IDSA News - July/August 2015
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Guideline on Diagnosis and Management of Vertebral Osteomyelitits Released
A new guideline released by IDSA on vertebral osteomyelitis warns that patients with persistent back pain despite therapy may have a spine infection that could lead to paralysis or death if not diagnosed and treated correctly. The first US guideline on this infection, it has been published in the journal of Clinical Infectious Diseases.
Vertebral osteomyelitis is fairly rare, and therefore often is overlooked because it causes back pain, a common ailment usually triggered by a pulled muscle or spine injury. Every year, two to six out of 100,000 people get vertebral osteomyelitis, in which bacteria enter into the blood stream and lodge in a disc, the structure that acts as a shock absorber between vertebrae in the spine. While vertebral osteomyelitis can occur in anyone, the infection is most common in older patients.
Simple blood tests to check for inflammation (including sedimentation rate and C-reactive protein) can help determine if vertebral osteomyelitis may be causing the pain, the guidelines note. If those tests are positive, the guidelines recommend the patient have a magnetic resonance imaging (MRI) test, which can differentiate between an infection and a common back problem, such as a slipped disc. If vertebral osteomyelitis is suspected after the MRI, the patient should have a biopsy to confirm infection and determine the bacteria responsible. Treatment typically involves six weeks of intravenous (IV) antibiotics. In about half of patients, surgery to remove the infection may be necessary.
Elie F. Berbari, MD, FIDSA, associate chair of education for the division of infectious disease at Mayo Clinic College of Medicine, and Steven K. Schmitt, MD, FIDSA, infectious disease physician at Cleveland Clinic co- authored the guidelines with the support an 11-member panel including infectious diseases physicians, an orthopedic surgeon and a radiologist. In addition to Drs. Berbari and Schmitt, the panel included: Souha S. Kanj, MD, FACP, FIDSA; Todd J. Kowalski, MD; Rabih O. Darouiche, MD; Andreas Widmer, MS, MD; Edward Hendershot, MD; Paul Holtom, MD; Paul Huddleston III, MD; Gregory Petermann, MD; and Douglas Osmon, MD.
CDC Updated Guidelines on Treatment of Sexually Transmitted Diseases
The U.S. Centers for Disease Control and Prevention (CDC) released its updated Sexually Transmitted Diseases Treatment Guidelines, 2015 in June. The full Guidelines and resources such as a pocket guide, wall chart, Apple STD Tx Guide App, and summary are available at www.cdc.gov/std/tg2015/default. The summary provides an overview of important updates to the previous iteration with new diagnostic, treatment, and prevention recommendations.
FDA Approves Technivie in Combination with Ribavirin for Treatment of HCV
The U.S. Food and Drug Administration recently approved Technivie (ombitasvir, paritaprevir and ritonavir) for use in combination with ribavirin for the treatment of hepatitis C virus (HCV) genotype 4 infections in patients without scarring and poor liver function (cirrhosis). Technivie in combination with ribavirin is the first drug that has demonstrated safety and efficacy to treat genotype 4 HCV infections without the need for co-administration of interferon, an FDA-approved drug also used to treat HCV infection.
IDSA offers two email services to help members stay informed of updates from FDA and the Centers for Disease Control and Prevention (CDC). Content includes a range of topics, including drug warnings, recalls, and outbreak investigations. Recent alerts have included:
Gilenya (fingolimod): Drug Safety Communication - FDA Warns About Cases of Rare Brain Infection (August 4, 2015)
Kaletra (lopinavir/ritonavir) product labeling updated (June 30, 2015)
Clinical Considerations for the Evaluation of Ill Travelers from Liberia to the United States (June 24, 2015)
Updated Information and Guidelines for Evaluation of Patients for MERS-CoV Infection (June 12, 2015)
IDSA members can sign up for these services online. (To subscribe, check the appropriate boxes to receive CDC’s Health Alert Network [HAN] messages and/or alerts from FDA, and provide your email address and name where indicated.)
Is Your Facility Experiencing Antibiotic Shortages?
IDSA members are urged to report drug shortages directly to FDA and to copy IDSA staff at firstname.lastname@example.org.
CMS Issues FAQ Document on ICD-10 Implementation
A new FAQ document from the Centers for Medicare and Medicaid Services (CMS) on implementation of ICD-10 codes is available on the IDSA website. As a reminder, Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code. The Medicare claims processing systems do not have the capability to accept ICD-9 codes for dates of service after September 30, 2015, or accept claims that contain both ICD-9 and ICD-10 codes for any dates of service. Submitters should follow existing procedures for correcting and resubmitting rejected claims.
White House Releases Five-Year HIV/AIDS Strategy
Reflecting progress and lessons since the release of the first U.S. National HIV/AIDS Strategy in 2010, the White House released a plan for the next five years with a focus on testing, comprehensive care, universal viral suppression, and full access to pre-exposure prophylaxis (PrEP) services for those at high risk. Continuing to prioritize key affected populations and geographic areas, the strategy incorporates scientific and policy advances that have occurred since 2010, including:
For more on the updated strategy, and to download a copy, visit AIDS.gov National HIV/AIDS Strategy overview. See the HIVMA statement on the strategy release here.
- Implementation of the Affordable Care Act
- New HIV testing tools and recommendations
- Research demonstrating treatment benefits including the START and HPTN 052 trials
- Agencies' approval of and guidelines for PrEP
21st Century Cures Act Progresses Through Congress
The U.S. House of Representatives passed the 21st Century Cures Act, H.R. 6, last month with an overwhelming bipartisan vote of 344-77. This legislation includes key IDSA priorities, such as the Limited Population Antibacterial Drug (LPAD) approval mechanism, a provision to improve the process for updating antimicrobial susceptibility breakpoints, increased funding for the National Institutes of Health (NIH), and an increase to the annual limit for the NIH loan repayment program. Over the last few years, IDSA members have undertaken significant advocacy—through emails, phone calls and in person meetings with congressional staff and members of Congress—in support of these policies, and these efforts have been critical to the Society’s success in advancing these priorities.
The U.S. Senate is developing its own legislation—Innovations for Healthier Americans—that will be similar in scope to Cures. IDSA is now advocating for inclusion of our priorities in this bill.
As part of these efforts, IDSA Antimicrobial Resistance Committee member, Helen Boucher, MD, FIDSA, spoke at a July 28 Senate briefing in support of the Senate LPAD legislation (the Promise for Antibiotics and Therapeutics for Health, or PATH Act, S. 185). She was joined by Janet Woodcock, MD, of the Food and Drug Administration (FDA), Prabha Fernandes of Cempra, and Alan Coukell of The Pew Charitable Trusts. The briefing garnered over 70 attendees, including key Senate staff and representatives from other stakeholder organizations.
You can help us advance the PATH Act by taking a minute or two to email your Senators through this link.
House, Senate Committees Recommend 2016 Funding to Address Antibiotic Resistance
Annual Appropriations Process Breaks Down as Leaders Clash over Sequestration
The House and Senate Appropriations Committees have approved spending bills for Fiscal Year (FY) 2016, which begins on October 1. Despite a challenging fiscal environment, the bills propose increasing support for the National Institutes of Health and other IDSA priority areas, including implementation of the National Action Plan for Combating Antibiotic-Resistant Bacteria. The House bill proposes:
Despite apparent steps forward for AR, the House bill includes proposals that would be significant setbacks, such as elimination of the Agency for Healthcare Research and Quality (AHRQ) and a reduction in the NIH extramural salary cap from Executive Level II (currently $183,300) to III ($168,700).
