IDSA News - September 2015
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CDC Investigates Multistate Outbreak of Listeriosis Linked to Soft Cheeses

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The Centers for Disease Control and Prevention (CDC), together with public health officials in several states and the U.S. Food and Drug Administration (FDA) is investigating a multistate outbreak of Listeria monocytogenes infections (listeriosis). According to an alert from the CDC, five rare DNA fingerprints of Listeria are included in this investigation. Twenty-four people infected with one of the closely related Listeria strains have been reported from nine states since August 8, 2010. Twenty-one people have been hospitalized. Five illnesses were pregnancy-related; one resulted in a fetal loss. One death was reported from Ohio. The investigation has not conclusively identified the source of this outbreak, but most ill people interviewed reported eating soft cheese before becoming ill but the investigation is ongoing.

IDSA offers two email services to help members stay informed of updates from FDA and CDC. Content includes a range of topics, including drug warnings, recalls, and outbreak investigations. Recent alerts have included:

US Compounding, Inc. Issues Voluntary Nationwide Recall of All Sterile Compounded Products FDA Alert (9/24/2015)

Avycaz (ceftazidime and avibactam): Drug Safety Communication - Dose Confusion and Medication Errors FDA Alert (9/22/2015)

Travelers from Liberia no longer require U.S. entry screening for Ebola CDC Alert (9/3/2015)

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 schang@idsociety.org.

IDSA Leaders Appointed to New Presidential Advisory Council on Combating Antibiotic Resistant Bacteria

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Martin Blaser, MD, FIDSA (IDSA past president); Helen Boucher, MD, FIDSA (IDSA incoming treasurer); Angela Caliendo, MD, PhD, FIDSA (IDSA Diagnostics Task Force chair); Sara Cosgrove, MD, FSHEA; Robert Weinstein, MD, FIDSA (IDSA Antibiotic Resistance Committee member); and Bruce Gellin, MD, MPH have been appointed to the newly established Presidential Advisory Council on Combating Antibiotic Resistant Bacteria (CARB).  

For years IDSA has been urging the federal government to create a group of non-government experts to advise government leaders on federal policy to address antimicrobial resistance.  The Society is honored to have such strong representation on this new body, whose formation is a part of larger efforts, led by the White House, to advance a set of comprehensive solutions to address antibiotic resistance.

Dr. Blaser will chair the Council, whose first public meeting occured on September 29. The Council will provide federal leaders with advice, information and recommendations regarding antibiotic stewardship, surveillance, and data collection in both human medicine and agriculture; development of new human antibiotics, diagnostics and agricultural alternatives for antibiotics; research on resistance; and the prevention of antibiotic-resistant infections.  The complete membership roster of the Council may be viewed here.

IDSA and HIVMA “Rally for Medical Research”

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IDSA and HIVMA participated in the 3rd annual “Rally for Medical Research” Capitol Hill Day event on Sept. 17. The Rally for Medical Research is a collaborative effort supported by 300 organizations representing a broad spectrum of diseases. Hundreds of partnering organization representatives from across the nation deployed across the Hill to urge Congress to invest in the National Institutes of Health for the health and economic security of our nation. Our messages were amplified by a social media effort targeting members of Congress and the general public.

S-FAR Holds Strategy Meeting with over 50 Partner Organizations

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IDSA convened a U.S. Stakeholder Forum on Antimicrobial Resistance (S-FAR) in-person strategy meeting in Washington, DC in early September. White House representative Susan Coller-Monarez delivered keynote remarks. Over 50 S-FAR partner organizations attended the meeting, representing human and veterinary medicine, public health, antibiotics and diagnostics industry, consumers and patients, and allied health.

The goal of the meeting was to discuss strategies and priorities for implementing the National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB). In the afternoon, the Society for Healthcare Epidemiology of America (SHEA) held the first S-FAR subgroup meeting on the human medicine-related antibiotic stewardship components of the CARB plan. To learn more about S-FAR visit www.s-far.org.

