IDSA News - September 2017
Earlier this year, we conducted an audit of our communications functions including the website, emails, social media, MyIDSA, and this newsletter, IDSA News. The audit included a member survey that provided valuable insight into the most effective ways to reach you—what’s working and what isn’t. Today, I want to share with you some improvements we are making in the ways we share information with you. Also, don’t miss out on your chance to talk about what matters most to you in the field at the upcoming Town Hall 2.0: Join the Conversation.
Earlier this year, we conducted an audit of our communications functions including the website, emails, social media, MyIDSA, and this newsletter, IDSA News. The audit included a member survey that provided valuable insight into the most effective ways to reach you—what’s working and what isn’t. Of course, one size does not fit all with a membership ranging in demographics and areas of focus, but we did find common themes and aim to make improvements based on those.
IDSA and HIVMA stand with the individuals, families and communities affected by flooding in the aftermath of Hurricane Harvey, and urge care, preparation and precautions in confronting health impacts that may pose risks in the days and weeks ahead.
IDSA and HIVMA stand with the individuals, families, and communities affected by flooding in the aftermath of Hurricane Harvey, and urge care, preparation and precautions in confronting health impacts that may pose risks in the days and weeks ahead. “We would like first to emphasize that while widespread disease outbreaks after flooding remain uncommon in the United States, hand hygiene, clean water, as well as access to medications will be essential for preventing and limiting the spread of infectious diseases during this time,” said IDSA President Bill Powderly, MD, FIDSA, and HIVMA Chair Wendy Armstrong, MD, FIDSA in a joint statement.
In addition, the Societies have compiled a list of resources that may be useful as the ramifications of the storm unfold and as our colleagues in the path of Hurricane Irma brace for its impact. The list will be updated as new information becomes available.
“Infectious disease physicians and scientists dedicate themselves to stopping infectious diseases in their tracks—whether it be preventing spread of disease through vaccine development, surveillance, or implementing the right treatment at the right time. Each of the individuals awarded the status of FIDSA has shown him or herself to be a leader in the field, in their community as well as in their institution. I congratulate each and every one and am honored to work with them in such a critical endeavor,” said IDSA President William Powderly, MD, FIDSA.
Applicants for IDSA Fellowship must be nominated by their peers and meet specified criteria, including continuing identification with the field of infectious diseases, national or regional recognition, and publication of their work. Nominees are reviewed and elected by the IDSA Board of Directors. Fellows of IDSA work in many different settings, including clinical practice, teaching, research, public health, and health care administration.
This year, the following individuals were honored as Fellows of IDSA:George Abraham, MD, FIDSA
IDWeek 2017 is just a month away! Here are a few highlights of resources, sessions, and events you won’t want to miss. For all of the most up-to-date information and to register, go to www.idweek.org.
Register now to take advantage of the best travel rates. Information about housing and travel discounts can be found at http://www.idweek.org/attendees/housing-and-travel.
Abstracts will be available through the Interactive Program planner, the IDWeek Mobile App, and a special online supplement to Open Forum Infectious Diseases (OFID), the open access journal from IDSA and HIVMA.
IDWeek Town Hall 2.0 – Join the Conversation
What matters most to you about the field of ID? Do you have ideas you want to share? Questions you want to ask? Join IDSA President Bill Powderly, MD, FIDSA and HIVMA Chair, Wendy Armstrong, MD, FIDSA in a lively discussion at Town Hall 2.0 on Friday, October 6, 6 – 7:30 p.m. in 06DE. Plan to ask your question during the event, or submit one ahead of time at: email@example.com. Be sure to attend.
We Love Our Trainees!
IDWeek offers several sessions and events designed especially for medical students, residents, and fellows—from the ID365 Lounge, which features ID MedTalks offering career advice, to a Career Networking Event with employers from around the country. All of this can be found at www.idweek.org/trainee.
Women in Infectious Diseases
Don’t miss this early morning Meet-the-Professor session about the issues women face as ID physicians. There will be a presentation from HIVMA Board Chair Wendy Armstrong, MD, FIDSA, on IDSA’s Gender Disparities Task Force report as well as a panel discussion. The session takes place Saturday, October 7, 7 – 8:15 a.m. in the Marriott Marquis Grand Ballroom 1+2. Come early for the complimentary continental breakfast!
Come match your knowledge of ID Trivia with contestants from three San Diego ID programs! The teams will battle it out to see who comes out on top in the IDBugBowl. This fun session takes place Saturday, October 7, 2 – 3:30 p.m. in 6AB.
IDWeek 2017 will play host to a number of affiliated events in San Diego. This year’s meeting will feature six accredited satellite symposia offering CME that is supplemental to credits offered by the official IDWeek Program. The IDExpo Hall will also feature Learning Lounges for attendees to view 45-minute presentations from various exhibiting companies during exhibition hours (Thursday—Saturday, 10 a.m. – 2 p.m.). Presentation Theaters and an Open Education Gallery are also planned. Watch your email for the complete affiliated event schedule available in September at www.idweek.org.