- $31.2 billion (+3%) for the National Institutes of Health
- $100 million increase for the National Institute of Allergy and Infectious Diseases (NIAID) component of the president’s antibiotic resistance (AR) initiative
- $120 million for the Centers for Disease Control and Prevention’s (CDC) new AR Solutions Initiative
- $30 million to further develop the CDC’s Advanced Molecular Detection (AMD) Initiative
- Level-funding at $415 million for the Biomedical Advanced Research and Development Authority (BARDA)
The Senate’s health spending bill proposes:
The Senate bill retains AHRQ but reduces its funding by 35%. The bill also proposes a cut of $32 million or 20% from the CDC Division of STD Prevention. The Senate bill maintains the NIH extramural salary cap at Executive Level II.
- $32.1 billion (+6%) for the National Institutes of Health
- $100 million increase for the NIAID component of the Administration’s AR initiative
- $30 million for the new CDC AR Solutions Initiative
- $30 million for AMD
- $473 million (+14%) for BARDA
After committee approval of these bills, the appropriations process largely stalled over disagreement on how to deal with a return of the full impact of sequestration (automatic, arbitrary and across-the-board budget cuts that began in 2013 to control spending), which is slated for FY 2016. Democrats in Congress and the White House have promised that the appropriations process will go no further until an agreement is reached to raise the federal spending cap for FY 2016, as was done for FY 2014 and 2015 in exchange for an extension of spending caps an additional two years into FY 2022 and 2023. As the new fiscal year approaches, Congress will likely pass a temporary funding measure, known as a continuing resolution, that will keep federal agencies open and operating at the previous year’s spending level until an agreement on sequestration can be achieved. However, the possibility of a government shutdown remains, particularly if no progress is made towards a deal on sequestration.
As the start of the fiscal year approaches, IDSA will continue to engage Congress and the Administration on the budget. We’ll need your help, so look for email advocacy alerts in September.
News from CDC: Recognizing the 20th Anniversary of the Emerging Infections Program
This month marks the 20th anniversary of the Centers for Disease Control and Prevention’s (CDC) Emerging Infections Programs (EIP). This partnership between CDC, state and local health departments, academic institutions, infection control practitioners, and other federal agencies has been instrumental in advancing CDC’s core mission of preventing illnesses and saving lives.
EIP protects against the spread of infectious disease by monitoring diseases as they emerge, evaluates and retools our responses to outbreaks, and transfers what’s been learned to the public health community. Many IDSA members have played an integral role in the success of the EIP and continue to support the program’s progress. The September 2015 issue of the Emerging Infectious Diseases Journal commemorates the 20th anniversary by featuring articles on various EIP activities and highlighting how this vital network has strengthened the science base and informed public health policy.
NIH Requests Input on its Strategic Plan
The National Institutes of Health (NIH) released its NIH-wide strategic plan last month. Developed in collaboration from leadership and staff from all 27 Institutes and Centers at the NIH, the plan sits above institute and individual center strategic plans to provide a unified set of principles to guide the NIH in pursuit of its mission. It outlines key “areas of opportunity” as well as “unifying principles” on how to set trans-NIH priorities and improve the biomedical research enterprise. NIH is seeking comments from the community by August 16. The IDSA Research Committee is currently drafting IDSA recommendations.
IDSA Comments on Criteria for $20 Million CARB Diagnostics Challenge
The White House’s multipronged National Action Plan for Combating Antibiotic Resistant Bacteria (CARB) aims to tackle antimicrobial resistance in many ways – one of which is a new $20 million dollar prize to develop rapid diagnostic tests. Known as “the Antimicrobial Point-of-Care Diagnostics Test Challenge,” the prize will be administered by the National Institutes of Health (NIH) and the Biomedical Advanced Research Development Authority (BARDA). IDSA drafted comments to this recently announced prize, strongly supporting the challenge and listing criteria that should be considered for the prize.
FDA Proposal Would Yield Better Data on Antibiotics in Meat, Poultry
The U.S. Food and Drug Administration (FDA) released a proposed rule this spring that would increase the amount of data the agency collects on antibiotic sales for use in food-producing animals. Specifically, the FDA proposes revisions to its annual reporting requirements for drug sponsors of all antimicrobials sold or distributed for use in food-producing animals in order to obtain estimates of sales by major food-producing species (cattle, swine, chickens, and turkeys). IDSA has repeatedly called on FDA to expand its sales data collection to species level (see here and here). The IDSA Public Health Committee is currently working on a comment letter in support of finalizing the rule.
Science Speaks Covers 8th International AIDS Conference
The IDSA Center for Global Health Policy blog, Science Speaks, covered the eighth International AIDS Conference in Vancouver, Canada with live reporting on:In addition, Science Speaks memorialized the life of pioneering physician and researcher Dr. Suniti Solomon, who first detected HIV transmission in India.
What Not to Miss at IDWeek 2015
In a Q&A with IDWeek staff, 2015 Chair James M. Hughes, MD, FIDSA, shares his thoughts on what’s most exciting about this year’s meeting.
- What are you most looking forward to at IDWeek this year?
The theme of IDWeek is “Advancing science, Improving care.” The scientific program committee, which includes representatives from the four sponsoring societies, has assembled a timely program featuring dynamic speakers and panelists who will be addressing a broad range of topics ranging from basic to translational science including updates on Ebola, antimicrobial resistance, antimicrobial stewardship, HIV, hepatitis C, and global health among many others. I am looking forward to the Opening Session on Ebola, the Closing Session on influenza and pandemic preparedness, the award lectures sponsored by the four sponsoring societies, and opportunities to interact with colleagues and trainees between sessions and during poster sessions.
- Are there any new session topics of interest?
The Scientific Program Committee put emphasis on developing sessions on the microbiome and on state-of- the-art diagnostics. The Pediatric Infectious Diseases Society is establishing a new lecture in honor of the late Dr. Caroline B. Hall; the first speaker will be Dr. John Williams speaking on Human Metapneumovirus. One session will feature a debate on tropical disease vaccines with a focus on malaria and dengue.
- What are the top 3 reasons people should attend IDWeek this year?
The meeting has sessions that will provide a broad range of scientific updates that should appeal to basic scientists, translational researchers, experienced clinicians, public health practitioners, infection preventionists, global health practitioners, and trainees in infectious diseases:
Interactive sessions provide the opportunity to compare your diagnostic and therapeutic approaches to difficult cases to approaches of experts.
Meet-the-Professor sessions and Poster Sessions provide the opportunity to interact informally with presenters.
Trainees have the opportunity to connect with senior Society members for a mentorship experience by participating in the IDWeek 2015 Mentorship Program.
OFID Offers Special Peer Review Track for Fellows of IDSA (FIDSA)
IDSA’s online only, fully open-access journal, Open Forum Infectious Diseases (OFID), offers a special peer review track for Fellows of IDSA (FIDSAs), which results in faster editorial decisions and publication. Fellows of the Society may submit one manuscript per year via this track. To qualify, the Fellow must be an author of the paper, must select reviewers (who may not be collaborators on the research project) to complete a specific review form, must revise the manuscript based on the reviewers’ comments, and then must submit the revised manuscript with the reviews to the editorial office. Manuscripts may be sent out for additional peer review, and based on the feedback from all of the reviewers and the judgment of the editorial team, a decision will be made. While there is not a guarantee of publication, this accelerated track results in quicker decisions.