Science Speaks Reports on New HIV and TB Resources

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The IDSA Center for Global Health Policy blog, Science Speaks, covered new reports and resources this summer, and Science Speaks brought them to readers’ attention with posts on:


IDSA Education and Research Foundation to Host Donors’ Lounge at IDWeek 2015

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The IDSA Education and Research Foundation is excited to announce the return of the Donors’ Lounge to this year’s IDWeek in San Diego. The lounge will improve upon last years’ experience with a centrally located room, guest passes for qualifying donors, and the addition of one-day passes for qualifying donors.  

The Donors’ Lounge provides a quiet space to catch-up on work or a comfortable space to watch sessions, as well as a local Wi-Fi hotspot, daily complimentary continental breakfast, coffee throughout the day, and a daily afternoon snack. Week-long access to the Donors’ Lounge is limited to qualifying Donors’ (a total of $500 or more given between October 13th, 2014 to present) and a one-day pass is available this year for our esteemed donors (a total of $250 - $499 given between October 13th, 2014 and present). Only qualifying donors and their guests will be granted entry to the lounge.  

Guest passes are available to those who have contributed $1000 or more. Donations will be accepted online at www.idsafoundation.org or at the Donors’ Lounge, room 21 in the San Diego Convention Center. Qualifying donors will receive official invitations.

Donations to the Foundation support a range of awards, scholarships, and mentorship opportunities to enhance the educational development of young investigators, fellows, scientists, and clinicians focusing on infectious diseases. For more information about the Donors’ Lounge or IDSA Foundation, please contact Albert Bond at abond@idsociety.org or 703-638-1501.

Thank You—We Couldn't Have Done it Without You

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(Pictured, Judith Feinberg, MD, FIDSA, with medical scholar Sydni Coleman)

Since 2002, more than 500 medical students have been paired with IDSA mentors, giving them a first-hand look at the rewarding field of infectious disease. The Medical Scholars program is just one of the efforts profiled in the inaugural Annual Report of the IDSA Education and Research Foundation.
 
The report highlights Foundation-supported programs and participants for 2014, showcasing their achievements and experiences. These examples illustrate the tremendous impact we can have on education and research – made possible only with your support and that of others like you.  

The Foundation and the recipients of the scholarships, grants, and awards are grateful for your support. For more information about the Foundation, or to donate, visit www.idsafoundation.org.

IDSA Education and Research Foundation Announces New Award in Memory of Robert C. Moellering, MD, FIDSA

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Robert Moellering, MD, FIDSA, past president of IDSA, was one of the world’s most respected leaders in infectious disease. His work contributed to major advancements in the understanding and development of antimicrobial agents and had worldwide influence on diagnostic tests and standard treatments for particular infections. The Robert C. Moellering Trainee Travel Grant supports attendance to IDWeek for two fellows-in-training who are presenting excellent research in the field of antibiotic resistance. Awardees will receive a $1250 travel grant and be recognized as an awardee of The Robert C. Moellering Trainee Travel Grant.  

Please consider a donation to the Foundation today to support programs such as this! Visit www.idsafoundation.org.


ASP Announces Accreditation Seminar

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Fellowship program directors, take note: The Association of Specialty Physicians (ASP) will sponsor its annual Accreditation Seminar April 19-20, 2016 in Las Vegas. The seminar provides an opportunity to gain practical perspective from regulatory leadership in the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Internal Medicine (ABIM) on upcoming events and goals for fellowship programs as well as networking opportunities and practical sessions with strategies to incorporate into your program. For more information, go to: http://www.im.org/p/cm/ld/fid=1233.

