uhlemann, MD, PhD.

Leila Kutob, University of South Carolina School of Medicine, Columbia, SC. “Effectiveness of Oral Antimicrobial Agents for Definitive Therapy of Gram-Negative Bloodstream Infections.” Mentor: Majdi Al-Hasan, MD.

Nathan Lo, Stanford University School of Medicine, Stanford, CA. “Cost-Effectiveness of Urine Sample Pooling Methodology for Diagnosis of Schistosomiasis.” Mentor: Jason Andrews, MD, SM, DMT&H.

Matthew Marcott, University of Pittsburgh - School of Medicine, Pittsburgh, PA. “Epidemiology and Outcomes of Intra-abdominal Candidiasis.” Mentor: Paschalis Vergidis, MD.

Alyssa Mezochow, Drexel University College of Medicine, Philadelphia, PA. “Pharmacokinetic Modeling and Simulation of Rifampician Dosing Strategies in the Treatment of Tuberculosis Meningitis.” Mentor: Christopher Vinnard, MD, MPH&TM, MSCE.

Lea Monday, Wayne State University School of Medicine, Detroit, MI. “Recognition of Clinically Significant Drug Interactions Among HIV Positive Outpatients on Antiretroviral Therapy.” Mentor: Jennifer Veltman, MD.

Jeremy Mudd, Warren Alpert Medical School of Brown University, Providence, RI. “Variance in Clinical Outcomes for Patients with Smear-Negative Tuberculosis at a Teaching Hospital in Ghana.” Mentor: Awewura Kwara, MD, MPH&TM.

Brittney Mull, Howard University College of Medicine, Washington, DC. “Linkage to Care and Retention of HIV Infected Patients Aged 50 and Older.” Mentor: Celia Maxwell, MD.

Cameron Myers, University of Missouri School of Medicine, Kansas City, MO. “A Quality Improvement Initiative to Decrease Unnecessary Streptococcal Antigen Testing in an Urban Pediatric Emergency Department.” Mentor: Angela Myers, MD, MPH.

William Perry, Wayne State University, Detroit, MI. “Assessing Nephrotoxicity of Concomitant Vancomycin and Piperacillin/Tazobactam Therapy.” Mentor: Keith Kaye, MD, MPH, FIDSA.

Gianmarco Raddi, David Geffen School of Medicine at UCLA, Los Angeles, CA. “Cost-Benefit Evaluation and Uptake Rate Analysis of Homeless Influenza Immunization in the 2015/2016 Season.” Mentor: Judith Currier, MD, FIDSA.

Anu Ramachandran, Johns Hopkins University School of Medicine, Baltimore, MD. “Evaluating the Cost-Effectiveness of CRAG-LFA Screening to Reduce Cryprococcal Mortality Among People Living With HIV in Uganda.” Mentor: Maunank Shah, MD, PhD.

Pranav Reddy, The Warren Alpert Medical School at Brown University, Providence, RI. “Evaluating a Practice-Based Approach for Improving Engagement with HIV care in Rhode Island.” Mentor: Aadia Rana, MD.

David Schaffer, University of North Carolina School of Medicine, Chapel Hill, NC. “Clinical Management of Syphilis Serofast Individuals in South China.” Mentor: Joseph Tucker, MD, PhD, MA.

Nathan Scheiner, University of Minnesota Medical School Minneapolis, MN. “Correlating HIV Knowledge and Risk Behaviors Among Adolescent Males in Minneapolis-Saint Paul.” Mentor: Meghan Rothenberger, MD.

Emily Martin Scott, University of Washington, Seattle, WA. “Molecular Epidemiology and Spatial Analysis of RSV and HMPV Transmission in Rural Nepal.” Mentor: Janet Englund, MD, FIDSA.

Aaron Shapiro, Alpert Medical School of Brown University, Providence, RI. “Developing a Model Hepatitis C Program Embedded within a Non-Profit Methadone Maintenance Program.” Mentor: Lynn Taylor, MD.

R. Gina Silverstein, University of Pittsburgh School Of Medicine, Pittsburgh, PA. “Factors Affecting Utilization of Medical Teleparasitology Among Trained Medical Technologists in Cordillera Administrative Region, Philippines.” Mentor: Peter Veldkamp, MD, MSc.