Feedback from authors about this track has been extremely positive:
“My collaborators and I were preparing to submit a grant revision to the National Institutes of Health. We were hoping to quickly get some follow-up data into a published manuscript to support the application,” says Ravi Jhaveri, MD, FIDSA, of the University of North Carolina School of Medicine. “I utilized the FIDSA fast track at OFID because I thought the speed of the process would be an advantage. In less than a month from the time we had the paper ready, we had identified reviewers, revised the paper according to their comments, and submitted all documents to OFID. We had our acceptance in less than 4 business days, well ahead of our grant deadline.”
Dr. Jhaveri notes that OFID’s status as an open access journal affiliated with IDSA and Oxford University Press provides the added benefit of exposure to valued colleagues in ID. His article, “Hepatitis C Virus (HCV) Vertical Transmission in 12-Month-Old Infants Born to HCV-Infected Women and Assessment of Maternal Risk Factors,” was published in the spring 2015 issue.
To submit your manuscript, read the instructions to authors and submit online. To submit via the FIDSA track, fill out this form.
Latest OFID Podcast Features Martin Blaser on the Microbiome
In the sixth installment of the Open Forum Infectious Diseases (OFID) podcasts, Editor in Chief Paul Sax, MD, FIDSA, speaks with IDSA Past President Martin Blaser, MD, FIDSA, of New York University about the overuse of antibiotics in the United States and the consequential impact on the human microbiota. They discuss how using antibiotics in excess can be linked to host of diseases plaguing humans today – from obesity and allergic diseases, to certain cancers.
Dr. Blaser is Muriel and George Singer Professor of Medicine and Professor of Microbiology at NYU, director of the Human Microbiome Program, and author of the book Missing Microbes: How the overuse of antibiotics is fueling our modern plagues. His accolades include founding the Foundation for Bacteriology and the Virtual Museum of Bacteria, and serving as chair of the Board of Scientific Counselors of the National Cancer Institute and of the Advisory Board for Clinical Research at the National Institutes of Health. In 2014, IDSA presented him with the Alexander Fleming Award for Lifetime Achievement.
IDSA launched OFID 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. Now indexed in PMC, the journal is fully peer-reviewed and freely accessible to all readers. To submit your manuscript, read the Instructions for Authors and submit online.
FIDSA Designees Announced: 113 Distinguished Physicians, Scientists Honored
IDSA has announced those who have been elected this year to be Fellows of IDSA (FIDSA). Fellowship in IDSA honors those who have achieved professional excellence and provided significant service to the profession.
“Each one of these physicians and scientists has achieved an outstanding level of accomplishment in the field of Infectious Diseases and is a recognized leader in his or her community and institution, whether it be a hospital, clinic, research lab, or other setting” said IDSA President Stephen Calderwood, MD, FIDSA. “IDSA recognizes these accomplished physicians, researchers, and scientists for their contributions to our field with the honored designation of FIDSA.”
Applicants for IDSA Fellowship must be nominated by their peers and meet specified criteria, including continuing identification with the field of Infectious Diseases, and national or regional recognition. Nominees are reviewed and elected by the IDSA Board of Directors. Fellows of IDSA work in many different settings, including clinical practice, teaching, research, public health, and health care administration.
This year, the following individuals were honored as Fellows of IDSA:
Lilian Abbo, MD, FIDSA
University of Miami, Miami, FL
Amesh Adalja, MD, FIDSA
UPMC Center for Health Security, Pittsburgh, PA
Mohammed S. Ahmed, MD, FIDSA
Carle Foundation Hospital, Urbana, IL
Murat Akova, MD, FIDSA
Hacettepe University School of Medicine, Ankara, Turkey
Cesar A. Arias, MD, FIDSA
University of Texas Medical School at Houston, Houston, TX
Jennifer K. Arnold, MD, FIDSA
The Permanente Medical Group, Oakland, CA
Bertha S. Ayi, MB, ChB, FIDSA
Global Infectious Disease Service, PC, Sioux City, IA
Jeremy R. Bariola, MD, FIDSA
University of Arkansas for Medical Sciences, Little Rock, AR
J. David Beckham, MD, FIDSA
University of Colorado School of Medicine, Aurora, CO
Colm J. Bergin, MD, FIDSA
St. James's Hospital, Dublin, Ireland
Christopher M. Bland, PharmD, FIDSA
Dwight D. Eisenhower Army Medical Center, Richmond Hill, GA
Indira Brar, MD, FIDSA
Henry Ford Hospital, Detroit, MI
Angela P. Campbell, MD, FIDSA
Centers for Disease Control and Prevention, Atlanta, GA
Kenneth G. Castro, MD, FIDSA
Rollins School of Public Heath, Emory University, Atlanta, GA
Martin S. Cetron, MD, FIDSA
Centers for Disease Control and Prevention, Atlanta, GA
Lisa M. Chirch, MD, FIDSA
University of Connecticut Health Center, Farmington, CT
Teena Chopra, MD, FIDSA
Wayne State University, Detroit, MI
George W. Christopher, MD, FIDSA
JPEO-CBD, Ft Belvoir, VA
Mitzi M. Chua, MD, FIDSA
Philippine Society for Microbiology and Infectious Diseases, Cebu, Philippines
Nina M. Clark, MD, FIDSA
Loyola University Medical Center, Maywood, IL
Heather Clauss, MD, FIDSA
Temple University Health Sciences Center, Philadelphia, PA
Nicholas G. Conger, MD, FIDSA
Wright-Patterson AFB Medical Center, Wright Patterson AFB, OH
Elizabeth Connick, MD, FIDSA
University of Colorado, Aurora, CO
Jennifer A. Curry, MD, FIDSA
Naval Medical Center San Diego, San Diego, CA
Raymond J. Dattwyler, MD, FIDSA
New York Medical College, Valhalla, NY
Matthew J. Dolan, MD, FIDSA
Defense Institute for Medical Operations, San Antonio, TX
Shira Doron, MD, FIDSA
Tufts Medical Center, Boston, MA
Erik R. Dubberke, MD, FIDSA
Washington University School of Medicine, St. Louis, MO
Peter T. Ender, MD, FIDSA
St. Luke's University Hospital and Health Network, Center Valley, PA
Timothy P. Endy, MD, FIDSA
State University of New York Upstate Medical University, Syracuse, NY
Eileen C. Farnon, MD, FIDSA
Temple University School of Medicine, Philadelphia, PA
Tasaduq N. Fazili, MD, FIDSA
Upstate Medical University, Syracuse, NY
Jacob Fleischmann, MD, FIDSA
GLA VA Healthcare System/UCLA, Los Angeles, CA
