IDSA News - May 2016
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CDC Recommends Testing of Urine for Zika Virus

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The Centers for Disease Control and Prevention (CDC) recently released a Morbidity and Mortality Weekly Report (MMWR) stating the preferred method for testing for Zika virus is through a urine sample. The virus is detectable for a longer period of time and at higher levels in urine than it is in blood. 

 
The CDC recommends that the real time reverse transcription-polymerase chain reaction (rRT-PCR) test can be performed up to two weeks after onset of symptoms, whereas the blood test can only detect Zika virus for about seven days after the onset of symptoms. A positive result from either specimen type is evidence of Zika virus infection. 
 
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: 
 
Possible Zika Virus Infection Among Pregnant Women — United States and Territories, May 2016 (CDC Alert, 5/20/2016) 
 
Nizoral (ketoconazole) Oral Tablets: Drug Safety Communication - Prescribing for Unapproved Uses including Skin and Nail Infections Continues; Linked to Patient Death (FDA Alert, 5/19/2016) 
 
Fluoroquinolone Antibacterial Drugs: Drug Safety Communication - FDA Advises Restricting Use for Certain Uncomplicated Infection (FDA Alert, 5/12/2016) 
 
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 mschang@idsociety.org.

Proposed Regulations for LDTs: IDSA Expresses Concerns

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The Food and Drug Administration (FDA)’s proposed guidance to regulate laboratory developed tests (LDTs) will impact many tests ID physicians rely on to identify the cause of infection and guide treatment selection. IDSA, along with the American Society for Microbiology (ASM) and the Pan-American Society for Clinical Virology (PASCV), published a joint policy paper on ID LDTs in Clinical Infectious Diseases to reiterate concerns with the guidance and offer recommendations to minimize the disruption of patient access to these important tests. 

 
In response to IDSA concerns that diagnostics for transplant-associated viruses in particular will be impacted severely by the LDT guidance, the FDA expressed an interest in holding an expert panel meeting devoted to discussing viral load testing to transplant-associated opportunistic viral infections. IDSA enthusiastically supports this meeting and hopes it will address the evidence of risk posed by these tests and their measures to mitigate this risk. IDSA responded with a letter with peer-reviewed evidence on the use of viral load testing to transplant viruses to support the FDA’s planning process and also offered suggested subject matter experts to serve on the panel.

Are You Ready for MACRA? IDSA is Here to Help

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Join us for a MACRA Implementation Webinar: The Role of ID Physicians in Medicare’s Quality Payment Programs and the Value-Driven Health Care Movement 

 
Please join IDSA on June 7, at 7 pm EDT for a webinar discussing the proposed regulations for the implementation of a new quality physician payment program for services provided under the Medicare program. 
 
The Centers for Medicare and Medicaid Services (CMS) recently released the proposed rule for payment reform changes as mandated by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Under MACRA, CMS is required to develop the Merit-Based Incentive Payment System (MIPS). The proposed regulation (PDF), in excess of 400 pages, outlines the requirements necessary for physicians to participate in the new MIPS program. The MIPS will combine certain parts of, and essentially replace, the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier, and the Medicare Electronic Health Record (EHR) incentive program. The new quality program will be a single program based on quality, resource use, clinical practice improvement, and the meaningful use of EHR. 
 
The webinar will provide information on the proposed MIPS implementation parameters, as well as provide information on the effect the new MIPS program will have on ID physicians. The webinar will be held in collaboration with Hart Health Strategies. Registration for IDSA members and their staff is available here: Webinar Registration

House and Senate far Apart on Zika Funding, IDSA Advocacy Continues

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IDSA continues advocacy in support of President Obama’s request for $1.9 billion in emergency funding to address the Zika virus both in Zika-endemic countries and within the United States. The requested funding would increase international capacity for surveillance, expand the Field Epidemiology Training Program, laboratory testing, and healthcare provider training; as well as accelerate R&D for medical countermeasures, including vaccines and diagnostics.

 
The Zika funding request had been largely stalled on Capitol Hill, since introduction in February, as the House and Senate debated if and how to pay for the emergency package. The White House, IDSA, and other advocates have argued that this emergency effort should not be funded by diverting funding from other domestic and global health programs. The Administration has already transferred roughly $589 million from Ebola resources to begin the response, including the evaluation of vaccine candidates, in light of the failure of Congress to act. 
 
In mid-May, the Senate and House of Representatives advanced very different Zika funding bills. The Senate bill would provide $1.1 billion, slightly more than half of President Obama’s request, to address Zika. The bill is not offset and would allow funds to be used in Fiscal Years 2016 and 2017. The bill, considered a compromise among leaders of the Senate’s spending committee, is likely to gain support from the White House. Simultaneously, on a party-line vote, the House approved $622 million to address Zika by moving funds from other health priorities. Funds in the House bill would only be available through the end of the current fiscal year, September 30. The White House has threatened to veto the House bill. Agreement on a final package will likely prove difficult to achieve, as the chambers are quite far apart in approach to the problem. Advocacy for at least the level of funding provided in the Senate bill will be extremely important in the days ahead. 
 
In support of the emergency funding request, IDSA has met with staff to key Members of Congress and written to leadership in both chambers. IDSA members are encouraged to contact their congressional representatives in support of Zika funding. In just three minutes, members can use the IDSA-HIVMA Action Center to support the Zika funding request.
 
During its advocacy work on Capitol Hill, IDSA policy staff have consistently shared messages that ID physicians hold leadership roles in domestic and international public health bodies on the front lines of the Zika virus response. ID physicians are also leading research efforts to learn more about Zika virus and develop urgently needed diagnostics, vaccines and therapies. IDSA and our members are also working to educate the public about Zika virus, including recommended precautions for pregnant women and the importance of preventing mosquito bites. Public health emergencies, such as the current Zika virus outbreak, underscore the need to invest in a robust ID physician workforce to ensure future generations of these invaluable experts are available to protect the public health. 

IDSA Research Committee on Capitol Hill to Urge Action on Policy Proposals

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Representative Tom Reed (R-NY) with Research Committee member Kami Kim, MD
 
Members of the IDSA Research Committee met with their representatives and senators earlier this month to help advance IDSA’s legislative priorities, including: increased funding for the National Institute of Allergy and Infectious Diseases (NIAID); revised Medicare reimbursement codes to more accurately reflect the value that ID physicians provide to patients; and economic incentives to spur R&D for new antimicrobials, rapid diagnostics and vaccines as part of federal efforts to combat drug resistance. The proposals are currently under consideration in Congress, so participating Research Committee members were able to add a timely constituent perspective to the dialogue on Capitol Hill.