IDSA Opening Reception and Posters in the Park
Be sure to attend the Opening Reception and Posters in the Park (Wednesday, October 4, 6 – 7:30 p.m. in the Poster Hall). The wine and cheese reception will feature poster presentations that have been specially selected by the respective societies.
Maintenance of Certification (MOC) Program
American Board of Internal Medicine (ABIM)
In addition to CME and CPE credit, IDWeek attendees can earn up to 29.75 MOC points for sessions at IDWeek. All CME-accredited sessions are also available for ABIM MOC points. To earn points, visit the CME/CPE/MOC pavilion or go online after the meeting to complete an evaluation, which requires your ABIM number and date of birth. Deadline: November 27, 2017.
American Board of Pediatrics (ABP)
Pediatricians may earn a total of 8 MOC points by attending 4 out of the 13 interactive sessions available for ABP MOC. To earn points, visit the CME/CPE/MOC pavilion or go online after the meeting to complete an evaluation, which requires your ABP number and date of birth. Deadline: November 27, 2017.
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.
Reviewed by Lauren Richey, MD, MPH, FIDSA
The HIV continuum of care includes diagnosis, linkage to care, retention in care, receipt of antiretroviral therapy, and viral suppression. Each of these is needed to improve clinical outcomes and to decrease transmission. The HPTN 065 study, the results of which were recently published in JAMA Internal Medicine, evaluated the use of patient financial incentives to improve linkage and viral suppression.
Thirty-nine clinic sites in the Bronx, N.Y., and Washington, D.C., were randomized to either financial incentives or standard of care. Financial incentives of up to $125 were given for labs and a clinical visit to patients newly diagnosed with HIV or to patients out of care for more than a year. The primary outcome was linkage to care within three months. For patients already engaged in care, a financial incentive of $70 a quarter was offered for viral suppression (400 copies/mL). The primary outcome for this group was the proportion of virally suppressed patients each quarter.
For linkage to care, the standard of care group increased linkage at three months from 73 percent to 83 percent, and the financial incentive group increased from 75 percent to 89 percent, which was not significantly different. For viral suppression, the baseline viral suppression was 62 percent, and the financial incentive group had a 3.8 percent higher proportion of viral suppression than the standard of care group (P = 0.01). This increase was slightly higher among patients not consistently virally suppressed at baseline (4.9 percent).
This study represents the largest to date using financial incentives in HIV care and demonstrates their feasibility in a large scale project that included more than 30 clinics in two different communities. The results were modest but significant for viral suppression. This lack of a robust improvement highlights the complex interplay of patient, community, and system factors that impact linkage and retention in care. Some of these factors are financial, but others are varied. A mixture of additional support services and interventions may be necessary to achieve ideal linkage and viral suppression.
Reviewed by Michael T. Melia, MD
Several studies have suggested that antibiotic therapy does not improve outcomes among patients with acute, uncomplicated diverticulitis. Despite these data, many guidelines recommend antibiotic treatment, and practice remains heterogeneous. Now, a randomized, controlled trial from 22 Dutch centers further argues against routine antibiotic use for this entity.A recent article in the British Journal of Surgery describes 570 patients enrolled between June 2010 and October 2012 with a first episode of mild, uncomplicated, left-sided, CT-confirmed acute diverticulitis. Patients were randomized to observation or antibiotic therapy with amoxicillin-clavulanic acid (1,200 mg IV every six hours for at least two days, then 625 mg orally three times daily to complete 10 days of treatment). Allergic patients were given ciprofloxacin + metronidazole. The primary outcome was time to recovery during six months of follow-up.
The median time to recovery was 14 days in the observation group and 12 days in the antibiotic group (hazard ratio for full recovery 0.91; P = 0.151). Recovery rates at six months did not differ between groups (89.3 percent in observation group, 93.2 percent in antibiotic group; P = 0.183), and readmission rates were comparable (17.6 percent in observation group, 12.0 percent in antibiotic group; P = 0.148). Among the observation group, more patients were treated on an outpatient basis, and the duration of initial hospitalization was shorter (two versus three days; P = 0.006). Rates of complicated, persistent, or recurrent diverticulitis were comparable between groups, and median abdominal pain scores declined at comparable rates.
This study should cause providers to pause before reflexively prescribing antibiotics for patients with acute, uncomplicated diverticulitis; patients managed with observation did not have more morbid courses, and they spent fewer days in the hospital. Given a lack of inferior outcomes, this study lends further support to supportive care—without broad-spectrum antibiotic therapy—for management of patients with acute, uncomplicated diverticulitis.(Daniels et al. Br J Surg. 2017;104(1):52-61.)
Reviewed by Terri Stillwell, MD
With the changing epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) infections, hospitals are turning to different preventative strategies, such as decolonization with mupirocin and/or chlorhexidine, as a means to decrease health care-associated MRSA infections. The use of these agents has raised concerns that this may create a niche for more virulent pathogens. In a recent article in Infection Control and Hospital Epidemiology, the authors assessed whether MRSA decolonization with mupirocin changed the risk of subsequent infections in neonatal intensive care unit (NICU) patients, our most vulnerable population.