Member Report

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MEMBERS

Broussard, Jessica, MSN, FNP
Castillo, Raul, MD
Quinson, Anne-Marie, MD
Schroeder, Claudia, PhD, PharmD
Slish, Judianne, PharmD
Varma-Basil, Mandira, MD

MEMBERS-IN-TRAINING

Abbas, Salma, MBBS
Bader, Justin, MBA, PharmD
Bajema, Kristina, MD
Baker, Thomas, MD
Banjade, Rashmi, MD
Berrevoets, Marvin, MD
Bharti, Sheena, DO
Boonyaratanakornkit, Jim, MD, PhD
Brown, Richard, MD
Burns, Mark, MD
Chaparro, Nazatio, MD
Cudahy, Patrick, MD
Dubrocq, Gueorgui, MD
Galvez Guerra, Eduardo, MD
Gillrie, Mark, MD, PhD
Glanternik, Julia, MD
Gomez Abundis, Gerardo, MD
Hayden, Brent, MD
Hemmersbach-Miller, Marion, MD, PhD
Hurley, Hermione, ChB, MB
Jagtiani, Anil, MD
Kim, Eunjung, MD
Kramer, Carolyn, MD
Kumar, Madan, DO
Lastinger, Allison, MD
Mandadi, Subhadra, MD, MBBS
Mascarenhas, Tresa, MD
McNulty, Moira, MD
Merrick, Maria, DO
Parajuli, Sunita, MD
Patel, Pinki, MD
Salazar, Yolima, MD
Schrank, Gregory, MD
Simmons, Jason, MD, PhD
Spence, Amanda, MD
Stack, Conor, MD
Stolar, Ellen, MD
Strich, Jeffrey, MD
Tenforde, Mark, MD
Umpunthongsiri, Sirikwun, MD
Valdivia, Liza, MD
Varughese, Tilly, MD
Vasquez Choy, Ana, MD
Wright, Julie, MD
Yu, Alexander, MD, MPH
Zhou, Yuan, MD

RESIDENTS

Baumgartner, Katrina, MD
Beganovic, Maya, PharmD, MPH
Chan, Tiffany, MD
Ciotola, Nicholas, DPM
Depena, Xelenia, MD
Elshazly, Ahmed, MD
Grandstaff, Melanie, MD
Hecht, Shaina, MD
Joerger, Torsten, MD
Leigh, Victoria, DO
Lindeman, Tara, PharmD
Marini, Rachel, PharmD
Schwarber, Natalie, PharmD

STUDENTS

Bamba, N'Dama
Campbell, Tonya
Monday, Lea

ASSOCIATES

Alsaedy, Abdulrahman, MD
Applegate, Elise, MS
Buising, Kirsty, MD, MPH, MBBS
Catalfomo, Tony, RPh
Chelliah, Daniel, MD
Crescencio, Juan Carolos, MD
Futterman, Donna, MD
Hong, Jin, PharmD
Johnson, Marc, MD
Koirala, Kanika
Wald, Heidi, MD
Whitecar, John, MD
Wilson, Tina, MD

DECEASED

Deborah Asnis, MD, FIDSA
Patricia Charache, MD, FIDSA
J. O. Hendley, MD, FIDSA
J. Michael Kilby, MD, FIDSA
Alan J. Magill, MD, FIDSA                
Joel A. Streng, MD          

From Ebola, Antibiotic Resistance and ABIM to Strategic Planning…A Year in Review

When I accepted the gavel for the IDSA Presidency nearly one year ago, we were in the midst of the Ebola outbreak in Africa and had recently dealt with our first cases in this country. I was proud, once again, to be a member of a profession and a Society that offers opportunities to save lives through direct patient care, to be involved in devising ways to successfully contain such an outbreak through public health interventions and research, and to help educate both medical professionals and the general public on the realities of infectious diseases. Today, as I am poised to hand the gavel to the next IDSA President, I am struck by all that IDSA continues to accomplish.