Jose Flores, MD, MSc, FIDSA
JM Research, PLLC, Houston, TX
Jason Gallagher, PharmD, FIDSA
Temple University, Philadelphia, PA
Anuradha Ganesan, MD, FIDSA
Walter Reed National Military Medical Center, Bethesda, MD
Eliot W. Godofsky, MD, FIDSA
Bach & Godofsky MD PA, Bradenton, FL
Hector F. Gorbea, MD, FIDSA
University of Puerto Rico School of Medicine, Guaynabo, PR
Linda M. Gorgos, MD, FIDSA
El Rio Health Center, Tucson, AZ
Edward Graviss, PhD, MPH, FIDSA
Houston Methodist Research Institute, Houston, TX
John Halperin, MD, FIDSA
Overlook Medical Center, Summit, NJ
Sarah P. Hammond, MD, FIDSA
Brigham and Women's Hospital, Boston, MA
Rafael Harpaz, MD, MPH, FIDSA
Centers for Disease Control and Prevention, Atlanta, GA
Walter C. Hellinger, MD, FIDSA
Mayo Clinic Jacksonville, Jacksonville, FL
Angela Hewlett, MD, FIDSA
University of Nebraska Medical Center, Omaha, NE
Wendell W. Hoffman, MD, FIDSA
Sanford Clinic, Sioux Falls, SD
Mary M. Horgan, MD, FIDSA
School of Medicine, University College, Cork, Ireland
James M. Horton, MD, FIDSA
Carolina's Medical Center, Charlotte, NC
Shirish Huprikar, MD, FIDSA
Mt. Sinai School of Medicine, New York, NY
Mamta K. Jain, MD, FIDSA
University of Texas Southwestern, Dallas, TX
Waleed Javaid, MD, FIDSA
SUNY Upstate Medical University, Manlius, NY
Keith R. Jerome, MD, PhD, FIDSA
University of Washington, Seattle, WA
Andre C. Kalil, MD, FIDSA
University of Nebraska, Omaha, NE
Mini Kamboj, MD, FIDSA
Memorial Sloan Kettering Cancer Center, New York, NY
Powel Kazanjian, MD, FIDSA
University of Michigan Health System, Ann Arbor, MI
Laura Kogelman, MD, FIDSA
Tufts Medical Center, Boston, MA
Erna M. Kojic, MD, FIDSA
Alpert Medical School/The Miriam Hospital, Providence, RI
Shyam Kottilil, MD, PhD, FIDSA
Institute of Human Virology, Baltimore, MD
James V. Lawler, MD, MPH, FIDSA
Naval Medical Research Center-Frederick, Fort Detrick, MD
Jonathan Li, MD, FIDSA
Brigham and Women's Hospital, Cambridge, MA
Mathias Lichterfeld, MD, PhD, FIDSA
Massachusetts General Hospital, Boston, MA
W. Ian Lipkin, MD, FIDSA
Columbia University, New York, NY
Vincent Lo Re, III, MD, FIDSA
University of Pennsylvania, Philadelphia, PA
Harrinarine Madhosingh, MD, FIDSA
Central Florida Infectious Disease Specialists, Longwood, FL
Tariq Mehmood, MD, FIDSA
Associates in Infectious Diseases, Floyds Knob, IN
Rachel Miller, MD, FIDSA
University of Iowa, Iowa City, IA
Neville Mobarakai, MD, FIDSA
Staten Island University Hospital, Westfield, NJ
Ryan P. Moenster, PharmD, FIDSA
St. Louis College of Pharmacy, St. Louis, MO
Franklin K. Murphy, MD, FIDSA
Sierra Infectious Diseases, Reno, NV
Jaan P. Naktin, MD, FIDSA
Leheigh Valley Physicians Group, Allentown, PA
Ramesh Nathan, MD, FIDSA
Los Robles Hospital and Medical Center, Thousand Oaks, CA
Duane W. Newton, PhD, FIDSA
University of Michigan Health System, Ann Arbor, MI
Akinwale Olatosi, MD, FIDSA
Kershaw Health, Elgin, SC
Genovefa A. Papanicolaou, MD, FIDSA
Memorial Sloan-Kettering Cancer Center, New York, NY
Timothy R. Pasquale, PharmD, FIDSA
Carolinas Healthcare System, Charlotte, NC
Naveen Patil, MD, FIDSA
Arkansas Department of Health, Little Rock, AR
Elizabeth J. Phillips, MD, FIDSA
Vanderbilt University, Franklin, TN
Sanjay Ram, MBBS, FIDSA
University of Massachusetts Medical School, Worcester, MA
Sanjay Revankar, MD, FIDSAFrancis X. Riedo, MD, FIDSA
Wayne State University, Detroit, MI
Evergreen Health, Kirkland, WA
Patrick A. Robinson, MD, FIDSA
ID in Davidson, Matthews, NC
Jose R. Romero, MD, FIDSA
University of Arkansas for Medical Sciences, Little Rock, AR
Michael Saccente, MD, FIDSA
University of Arkansas for Medical Sciences, Little Rock, AR
Patrick C. Seed, MD, FIDSA
Duke University School of Medicine, Durham, NC
Deborah E. Sentochnik, MD, FIDSA
Bassett Helathcare, Cooperstown, NY
Susan Seo, MD, FIDSA
Memorial Sloan-Kettering Cancer Center, New York, NY
Andi L. Shane, MD, MPH, FIDSA
Emory University School of Medicine, Atlanta, GA
Samuel A. Shelburne, MD, PhD, FIDSA
MD Anderson Cancer Center, Houston, TX
Mahmoud A. Shorman, MD, FIDSA
Marshall University, Huntington, WV
Marc O. Siegel, MD, FIDSA
Medical Faculty Associates, George Washington University,
Juan G. Sierra-Madero, MD, FIDSA
Instituto Nacional De Ciencias Medicas Y Nutricion S.Z., Mexico, Mexico
Jacek Skarbinski, MD, FIDSA
Centers for Disease Control and Prevention, Atlanta, GA
Sally B. Slome, MD, FIDSA
Kaiser Permanente, Oakland, CA
Steven L. Solomon, MD, FIDSA
Global Public Health Consulting, Atlanta, GA
Rajeev Soman, MD, FIDSA
Hinduja Hospital Mumbai, Mumbai, India
Pranavi Sreeramoju, MD, FIDSA
University of Texas Southwestern Medical Center, Dallas, TX
Jeffrey L. Stephens, MD, FIDSA
Mercer University School of Medicine, Macon, GA
Scott Stienecker, MD, FIDSA
Parkview Health, Fort Wayne, IN
Robert L. Stiller, MD, FIDSA
Permanente Medical Group Inc., San Jose, CA
Jose A. Stoute, MD, FIDSA
Penn State Hershey Medical Center, Hershey, PA
Judy Streit, MD, FIDSA
University of Iowa, Iowa City, IA
Vidya Sundareshan, MD, FIDSA
Southern Illinois University School of Medicine, Springfield, IL
James C. Sunstrum, MD, FIDSA
Sunstrum Medical Associates, Dearborn, MI
William H. Tettelbach, MD, FIDSA
Intermountain Healthcare, Salt Lake City, UT
Harrys A. Torres, MD, FIDSA
University of Texas M.D. Anderson Cancer Center, Houston, TX
Chukwudum Uche, MD, FIDSA
Infectious Disease Associates, Las Vegas, NV
Chirag V. Vasa, MD, FIDSA
Mount Sinai Hospital of Queens, Astoreia, NY
Keyur S. Vyas, MD, FIDSA
University of Arkansas for Medical Sciences, Little Rock, AR
Gary P. Wang, MD, FIDSA
University of Florida, Gainesville, FL
Risa M. Webb, MD, DTM&H, FIDSA
University of Mississippi Medical Center, Jackson, MS
Christian J. Woods, MD, FIDSA
Medstar Washington Hospital Center, Washington, DC
Naoki Yanagisawa, MD, PhD, FIDSA
Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
Richard Zuckerman, MD, FIDSA
Dartmouth-Hitchcock Medical Center, Lebanon, NH
Members on the Move
Jeanne M. Marrazzo, MD, FIDSA has been named chair of the American Board of Internal Medicine's (ABIM) Council. The council guides the policies and procedures for Certification and maintenance of certification (MOC) in all of the disciplines of internal medicine. Dr. Marrazzo is professor of medicine in the Division of Allergy and Infectious Diseases at the University of Washington and director of the Seattle STD/HIV Prevention Training Center.
William Schaffner, MD, FIDSA professor of preventive medicine and infectious diseases at Vanderbilt University, has been named medical director of the National Foundation of Infectious Diseases.
Jack Sobel, MD, FIDSA has been named dean of the Wayne State University School of Medicine for two years. He has served as interim dean since last November.
MEMBERSAni, Agatha, MSc, MT, PhD
Bean, Madelyne Ann, PharmD
Beebe, James, PhD
Carter, E Jane, MD
Donskey, Curtis, MD
Dutta, Shubhadeep, PharmD, RPh
Eby, Joshua, MD
Egan, Elizabeth, MD, PhD
Fedorenko, Marianna, PharmD
Gonzalez, Elizabeth, PharmD
Koshy, Anita, MD
Magcalas, Edgar, MD
Malik, Asim, MD
McElvania TeKippe, Erin, PhD
Nguyen, Cynthia, PharmD
Ogoina, Dimie, MBBS
Panther, Lori, MD, MPH
Patel, Ketan, MD
Patel, Nikita, PharmD
Rijnders, Bart, MD, PhD
Saade, Elie, MD, MPH
Sankar, Shukdeo, MD
Sharp, Tyler, PhD
Shevkani, Manoj, MD
Singh, Sushma, MD
Tan, Thuan-Tong, MBBS
Tufa, Tafese, MD, MSc
Tugume, Lillian, MD, ChB
Uyemura, Trevor, MD
Walser, Brandon, MD
Weinstein, Edward, MD, PhD
MEMBERS-IN-TRAINING/FELLOWSAbassi, Mahsa, DO
Abergel, Glen, MD
Abulhamayel, Yem, MD
Adekambi, Toidi, PhD
Adhikari, Prabhat, MD
Ahrens, Jillian, MD
Alexander, Andrew, MD
AlMansoori, Dalal, MD
Almoosa, Zainab, MD, MBBS
Al-Obatar, Mohanad, MD
Alpern, Jonathan, MD
Alsharekh, Enas, MD
Ameri, Allen, MD
Antar, Annukka, MD, PhD
Arinze, Folasade, MD
Avner, Benjamin, MD, PhD
Ayoade, Folusakin, MD
Baghban, Adam, MD
Bajrovic, Valida, MD
Balabanian, Gregory, MD
Bapat, Anita, MD
Bartash, Rachel, MD
Bartley, Patricia, MD, MSc
Bauer, Matthew, DO
Beeler, Cole, MD
Bobkova, Elina, MD
Boyce, Ross, MD, MSc
Bran, Andres, MD
Branch, Rebecca, MD
Bryan, Nicole, MD, PhD
Bryant, Paul, MD
Burnham, Jason, MD
Caballero, Andrea, MD
Caragol, Laura, MD
Carvour, Martha, MD
Castellani, Lucas, MD
Castro, Robert, MD
Castro-Borobio, Manuel, MD
Chakkour, Wadih, MD
Chalana, Indu, MD
Chan, Austin, MD
Chia, Po Ying, MBBS
Cho, Christine, MD
Clemenzi-Allen, Angelo, MD
Cooper, Christopher, MD
Coppock, Dagan, MD
Cornejo Cisneros, Enrique, MD
Damioli, Laura, MD
Dejace, Jean, MD
Delgado Malaga, Sandra, MD
Desai, Avani, MD
Dhillon, Geeti, MD
Diaz, Amaury, MD
Dobosz, Anna, MD
Dwivedi, Shamik, DO
Ebers, Andrew, MD
Elfekey, Mohammed, MD
Estelle, Carolee, MD
Farhadian, Shelli, MD, PhD
Ferren, Katie, MD
Figueroa, Nilka, MD
Foltz, Christopher, MD
Foster, Catherine, MD
Franco Garcia, Alexandra, MD
Fulcher, Jennifer, MD, PhD
Gandhi, Sejal, MD
Garcia, Steven, DO
Gersh, Jill, MD
Giwa, Bashirat, MBBS
Golob, Jonathan, MD, PhD
Gomadam, Saritha, DO
Gonzalez-Vale, Marijesmar, MD
Greendyke, William, MD
Grennan, Dara, MD
Grewal, Harkiran, MD
Guenete, Alexis, DO
Guerrero-Wooley, Richelle, MD
Habib, Onaizah, MD
Hajar, Zeina, MD
Hammadi, Ahmed, MD
Hartmann, Carlos, MD
Hasen, Ruth, MD
He, Peimei, MD
Helou, Elie, MD
Hesse, Shayla, MD
Hiensch, Robert Jan, MD
Holzman, Samuel, MD
Hussain, Noman, MD
Ilieva, Valeria, MD
Ivanaviciene, Jurate, MD
Jablonski, Lindsay, MD
Jacobs Slifka, Kara, MD, MPH
Jagadeesan, Vidya, MD
Jandhyala, Deeksha, MD
Jean, Wisna, MD
Jeong, Young-Gwang, MD
Jitmuang, Anupop, MD
John, Blessy, MD
Jose, Jo-Ann, MD
Jose, Jasmin, MD
Kachhdiya, Suresh, MD
Kanthula, Ruth, MD, MPH
Kanwar, Anubhav, MD
Kato, Hideaki, MD
Kelly, Sean, MD
Khalil, Elie, MD
Khanal, Prakash, MBBS
Kim, Jiun, MD
Kirsch, Denise, MD
Kitt, Eimear, MD, ChB
Klevtsova, Ekaterina, MD
Klinkova, Olga, MD
Kmeid, Joumana, MD
Krapp Lopez, Fiorella, MD
Krishna, Amar, MD
Krueger, Karen, MD
Kulla, Bakri, MD
Lapidot, Rotem, MD
Lebron, Dora, MD
Lee, Ka Yeon, MD
Leon, Jacobo, MD
Lofgren, Sarah, MD
Mahmood, Maryam, MD
Mahmutoglu, Derya, MD
Majorant, Denisa, MD
Malviya, Meenal, MD
Martin, Jonathan, DO
Masel, Jennifer, MD
Mathur, Poonam, DO, MPH
Mehra, Sonia, MD
Michael, Heather, MD
Mody, Aaloke, MD
Molony, Kate, DO
Montague, Brian, DO, MPH
Montenegro, Miguel, MD
Mourya, Rajesh, MBBS
Moussavi, Farzad, MD
Mucheli, Sharavan Sadasiv, MD, MBBS, MRCP
Multani, Ashrit, MD
Murdoch, James, MD
Murillo, Monika, MD
Muthulingam, Dharushana, MD
Nakagawa, Hidenori, MD
Ng, Deborah, MRCP
Nguyen, David, MD, PhD
Oey, Michael, MD
Ortigoza, Mila, MD, PhD
Osiro, Berilonson, MD
Pacholec, Marie, DO
Pande, Anupam, MPH
Pandya, Shuchi, MD
Park, Jiyoung, MD
Patel, Anar, MD
Patel, Sachin, MD
Patterson, Shane, MD
Perez, Martita, MD
Pomerantz, Heather, MD
Poonawala, Husain, MBBS
Quadri, Syeda, DO
Raabe, Vanessa, MD
Rahman, Saidor, MD
Raymond-Guillen, Luke, MD
Reddy, Shivani, DO
Rizvi, Khulood, MD
Rosario Rosario, Gisela, MD
Rostad, Christina, MD
Rudd, David, DO
Ruderfer, Daniel, MD
Russo, Michael, MD
Sabin, Arick, DO
Saglan, Naif, MD
Saini, Ena, MD
Sambathkumar, Lakshmi, MD
Sandhu, Rikinder, MD
Sewnarine, Michelle, MD
Shah, Kamini, MD
Shah, Pooja, MD
Shapiro, Adrienne, MD, PhD
Shively, Nathan, MD
Shukla, Bhavarth, MD, MPH
Singh, Prachi, DO
Sivarajah, Thulashie, MD
Slawek, Deepika, MD
Soneji, Maulin, MD
Sotello Aviles, David, MD
Steinberg, Majella, DO
Stucky, Nick, MD
Tam, Jennifer, MD
Tanna, Sajal, MD, MPH
Tarasiuk-Rusek, Aneta, MD
Tash, Kaley, MD
Tekippe, Michael, MD, PhD
Tong, Celica, PharmD
Tongma, Chawat, MD
Tuddenham, Susan, MD, MPH, MSc
Vargas Velandia, Edwin, MD
Vaughan, Ana Maria, MD, MPH
Velagapudi, Manasa, MD
Vicetti Miguel, Claudia, MD
Wallender, Erika, MD
Wanjalla, Celestine, MD, PhD
Weber, Devin, MD
Wiley, Zanthia, MD
Wolf, Brian, MD
Woodworth, Michael, MD
Yamamoto, Michele, MD
Yang, Shangxin, PhD
Zeesham, Nakhath, MD
Zhu, Frank, MD
Zola, Courtney, MD
RESIDENTSAlfishwy, Mostafa, MD
Aronson, Jenny, MD
Au, Elizabeth, MD
Bricker-Ford, Robin, PharmD
Buss, Brian, PharmD
Desai, Angel, MD
Dobrzynski, David, MD
Egan, Keith, DO
Emberger, Jennifer, MD, MPH
Forrester, Jeanne, PharmD
Hojat, Leila, MD
Karmally, Rachel, MD
Kofman, Aaron, MD
Kopelman, David, MD
Lim, Kathlyn, PharmD
Magda, Gabriela, MD
Mehta, Samar, MD, PhD
Melendez-Gonzalez, Hector, MD
Novin, Alexander, PharmD
Rudd, Kelly, PharmD
Sabo, Michelle, MD, PhD
Salberg, Jonathan, DO
Simms, Andrew, MD