David Smyth, University of Utah School of Medicine, Salt Lake City, UT. “Targeting HIV-1 Cellular Reservoirs.” Mentor: Adam Spivak, MD.

Allison Stickles, Oregon Health & Science University, Portland, OR. “Efficacy of Whole-Cell Plasmodium falciparum Vaccines in a Malaria Human Challenge Model.” Mentor: M. Juliana McElrath, MD, PhD, FIDSA.

Akanksha Vaidya, Weill Cornell Medical College, New York, NY. “Predictive Value of a TB-Symptom Screen in HIV Infected and HIV Uninfected Pregnant Women in Pune, India” Mentor: Jyoti Mathad, MD, MSc

Adam Verhoef, University of Iowa Carver College of Medicine, Iowa City, IA. “Molecular Methods for Diagnosing Asymptomatic Leishmaniasis.” Mentor: Mary Wilson, MD.

Christina Warner, University of Minnesota Medical School, Minneapolis, MN. “Effectiveness of Screening and Decolonization of S. aureus in Surgery Outpatients.” Mentor: Susan Kline, MD, MPH.

Jason Ya, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH. “Impact of Iron Transport on HIV-Associated Immune Activation and Neurocognitive Impairment: a CNS HIV Antiretroviral Therapy Effects (CHARTER) Study.” Mentor: Asha Kallianpur, MD, MPH.

William Yang, Duke University, Durham, NC. “Biomarkers in the Host Response to Enterotoxigenic E. coli (ETEC) Infection.” Mentor: Ephraim Tsalik, MD, MHS, PhD.

Sophie Zhao, Vanderbilt University School of Medicine, Nashville, TN. “Use of Antibiotics and Antivirals in Community Dwelling Children with Acute Respiratory Illness.” Mentor: Helen Talbot, MD, MPH

Bridging Ryan White Providers & FQHCs -- A Webinar Series

Join HIVMA for a spring webinar series to learn about opportunities for Ryan White providers to partner with or to become Federally Qualified Health Centers.

May 13, 1 to 2 pm EST – FQHC Program Requirements 101
Register Online

May 27, 1 to 2 pm EST – Pathways to Becoming an FQHC
Register Online

June 10, 1 to 2 pm EST – Ryan White and FQHC Collaborative Agreement Opportunities
Register Online

Each session will feature a presentation and discussion with experts from Feldesman+Tucker+Leifer+Fidell, which specializes in providing guidance on federal program requirements and policies. Reading resource recommendations will be offered to enhance learning in between the webinar sessions.

More information is online at www.hivclinician.org.

OFID Editor in Chief Interviews Author Seth Mnookin in Latest Podcast

In the fifth installment of the Open Forum Infectious Diseases (OFID) podcast, Editor in Chief Paul Sax, MD, engages with award-winning author and journalist Seth Mnookin about his critically acclaimed “medical detective story,” The Panic Virus: The True Story Behind the Vaccine-Autism Controversy.

Mnookin fields questions on lessons learned in the recent measles outbreak, how to bridge the disconnect between scientific research and public knowledge, and what fueled the misinformation fire in the vaccine-autism conundrum.
 
IDSA launched the journal in 2014 in partnership with Oxford University Press to offer the rapid publication of clinical, translational, and basic research for all aspects of infectious diseases, with a focus on studies that have the potential to improve patient care. The journal is fully peer-reviewed and freely accessible to all readers.

To submit your manuscript, read the Instructions for Authors and submit online.

To read timely updates from OFID, sign up for the journal’s free electronic table of contents (e-TOC) alerts at http://oxford.ly/OFIDalerts.

Apply for a Fellowship with ARLG

The Antibiotic Resistance Leadership Group (ARLG) has announced a new fellowship opportunity. The ARLG Fellowship supports a master’s degree related to clinical research, in addition to hands-on experience designing and operationalizing ARLG clinical studies. The goal of this unique opportunity for infectious disease fellows is to create the next generation of leaders in the field. A two-year position, with salary support and tuition will be provided.

ARLG is an initiative funded by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institutes of Health (NIH), which is tasked with developing and prioritizing a clinical research agenda and designing, implementing, and conducting clinical studies to address the growing public health threat of antibacterial resistance.

Apply today!