 

HIVMA Leaders Promote HIV Research and ID Specialty on Capitol Hill

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HIVMA Executive Director, Andrea Weddle with HIVMA Board Members (l to r): Raj Gandhi, MD, FIDSA; Bill Towner, MD, FIDSA; Judy Aberg, MD, FIDSA; Carlos del Rio, MD, FIDSA; Wendy Armstrong, MD, FIDSA; HIVMA staff member Kim Miller; Michelle Collins-Ogle, MD;  Rochelle Walensky, MD, MPH, FIDSA; Ada Adimora, MD, MPH, FIDSA; and Donna Futterman, MD

HIVMA leaders met with more than 20 Congressional offices earlier this month highlighting the importance of a sustained commitment to robust funding for HIV/AIDS programs including HIV/AIDS research at the National Institutes of Health in addition to the importance of the infectious disease workforce in terms of increasing the number of young doctors choosing the field of ID and placing appropriate value on the work they do.


Michelle Collins-Ogle, MD; Senator Thom Tillis (R-NC); Ada Adimora, MD, MPH, FIDSA

With HIV/AIDS research proposed to be flat-funded for a third year in a row, now is a critical time to educate policymakers on the importance of sustaining the commitment to HIV/AIDS research. Please help amplify the message by calling on your legislators to sustain robust funding for NIH and other programs critical to addressing the HIV epidemic through the IDSA/HIVMA Action Center. It only takes a few moments to help make a difference!


 

Science Speaks Reports on Global Infectious Disease Responses

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Science Speaks, the official blog of the Center for Global Health Policy, covered developments in policy and research responses to tuberculosis, malaria, Zika and HIV over the last month with reporting on: 

 


New Grant Funding for IDSA’s Center for Global Health Policy

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IDSA’s Center for Global Health Policy has received a new grant from Capital for Good for its work to inform evidence-based responses to HIV and tuberculosis through the first quarter of 2017. 

 
The grant, for $287,238, will support reporting from major scientific conferences, and outreach to policymakers during the upcoming transition to a new administration and Congress that will bring new leadership of federal agencies tasked with global health responses, and significant changes in the congressional leadership overseeing global health responses and funding. 
 
It will provide resources for the development of briefing papers outlining scientific developments and impacts, engaging physician member experts in policy education, and collaborating with other global health advocates on strategy and messaging. 
 
The IDSA Center for Global Health Policy began in 2008 with a grant from the Bill and Melinda Gates Foundation, and has since received grants through Capital for Good that have supported congressional staff study tours of IDSA member programs in southern Africa as well as other opportunities to bring the voices of physician members to policy makers. The Global Health team of staff and member volunteers raises awareness of the need for policies and resources responding to emerging, resurgent and neglected infections, including Ebola and Zika worldwide.

New Global Center Papers on HIV and Tuberculosis

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The IDSA Center for Global Health Policy has issued the latest in a series of papers on diseases and outbreaks, one focused on HIV (PDF) and another on Tuberculosis (PDF). The first paper provides information on HIV history, responses, and projections on the pandemic and the other examines the history of global TB, the current responses and recommends future steps. As with the other papers in the series on Zika (PDF) and Ebola (PDF), these papers have been developed to help IDSA members inform policymakers and opinion-shapers about the impacts of the diseases and the efforts needed to mount and sustain effective responses.

Congratulations to this year’s Medical Scholars!

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The IDSA Education and Research Foundation is pleased to announce the participants in this year’s Medical Scholars Program. The Medical Scholars Program, established in 2002, has awarded over 600 medical students interested in the sub-specialty of infectious diseases the opportunity to pursue independent clinical or research activities outside their institutional programs and 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 in early-December 2016. The Foundation’s Medical Scholars Program is supported by member donations and the Allergan Foundation. Look out for the 2015 IDSA Education and Research Foundation Annual Report next month.
 

Alastair Murray, George Washington University, Washington, DC. "The Effect of Preterm Birth on Transplacental Antibody Transfer of Measles IgG, Rubella IgG and Clostridium tetani Toxin IgG in Rural Nepal." Mentor: Janet Englund, MD.

 

Alexandra Forrest, Drexel University College of Medicine, Philadelphia, PA. "Incorporating Screening for Pre-exposure Prophylaxis into Rapid HIV Testing in a High Risk Neighborhood in Philadelphia." Mentor: Zsofia Szep, MD, MSCE.

 

Alexandra Linn, University of Pittsburgh School of Medicine, Pittsburgh, PA. "Potential Sexual Transmission of Zika virus in the City of Teresina, Brazil." Mentor: Fernanda Silveira, MD, MS.

 

Alyssa Brandt, Penn State Hershey College of Medicine, Hershey, PA. "Identification of Complement Receptor 1 on the Surface of Plasmodium falciparum Merozoites." Mentor: Jose Stoute, MD.

 

Amy Beeson, University of Colorado School of Medicine, Denver, CO. "Factors Associated with Mortality During Treatment for Multidrug-Resistant Tuberculosis in KwaZulu-Natal, South Africa." Mentor: Sheela Shenoi, MD, MPH.

 

Andrew Wickerham, Tulane University School of Medicine, New Orleans, LA. "Time to Targeted Therapy Before and After Implementing BioFire Blood Culture Identification Panel." Mentor: Jeffrey Percak, MD.

 

Anna Barker, University of Wisconsin, School of Medicine and Public Health, Madison, WI. "Agent Based Modeling Strategies to Reduce Clostridium difficile Infection." Mentor: Nasia Safdar, MD, PhD.

 

Anthony Bai, University of Ottawa, Ottawa, Ontario, Canada. "Effectiveness of a Care Map Versus Infectious Diseases Consultations in the Management of Staphylococcus aureus Bacteremia: A Pilot Study." Mentor: Andrew Morris, MD, SM, FRCP(C).

 

August Longino, University of Washington School of Medicine, Seattle, WA. "Factors Affecting Adherence to Pre-Exposure Prophylaxis (PrEP) Among Men Who Have Sex With Men and Transgender Women In Lima, Peru." Mentor: Ann Duerr, MD, PhD, MPH.

 

Austin Wesevich, Washington University School of Medicine, St. Louis, MO. "Effectiveness of Isoniazid Preventive Therapy in the Pre-ART Period in Malawi." Mentor: Mina Hosseinipour, MD, MPH.

 

Avery Nelson, University of South Carolina School of Medicine, Columbia, SC. "Optimal Duration of Antimicrobial Therapy for Gram-negative Bloodstream Infections." Mentor: Majdi Al-Hasan, MBBS.

 

Ayla Cash, University of Toledo College of Medicine, Toledo, OH. "The Impact of Cancer and Transplant Therapies on HIV-1 Reservoirs." Mentor: Christine Durand, MD.

 

Brenna Stanczyk, University of North Carolina, Chapel Hill, NC. "Option B+: ART Safety and Durability during First and Subsequent Pregnancies." Mentor: Mina Hosseinipour, MD, MPH.

 

Bryan Nycz, University of Colorado School of Medicine Anschutz Medical Campus Aurora, CO. "Evaluation of Microbiome Dynamics and Infection Risk Among Pediatric Patients with Acute Myelogenous leukemia (AML)." Mentor: Samuel Dominguez, MD.

 

Charlotte Lin, Washington University School of Medicine, St. Louis, MO. "Candida Bloodstream Infections at a Tertiary Care Center: Defining Attributable Mortality and Building Clinical Predictive Models for Mortality." Mentor: William Powderly, MD.

 

Chelsea Zhu, University of Toledo College of Medicine, Toledo, OH. "A Multidisciplinary Study of the Use and Outcomes Associated with the Respiratory Pathogen Panel." Mentor: Deepa Mukundan, MD.

 

Christina Godfrey, University of Maryland School of Medicine, Baltimore, MD. "Effectiveness of Alternative Antiretroviral NRTI-Sparing Regimens in HIV-Infected Patients." Mentor: David Riedel, MD, MPH.

 

Christine Pack, University of Texas at Southwestern, Dallas, TX. "HIV Outcomes for Foreign-Born Patients in the United States." Mentor: Arti Barnes, MD.

 

David Roberts, University of Washington School of Medicine, Seattle, WA. "Optimizing antiretroviral therapy delivery: the cost-effectiveness of clinic- and mobile-based models for ART initiation and monitoring among HIV-positive persons in South Africa." Mentor: Ruanne Barnabas, MD, DPhil.

 

Denise Lobo, University of Florida College of Medicine, Gainesville, FL. "Investigating the Additive Benefit of the Urine Lipoarabinomannan Test to Current TB Diagnostics among HIV+ Adults in Panama City, Panama." Mentor: Amy Vittor, MD PHD.

 

Elizabeth Larson, Albert Einstein College of Medicine, Bronx, NY. "Rotavirus Vaccine Impact on Diarrheal Disease Burden in Mali." Mentor: Karen Kotloff, MD.

 

Elizabeth Lendrum, University of Cincinnati College of Medicine, Cincinnati, OH. "Identification and Mitigation of Risk for Multi-Drug Resistant Bacterial Infections Using Machine Learning Algorithms." Mentor: David Haslam, MD.

 

Elliott Russell, Northwestern University Feinberg School of Medicine, Chicago, IL. "Epidemiology and Outcomes of Hospitalized Adults with Parainfluenza Virus:  A 7-Year Retrospective Study." Mentor: Michael Ison, MD, MS.

 

Emily Liang, David Geffen School of Medicine at UCLA, Los Angeles, CA. "Evaluation of T cell immune phenotype and function in elderly kidney transplant patients." Mentor: Joanna Schaenman, MD, PhD.

 

Jeremiah John Locquiao, University of Illinois at Chicago College of Medicine, Chicago, IL. "A Study of Men who have Sex with Men and HIV Prevalence in the Latino Population of the West Side of Chicago." Mentor: Maximo Brito, MD, MPH.

 

Jesse Gettinger, University of Alabama School of Medicine Birmingham, AL. "Mechanistic insights of broadly reactive CD8 T cells targeting HIV." Mentor: Paul Goepfert, MD.

 

Julian Gatta, Case Western Reserve University School of Medicine, Cleveland, OH. "Exploring the Clinical Burden and Molecular Basis of Burkholderia spp. Infections in the Philippines." Mentor: Robert Bonomo, MD.

 

Katrina Stime, University of Washington School of Medicine Seattle, WA. "Quantifying the cost of implementing a model for chronic HIV care with point-of-care viral load testing and task shifting among nurses." Mentor: Paul Drain, MD, MPH, FACP.

 

Mackenzie Hild, University of Washington, Seattle, WA. "Measuring Adherence of Isoniazid Prevention in HIV Exposed Infants in Rural Kenya." Mentor: Dr. Sylvia LaCourse.

 

Manoj Maddali, Johns Hopkins University School of Medicine, Baltimore, MD. "Epidemiological impact of achieving UNAIDS 90-90-90 targets for HIV care in India." Mentor: Maunank Shah, MD, PhD.

 

Matthew Murrill, Johns Hopkins University School of Medicine, Baltimore, MD. "Understanding Loss to Follow-up from Drug-resistant Tuberculosis Treatment in Pune, India." Mentor: Amita Gupta, MD, MHS.

 

Megan Mayer, University of Washington School of Medicine Seattle, WA. "Mental Health and Psychosocial Factors Influencing Engagement in HIV Care and Treatment in South Africa." Mentor: Paul Drain, MD, MPH, FACP.

 

Meredith Shaw, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA. "The impact of chronic Trichomonas vaginalis infection on inflammation-dependent HIV shedding in cervical tissues." Mentor: David Martin, MD.

 

Michael Harper, Medical Scientist Training Program University of Colorado School of Medicine Aurora, CO. "Adolescent Immune Responses to Mycobacterium Tuberculosis Vaccines." Mentor: Juliana McElrath, MD, PhD.

 

Michael Hernandez, Columbia University College of Physicians & Surgeons, New York, NY. "Utilizing Smartphone Technology to Collect Information About Patterns of PrEP Use Among MSM." Mentor: Magdalena Sobieszczyk, MD, MPH.

 

Michael Slade, Washington University School of Medicine, St. Louis, MO. "BK Virus-Associated Hemorrhagic Cystitis in Patient Undergoing Haploidentical Hematopoietic Cell Transplant." Mentor: Steven Lawrence, MD, MSc.

 

Nagina Khudaynazar, St. George's University, True Blue, Grenada. "Efficacy of an EBV-based chimeric VLP in humanized mice – a prelude to disease prevention." Mentor: Joyce Fingeroth, MD.

 

Natalie Cain, University of Miami Miller School of Medicine, Miami, FL. "Exploring Diagnostic Techniques and Medical Care of Cutaneous Leishmaniasis in Cali, Colombia." Mentor: Paola Lichtenberger, MD.

 

Nicole Stephens, Wake Forest School of Medicine, Winston-Salem, NC. "Iron Biomarkers in HIV-associated Cryptococcal Meningitis." Mentor: Anne Frosch, MD, MPH.

 

Noora Siddiqui, University of Alabama at Birmingham School of Medicine, Birmingham, AL. "Acquisition of HCMV from breast milk: correlates of protection." Mentor: Suresh Boppana, MD.

 

Patrick Wen, UT Southwestern, Dallas, TX. "Development of Novel Gene-Silencing Therapeutics for Acinetobacter baumannii Biofilms." Mentor: David Greenberg, MD.

 

Paul Han, University of Maryland School of Medicine, Baltimore, MD. "Severe Malaria in Malian Children and Seroreactivity to Variant Surface Antigens." Mentor: Mark Travassos, MD, MSc.

 

Quinn Dufurrena, Albert Einstein College of Medicine Bronx, NY. "Impairment of Glucose Stimulated Insulin Secretion with Trypanosoma cruzi Infection." Mentor: Herbert Tanowitz, MD.

 

Raina Aggarwal, The University of Virginia School of Medicine, Charlottesville, VA. "The Expansion of Mental Health Services and the Effect of Expanded Mental Health Services on HIV Outcomes in one Southeastern Ryan White-funded HIV Clinic." Mentor: Kathleen McManus, MD, MSCR.

 

Ravi Jariwala, University of Alabama at Birmingham (UAB), Birmingham, AL. "Significance of HSV DNAemia in neonates who undergo sepsis evaluation." Mentor: Suresh Boppana, MD.

 

Rayad Barakat, Uniformed Services University of Health Sciences F. Edward Hébert School of Medicine, Bethesda, MD. "Effect of Antiobiotics on Outcomes of Leishmaniasis Treated with Sodium Stibogluconate." Mentor: Naomi Aronson, MD.

 

Rebecca Abelman, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. "Social Support and its Role in Retention in Care for the HIV-Positive Incarcerated Population." Mentor: Robert Gross, MD, MSCE.

 

Rebecca Lee, University of Maryland School of Medicine Baltimore, MD. "Impact of HCV Eradication on the Immune System in HIV Infected Subjects." Mentor: Shyamasundaran Kottilil, MBBS, PhD.

 

Ronnye Rutledge, Yale School of Medicine, New Haven, CT. "Feasibility and Acceptability of Community-Based PreP Dissemination in Criminal Justice-Involved Women." Mentor: Jaimie Meyer, MD, MS.

 

Ruth Reed, University of North Carolina School of Medicine, Chapel Hill, NC. "Investigating Molecular Markers of Chloroquine-Resistant Plasmodium vivax." Mentor: Jessica Lin, MD.

 

Sahil Aggarwal, University of California, Irvine School of Medicine, Irvine, CA. "HIV-Related Stigma of Young People Living with HIV/AIDS in Mwanza, Tanzania." Mentor: Catherine Diamond, MD, MPH.

 

Samantha Mazetis, Frank H Netter MD School of Medicine at Quinnipiac University, North Haven, CT. "A Qualitative Analysis of Healthcare Worker Attitudes Towards Prescribing PrEP for Adolescents: A Longitudinal, Multicenter Study." Mentor: Thomas Murray, MD, PhD.

 

Sarah Gunby, University of Washington School of Medicine, Seattle, WA. "Determining the T cell response to primary genital herpes simplex virus type 1 infection." Mentor: Christine Johnston, MD, MPH.

 

Shawkut Ali, GRU/UGA Medical Partnership, Medical College of Georgia, Athens, GA. "Utilization of the Emergency Department by Homeless Individuals with a Mental Illness." Mentor: Frederick Altice, MD.

 

Shruti Chandramouli, Emory University School of Medicine, Atlanta, GA. "Are HIV-Infected Adolescents Practicing Safer Sex Than Their HIV-Uninfected Counterparts?- A Comparison of Adolescent Attitudes and Behaviors." Mentor: Athena Kourtis, MD, PhD, MPH.

 

Sibani Das, University of Washington School of Medicine, Seattle, WA. "Molecular and Clinical Epidemiology of Recurrent Plasmid-Borne Beta-Lactam Resistant Enterobacteriaceae Infections in Pediatric Populations." Mentor: Danielle Zerr, MD, MPH.

 

Stephen Manning, Baylor College of Medicine, Houston, TX. "Developing a Mobile Health (mHealth) HIV Testing Text Message Campaign." Mentor: Monisha Arya, MD, MPH.

 

Tara Ness, University of Washington School of Medicine Seattle, WA. "Case-based Healthcare Provider Education and Clinical Management Support as an Effective Means for Managing HIV in Pregnancy in Rural, Resource Limited Settings." Mentor: Brian Wood, MD.

 

Theodore Pak, Icahn School of Medicine at Mount Sinai, New York, NY. "Estimation of Attributable Cost of Clostridium difficile Infection from Electronic Medical Record Data." Mentor: Shirish Huprikar, MD.

 

Tiange Zhang, Loyola University Chicago Stritch School of Medicine, Maywood, IL. "Correlates of HIV Testing among High-Risk MSM in China." Mentor: Joseph Tucker, MD, MA, PhD.

 

Timothy Walsh, Florida State University College of Medicine, Tallahassee, FL. "Evaluation of a Pre Exposure Prophylaxis intervention for African American men who have sex with men." Mentor: John Schneider, MD, MPH.

 

Tyler Degener, Drexel University College of Medicine, Philadelphia, PA. "Factors Associated with Non-Adherence to Antiretroviral Therapy in HIV-Positive Individuals." Mentor: Amy Baranoski, MD.

 

Victoria Bachman, University of Washington School of Medicine, Seattle, WA. "Determinants of High-Risk Behavior for HIV Acquisition Among Men Who Have Sex With Men in Lima, Peru." Mentor: Ann Duerr, MD, PhD, MPH.

 

Victoria Bawel, Stanford University School of Medicine Stanford, CA. "Mapping Diarrheal Illness and Analyzing Geospatial Health Factors in Informal Settlements of Nairobi, Kenya." Mentor: David Relman, MD.

 

Vishesh Kothary, Vanderbilt University School of Medicine, Nashville TN. "Identification of genes necessary for in vitro biofilm formation in Streptococcus agalactiae using transposon mutagenesis." Mentor: David Aronoff, MD.

 

Vytas Karalius, Mayo Medical School, Rochester, MN. "Bordetella parapertussis Outbreak in Southeastern Minnesota, 2014." Mentor: Robin Patel, MD.

 

Xuan Li, Rush Medical College, Chicago, IL. "Development of Point of Service Testing for Diagnosis of Maternal Toxoplasmosis Infection in Panama." Mentor: Rima McLeod, MD.

 

Yusuf Chao, Northwestern University Feinberg School of Medicine, Chicago, IL. "Utilizing the Electronic Health Record to Construct Syndrome-Specific Antibiograms in Pediatrics." Mentor: Sameer Patel, MD, MPH.

 

Zachary Holcomb, Duke University School of Medicine, Durham, NC. "Identification and Evaluation of Host-Derived Biomarker Signatures to Predict Invasive Candidiasis in Immunocompromised Human Hosts." Mentor: Micah McClain, MD, PhD.

 

Zachary Tabb, Alpert Medical School, Providence, RI. "Evaluating a Mental Health Intervention to Improve Mental Health and HIV Outcomes among HIV-Infected Tanzanian Youth." Mentor: Dorothy Dow, MD, MSc-GH.

 
 

ABIM to Offer New MOC Option Based on Feedback

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The American Board of Internal Medicine (ABIM) will begin offering a new Maintenance of Certification (MOC) assessment option in January 2018. The new option will:

  • Take the form of shorter assessments that doctors can choose to take on their personal or office computer—with appropriate identity verification and security—more frequently than every 10 years but no more than annually;
  • Provide feedback on important knowledge gap areas so physicians can better plan their learning to stay current in knowledge and practice; and
  • Allow physicians who engage in and perform well on these shorter assessments to test out of the current assessment taken every 10 years
Those who meet a performance standard on shorter assessments will not need to take the 10-year exam again to remain certified. ABIM’s assessment taken every 10 years will remain available as an option, and both assessments will reflect the input ABIM has received from a diverse range of physicians and stakeholders over the past year. 
 
IDSA has worked diligently over the past several years with other internal medicine societies to share our concerns about assessments with ABIM. 
 
The full announcement about the new MOC Option can be found here.

Have Questions about the New “All-In” Match Policy? We Have Answers!

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As reported in last month’s issue of IDSA News, IDSA has elected to adopt an “All-In” policy for the 2016 Match cycle. 

 
The Training Program Directors’ Committee and the ID Recruitment Task Force along with IDSA staff are working with program directors to answer questions regarding implementation of this policy. An FAQ document was added recently to the resources available about this policy on the IDSA website, providing information on what led to this decision, how the change will affect internal candidates and ID Fellowship Training Programs, as well as providing definitions of terms and various organizations involved in the match. For more information and to view the new FAQ document, see the IDSA website or contact Rachel Shnekendorf, 703-299-0879, rshnekendorf@idsociety.org, or Dana Johnston, 703-740-4789, djohnston@idsociety.org.

CDC Now Accepting EIS Applications

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The Centers for Disease Control and Prevention (CDC) has announced the opening of its Epidemic Intelligence Service (EIS) application period for the 2017 Class of EIS officers, which will run through August 15. 

 
During the two-year, post-doctoral fellowship, physicians and other health professionals learn to apply epidemiology to solve public health problems while working with the CDC to respond to outbreaks in the US and abroad. Each year, the CDC selects 70 to 80 new EIS officers. 
 
Learn more about the application process here.

IDWeek Mentorship Program

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Are you considering a career in infectious disease? The IDWeek Mentorship Program offers opportunities for mentorship and networking through one-on-one interactions between leaders in the field and fellows, residents and medical students during IDWeek.

  • Networking begins the first day of IDWeek with a meet-and-greet lunch 
  • $500 travel stipend available to residents and medical students 
  • Structured exclusive breakfast session with IDWeek speakers
Mentors and mentees interested in participating in the program should indicate interest during their registration for IDWeek 2016. For more information, please email foundation@idsociety.org.
 
When you meet with leaders in the field of ID, they tell you about their career path, and they talk about how they started off, their struggles or their accomplishments, and it makes you think that you can achieve what they have achieved. They’re all so humble and approachable. It’s just so nice to have them in the same room with you.”
— Sonali Advani, MD, MPH

Members on the Move

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Wendy Armstrong, MD, FIDSA, chair of IDSA’s ID Training Program Directors Committee and chair of the ID Recruitment Task Force, has been named a Healthcare Hero by the Atlanta Business Chronicle. Dr. Armstrong is medical director of Grady Health System’s Ponce de Leon Infectious Disease Center in Atlanta.

 

Richard H. Ebright, PhD, FIDSA, Board of Governors professor of chemistry and chemical biology at Rutgers University and laboratory director at the Waksman Institute of Microbiology, has been elected to the American Academy of Arts and Sciences. He will be inducted into the academy in October 2016.

 

Robert S. Jones, DO, FIDSA, has been re-elected to serve on the Board of Trustees of the Pennsylvania Osteopathic Medical Association. Dr. Jones is medical director of Reading Health Partners and medical director of process improvement/clinical integration for Reading Health System. He is also director of osteopathic medical education at Reading Hospital and medical co-director for Horizon Healthcare Services.

 

Darilyn V. Moyer, MD, has been selected as the next executive vice president and chief executive officer of the American College of Physicians. She will begin her term in September 2016. Dr. Moyer is professor of medicine, executive vice chair for education in the Department of Medicine, Internal Medicine Residency program director, and assistant dean for Graduate Medical Education at Lewis Katz School of Medicine at Temple University.


Carlos del Rio, MD, FIDSA, chair of HIVMA, has been selected as the 2016 recipient of the Ohtli Award, one of the highest awards given by the Government of Mexico. Dr. del Rio is professor of medicine in Emory University School of Medicine and Hubert Professor and chair of the Hubert Department of Global Health in Emory’s Rollins School of Public Health. 

Member Report

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IDSA welcomes the following new members:

MEMBERS

Ali, Syed, MD

Al-Maslamani, Muna, MBBS

Bankowski, Matthew, PhD

Bhat, Prashanth, MD, MPH

Coffey, Susa, MD

Cretella, David, PharmD

Frens, Jeremy, PharmD

Gade, Neeta, MD

Heung, Lena, MD, PhD

Ljungman, Per, MD, PhD

McManus, Mualla, PhD

Mehta, Kayur, MD

Ramaprasad, Charulata, MD, MPH

Reddy, Manthani, MD

Sukerman, Ellie, MD

Taneja, Neelam, MD

MEMBERS-IN-TRAINING

Albenayan, Eyad, MD

Alsaeed, Mohammed, MBBS

Alvarez, Julio, MD

Brown, Douglas, MD

Bulman, Zackery, PharmD

De Leon-Borras, Rafael, MD

Eljaaly, Khalid, PharmD

Kao, Carol, MD

Kelly, Devin, DO

Khan, Salman, MD

Lakota, Elizabeth, MS, PharmD

McFarlane, Alexandra, MD, BSN

McKamey, Lacie, PharmD

Medina Piñon, Isai, MD

Raval, Krunal, MD

Roshan, Bakht, MD

Suady Barake, Suhaireirene, MD

Tellez Marroquin, Ricardo, MD

White, Bryan, PharmD

RESIDENTS

Banks, Sarah, MD

Cannon, Chase, MD

Chow, Eric, MD

Guffey, Maighan, DO

Hilsendager, Cami, MD

Li, Annette, MD

Mason, Jocelyn, PharmD

Pearson, Courtney, MD

Polak, Jonathan, MD

Shrestha, Subarna, MD

Shukalek, Caley, MD

Smith, David, MD

STUDENTS

Abelman, Rebecca

Aggarwal, Raina

Ahmed, Bilaal

Bai, Anthony

Barker, Anna

Cain, Natalie

Chao, Yusuf

Daubert, Michael

Degener, Tyler

Dufurrena, Quinn

Dupont, Elizabeth

Eby, Jessica

Forrest, Alexandra

Francheville, W. Jordan

Godfrey, Christina

Gunby, Sarah

Holcomb, Zachary

Ize-Iyamu, Oyenmwen

Jariwala, Ravi

Kamath, Rahul

Karalius, Vytas

Khudaynazar, Nagina

Kothary, Vishesh

Kung, Vanessa

Lee, Rebecca

Lendrum, Elizabeth

Liang, Emily

Lin, Charlotte

Liu, Natalia HG

Locquiao, Jeremiah John

Maddali, Manoj

Manning, Stephen

Mazetis, Samantha

McCormick, Melissa

Murray, Alastair

Nelson, Avery

Ness, Tara

Nycz, Bryan

Pak, Theodore

Reed, Ruth

Roberts, David

Russell, Elliott

Rutledge, Ronnye

Shaw, Meredith

Siddiqui, Noora

Slade, Michael

Stime, Katrina

Tabb, Zachary

Walsh, Timothy

Wang, Hannah

Wen, Patrick

Wickerham, Andrew

Zhu, Chelsea

ASSOCIATES

Bhola, Shelley, MSN

Bhunpaen, Jennifer, MD

Brown, Brian, RPh

Buckland, Martin

Corvari, Linda, PharmD

Eldred, Lois, DrPH, MPH, PA-C

Glick, Marcia, PharmD

Juskowich, Joy, MD

Kammerer, Audra, PhD

Koser, Paul, PhD

Mattson, Debra, PA-C

Miller, Kimberly, PharmD

Muratani, Tetsuro, PhD

Omobowale, Olubukola, MBBS

Owusu-Sekyere, Anita, MD, ChB

Pulia, Michael, MD, MS

Shukla, Rajesh, PhD

Thayer, Lauren, BSN

Viteri, Yvonne, PharmD

Zelenetz, Paul, MD

DECEASED

Aldona Baltch, MD, FIDSA

What is IDSA Doing about the Future of ID?

The Society recently released the results of its Compensation Survey. The response from members was reminiscent of the response to last year’s Match results. A thread within both responses was, “What is IDSA doing about it?” Several efforts are underway including projects under the leadership of the Clinical Affairs Committee and the ID Recruitment Task Force that I am confident will make a difference in both of these areas that are of considerable concern among our members. Equally important in the feedback that we’ve received is that members need to hear more from us about our work and also need mechanisms to engage in discussion about these and other issues. I’m excited about some upcoming new avenues for such dialogue.

The results of IDSA’s Compensation Survey conducted among members last fall have been published in Open Forum Infectious Diseases (OFID). The objective of the survey, undertaken by IDSA’s Clinical Affairs Committee, was to offer a more accurate representation of compensation across the specialty by using a larger sample size than previously published surveys. Several findings stood out to me and have sparked impassioned discussion among our colleagues.
 
While detailed findings for those who identified their area of focus as “Research,” “Public Health,” and “Other” are available in the full survey report, the authors focused their analysis on those who indicated “Patient Care” as their primary responsibility as this group represents approximately 50 percent of IDSA’s membership. The finding that seems to have provoked the greatest response is that private practice physicians’ income averaged $277,611 (ranging from $50,000 to $1.45 m), with a median range of $170,000 to $272,500 across the sub-segment of patient care. ID specialists employed at academic medical centers reported the lowest compensation level of all of the patient care sub-segments. Clearly, there are outliers in this data but, understandably, the authors included them in order to demonstrate the broad range reported by members. 
 
The response to the compensation survey was reminiscent of the response to last year’s Match results. A thread within both responses was, “What is IDSA doing about it?” 
 
As noted in an IDSA-sponsored study and accompanying editorial recently published in Clinical Infectious Diseases (CID), those who choose the field of ID do so for the love of the specialty, the intellectual challenges, the unique opportunity to look at the whole patient rather than one specific organ or system, and the chance to improve and protect the health of the entire population. So, it’s not surprising to me that there is frustration with the pace of change within the field, in terms of how the specialty is compensated, and in terms of making sure that the best of the best are drawn into our field. I assure you that while change may be slow and incremental, IDSA is engaged on several fronts and numerous initiatives and is committed to realizing real and tangible change. 
 
Dan McQuillen, MD, FIDSA, a past chair of the Clinical Affairs Committee (CAC) and current IDSA co-chair of IDWeek, outlined in a recent blog post several such initiatives, including our participation in the Cognitive Care Alliance (read more about the Alliance here and here), which has as its goal to harness the collective power of cognitive specialties to raise awareness among policymakers that the current payment system undervalues the complex medical decision-making that is foundational to cognitive care. In addition, members of the CAC have been working on developing billing codes that capture the non-face-to-face work related to patient care that ID specialists perform.  As well, members of the CAC have been focused on promoting performance-based contracts for administrative services such as infection control and antimicrobial stewardship that align with hospital value-based performance metrics. The Compensation Survey is but one piece in an extensive, concerted effort aimed at bolstering the value of the ID specialist. 
 
Our advocacy work on Capitol Hill also offers opportunities to promote the value of infectious disease specialists, particularly during outbreaks such as Ebola and Zika. The policy team and member spokespersons continually work to educate Members of Congress and their staff about physician workforce issues as well as unique ID issues and have urged them to direct the Centers for Medicare and Medicaid Services to undertake the research necessary to update the evaluation and reimbursement codes for ID specialists.  
 
In addition to these efforts, the ID Recruitment Task Force, led by Wendy Armstrong, MD, FIDSA, is making good progress on a number of fronts, including efforts to re-evaluate microbiology curricula at medical schools, as detailed in another recent study in CID. We’re also making progress on IDSA’s messaging campaign in which we are targeting audiences and developing messaging that communicates the value of the ID specialist to policy makers, payers, hospital execs and others along with an additional set of messages to reach those starting out in medicine about the rich and rewarding career that infectious diseases offers. 
 
I want to thank each of the individual IDSA members who are leading efforts to address these concerns for the benefit of the entire specialty. They continue to carve out from their own personal time to advance these vexing, complex issues that make up the goals of our Society. 
 
Another important message that came across loud and clear to IDSA leadership is that we need to be better at communicating to and informing our members about the priorities and initiatives underway to address concerns that we deeply share with you. Two exciting announcements on that front are:
 
  • At IDWeek in New Orleans, we will be hosting a town hall style “Securing the Future of ID” meeting. You will hear from me, Carlos del Rio, MD, FIDSA, chair of the Board of the HIV Medicine Association, and others about ongoing efforts by IDSA and HIVMA to advance the field that all of us hold dear. But this won’t be a one-way discussion. We want to hear from all of you. The town hall will be an interactive opportunity for you to speak up, share your thoughts and concerns, and spark novel ideas.
  • In addition, we will soon be launching a newly crafted “MyIDSA,” the members-only section of the IDSA website. This will become your destination for networking with your colleagues and strengthening the community of IDSA. You’ll be able to join lively online discussions, pose questions, find colleagues, and find the latest news from the Society. We’re aiming to harness the energy and excitement of the hallway conversations at IDWeek, put them online, and make them last throughout the year.
I look forward to engaging with every one of you through these two exciting platforms. I’ve always been proud to be an infectious disease specialist and a member of IDSA. I’m excited about continuing to work with all of you to make our specialty and our Society stronger.
 

IDSA Foundation Offers Three Research Awards in 2016

The application period for three research awards available through the IDSA Education and Research Foundation is now open. Find out who is eligible and how to apply!

The IDSA Education and Research Foundation is pleased to offer three research awards in 2016. Our goal is to support promising young researchers who may not otherwise find funding as federal and other institutional research support becomes more difficult to obtain. 

  
2016 Young Investigator Awards 
  • Pfizer Young Investigator Award in Vaccine Development 
  • IDSA Young Investigator Award in ID 
  • IDSA Postdoctoral Fellowship Award in ID 
Who should apply: 
  • Candidates who have completed an ID fellowship within the last four years 
  • Candidates currently enrolled in an accredited ID fellowship 
For more information or to submit an application visit http://www.idsociety.org/IDSA_Research_Awards/
 
Application Deadline: July 15, 2016

Accessing the Members-Only Section of the IDSA Website—Action Needed!

Don’t miss out on the new, dynamic features of the members-only section of the IDSA website. To access the improvements and upgraded technologies made to this portion of the site, you will need to update your password. Easy instructions are available here!

Improvements and upgraded technology on the members-only section of the IDSA website mean new, dynamic features for members! In order to access these new online tools, you will need to change your password. You should have received an email from from noreply@salesforce.com; on behalf of; Membership info@idsociety.org, which contains a link and instructions on how to change your password. 

 
How to log in for the first time 
If you missed the email: 
  • Go to https://mymembership.force.com/CPBase__forgot_password 
  • From there you will enter your email address to have a temporary password emailed to you. 
  • When you receive the email, click the link and follow the instructions to reset your password. That's it!
  • Having trouble? Contact us at 703-299-0200 for help! 
Learn more about the changes to come. And watch your inbox for more information and easy access!

Senate Bill Threatens Medical Research at the Department of Defense

A new bill introduced in the Senate would place dramatic restrictions on all medical research funded by the Department of Defense, including requirements that could severely limit ID research. Take action today to ask your Senator to support an important amendment to the bill that would eliminate these restrictions.

Take Action Today


The US Department of Defense funds $1.7 billion in medical research efforts, including significant infectious disease-related research in antimicrobial resistance, HIV infection, tuberculosis, influenza, vaccine development and hepatitis B and C, among others. Provisions in a new Senate bill that renews defense programs for the next fiscal year, however, would place dramatic restrictions on all medical research, requiring the Secretary of Defense to certify that any research activity directly benefit active duty service members. IDSA’s concern is that the bill’s narrow interpretation and new administrative requirement could actually severely limit ID research that is important to our troops, particularly given the rapidly evolving and spreading nature of infectious diseases. The provisions also would subject much of the funded research to onerous auditing and contracting requirements that are now reserved for major defense contractors. 
 
Senators Durbin (D-IL) and Cochran (R-MS) are leading a bipartisan effort to eliminate these restrictions through an amendment to the bill to be offered the week of June 6 – when the bill will be considered by the full Senate.
 
Congress will be paying close attention the views of their constituents on this issue and others. Take a few minutes today to let your Senators know you support maintaining a strong medical research portfolio at the Department of Defense unencumbered by rigid definitions and bureaucratic obstacles. 
Here’s what you can do: 
  • Call the Capitol Hill switchboard at 202-224-3121 and ask to speak with your Senator’s office. Ask your Senators to cosponsor the Durbin/Cochran amendment to the Defense bill – Amendment 4369. If your Senators are already cosponsors, let their offices know it is appreciated. 
  • Send an email from the IDSA/HIVMA advocacy center to your Senators. 
  • Engage in social media championing the value of ID research at the Department of Defense by using the hashtag #ResearchNotRedTape 
  • Write a letter to your local paper about the importance of ID medical research at the Department of Defense in protecting military personnel and advancing national security goals

Journal Club

Solithromycin Compared to Moxifloxacin for the Treatment of Community-Acquired Bacterial Pneumonia; Low Yield of Blood Cultures Performed in Response to Fever/Leukocytosis in Inpatients; Body Fat Distribution Changes with Modern ART; Another Opportunity to Vaccinate: Flu Vaccine in the Hospitalized Surgical Patient

In this feature, a panel of IDSA members identifies and critiques important new studies in the current literature that have a significant impact on the practice of infectious diseases medicine.

Click here for the previous edition of Journal Club. For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, in each issue of Clinical Infectious Diseases.
Back to Top 
Solithromycin Compared to Moxifloxacin for the Treatment of Community-Acquired Bacterial Pneumonia 
Reviewed by Zeina Kanafani, MD, MS 
 
Community-acquired bacterial pneumonia (CABP) is a common and potentially serious infection. Treatment is complicated by the emergence of S. pneumoniae resistance and the difficulty in establishing a microbiological diagnosis in atypical infections. Solithromycin, a fourth-generation macrolide antibiotic under clinical development with activity against extracellular and intracellular organisms, including macrolide-resistant S. pneumoniae and M. pneumoniae, may offer a new treatment option.
 
The SOLITAIRE-ORAL trial, described in a recent Lancet Infectious Diseases article, was a multi-center, randomized, double-blinded, non-inferiority trial of oral solithromycin (800 mg on day 1, 400 mg on days 2-5, and placebo on days 6-7) versus oral moxifloxacin (400 mg on days 1-7) in patients with CABP. A total of 426 patients were randomized to receive solithromycin and 434 to moxifloxacin. There were no differences in the baseline characteristics between patients in the two study arms. S. pneumoniae and H. influenzae were the most frequently isolated organisms (23 percent and 16 percent, respectively). The prevalence of macrolide resistant S. pneumoniae was low in both arms. 
 
Early clinical response in the intention-to-treat population was achieved in 78.2 percent of patients receiving solithromycin and in 77.9 percent of those receiving moxifloxacin, which satisfied the non-inferiority assumption of the trial. In the subgroup analysis, patients with Pneumonia Outcomes Research Team (PORT) risk class III and IV, older than 65 years, and those with chronic obstructive pulmonary disease (COPD) or asthma responded better to solithromycin compared to moxifloxacin, but these differences did not reach statistical significance. Treatment failure and mortality rates were similar. In the microbiological intention-to-treat population, early clinical response was lower in the solithromycin vs. moxifloxacin group, although the difference was not significant, and the non-inferiority margin of 15 percent was still met. There was no difference in the proportion of patients developing treatment-emergent adverse events. The main limitation of the study was the relatively short follow-up period (30 days). 
 
The investigators concluded that solithromycin, which must still meet regulatory approval, is a promising treatment option in patients with CABP. 
 
 
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Low Yield of Blood Cultures Performed in Response to Fever/Leukocytosis in Inpatients
Reviewed by Christopher J. Graber, MD, MPH, FIDSA

The cultural norm of inpatient care frequently dictates that an evaluation for fever in a hospitalized patient should automatically prompt a non-evidence-based “full-fever workup” consisting of blood cultures, urinalysis with urine culture, sputum culture, and/or a chest x-ray. This “shotgun” approach is often unnecessary and can drive potentially inappropriate antibiotic use. A recent study published in the Journal of Hospital Medicine specifically examined its most common component, blood cultures, with regard to indications and yield. 
 
The authors reviewed 576 blood culture orders from 363 patients hospitalized on general medicine or cardiology services over a seven-month period at a Veterans Administration teaching hospital where an indication had to be listed as a part of the order. The rate of “true” blood culture positivity was 3.6 percent; the false-positive rate was 2.3 percent (most typically from coagulase-negative staphylococci). The most common listed indications for blood cultures were fever alone (25.6 percent), fever with an additional indication (22.6 percent), follow-up of positive blood cultures (11.3 percent), fever and leukocytosis (9.4 percent), and leukocytosis alone (9.4 percent), but the only indication associated with true positivity was follow-up of previous positive culture (likelihood ratio [LR] 3.4). Patients already on antibiotics at the time of the culture rarely had true positivity (1.4 percent, LR 0.4), and the only working diagnosis associated with true culture positivity was bacteremia/endocarditis (LR 3.7). 
 
This study highlights the low utility of the routine “culture if spikes” approach to the care of the febrile hospitalized patient without taking additional clinical information into context, particularly if that patient is already being treated with antibiotic therapy and the culture is not being done to follow up on a prior positive. Attention to clinician behavior in this arena could be a valuable target for intervention by antimicrobial stewardship programs.
 
(Linsenmeyer et al. J Hosp Med. 2016;11(5):336–340. )
 
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Body Fat Distribution Changes with Modern ART
Reviewed by Brian R. Wood, MD
 
Early antiretrovirals (ARVs) notoriously caused dystrophic changes in body fat, including lipoatrophy (primarily a consequence of mitochondrial toxicity from thymidine analogue nucleoside reverse transcriptase inhibitors) and lipohypertrophy, often attributed to protease inhibitors (PIs). What happens to body fat with modern ARVs? Do integrase inhibitors, which now dominate recommended first-line regimens, cause body fat alterations? 
 
In a recent open-label, randomized study, treatment-naïve HIV-infected adults with no known cardiovascular disease, diabetes, use of lipid-lowering medications, or uncontrolled thyroid disease were randomized to tenofovir DF-emtricitabine plus either raltegravir, ritonavir-boosted atazanavir, or ritonavir-boosted darunavir. Investigators monitored peripheral and central body fat using abdominal CT and whole-body dual-energy absorptiometry (DXA) scans (at baseline and 96 weeks). 
 
The 328 persons randomized were predominantly male (90 percent), white non-Hispanic (44 percent), with a median age of 36, CD4 count of 349 cells/ml, and body mass index (BMI) of 25 mg/kg2. Participants experienced similar increases in BMI across study arms (3.8 to 4.7 percent). Significant fat gains were detected in all compartments: limbs (13.4 percent), subcutaneous (19.9 percent), visceral and abdominal (25.8 percent), trunk (18.0 percent), and lean mass (1.8 percent); there was no statistically significant difference in fat gains between the PI groups or comparing raltegravir to the combined PI arms. Greater fat gains occurred in those with higher baseline HIV RNA or IL-6 level.
 
Notably, the majority of individuals, even those with a baseline BMI in the normal to overweight range, experienced significant fat gains, especially centrally. Raltegravir led to similar fat distribution changes as modern boosted PIs, which challenges the common belief that integrase inhibitors are better than PIs in this regard and suggests that the changes are primarily a result of HIV control and not an ARV class effect.
 
As the authors note, the long-term clinical consequences of such fat increases, which may surpass “return-to-health” levels, are not well defined, though other recent research suggests that changes in body fat composition with antiretroviral therapy (ART) contribute to elevated rates of hypertension. Anecdotally, I have seen many individuals who initiate ART and, even though wasting was not readily apparent at baseline, gain significant weight over subsequent months, leading to new hypertension, diabetes, or other evidence of metabolic syndrome.
 
Discussion regarding diet, exercise, potential weight gain, and prevention of complications of excess weight gain should be a part of routine ART counseling.
 
(McComsey et al. Clin Infect Dis. 2016 Apr 1;62(7):853-62.
(van Zoest et al. Clin Infect Dis. 2016 May 3.)
 
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Another Opportunity to Vaccinate: Flu Vaccine in the Hospitalized Surgical Patient
Reviewed by Manie Beheshti, MD

Less than half of the U.S. population is vaccinated against influenza annually. Aiming to capitalize on opportunity, the Advisory Committee on Immunization Practices (ACIP) recommends that all eligible hospitalized patients receive the influenza vaccine prior to discharge. This practice is a measured quality metric by the Joint Commission and the Centers for Medicare and Medicaid Services. However, possibly due to lack of safety data evaluating influenza vaccination in this setting, providers may be hesitant to vaccinate hospitalized patients due to concerns about vaccine reactions affecting post-operative care. 
 
Researchers at Kaiser Permanente Southern California aimed to address this issue in a recent publication in the Annals of Internal Medicine. Spanning three influenza seasons between 2010 and 2013 across 14 hospitals, their study encompassed over 42,000 surgeries in the adjusted analysis. Among these surgical patients, 6,420 were vaccinated during hospitalization. Vaccination was not associated with an increased risk of readmission, emergency department visits, post-discharge fever (defined as a temperature ≥38.0°C), or the need for clinical evaluation for an infection. An increased risk for outpatient visits was detected, but this was marginal (5 percent). Of interest, 34 percent of the study patients were unvaccinated for the duration of influenza season, leaving a large vaccination gap in a population that had multiple health care encounters.
 
In sum, this data lends support to the practice of vaccinating hospitalized surgical patients, as there was no strong evidence for any increased risk with vaccination in this cohort. Given the missed vaccination opportunities in more than one-third of the study population and the lack of vaccination in such a large portion of the U.S. population, increasing vaccine efforts in this cohort could help reduce a portion of the vulnerable population.
 
(Tartof et al. Ann Intern Med. 2016;164(9):593-9.)

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
  • Cerebrospinal Fluid Galactomannan Testing for the Diagnosis of Cerebral Aspergillosis
  • Recurrent Diarrhea After Clostridium difficile Infection (CDI): Not Always CDI Even if Polymerase Chain Reaction Is Positive
May 1
  • Safety of a Single Dose of Gentamicin in Sepsis
  • Bacteriophage and Biofilm