Smith, Tiffeny, PharmD
Stevens, Brooke, PharmD
Stokes, William, MD
Turner, Sarah, DO
Williams, Jonathan, MD
Workman, Adrienne, MD
Smith, Elaine Marie
ASSOCIATESAmaechi, Prince, MD
Anderson, Debra, PharmD, RPh
Artime, Emily, PA-C
Berbel Caban, Ana, MD
Beyrer, Chris, MD, MPH
Bland, Sarah, RPh
Broom, Colin, MD
Cazali, Iris, MD
Dada-Adegbola, Hannah, MBBS
Dupnik, Kathryn, MD
Foran, Sal, PharmD
Foutes, Justn, MBA
Gill, Steven, PhD
Gupta, Ekta, MD
Johannsen, Eric, MD
Johari, Fatima, MD
Khawaja Nadeem, Kymacare, MA
Law, Kacie, PA-C
Mahdi, Mohammed, PharmD
Manzoor, Shahanshah, BSN
Martinez, Jorge, MD
Petzold, Elizabeth, PhD
Rahav, Galia, MD
Resman, Masha, MD
Richardson, Jennifer, PA-C
Rogers, Sara, NP
Sheth, Nisha, MD
Sobcinski, Mary Kay, RN
Streifel, Amber, PharmD
Tyler, Eleanor, PhD
Ulrich, Robert, MD
Vakil, Niyati, PharmD
Vega, Rhonda, DVM
Wojciechowski, Amy, PharmD
Wojtecki, Jeremy, PA-C
Wong, Sharon, MD, PhD
Wu, Frances, MD
Zappas, Kristie, PharmD
Setting IDSA’s Course to Lead the Future of ID
During its June meeting, the IDSA Board of Directors engaged in a strategic planning process that was greatly influenced by your feedback to the member survey regarding Society priorities. We examined the effectiveness of our activities in order to readjust our course accordingly—building on the initiatives that have been successful, and refining our tactics based on the issues facing the field of Infectious Diseases today. In many respects, our priorities encompass issues the Society has been addressing over the last several years. What is new, however, is a greater emphasis on two key areas: recruiting young doctors into the field and promoting the value of the ID specialist.
A strategic planning process is, by definition, a means for setting a course for the future. But, as Winston Churchill once said, “However beautiful the strategy, you should occasionally look at the results.” Thus, during its June meeting, the IDSA Board of Directors spent a fair amount of time examining the effectiveness of our activities in order to readjust our course accordingly—building on the initiatives that have been successful, and refining our tactics based on the issues facing the field of Infectious Diseases today.
Your responses to the member survey in preparation for the strategic planning meeting were invaluable, and on behalf of the entire Board and staff of IDSA, I thank you for the insightful feedback you provided. Many consistent themes emerged from that survey and those helped shape the priorities we ultimately defined. Over the next two to three years, IDSA’s top priorities are:
- To promote the value of the ID specialist
- To attract the best and brightest to ID
- To promote ID leadership in antimicrobial resistance efforts and antimicrobial stewardship
- To continue to produce useful, timely, and relevant guidelines
- To promote ID/HIV research and its clinical translation
- To advocate for essential funding for critical prevention and public health programs in ID/HIV
In many respects, these are not “new” priorities. Rather, they encompass the priorities the Society has been addressing over the last several years. What is new, however, is a greater emphasis on two key areas: First is attracting students and residents to ID in light of the decreasing number of applicants for ID fellowships, both adult and pediatric. The work of our Task Force on ID Recruitment, under the leadership of Wendy Armstrong, MD, FIDSA, chair of IDSA’s ID Training Program Directors Committee, is well underway, examining the match results and other existing data, reviewing current efforts to recruit young physicians into the field. Ultimately this group will make recommendations on additional efforts the Society should undertake in the short and long term. The second key area is promoting the value of the ID specialist in the changing healthcare system. We are in the process of conducting a compensation survey of our membership so that we can gather accurate information that will allow us to better advocate for the profession and to attract the best and the brightest to our field. Clearly, these two priorities directly relate to each other. We will not be able to attract the best and the brightest people to the field absent attractive career opportunities.
This is at the core of IDSA’s mission — to define and promote the specialty. Although many organizations share our commitment to research, education, public health and prevention, IDSA is unique in one respect: Only IDSA has defined its role as making sure the specialty continues to prosper and its value is appropriately recognized by policymakers and other key stakeholders across the healthcare system.
Many efforts to address each of these six priorities are ongoing or already underway, thanks to the work of IDSA’s many committees and task forces, as well as the IDSA Education and Research Foundation. In the coming months, the Board and staff will be developing specific implementation plans to enhance efforts, especially those related to attracting people to the specialty and promoting ID’s value. In addition, we are going to re-evaluate and enhance the development of clinical practice guidelines, an activity that IDSA members continue to rate highly.
The Society will continue its important initiatives on antimicrobial resistance, federal funding for ID and HIV programs, global health, and all the work related to IDWeek, our journals, and other educational efforts. Future decisions about resource allocations will be based on these priorities, including the investment of new resources to promote the specialty, which are now feasible given that the Society’s financial position has grown stronger. These efforts will be shared with you here in IDSA News and in other venues. To read the complete Statement of Purpose and Long Term Goals/Objectives outlined by the Board, log in to the members-only My IDSA section of the website.
As I have said numerous times during my tenure as president of IDSA, I am proud to be a member of a Society so committed to the field and the professionals for whom it is a calling. I look forward to being a part of meeting these goals and objectives and working with each of you in that pursuit.
IDSA Compensation Survey: Take 5 Minutes to Help Us Advocate for You
We need your help! Please take 5 minutes to complete the IDSA Compensation Survey. The data gleaned from the survey will allow us to gauge the average compensation for an ID professional and will assist us in advocating for the specialty and our members. We know that compensation is one of the factors that medical students and residents consider when choosing a specialty. Help us provide a more accurate picture of the average compensation for an ID professional, so that we can attract the best and brightest to our field.
IDSA is dedicated to demonstrating the value that IDSA specialists bring to the healthcare system—but we need your help.
Please take 5-10 minutes to complete the IDSA compensation survey, which seeks to gauge the average compensation for an ID professional. By doing so, you'll help your Society advocate for the specialty and our members.
Why another survey? Several sources (e.g., MGMA, Medscape) publish compensation data by specialty. Historically, the representation of ID specialists in these surveys has been low, which calls into question the accuracy of the results. That's why IDSA is conducting this survey. We're aiming for a larger sample size that more accurately reflects the diversity of career opportunities within ID. We want to hear from people who work in clinical care, research, and public health.
We know that compensation is one of the factors that medical students and residents consider when choosing a specialty. Help us provide a more accurate picture of the average compensation for an ID professional, so that we can attract the best and brightest to our field.
Please help us meet our goal: 2500 responses by August 22.
This survey will not ask for any information that would disclose your personal identity, and your answers will be reported completely anonymously.
Please click here to complete the survey. We're asking for 5-10 minutes of your time to help us promote the specialty of ID.
Take Part in IDSA’s Future: Cast Your Vote in Board Elections
All IDSA and HIVMA members should have received an email this week for both the IDSA and HIVMA elections with a subject line "2015 IDSA/HIVMA Elections." The electronic ballot makes it easy for you to vote. Voting is an important way for every member to influence the future direction of IDSA and HIVMA. Please exercise your right to vote! Deadline for voting is September 10.
IDSA members should have received an email this week for both the IDSA and HIVMA elections with a subject line "2015 IDSA/HIVMA Elections."
"In addition to voting for officers and Board members, you'll also be asked to approve a revision in the IDSA Bylaws: to eliminate the requirement that new regular members must be nominated by a current member or fellow.
Why the change? Because it's an antiquated practice that impedes membership growth. We want to make the Society more inclusive and welcoming to colleagues from around the world, including those who work in locations where finding a local IDSA member to sign an application may be difficult. Currently, these individuals often end up joining the Society as associate members, which means they can't vote in elections and aren't eligible to serve on committees. Please help us make this change.
The deadline for casting your vote is September 10. If you have difficulty voting, have questions about voting online, or need another ballot, please contact Election Services Corporation by email at email@example.com or call 1-866-720-HELP (4357), 9 a.m. – 5 p.m. EDT.
If you have questions about the Bylaws Change, please contact Member Services at 888-844-IDSA or 703-299-0200.
The electronic ballot makes it easy for you to vote. Voting is an important way for every member to influence the future direction of IDSA and HIVMA. Please exercise your right to vote.
- Echocardiography and Cardiac Device Removal, if Present: Necessary for All with Staphylococcus Bacteremia?
- Addition of IV Metronidazole to Oral Vancomycin for Severe C. difficile Infection: Data to Support a Common Clinical Practice;
- Comparing Interferon-γ Release Assay and Tuberculin Skin Testing for TB Screening in Exposed Health Care Workers;
- Synergy Despite Resistance: Colistin-Tigecycline for XDR A. baumannii and Excess Mortality Compared to Colistin-Carbapenem;
- Preexposure Prophylaxis for Serodiscordant Couples who Wish to Conceive
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.
Echocardiography and Cardiac Device Removal, if Present: Necessary for All with Staphylococcus Bacteremia?
Reviewed by Manie Beheshti, MD
Two commonly encountered quandaries for ID clinicians are determining the utility of transesophageal echocardiograms (TEE) and the need for removal of a cardiovascular implantable electronic device (CIED), when present, in patients with Staphylococcus aureus bacteremia (SAB). Recent data from the Mayo Clinic provides a simple framework to aid clinicians in these situations.
In a recent issue of Clinical Infectious Diseases, researchers retrospectively reviewed nearly 700 patients with SAB over a five-year period. Using multivariable analysis, three independent predictors of infective endocarditis were identified: SAB acquired in the community, cardiac device presence, and prolonged bacteremia (72 hours or greater). Using a scoring system to maximize sensitivity, specificity, and negative predictive value, the authors propose a two-stage scoring system using the above predictors.
A high score on day one of SAB was 96 percent specific for infective endocarditis (IE), leading to the recommendation to pursue TEE (see Figure 3 in the study for a detailed flowchart). In those with low scores on day one, a second analysis was made on day five, at which time a low score carried a greater than 98 percent sensitivity and negative predictive value for IE, thus allowing for deferral of TEE.
In the February 2015 issue of Circulation: Arrhythmia and Electrophysiology, researchers from the same institution identified high-risk features in those with a CIED (permanent pacemaker, greater than one device-related procedure, and duration of SAB for four or more days). Using similar analytics, they conclude that in the absence of these risks, those patients without evidence of generator pocket infection may be monitored closely without device extraction.
These two studies aim to answer a commonly encountered question for patients with SAB. Although prospective studies are needed to validate these data, the authors are able to provide a much needed framework to aid the clinician’s risk assessment for each patient. While clinical judgment supersedes any algorithm, these informative studies certainly help provide further evidence to support clinical decisions.
(Palraj et al. Clin Infect Dis. 2015;61(1):18-28 and Sohail et al. Circ Arrhythm and Electrophysiol. 2015;8:137-144)
Addition of IV Metronidazole to Oral Vancomycin for Severe C. difficile Infection: Data to Support a Common Clinical Practice
Reviewed by Christopher J. Graber, MD, MPH, FIDSA
Intravenous (IV) metronidazole is commonly used in combination with oral vancomycin for the treatment of severe Clostridium difficile infection (CDI), but the practice carries only a C-III (expert opinion) recommendation in the most recent SHEA-IDSA guidelines. However, a recent study published in Clinical Infectious Diseases provides some data to support the approach.Eighty-eight patients who were admitted to the intensive care unit (ICU) at a single institution from June 2007 to September 2012 and met at least three of seven pre-specified criteria for severe CDI were analyzed; 44 patients who received IV metronidazole in addition to oral vancomycin were matched to 44 who did not, based on Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores. Patients in the IV metronidazole group had significantly higher leukocytosis and moderate to severe renal disease and lower mean arterial pressures.
The group receiving IV metronidazole had an in-hospital mortality of 15 days, compared to 21 days for the monotherapy group (p=0.03), though other outcomes (clinical success at day 6, 10, and 21; length of stay in hospital or ICU after CDI diagnosis) were similar between the two groups. In a multivariable analysis, only two factors were independently associated with survival: serum albumin (OR 0.87, p=0.011) and receipt of IV metronidazole (OR 4.54, p=0.008).
This study has limitations: its retrospective single-center nature, its relatively small number of patients, a higher (yet not statistically significant) proportion of patients in the IV metronidazole group receiving rectal vancomycin (18.2 percent vs. 4.5 percent), and differences in dosing of oral vancomycin between the two groups (somewhat more aggressive in the group receiving IV metronidazole). Nonetheless, this study provides important insights regarding optimal management of one of our most common life-threatening diseases.
(Rokas et al. Clin Infect Dis. 2015; published online May 29, 2015, doi: 10.1093/cid/civ409)
Comparing Interferon-γ Release Assay and Tuberculin Skin Testing for TB Screening in Exposed Health Care Workers
Reviewed by Zeina Kanafani, MD, MS
The value of the interferon-γ release assay (IGRA) in the diagnosis of latent tuberculosis (TB) infection among health care workers (HCWs) has not been fully elucidated. A recent Infection Control & Hospital Epidemiology study, conducted at 14 hospitals in France, compared the efficiency of the tuberculin skin test (TST) to that of IGRA in diagnosing latent TB infection among HCWs at high risk of TB exposure.Upon study entry, all subjects had a TST and IGRA, and both tests were repeated in one year. The cut-off for TST positivity was set at ≥10 mm of induration, and conversion was defined as an increase in induration of ≥10 mm from baseline. IGRA was performed using QuantiFERON TB Gold (QFT-G). Indeterminate results with QFT-G were further tested by the T-SPOT TB assay.
A total of 807 participants underwent baseline testing, with 113 (14 percent) having a positive IGRA and 446 (55.3 percent) having a positive TST. Almost all HCWs had received the bacille Calmette-Guérin (BCG) vaccine. IGRA positivity correlated with TST induration such that IGRA was more likely to be positive as TST induration increased (2.8 percent with TST 0-4 mm induration vs. 25.2 percent with TST ≥ 15 mm induration). At one-year follow-up, the conversion rate was 9.0 percent by IGRA and 2.5 percent by TST. Only one participant had conversion by both assays. In addition, quantitative testing of QFT-G revealed a reversion rate at one-year follow-up of 40.0 percent if baseline QFT-G was 0.35-0.69 IU/mL, and 6.1 percent if baseline QFT-G was ≥1 IU/mL (p = 0.001).
In this cohort of BCG-vaccinated, high-risk HCWs, the prevalence of positive TST was higher than that of positive IGRA. IGRA testing was associated with higher conversion rates compared to TST testing, and reversion rates were high with borderline values of QFT-G. Given these results, and the poor correlation between TST and IGRA positivity, the value of IGRA in the diagnosis of latent TB infection remains uncertain.
(Lucet et al. Infect Control Hosp Epidemiol. 2015;36(5):569-574.)
Synergy Despite Resistance: Colistin-Tigecycline for XDR A. baumannii and Excess Mortality Compared to Colistin-Carbapenem
Reviewed by Nirav Patel, MD
Extensively drug-resistant (XDR) Acinetobacter baumannii, susceptible only to colistin and tigecycline, is a frequent and deadly pathogen. Treatment is hampered with poor outcomes using monotherapy, as well as the development of resistance. Combination therapy has been advocated, although well-designed studies have been limited due to challenges in study design, recruitment, and heterogeneous study populations. Furthermore, initially promising data for the combination of colistin and rifampin was later refuted in a larger, randomized trial that found no mortality benefit.
Given this background, researchers initiated a prospective, observational study at three large hospitals in Taiwan from 2010 to 2013, with the results recently published in Critical Care Medicine. Patients were included if they had bacteremia from XDR A. baumannii (genospecies 2) and were prescribed colistin in combination with tigecycline or a carbapenem.Of 176 patients screened, 31 patients were in the colistin-tigecycline arm and 29 in the colistin-carbapenem arm. The groups were fairly evenly matched with regards to severity. Crude 14-day mortality was not significantly different (35 percent in the colistin-tigecycline arm versus 15 percent in the colistin-carbapenem arm [p=0.105]). Breakthrough XDR bacteremia was noted in 18 percent of the colistin-tigecycline patients versus 0 percent in the colistin-carbapenem group (p=0.059). Excess 14-day mortality was seen the colistin-tigecycline patients, when the tigecycline minimum inhibitory concentration was >2 mg/L compared to colistin-carbapenem (hazard ratio 6.93, p=0.009).
As noted in a related editorial, there are a number of limitations with this study, including its size and non-randomized nature. However, despite in vitro resistance, the use of a carbapenem in combination with colistin offers advantages compared to tigecycline. This may be related to differences in the mechanism of action or the low serum drug levels of tigecycline. A prospective, randomized trial is needed to definitively answer the question. Until then, it seems reasonable to adopt the colistin-carbapenem combination for this formidable pathogen.
(Cheng et al. Crit Care Med. 2015;43(6):1194-204.)
Preexposure Prophylaxis for Serodiscordant Couples who Wish to ConceiveMany heterosexual serodiscordant couples wish to conceive yet believe they have no options. If the female partner is HIV-infected, self-insemination during ovulation is a viable strategy. If the male partner is HIV-infected, options were traditionally limited to sperm washing and other costly procedures. Now, antiretroviral treatment-as-prevention combined with preexposure prophylaxis (PrEP) opens the door to new approaches. Data to guide these decisions were previously limited to small observational studies and expert opinion.
Reviewed by Brian R. Wood, MD
In The Journal of Infectious Diseases, researchers recently modeled the average annual probability of a “successful outcome” (having a child and remaining HIV-uninfected) or “unsuccessful outcome” (not having a child and becoming HIV-infected) for women age 18 to 49 who have condomless sex with an HIV-infected man. Investigators modeled outcomes for the “ideal circumstance” (suppressive ART for the male partner, STI screening and treatment, daily PrEP for the female partner, and sex only during days of ovulation) or “suboptimal circumstance” (same parameters except with sex distributed throughout the menstrual cycle).
Under the ideal circumstance, the likelihood of a successful outcome was 29.1 percent with ART alone and only increased to 29.2 percent with the addition of PrEP (P=0.45); the likelihood of an unsuccessful outcome was 0.1 percent with ART plus PrEP and 0.4 percent with ART alone. In the suboptimal circumstance, the likelihood of success was 26.8 percent with ART alone and increased to 27.3 percent with adjunctive PrEP (P<0.0001), whereas the probability of an unsuccessful outcome with ART plus PrEP was 0.8 percent. In both circumstances, older maternal age decreased the likelihood of success.
This intriguing analysis suggests that, under ideal circumstances, PrEP does not provide significant additive benefit to suppressive ART for couples who wish to conceive. Importantly, even with suppressive ART, the frequency of condomless sex impacted transmission risk, which has implications for PrEP counseling in general. The authors are developing a tool to estimate transmission risk based on modifiable factors, which will aid in counseling serodiscordant couples. A variable that can’t be measured in a modeling study is the peace of mind that PrEP offers, which should also be considered.
(Hoffman et al. J Infect Dis. 2015; published online June 19, 2015; doi: 10.1093/infdis/jiv305)
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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: July 15
Exposure to Antibiotics May Be Unavoidable in China
- Candida Endocarditis: Surgery May Not Be Necessary for All
- Case Vignette: Is Valve-in-Valve-in-Valve-in-Valve Coming Next?
- Acute HIV Infection: When Fitness Is a Bad Thing
- Case Vignette: Apparent Transmission of Scedosporium From an Organ Donor Who Experienced Near-drowning