New ABIM Foundation Grants Advance Stewardship Competencies in Medical Education

A new "Putting Stewardship into Medical Education and Training" grant program from the ABIM Foundation will award up to six grants of $25,000 each to clinical training programs in medicine and surgery, nursing, and other allied health professions. The goal of the grants is to expand existing training program initiatives or launch new ones designed to reduce the overuse of certain tests or procedures.
 
Grant recipients will also participate in an existing learning network created by Costs of Care and the ABIM Foundation to share ideas and collaborate in the development of learning strategies in medical education and training.

Grant applications are due by May 18, 2015.


In Memoriam

In Memoriam: Vincent A.T. Andriole, MD, FIDSA (1931-2015)

Vincent Anthony Thomas Andriole, MD, FIDSA, former president of IDSA, passed away on April 26, 2015 at age 83. Dr. Andriole, a renowned clinician, teacher, researcher, author and editor, was emeritus professor of medicine at Yale University School of Medicine, attending physician at Yale-New Haven Hospital, and attending physician at Bridgeport Hospital in Connecticut.

He received his medical degree from Yale University and completed postgraduate training at North Carolina Memorial Hospital, National Institutes of Allergy and Infectious Diseases/National Institutes of Health (NIH), and Yale University School of Medicine. In addition, he served in the Navy Reserve and with the US Public Health Service/NIH in Bethesda, Maryland.

Dr. Andriole was passionate about investigation; throughout his career, his research centered on the pathenogenesis, diagnosis, and treatment of bacterial and fungal infections, and newer antimicrobial agents. He was also outspoken about the importance of teaching and mentoring and sharing his passion for ID with others. Dr. Andriole was the founder of the Connecticut Infectious Diseases Society—the first state infectious diseases society.

Dr. Andriole was the recipient of numerous awards including the Laureate Award of the American College of Physicians and the Bristol Award (now the Alexander Fleming Award), the highest honor of IDSA.

He is survived by his wife of 43 years, Daria Louise DeRose Andriole, four children, and five grandchildren.

In Memoriam: William A. Craig, MD, FIDSA (1939-2015)

William Alexander Craig, MD, FIDSA, passed away on March 12, 2015 at age 75. Dr. Craig received his medical training at Tufts Medical School, followed by an internal medicine residency and infectious diseases fellowship at the University of Wisconsin. He joined the Wisconsin faculty as a founding member of the Infectious Disease Division in 1973. He was professor emeritus in infectious disease at his passing.

From early in his career, Dr. Craig was widely considered among the most knowledgeable in the world on the topic of antibiotics. He had a personal hand in the preclinical research of most antibiotics that have come to market in the last four decades.

Dr. Craig was awarded several prestigious honors including the Garrod Medal from the British Society for Antimicrobial Chemotherapy, the Sanofi-Aventis Award from the American Academy of Microbiology, and the Bristol Award (now the Alexander Fleming Award), IDSA’s highest honor.

He was considered an extraordinarily generous mentor who inspired a passion for investigation and a dedication to scientific integrity in his trainees.

Dr. Craig is survived by Judy, his wife of 52 years, two children, and four grandchildren.

Members on the Move

The American Board of Internal Medicine (ABIM) recently announced the members of the ABIM Infectious Disease Board. The following IDSA/HIVMA members are among those announced:

  • George M. Abraham, MD, associate chief of medicine at Saint Vincent Hospital, Worcester, MA
  • Helen W. Boucher, MD, FIDSA, director of the Infectious Diseases Fellowship Program and staff physician in the Division of Geographic Medicine and Infectious Diseases at Tufts Medical Center, Boston, MA
  • Joel E. Gallant, MD, FIDSA, medical director of Specialty Services at the Southwest CARE Center in Santa Fe, NM
  • Jeanne M. Marrazzo, MD, FIDSA, professor, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
  • Jeffrey S. Rapp, MD, private practice and member of the attending staff at Cedars –Sinai Medical Center in Los Angeles, CA
  • Heather C. Yun, MD, FIDSA, active duty lieutenant colonel in the United States Air Force, associate professor of medicine at the Uniformed Services University of the Health Sciences, and adjunct associate professor of medicine and infectious diseases at the University of Texas Health Science Center at San Antonio, TX
  • James Curran, MD, FIDSA, principal investigator and co-director of the Emory Center for AIDS Research, has been awarded the honor of being named to the American Academy of Arts and Sciences. Dr. Curran has faculty appointments in the Emory School of Medicine and the Nell Hodgson Woodruff School of Nursing.