In a retrospective, multicenter cohort study, patients from three NICUs with established MRSA decolonization protocols (weekly surveillance screening followed by decolonization with mupirocin) were studied to see if risk of Gram-positive cocci (GPC) and Gram-negative bacilli (GNB) infections varied by exposure to mupirocin. From January 2007 to December 2014, 16,144 neonates were admitted to the study NICUs, 522 (3.2 percent) of which were found to be MRSA-colonized. Of those MRSA-colonized patients, 74 percent underwent decolonization with mupirocin.
During the study period, a total of 37 GPC infections occurred, an incidence rate (IR) of 2.0 per 1,000 patient days. Mupirocin-decolonized patients’ rate of GPC infections was 64 percent lower than those that did not receive mupirocin (1.4 vs. 3.9 infections per 1,000 patient days; P = 0.001). A total of 29 GNB infections occurred, an IR of 1.6 per 1,000 patient days. There was no statistically significant difference in GNB infections between those who had been decolonized with mupirocin and those who had not. Results remained true across various specimen types and pathogens, with Staphylococcus aureus bloodstream infections also lower in those who had received mupirocin decolonization (incidence rate ratio = 0.10, 95 percent confidence interval [CI]: 0.01-0.51).
While additional studies on long term effects of decolonization are still warranted, this study shows that mupirocin-based decolonization decreased risk of GPC infections, without increasing the risk of GNB infections.
Reviewed by Kelly Cawcutt, MD
Measles outbreaks continue to occur in the U.S. with over half of imported measles cases being secondary to unvaccinated U.S. travelers acquiring measles while abroad. Given the high infectivity of measles and high likelihood of transmission to other unvaccinated individuals, assessment of measles, mumps, and rubella (MMR) vaccination during pretravel consultation is prudent.
In a recent observational study of 24 pretravel clinics in the U.S. published in Annals of Internal Medicine, researchers assessed missed opportunities for MMR immunization among departing adult travelers. This study utilized travel clinic sites associated with the Global TravEpiNet consortium which uses structured questionnaires for travelers and providers including measles immunity and immunization history.
Nearly 41,000 adults were included, with 6,612 (16 percent) considered eligible for MMR immunization during their pretravel visit. Fifty-three percent of these were not ultimately vaccinated, due either to traveler refusal (48 percent; the most common reason for refusal was lack of concern for illness), provider decision (28 percent), or health system barrier (24 percent; predominantly the need to travel to a secondary site to receive the vaccine). When reviewed by site type and location, fewer travelers received vaccination if they presented in the South or to a non-academic center.
Based on this study, approximately 1 in 6 adult travelers from the U.S. would be eligible for MMR immunization during their pretravel consultation for both individual and public health benefit. The implications are significant. According to the authors, there are 30 million air travelers from U.S. to international locations per year. If this study is in fact generalizable, nearly 5 million of these travelers may be at risk for measles infection.
There is a clear opportunity to improve assessment and MMR immunization during pretravel consultations through improved awareness, increased provider and patient education regarding risk of measles, and by appropriate stock of the MMR vaccine at travel clinics.
Sepsis affects 1 million people each year in the U.S. and is associated with significant morbidity and mortality. Advances in therapy have cut the overall mortality risk from 46.9 percent in the early 1990s to 29 percent by 2009. This still high risk for death has prompted exploration of other avenues where incremental improvements can be realized. Beta-lactam antibiotics are frequently used given their wide spectrum of activity. However, the optimal method of drug dosing and administration has not yet been elucidated. Their efficacy is time-dependent, with killing of bacteria occurring when serum/tissue concentrations are greater than the minimum inhibitory concentration. Thus, continuous infusions of beta-lactams have been studied but to-date have not shown a clear benefit.
A meta-analysis published in the American Journal of Respiratory and Critical Care Medicine included three randomized controlled trials that compared continuous infusions of beta-lactam antibiotics to intermittent therapy for severe sepsis. The investigators focused on severe sepsis as they hypothesized a greater benefit in that scenario. The primary endpoints were 30-day in-hospital mortality and clinical cure, as assessed by a blinded clinician. In an unadjusted analysis of continuous infusions, the relative risk (RR) was 0.73 for hospital mortality, which remained significant after adjusting for confounders. There was an improvement in clinical cure (RR 1.32) but this was not significant in the multivariable analysis. However, the high heterogeneity (I2 = 64 percent) for this endpoint and outlier status of one of the included studies likely influenced the results.
While the case is far from closed, this meta-analysis focusing on severe sepsis suggests that continuous beta-lactam infusions deserve further study. Fortunately, it appears that a large, multicenter effort is underway: the BLING III trial. It is anticipated to start by September 2017 and enroll 7,000 patients from 70 intensive care units worldwide. Such knowledge may help further improve outcomes from sepsis.
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: