IDSA News - September 2017
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IDSA President to Deliver Keynote at World AMR Congress

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The third annual World Anti-Microbial Resistance (AMR) Congress, being held September 14 and 15 in Washington, DC, will provide a forum to discuss the current global public health crisis of AMR, and to formulate a collaborative response to tackle all aspects of the crisis. Leaders in policy, drug development, and research will discuss these challenges, including spurring antibiotic development, and developing more efficient diagnostics solutions to improving stewardship.

William Powderly, MD, FIDSA, president of IDSA, will co-present the keynote address with American Society for Microbiology President, Susan Sharp, PhD. The address will focus on initiatives to drive legislative efforts and policies to spur antibiotic and diagnostics development and curb antimicrobial resistance. The World Anti-Microbial Resistance Congress brings together key stakeholders including industry, international organizations, academia, government, regulators, payers and centers of care, to address this multi-faceted rising public health threat.

A limited number of tickets are available to IDSA members interested in attending the meeting. Please email Jennifer Morales at to request a ticket. Tickets will be distributed on a first come, first serve basis.

IDSA Members Give Congressman a First-Hand Look at Impact of ID/HIV Funding

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Douglas Drevets, MD, FIDSA, chief of infectious diseases at the University of Oklahoma Health Sciences Center (OUHSC), and Nelson Agudelo Higuita, MD, assistant professor of medicine at OUHSC, welcomed U.S. Rep. Tom Cole (R-OK) for a tour of OUHSC’s HIV Clinic and a dialogue about the impact of federal funding for infectious disease and HIV research and public health programs in Oklahoma. The visit, which took place during Congress’s August recess, was timely because Rep. Cole chairs a House subcommittee that plays a key role in health funding.

U.S. Rep. Tom Cole (R-OK); Douglas Drevets, MD, FIDSA; and Nelson Agudelo Higuita MD, of Oklahoma University Health Sciences Center

Volunteers like Drs. Drevets and Agudelo Higuita are the backbone of IDSA and HIVMA advocacy efforts. To volunteer, please join the Member Advocacy Program (MAP). As a MAP member, you will receive the latest ID/HIV policy news through our new Advocacy Bulletin, and other resources designed to help you be more involved in advocacy in our nation’s capital, or in your community. Contact Lisa Cox, with IDSA at or Kim Miller with HIVMA at, to sign up for the MAP and to receive the Advocacy Bulletin.

RSVP for Ryan White Coalition Luncheon at IDWeek

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Ryan White care providers won’t want to miss this opportunity during IDWeek to meet with colleagues at HIVMA’s annual Ryan White Medical Providers Coalition luncheon. Join us on Friday, October 6 from 12:15 pm to 1:45 pm at the Marriott Marquis in San Diego. Catch up on the latest news on the Ryan White Program, the Affordable Care Act, and more. Network with other Ryan White providers and share what’s happening in your community.

Email us to RSVP and for additional information.

Science Speaks

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Live from IAS 2017: Science Speaks Coverage of Global HIV Innovations, Progress, Funding

When physicians, researchers, and program planners from around the world gathered in Paris for the 9th IAS Conference on HIV Science in late July, the IDSA global Science Speaks blog provided live coverage of presentations on developments in HIV self-testing, funding, expanded treatment guidelines, affordable medicines, funding impacts, and more. Full conference coverage can be found at Science Speaks.

Stipends Available to ID Medical Student Interest Groups

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IDSA is committed to attracting new doctors to the field of infectious diseases. In an effort to increase awareness of the field among medical students and residents, IDSA will provide $500 stipends to infectious disease student interest groups at medical schools.

This initiative provides new and existing student groups the opportunity to hold various informational or networking events.

For additional information on requirements, program ideas, and to fill out an application, visit the Medical Student Interest Groups webpage.

Practice Exam is Back!

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IDSA’s practice examine provides a general review of infectious diseases in preparation for the American Board of Internal Medicine recertification exam. The one-hour and 40-minute, timed practice exam contains 50 case-based multiple-choice questions. Test-takers receive their score and a report containing learning objectives of items answered incorrectly.

The IDSA exam has been created in cooperation with the National Board of Medical Examiners.

This practice exam and all other IDSA courses can be found in the members-only section of the IDSA website. IDSA members pay only $100 ($150 nonmember rate).