Jack Whitescarver, MD, the longest serving director of the Office of AIDS Research (OAR) at the National Institutes of Health (NIH) will soon step down from his post, following a career at the NIH that started at the beginning of the AIDS epidemic.

 

Member Report

MEMBERS
Blackburn, Brian, MD
Brown, Jack, PharmD
Cardenas, Ana, PhD
Corea, Angela, MD
Gaensbauer, James, MD, MSPH
Graham, David, MD
Haupt, Richard, MD, MPH
Illuminati, Luise, MD
Khanna, Prerna, MD, MPH
Lumsden, Graham, BVM&S, Dip. M, MRCVS, MCIM
Luxmi, Shobha, MD, MRCP
Mark, Robert, PhD
Trevejo, Jose, MD, PhD
Ying, Ivan, MD

MEMBERS-IN-TRAINING (FELLOWS)
Alharbi, Musaed, MD
Alkhaotani, Nashwa, MBBS
Bednarz, Przemyslaw, MD
Cox, Andrew, MS
Dhiloo, Azizullah, MBBS
El-Sayed, Osama, MD
Fiorito, Theresa, MD, MS
Herc, Erica, MD
King, Helen, MD
Lopez, Eliana, MD
Marson, Alexander, MD, PhD
Moulton, Elizabeth, MD, PhD
Nyaku, Amesika, MD
Quarshie, Christopher, DO
Rampaul, Marlon, MBBS
Reich, Patrick, MD
Romero, Fabian, MD
Schrimsher, Jennifer, MD, MPH
Sung, Julia, MD

RESIDENTS
Babiker, Ahmed, MBBS
Bean, Holly, DO
Beatty, Norman, MD
Dhatt, Roopa, MD
Jao, Archimedes, MD
Kobayashi, Takaaki, MD
McGuffey, Grant, PharmD
Neyra, Karyna, MD
Ocwieja, Karen, MD, PhD
Schranz, Asher, MD

STUDENTS
Andersen, Britt
Bourdillon, Paul
Briggs, Kayla
Bush, Chad
Cerdena, Ignacio
Connors, Jennifer
Craft, Joshua
Diaz, Chanelle
Drake, Kory
Flippo, Hilar
Flynn, Andrew
Freeman, Megan
Fritz, Lisa
Gold, Jeremy
Goldman-Israelow, Benjamin
Harrington, Bryna
Ireland, Peter
Jeyakumar, Nikeshan
Kenney, Claire
Kojima, Noah
Kreider, Edward
Kress, Anna
Lo, Nathan
Newman, Kira
Nye, Derek Michael
Reddy, Pranav
Rosen, Geoffrrey
Rowley, Carol
Silverstein, R Gina
Varley, Cara
Virgen, Cesar
Yang, William
Yang, Kailin
Yuh, Tiffany
Zhao, Sophie

ASSOCIATES
Alang, Neha, MD, MBBS
Alruwaili, Alya, PharmD
Anderson, Hurdle, PharmD
Awali, Reda, MD, MPH
Bassey, Edemekong, MD
Behlau, Irmgard, MD
Bukhari, Syed, MD
Cammarata, Sue, MD
Ciarleglio, Anita, PhD, RPh
Euler, Calvin, RPh
Garrett, Roger, RPh
Hekmatpour, Erin, MD
Hudec, Martin
Kadzirange, Gerard, MD
Kestler, Mary, MD
Kiernan, Martin, MPH, RN
Kumar A S, Anoop, MBBS, MD
Leoniak, Jennifer, DO, MS
Lochner, Harold, MD
Maloley, Paul, PharmD
Martinez, Lucia, MD
Opavsky, Mary Anne, MD
Rao, Keshav, MBBS, MD
Saluja, Arpit, MD
Sarwar, Uzma, MD
Setlak, Paul, MBA, PharmD
Turner, Harshini, MD
Warner, Mark, MS
Waters, Dustin, PharmD
Woolard, Kristin, MSN, NP

DECEASED
Andriole, Vincent, MD
Craig, William, MD
Humphreys, Donald, MD




On Lyme, As with All Infections, Advocating for Patients is our Highest Priority

Lyme disease is a very important and growing problem. It is for that reason, in addition to new information published in recent years, that IDSA has undertaken the process of developing a guideline that now brings together three medical societies, IDSA, the American Academy of Neurology, and the American College of Rheumatology, along with representation from eight other medical and scientific specialties. We are committed to developing a guideline that will have the best interests of patients at its core and will reflect the best science available.


Few issues have drawn attention to IDSA in quite the way that Lyme disease has. Despite the fact that our treatment guidelines have become the focus of frustration for some individuals, IDSA always has been and always will be committed to advocating for the best possible care for patients based on the best available science.

While the majority of individuals diagnosed and treated for Lyme with current approaches improve rapidly and have a full recovery, there are some patients who have persisting symptoms. Unfortunately, we do not yet understand the mechanism of this sufficiently to know the best evidence-based approach to help these patients. As many of you are aware, four federally funded blinded studies examined the use of longer term intravenous antibiotics in such patients but were not able to find a meaningful difference in treated versus control patients. And, of course, the consequences of long-term use of antibiotics are of great concern to all of us.

We also know that current Lyme diagnostics are not ideal, and as in other areas of ID, we have been advocating for needed investments to find improved diagnostics that are appropriately validated in peer-reviewed publications and approved by the Food and Drug Administration. We need improved disease recognition not only to identify Lyme disease rapidly but also to ensure patients are not misdiagnosed with Lyme when in fact they have something else for which treatment might be effective.

Lyme is a very important and growing problem. It is for that reason, in addition to new information published in recent years, that IDSA has undertaken the process of developing a guideline that now brings together three medical societies: IDSA, along with the American Academy of Neurology and the American College of Rheumatology, each with complementary expertise. In addition, we have official representation from eight medical and scientific organizations with expertise including cardiology, microbiology, and pathology. We have also enlisted two medical librarians to do the comprehensive literature search related to the key questions the panel has been asked to evaluate, as well as an expert in methodology to ensure that the literature reviewed is evaluated for the quality of the evidence provided. In addition, the panel includes a healthcare consumer with experience in medical and scientific discussion and decision-making, and we are working to add at least one current or former patient or parent of a patient treated for confirmed Lyme disease to the membership of the panel. The development process also includes two public comment periods, one regarding the project plan which recently ended and one when a draft of the new guideline is available.


This will be a long and rigorous process, but one that I am confident will present the best recommendations based on current evidence for diagnosing and treating patients for Lyme disease. We are likely many months from a final guideline and I have no doubt that during those months, we will continue to receive questions regarding the update of this guideline. We must do our best to answer those questions honestly and as openly as possible. We are committed to developing a guideline that will have the best interests of patients at its core and will reflect the best science available.

Tell Us What Matters Most to You with IDSA

Before the IDSA Board of Directors’ strategic planning session in June, we need your feedback. Please take a few minutes to give us your thoughts on the important issues and how we as a Society can best meet your needs with the resources we have.

The IDSA Board of Directors is holding a strategic planning session in June to identify the Society's key priorities for the next two to three years. We want to focus on those issues and activities that will have the most impact on the field of infectious diseases and will help you thrive in an increasingly challenging environment.

Below is a link to a brief survey (one version for members who are in training; one for everyone else), which should take less than 10 minutes to complete. The survey is anonymous, but those who complete it will be eligible to win free registration to IDWeek 2015 this October in San Diego.

Members-in-Training Survey
Survey of All Other Members

Please take a few minutes to give us your thoughts on the important issues and how we as a Society can best meet your needs with the resources we have. Your anonymous participation in this survey will be extremely helpful and is much appreciated.

New White House Plan on Antibiotic Resistance Covers Key IDSA Priorities

President Obama’s new National Action Plan for Combating Antibiotic Resistant Bacteria (CARB) covers major IDSA priorities including: establishment of stewardship programs, monitoring antibiotic use and resistance patterns, researching and evaluating methods for combating resistance, strengthening surveillance, enhancing the development and use of diagnostic tests, promoting antibiotic R&D and more.

President Obama released a new National Action Plan for Combating Antibiotic Resistant Bacteria (CARB) in late March that provides detailed timelines for meeting specific goals.

The plan covers key IDSA priorities including: establishment of stewardship programs, monitoring antibiotic use and resistance patterns, researching and evaluating methods for combating resistance, strengthening surveillance, enhancing the development and use of diagnostic tests, promoting antibiotic research and development (R&D), expanding the Antibacterial Resistance Leadership Group (ARLG), and improving international collaboration to address antimicrobial resistance.  


IDSA has long called for the type of specific timelines and benchmarks for measuring progress included in this action plan, which has been hailed as the most comprehensive and detailed plan for addressing antibiotic resistance ever undertaken by the U.S. government. IDSA released a statement to the media upon the action plan’s release and was featured in multiple news articles on the action plan.  

The plan will require new funding from Congress, for which IDSA is leading advocacy efforts. You can click on this action alert to email your congressional representatives in a few short minutes to encourage them to fund this initiative.

The White House plans to release two addendums to this plan: (1) recommendations on economic incentives to stimulate antibiotic R&D; and (2) a national action plan on drug-resistant tuberculosis.

IDSA Journal Club

Effects of C. difficile Infections on Hospital Readmissions; Ensuring Proper Antimicrobial Use at Hospital Discharge: The Next Frontier of Antimicrobial Stewardship?;Your Neighbor's Antibiotics: A Novel Risk Factor for C. difficile Infection; The QuantiFERON Quandary: Limitations in Steroid Treated Patients; Estimating HIV Transmission Rates at Each Step of the Care Continuum

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.

Effects of C. difficile Infections on Hospital Readmissions
Reviewed by Zeina Kanafani, MD, MS

Clostridium difficile infections (CDI) have been associated with increased morbidity and increased utilization of health services. The impact of recurrent CDI on hospital readmissions was recently highlighted in two articles published in the American Journal of Infection Control.

The first is a review of data from the Detroit Medical Center health system. The authors categorized hospital discharges in 2012 into all-cause discharges (no CDI; n=51,353) and CDI discharges (n=651), which were further subdivided into community-onset (CO) CDI (n=318) and hospital-onset (HO) CDI (n=297). They then categorized readmissions into four groups: all-cause readmissions (no CDI during index admission; n=7,379), CO and HO readmissions (patients from CO and HO CDI groups, readmitted for any reason; n=99 and 86, respectively), and CDI readmissions for CDI (patients with CDI in index admission readmitted for CDI; n=48).

CDI discharges were more likely to be ≥60 years of age compared to all-cause discharges (59 percent vs. 43 percent; p<0.001), and CDI cases were more likely to be discharged to a health care facility than to home (OR=3.65; p=0.001). Whereas 30 percent of CDI discharges were readmitted during the study period, only 14 percent of all-cause discharges were readmitted. In addition, the average length of stay among CO and HO CDI readmissions was longer than that for all-cause readmissions. Finally, the cost of a CDI discharge and readmission was around $9,000.

In the second article, Olsen et al. analyzed data from 3,950 CDI cases. The CDI recurrence rate within 42 days was 11 percent, and the readmission rate was 45 percent within 180 days. Compared with those without a recurrence, patients who experienced a recurrence were more likely to be readmitted (85 percent vs. 41 percent; p<0.001). They also had a greater mean number of readmissions within 180 days (1.72 vs. 0.81; p<0.001) and a greater mean number of hospital readmission days (18.6 vs. 17.6 days; p<0.001). On multivariable analysis, recurrent CDI was independently associated with a significant increase in both the total number of readmission hospital days (rate ratio 3.97; 95 percent CI 3.11-5.08) and the number of hospital readmissions (rate ratio 2.54; 95 percent CI 2.21-2.91).

These two retrospective studies confirm that patients who experience a recurrence of CDI are at higher risk of being readmitted than patients without a recurrence. Increased length of hospital stay, number of hospital admissions, and hence cost of care are all consequences of recurrences. Emphasis on prevention strategies is therefore essential in decreasing such morbidity among hospitalized patients with CDI.

(Chopra et al. Am J Infect Control. 2015;43(4): 314–317. and Olsen et al. Am J Infect Control. 2015;43(4):318–322.)

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Ensuring Proper Antimicrobial Use at Hospital Discharge: The Next Frontier of Antimicrobial Stewardship? 
Reviewed by Christopher J. Graber, MD, MPH, FIDSA

Most antimicrobial stewardship programs in the inpatient setting focus on de-escalating unnecessary broad-spectrum intravenous antibiotic use and, in the outpatient setting, focus on reducing antibiotic use in situations where an antibiotic may not be indicated (i.e., uncomplicated upper respiratory infections). But the transition from inpatient to outpatient may be particularly fertile ground for reducing inappropriate antimicrobial usage.

A recent study published in Infection Control & Hospital Epidemiology examined the appropriateness of antimicrobial therapy prescribed at discharge at a large academic public safety-net hospital. The authors reviewed—for appropriateness of antibiotic prescription—a random sample of 150 charts of patients discharged on an oral antibiotic over a one-year time frame from July 2012 through June 2013. Urinary tract infection (UTI) (23 percent), skin and soft tissue infection (22 percent), community-acquired pneumonia (CAP) (17 percent), and gastrointestinal infection (15 percent) were the most common indications for antibiotics. Fluoroquinolones (37 percent) were the most frequently prescribed antibiotic class, despite local treatment algorithms discouraging fluoroquinolones as oral step-down therapy for UTI and CAP.

Fifty-three percent of antibiotic courses were deemed inappropriate, most commonly due to excessive treatment duration (33 percent of inappropriate courses), suboptimal antibiotic selection (17 percent), incorrect dose (9 percent), and conditions not requiring antibiotics (5 percent). CAP was associated with inappropriateness (even though the institution had a CAP treatment algorithm), and infectious diseases consultation and azithromycin use were associated with appropriateness.

The authors noted that almost two thirds of the total antibiotic duration was completed in the outpatient setting, further underscoring the need to ensure guideline-concordant therapy at hospital discharge, especially with regard to length of therapy.

(Yogo et al. Infect Control Hosp Epidemiology. 2015;36(4):474-8.)
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Your Neighbor’s Antibiotics: A Novel Risk Factor for C. difficile Infection
Reviewed by Manie Beheshti, MD

Widely accepted risk factors for Clostridium difficile infection (CDI) include advanced age, antibiotic exposure, chemotherapy, hospitalization, use of proton pump inhibitors, and gastrointestinal surgery. Although exposure to patients with CDI is a more recognized risk factor, the role of the more prevalent asymptomatic carriers is less well understood.

In the April 2015 issue of the Journal of the American Medical Association (JAMA) Internal Medicine, researchers in Canada assessed the risk of CDI in hospitalized patients with respect to their hospital ward’s antimicrobial usage. This single-center study was conducted at a teaching hospital. Sixteen wards were included (five intensive care units, eight medical-surgical wards, and one oncology ward). Over the course of the nearly two-year study, over 34,000 patients were evaluated with a total of 255 CDIs. Using multivariable and multilevel models, the researchers found that regardless of recent antimicrobial exposure, there was a 34 percent increase in CDI for every 10 percent increase in days of antimicrobial therapy at the ward level.

The unique perspective of this study helps highlight CDI risks beyond just a single patient’s risk factors. Use of antibiotics at the ward level impacts CDI risk regardless of a patient’s antimicrobial use. This novel risk factor could have far greater implications in understanding CDI transmission and risk. Further, it adds to the growing list of benefits in the new era of antimicrobial stewardship. As stated in the accompanying editorial, “the main finding of this study reveals how antibiotics, by affecting a subset of patients … put the entire population, including those who do not receive antibiotics, at increased risk via increased transmission.”

(Brown et al. JAMA Intern Med. 2015;175(4):626-633.)
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The QuantiFERON Quandary: Limitations in Steroid Treated Patients
Reviewed by Nirav Patel, MD

Interferon-gamma release assays (IGRAs) offer an alternative screening tool for latent tuberculosis infection (LTBI), with some added advantages over tuberculin skin testing, such as positive and negative controls built into the test itself. However, there have been concerns regarding the validity of IGRAs in the setting of preexistent anti-tuberculous drugs or in the presence of immunomodulators such as steroids, which a recent article in Tuberculosis attempts to address.

In the study, blood from 10 adult patients with LTBI was inoculated into the standard QuantiFERON-TB Gold In-Tube (QFT) as well as tubes containing therapeutic concentrations of isoniazid, rifampin, isoniazid+rifampin, ciprofloxacin, or dexamethasone. Analysis of cytokines, including TNF-α, IL-1ra, IL-2, IL-10, IL-13, IP-10, and MIP-1β, was performed, along with routine QFT.

No significant effects were noted in cytokine production in the presence of anti-tuberculous drugs; however, four of 10 patients converted the QFT result from positive to negative in the presence of dexamethasone. There was no corresponding change in the mitogen (positive) control.

Perhaps the results are not surprising, as tuberculosis specific T-cells represent only a very small fraction of peripherally circulating T-cells. Thus, responses in these specific T-cells may be blunted by steroid exposure, while mitogen stimulates all circulating T-cells, and would still meet criteria for a positive response.

Nonetheless, there is significant clinical concern regarding these findings, as many patients undergo LTBI screening using IGRAs prior to starting aggressive immunosuppressive regiments. A large number of these patients are already on steroid therapy at baseline and thus could have false-negative results. A detailed clinical evaluation for tuberculosis exposure risk and a consideration for treatment of LTBI remain essential.

(Special thanks to Daniel Hoft, MD, PhD, FIDSA, for his suggestions and comments.)

(Clifford et al. Tuberculosis. published online: February 13, 2015.)
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Estimating HIV Transmission Rates at Each Step of the Care Continuum
Reviewed by Brian R. Wood, MD

The HIV care continuum or “treatment cascade” describes the number of individuals who are 1) infected but undiagnosed, 2) diagnosed but not retained in care, 3) retained in care but not prescribed antiretroviral therapy (ART), 4) prescribed ART but not virally suppressed, or 5) virally suppressed. Now, a new spin on this model may help guide HIV prevention efforts.

Researchers incorporated data from three large databases to estimate the number of HIV transmissions and rate (annual per-person transmissions) at each step of the care continuum, stratified by sex, risk category, and age group. The analysis, reported in Annals of Internal Medicine, demonstrates that of the approximately 1.2 million people living with HIV in the United States, 18.1 percent remain undiagnosed, 45.2 percent are diagnosed but not retained in care, 4.1 percent are retained in care but not prescribed ART, 7.2 percent are prescribed ART but not virally suppressed, and 25.3 percent are virally suppressed. The highest rate of transmission is attributable to undiagnosed individuals (6.6 transmissions per 100 person-years), followed by those diagnosed but not retained in care (5.3 transmissions per 100 person-years). These two groups account for 91.5 percent of HIV transmissions.

Successful advancement along the care continuum is associated with a reduction in transmission rate; viral suppression, the ultimate step in the cascade, leads to a 94 percent reduction. Men account for the majority of HIV transmissions, with the most frequent risk factor being male-to-male sex. Younger people (ages 25 to 34) and men who have sex with men (MSM) who use injection drugs account for the highest transmission rates overall.

The most notable finding is the staggering impact of undiagnosed individuals and those not retained in care on new HIV infections. However, the data also confirm the striking effect of viral suppression on transmission rate. This data can help us understand the impact of efforts to improve each step of the care continuum as we continue to strengthen screening, linkage, and retention in care programs and strive toward early, effective ART for all HIV-infected persons.

(Skarbinski et al. JAMA Intern Med. 2015;175(4):588-596.)

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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:

May 15
  • Vaccination Against Japanese Encephalitis: How Safe Is It?
  • Delayed Hemolysis After Artesunate Treatment of Severe Malaria
  • Case Vignette: Asymptomatic Bartonella Bacteremia in a Blood Donor
May 1
  • Sepsis in Hematopoietic Stem Cell Transplant and Solid Organ Transplant Recipients: Very Different Outcomes
  • Varicella Zoster Infection and Central Nervous System Complications in Children Since the Introduction of Vaccination
  • Case Vignette: Transplanting a Malarious Heart
April 15
  • Influenza and Pregnancy: Too Much of an Immune Response?
  • The Mechanism of Plasmodium falciparum Resistance to Artemisinin
  • Fat Cells—Enemies of Staphylococcus aureus
April 1
  • Decision Fatigue—When Prescribing an Antibiotic Is the Easy Way Out
  • Toscana Virus