When I accepted the gavel from Barbara Murray, MD, FIDSA, at IDWeek 2014 for the IDSA Presidency, we were in the midst of the Ebola outbreak in Africa and had recently dealt with our first cases in this country. I recall vividly the crowds gathered at the plenary sessions featuring physicians who had been on the front lines of treating patients in Africa and the deluge of questions from the media trying to provide answers to a worried and curious public. I was proud, once again, to be a member of a profession and a Society that offers opportunities to save lives through direct patient care, to be involved in devising ways to successfully contain such an outbreak through public health interventions and research, and to help educate both medical professionals and the general public on the realities of infectious diseases. While the battle against the Ebola outbreak isn’t over, we’ve seen enormous success in getting it under control in the African countries affected. One year later, as I am poised to hand the gavel to the next IDSA President, Johan Bakken, MD, FIDSA, and reflect on this past year, I am struck by all that IDSA continues to accomplish.

This past year, we have begun to make progress on better compensation for the ID specialist, with a 10.3% increase in median compensation reported in the MGMA survey data and a 22% increase reported in the Medscape survey data over the past year. We also undertook our own extensive compensation survey of IDSA members and are currently completing analysis of the nearly 2,000 responses we received.

This year we have seen major advances in the fight against antimicrobial resistance from a policy perspective. In the last 12 months, we’ve seen the introduction of a national action plan showing significant commitment at the federal level to addressing this problem, and we recently learned of the addition of six leading infectious diseases physicians—all IDSA members—to the President’s Advisory Council on AR. The 21st Century Cures Act, which includes many important provisions related to antimicrobial resistance and revitalizing the National Institutes of Health, is moving through Congress, and just this month, members of the House of Representatives introduced the Reinvigorating Antibiotic and Diagnostic Innovation (READI) Act, with important tax credit incentives for drug development. Read more about this bill in this issue of IDSA News.

I’ve written in the past about IDSA’s efforts in addressing your concerns about recent changes with the American Board of Internal Medicine and recertification requirements. Thanks to the persistent efforts of members and staff working together with the American College of Physicians and other internal medicine subspecialty societies, we have made strong headway in reversing these burdensome changes. I can assure you that this issue will remain a focus because we know what it means to your ability to do the work you are committed to doing.

Our guidelines continue to be among the most valued services we provide our members. In addition to the detailed work being done on the development of a new guideline on the diagnosis, treatment and prevention of Lyme disease, we continue to update our guidance on the treatment of hepatitis C and have completed three additional guidelines. No fewer than 13 additional guidelines are planned for the upcoming year.

The Board of Directors completed a strategic planning process, assisted by data provided by our members and members-in-training of the most important issues they perceive, and I will summarize the main findings of that process at the upcoming Business Meeting at IDWeek 2015 in San Diego. Two of the highlights include continuing to advocate for the ID specialist and bringing awareness to the value we bring to health care, and developing a strategy for reaching young people in medicine and showing them how fulfilling a career in ID can be.

Thank you for being a member of this Society. I know many of you join me in the belief that this organization uniquely represents the field of infectious diseases—its history and its roots, its challenges and current accomplishments, and its future.

Bipartisan Antibiotic and Diagnostic Tax Credit Bill Introduced in Congress

The READI Act, legislation long-championed by IDSA, would provide a new 50% tax credit for phase two and three clinical trials to support the research and development of new antibiotics and antifungal drugs and also supports R&D of new rapid ID diagnostic tests. Learn how you can help advance this important legislation.

Reps. Charles Boustany (R-LA), Mike Thompson (D-CA), Erik Paulsen (R-MN), John Shimkus (R-IL) and Gene Green (D-CA) introduced the Reinvigorating Antibiotic and Diagnostic Innovation (READI) Act, H.R. 3539, on Sept. 17.  Championed by IDSA, the READI Act would provide a new 50% tax credit for phase two and three clinical trials (similar to the successful Orphan Drug tax credit) to support the research and development of new antibiotics and antifungal drugs that treat serious or life-threatening infections and address an unmet medical need. The bill also supports R&D of new rapid ID diagnostic tests that provide results in under four hours.  IDSA secured broad stakeholder support for the READI Act, including from other medical, scientific, and healthcare provider societies; patient groups; industry; and public health.  

To help READI advance in Congress, we need more representatives to cosponsor this bill.  You can help by taking three minutes to email your representative with a request prepared by IDSA through this link.

Drug Company Reverses 5,000% Increase in Drug Price

Member Concerns Spur IDSA/HIVMA Action
In response to concerns from IDSA and HIVMA members about a sudden increase in the pricing of a drug used to treat toxoplasmosis, IDSA President Stephen Calderwood, MD, FIDSA, and HIVMA Chair Adaora Adimora, MD, FIDSA, wrote to the drug company’s officials urging a revision in its pricing strategy.

IDSA and HIVMA recently challenged a sudden price increase for pyrimethamine, a generic drug used to treat toxoplasmosis. Turing Pharmaceuticals acquired the drug in mid-August and increased the price from $13.50 to $750 per tablet. After hearing concerns from IDSA and HIVMA members, IDSA President Stephen Calderwood, MD, FIDSA, and HIVMA Chair Adaora Adimora, MD, FIDSA, wrote to Turing officials urging the company to revise its pricing strategy.

The jump in the drug price caught the attention of policy-makers and the media, which led to a groundswell of media requests for interviews with HIVMA spokespersons resulting in over 100 news stories quoting HIVMA and IDSA experts, including pieces in the New York Times, USA Today, The Washington Post and NBC News. Immediately following the news coverage, Turing announced that it would lower the price of the drug within a few weeks. The new price has not been disclosed.  

IDSA Journal Club

Antibiotic Treatment of CAP in Children: Do We Adhere to National Guidelines? Does C. difficile Colonization Increase the Risk for C. difficile Disease? Addressing Gonorrhea: Screening for Asymptomatic Pharyngeal Infection Among MSM and Expedited Partner Therapy; Universal Glove and Gown Use Within the ICU: An Annoyance or a Benefit?

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.

Antibiotic Treatment of CAP in Children: Do We Adhere to National Guidelines?
Reviewed by Terri Stillwell, MD

In 2011, IDSA, in conjunction with the Pediatric Infectious Diseases Society, published a clinical practice guideline for the management of community-acquired pneumonia (CAP) in children older than 3 months of age. For healthy, fully immunized children with uncomplicated CAP, the guideline recommends ampicillin, or penicillin G, as first-line treatment, perhaps a more narrow-spectrum antimicrobial than was the practice at the time. A recent Pediatrics article looked at the impact this guidance has had on prescribing practices at three major U.S. children’s hospitals. 

Analyzing prescribing data from 20 months prior to and nine months after guideline publication, the authors assessed the monthly percentage of CAP treated with a third-generation cephalosporin versus the percentage treated with ampicillin/penicillin. The study included 2,121 children: 1,303 in the pre-guideline cohort, and 772 in the post-guideline cohort. Third-generation cephalosporin use was consistent throughout the pre-guideline period, with a monthly median of 52.8 percent of children with CAP receiving this type of antibiotic; ampicillin/penicillin use was steady at a monthly median of 2.7 percent. After the guideline was published, third-generation cephalosporin use decreased 12.4 percent, with ampicillin/penicillin use increasing 11.3 percent.

Two hospitals involved in the study proactively disseminated information regarding guideline recommendations; in those institutions, a statistically significant decline in third-generation cephalosporin use was seen, with absolute declines of 27.6 percent and 17.3 percent, respectively. The remaining hospital saw a decline in use, but it was not statistically significant. Despite these decreases, at the end of the study, third-generation cephalosporins continued to be prescribed for 44.8 percent of children with CAP.

National guidelines can help lessen variations and reinforce best practices. However, these findings suggest acceptance of these recommendations into day-to-day practice may be slow and could benefit from proactive dissemination of the guidelines at the local, hospital level.

(Williams et al. Pediatrics. 2015;136(1):44-52.)

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Does C. difficile Colonization Increase the Risk for C. difficile Disease?
Reviewed by Jennifer Brown, MD

Clostridium difficile is a significant cause of health care-associated infections. The impact of asymptomatic C. difficile colonization on the risk for C. difficile disease development is not well understood.

In the July issue of Infection Control and Hospital Epidemiology, investigators described the results of a single-center, prospective study that assessed the development of C. difficile disease in adult patients with, and without, asymptomatic C. difficile colonization. Rectal swab specimens were obtained from patients upon admission to the intensive care unit (ICU), and weekly thereafter, until ICU discharge. Polymerase chain reaction (PCR), followed by toxigenic bacterial culture for all PCR-positive specimens, was performed on the rectal screening specimens as well as on stool specimens submitted for clinical care. Patients were monitored for the development of C. difficile disease during their hospital stay and for up to one month after hospital discharge.

At admission, there were 17 (3.1 percent) patients with asymptomatic toxigenic C. difficile colonization and 525 (96.9 percent) without colonization. Three additional patients were found to be colonized during hospitalization via weekly surveillance swabbing. C. difficile disease developed in eight (1.5 percent) patients during hospitalization and four (0.7 percent) patients within one month of discharge. After multivariable analysis, colonization with C. difficile on admission was an independent risk factor for development of C. difficile disease (relative risk, 8.62 [95 percent CI, 1.48-50.25], P = .017). Colonization during hospitalization was also an independent risk factor (relative risk, 10.93 [95 percent CI, 1.49-80.20], P = 0.19).

One limitation of the study is the low prevalence of patients colonized with toxigenic C. difficile on hospital admission. Also, the diagnosis of symptomatic C. difficile disease was determined by retrospective clinical chart review, thus actual rates may have been skewed. Nonetheless, the results of this paper are intriguing and may have implications for infection prevention and antimicrobial stewardship measures. 

(Tschudin-Sutter et al. Infect Control Hosp Epidemiol. 30 July 2015. [Epub ahead of print])

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Addressing Gonorrhea: Screening for Asymptomatic Pharyngeal Infection Among MSM and Expedited Partner Therapy
Reviewed by Michael T. Melia, MD

Two recent articles highlight underutilized practices in the prevention and treatment of gonorrhea: screening for asymptomatic pharyngeal gonococcal infection and expedited partner therapy (EPT).

In a Sexually Transmitted Infections article, the authors conducted a case-control study of men who have sex with men (MSM) who sought care at a sexually transmitted disease (STD) clinic between 2001 and 2013. Approximately 5,300 cases of symptomatic urethritis were diagnosed based upon the presence of urethral discharge, dysuria, or other urethral discomfort plus ≥5 WBC/HPF on urethral discharge Gram stain. Patients were diagnosed with non-gonococcal, non-chlamydial urethritis (NGNCU) if they had a diagnosis of urethritis but negative testing for gonorrhea and chlamydia.

MSM were grouped into four categories based upon self-reported behavior during the previous 60 days: (1) insertive oral sex only; (2) always-protected insertive anal sex plus oral sex; (3) unprotected or inconsistently protected insertive anal sex with or without oral sex; (4) no sex. The risk of acquiring symptomatic urethritis through oral sex was estimated by behavioral categorization and by calculating the population-attributable risk percent.

Based upon self-reported sexual behaviors, 27.5 percent of symptomatic gonococcal urethritis was acquired through oral sex, as was 31.4 percent of symptomatic chlamydial urethritis and 35.9 percent of symptomatic NGNCU. Similar estimates were obtained by calculating the population-attributable risk percent for symptomatic gonococcal (33.8 percent) and NGNCU (27.1 percent), although the calculated estimate for symptomatic chlamydial urethritis was only 2.7 percent. These data suggest that over one-third of symptomatic gonococcal and NGNCU may be attributable to oral sex, highlighting the importance of pharyngeal screening for gonorrhea among MSM, as well as the potential role of the oropharynx in causing a substantial proportion of NGNCU.

The partners of patients diagnosed with gonorrhea are permitted to receive EPT in a majority of states.  EPT has been associated with increased rates of partner treatment and reduced rates of recurrent gonorrhea for patients, and it is recommended by the Centers for Disease Control and Prevention for sex partners of heterosexuals with uncomplicated gonorrhea when there is concern that partners may not promptly seek medical attention. The frequency with which EPT is utilized, however, is not known.

A recent article in Sexually Transmitted Diseases reviewed data from seven U.S. jurisdictions participating in the STD Surveillance Network. A random sample of 23,363 gonorrhea cases reported between 2010 and 2012 was reviewed. Overall, only 5.4 percent of patients eligible for EPT—those who reported ≥1 sex partners during the 60-90 days prior to their gonorrhea diagnosis—reported receiving EPT to treat their sex partners, including 6.6 percent of heterosexual patients and 2.6 percent of MSM.

While EPT for MSM with gonorrhea is not currently recommended owing to a high risk of coinfection, including undiagnosed HIV, among patients’ sex partners, these data highlight how infrequently it is implemented across diverse populations. When considered with data suggesting individual and population-level benefits of EPT, this study suggests that additional efforts to increase EPT would be associated with significant benefit and reduced morbidity.

(Barbee et al. Sex Transm Infect. 2015 Aug 21. [Epub ahead of print] and Stenger et al. Sex Transm Dis. 2015;42(9):470-4.)

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Universal Glove and Gown Use Within the ICU: An Annoyance or a Benefit?
Reviewed by George R. Thompson III, MD

Contact precautions (glove and gown use prior to entry to a patient’s room) are recommended by the Centers for Disease Control and Prevention for patients colonized or infected with antibiotic-resistant bacteria in an attempt to reduce transmission within the hospital setting. However, in prior studies, contact precautions have been shown to increase the frequency of adverse events, and health care workers visit patients on contact precautions less frequently than patients not on contact precautions.   

Universal glove and gown use (contact precautions for all patients) was examined in a recent cluster randomized trial to better assess the role confounding factors may have played in past studies. This study, described in an article published in Clinical Infectious Diseases, compared 900 patients in the intensive care unit (ICU) under universal gown and glove use to 900 patients in a control ICU (patients received contact precautions only if they were known to be colonized or infected with an antibiotic-resistant organism).

Overall, adverse events were not associated with universal glove and gown use. In fact, an increased number of infectious (P<0.001), cardiovascular (P=0.02), and surgical adverse events (P=0.001) occurred in the control group. The reasons for the latter two complications are not clear from the results but bear further study in future trials.

These results are of great interest in the fight against hospital-acquired infections and will likely soon be adopted within the ICU setting. Adoption of universal glove and gowns to all hospitalized patients initially seems similarly prudent and offers the advantage of avoiding delays with hospital admissions while awaiting a “contact isolation” room. However, these results will need to be validated in the non-ICU setting and potentially for a longer period of time to avoid a Hawthorne effect and to ensure provider “fatigue” does not set in during adoption of potentially new standard practices.

(Croft et al. Clin Infect Dis. 2015;61(4):545-553.)

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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:

September 15
  • Eosinophilia as a Predictor of Hypersensitivity Reactions in Outpatients Receiving Parenteral Antibiotics
  • Failure of Ethanol Lock to Prevent Infection of Temporary Hemodialysis Catheters
  • Case Vignette: A Lethal Common Cold Viral Infection
  • Case Vignette: Fever in a Visitor From India (With a Side Trip to Massachusetts)
September 1
  • Colorado Tick Fever
  • Trimethoprim-Sulfamethoxazole Versus Vancomycin for MRSA Infections

August 15

  • Treatment of Pyogenic Vertebral Osteomyelitis—6 Weeks is Enough
  • Herpes Zoster Vaccination and Corticosteroid Use

August 1

  • Cryptococcal Infection in Patients With Hepatic Cirrhosis, Including Transplantation Candidates
  • A Genetic Defect Accounting for Susceptibility to Lethal Influenza Virus Infection
  • Case Vignette: Arcobacter Bacteremia in a Patient With Diarrhea and Chronic Lymphocytic Leukemia