Improving IDSA’s Communications with Members

William G. Powderly, MD, FIDSA
IDSA President

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.

William G. Powderly, MD, FIDSA
IDSA President

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.

Feedback on the newsletter was quite positive with many indicating a more frequent publication would be useful. Beginning this fall, IDSA News will be published every other week and will be redesigned in a simpler, concise, mobile-friendly fashion that will allow you to quickly identify the articles most relevant to you. We’ll continue to include regular features such as Journal Club and a recap of CDC and FDA alerts along with new features such as highlights from the news clips, top discussions on MyIDSA, and more. The President’s Message will be moving to MyIDSA, which will allow you to comment on the message and engage fellow members in a discussion on its subject. 
Response to MyIDSA, which was launched one year ago, has been overwhelmingly positive. We have begun to develop the community further by opening sub-communities focused on specific topics such as the Global HIV and TB community. We have also launched a community for program directors and soon will be opening a community for those in the early stages of their career. I’m excited about the networking and information-sharing on MyIDSA and look forward to seeing it continue to expand.
I sincerely hope that these changes allow you to learn more about the Society and keep abreast of our progress. However, successful communication is never one-sided, and as I often have, I urge you once again to take part in this Society. That may be by volunteering, by responding to surveys, or simply by speaking out and sharing your thoughts and ideas. 
You’ll have an opportunity to do just that at the 2nd annual Town Hall to be held on Friday, October 6, at 6:30 p.m. during IDWeek. (Look for the many signs pointing the way.) During the Town Hall 2.0, Join the Conversation, we want to hear from you about what matters most to you in the field of ID, what inspires you, what worries you, what the future looks like to you, and how we make that a reality. Because our goal is to have a lively dialogue, there will be no formal presentations. The conversation will be guided by what’s on your mind. You can submit your questions and thoughts in advance by emailing them to or by tweeting them to #idweektownhall. Join us for the event in San Diego, and please continue to be engaged in your Society.

Standing by Our Colleagues Hit by Hurricane Harvey and Preparing for Irma

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.

IDSA Honors 102 Distinguished Physicians, Scientists with FIDSA

Please join us in congratulating the outstanding physicians and scientists who have been awarded FIDSA status this year by the Society. Fellowship in IDSA honors those who have achieved professional excellence and provided significant service to the profession.

“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
Saint Vincent Hospital, Worcester, MA

Grace Aldrovandi, MD, FIDSA
UCLA, Los Angeles, CA

Mark Anderson, MD, FIDSA
CHI Memorial Infectious Disease Associates, Lookout Mountain, GA

Henry Anyimadu, MD, FIDSA
Hospital of Central Connecticut, Farmington, CT

Meghan Baker, MD, ScD, FIDSA
Partners, Chestnut Hill, MA

Roger Bedimo, MD, FIDSA
VA North Texas Health Care System, Dallas, TX

John Beigel, MD, FIDSA
Leidos Biomedical Research, Inc., Bethesda, MD

Janis Blair, MD, FIDSA
Mayo Clinic Arizona, Phoenix, AZ

Jason Blaylock, MD, FIDSA
Walter Reed National Military Medical Center, Olney, MD

Catherine Blish, MD, PhD, FIDSA
Stanford University School of Medicine, Stanford, CA

Lisa Brumble, MD, FIDSA
Mayo Clinic Florida, Jacksonville, FL

Carey-Ann Burnham, PhD, FIDSA
Washington University in St. Louis, St. Louis, MO

Michael Burns, MD, FIDSA
University of California Irvine Medical Center, Orange, CA

Carlos Bustamante, MD, FIDSA
Edelstein & Bustamante MD's PA, Aventura, FL

J. William Campbell, MD, FIDSA
St. Luke's Hospital, St Louis, MO

Wilbur Chen, MD, FIDSA
University of Maryland School of Medicine, Baltimore, MD

Shingo Chihara, MD, FIDSA
Virginia Mason Medical Center, Bellevue, WA

Andrea Ciaranello, MD, MPH, FIDSA
Massachusetts General Hospital, Boston, MA

Antonio Crespo, MD, FIDSA
Orlando Health Infectious Disease, Orlando, FL

Christopher Crnich, MD, PhD, FIDSA
University of Wisconsin, Madison, WI

Christopher da Costa, MBA, MD, PhD, FIDSA
Synthetic Biologics, Furlong, PA

Sandip Datta, MD, FIDSA
National Intitutes of Health/National Institue of Allergy and Infectious Diseases (NIH/NIAID), Bethesda, MD

Susanne Doblecki-Lewis, MD, FIDSA
University of Miami Miller School of Medicine, Miami, FL

Eric Ehrensing, MD, FIDSA
Ochsner Medical Foundation, New Orleans, LA

Michael Frank, MD, FIDSA
Medical College of Wisconsin, Milwaukee, WI

Thomas Fraser, MD, FIDSA
Cleveland Clinic Foundation, Cleveland, OH

Cyril Gaultier, MD, FIDSA
Cedars Sinai Medical Group, Los Angeles, CA

Marie George, MD, FIDSA
Southwestern Vermont Medical Center, Bennington, VT

Michelle Gonzalez-Ramos, MD, FIDSA
University Of Puerto Rico, Guaynabo, PR

David Greenberg, MD, FIDSA
University of Texas Southwestern, Dallas, TX

Aric Gregson, MD, FIDSA
University of California Los Angeles, Los Angeles, CA

Fadi Haddad, MD, FIDSA
Sharp Grossmont Hospital, La Mesa, CA

Natasha Halasa, MD, FIDSA
Vanderbilt University Medical Center, Nashville, TN

Lee Harrison, MD, FIDSA
University of Pittsburgh, Pittsburgh, PA

Michael Hill, MD, FIDSA
St. Tammany Parish Hospital, Covington, LA

Bruce Hirsch, MD, FIDSA
North Shore University Hospital, Manhasset, NY

Steven Holland, MD, FIDSA
NIH/NIAID, Bethesda, MD

Douglas Holt, MD, FIDSA
University of South Florida, Tampa, FL

Nicole Iovine, MD, PhD, FIDSA
University of Florida College of Medicine, Gainesville, FL

Nicolas Issa, MD, FIDSA
Brigham and Women's Hospital, Boston, MA

Jesse Jacob, MD, FIDSA
Emory University, Atlanta, GA

Wafaa Jamal, MD, FIDSA
Kuwait University, Al Shaab, Kuwait

Julie Joseph, MD, FIDSA
Columbia University College of Physicians & Surgeons, New York, NY

Alexander Kallen, MD, FIDSA
Centers for Disease Control and Prevention, Decatur, GA

Carol Kemper, MD, FIDSA
Palo Alto Medical Foundation, Portola Valley, CA

Dennis Kim, MD, PhD, FIDSA
Massachusetts Institute of Technology, Cambridge, MA

John Koethe, MD, FIDSA
Vanderbilt University Medical Center, Nashville, TN

Colleen Kraft, MD, FIDSA
Emory University, Atlanta, GA

Douglas Kwon, MD, PhD, FIDSA
Massachusetts General Hospital, Cambridge, MA

Kerry LaPlante, PharmD, FIDSA
University of Rhode Island, Kingston, RI

Cornelia Lass-Florl, MD, FIDSA
Medical University of Innsbruck, Innsbruck, Austria

Jennifer Le, MA, PharmD, FIDSA
University of California San Diego, La Jolla, CA

Nelson Lee, MD, FIDSA
The Chinese University of Hong Kong, Shatin, Hong Kong

Latania Logan, MD, FIDSA
Rush University Medical Center, Chicago, IL

Maricar Malinis, MD, FIDSA
Yale University School of Medicine, New Haven, CT

Ashley Maranich, MD, FIDSA
Tripler Army Medical Center, Kaneohe, HI

Gabriel Martinez, MD, FIDSA
Ponce Health Science University, Coto Laurel, PR

Kara Mascitti, MD, FIDSA
St. Luke's University Health Network, Bethlehem, PA

Lynn Matthews, MD, FIDSA
Massachusetts General Hospital, Boston, MA

Larissa May, MD, MSPH, FIDSA
University of California Davis, Sacramento, CA

Samuel Merrick, MD, FIDSA
New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY

John Midturi, DO, FIDSA
Baylor Scott & White Health SW Medical Center, Temple, TX

Baijayantimala Mishra, MD, FIDSA
AII India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, India

Jose Montero, MD, FIDSA
University of South Florida, Brandon, FL

Sandhya Nagarakanti, MD, FIDSA
Newark Beth Israel Medical Center, Newark, NJ

Richard Nathan, DO, FIDSA
Idaho Falls Infectious Diseases, Idaho Falls, ID

Mihai Netea, MD, PhD, FIDSA
Radboud University Medical Center, Niymegen, Netherlands

James Newton, MD, FIDSA
Washington Regional Medical Center, Fayetteville, AR

Olusegun Ogunlesi, MD, FIDSA
Lake Health, Willoughby, OH

Debra Palazzi, MD, FIDSA
Baylor College of Medicine, Houston, TX

Gopi Patel, MD, FIDSA
Icahn School of Medicine at Mount Sinai, New York, NY

Sheral Patel, MD, FIDSA
U.S. Food and Drug Administration, Silver Spring, MD

Sarah Rawstron, MBBS, FIDSA
Brooklyn Hospital Center, Staten Island, NY

Lauren Richey, MD, MPH, FIDSA
Medical University of South Carolina, Charleston, SC

Janelle Robertson, MD, FIDSA
Eglin AFB Hospital, Niceville, FL

Nasia Safdar, MD, FIDSA
University of Wisconsin, Madison, Madison, WI

Joshua Schiffer, MD, FIDSA
Fred Hutchinson Cancer Research Center, Seattle, WA

John Schwab, MD, FIDSA
Bayview Infectious Disease Consultants, Virginia Beach, VA

Ian Seemungal, MD, FIDSA
Virginia Hospital Center, Arlington, VA

Rangaraj Selvarangan, PhD, FIDSA
Childrens Mercy Hospital, Kansas City, MO

Jasjit Singh, MD, FIDSA
Children's Hospital of Orange Cty, Orange, CA

Ameeta Singh, MD, FIDSA
University of Alberta, Edmonton, AB, Canada

Benjamin Stermole, DO, FIDSA
Mike O'Callaghan Military Medical Center, Nellis AFB, Las Vegas, NV

Kayla Stover, PharmD, FIDSA
University of Mississippi, Jackson, MS

Rebecca Sunenshine, MD, FIDSA
CDC and Maricopa County Department of Public Health, Phoenix, AZ

Giorgio Tarchini, MD, FIDSA
Cleveland Clinic Florida, Weston, FL

Pritish Tosh, MD, FIDSA
Mayo Clinic, Rochester, MN

MaryAnn Tran, MD, FIDSA
Baylor Scott & White - Round Rock, Leander, TX

Virginia Triant, MPH, FIDSA
Massachusetts General Hospital, Concord, MA

Ephraim Tsalik, MD, PhD, FIDSA
Duke University, Durham, NC

Sotirios Tsiodras, MD, PhD, FIDSA
National and Kapodistrian University of Athens Medical School, Athens, Greece

Brian Tsuji, PharmD, FIDSA
University at Buffalo, Buffalo, NY

Lisa Veach, MD, FIDSA
UnityPoint Clinic, Des Moines, IA

Ole Vielemeyer, MD, FIDSA
Weill Cornell Medical College, New York, NY

George Viola, MD, MPH, FIDSA
MD Anderson Cancer Center, Houston, TX

Jennifer Wang, MD, FIDSA
University of Massachusetts, Worcester, MA

Shu-Hua Wang, MD, PharmD, FIDSA
Ohio State University Medical Center, Columbia, OH

Siriorn Watcharananan, MD, FIDSA
Ramathibodi Hospital, Bangkok, Thailand

Benjamin P. Westley, MD, FIDSA
Benjamin P. Westley MD, Anchorage, AK

Nathan Wiederhold, PharmD, FIDSA
University of Texas Health Science Center at San Antonio, San Antonio, TX

Laila Woc-Colburn, MD, FIDSA
Baylor College of Medicine, Houston, TX

Tirdad Zangeneh, DO, FIDSA
University of Arizona, Tucson, AZ

Countdown to IDWeek 2017

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

Register now to take advantage of the best travel rates. Information about housing and travel discounts can be found at

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: 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

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!

IDBugBowl 2017
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.

Affiliated Events
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

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.

Visit the IDWeek website for the list of sessions, the Interactive Program Planner and the meeting app for session details, and look for the CME/MOC logo next to session titles in the Final Program book. Additional MOC points can be earned through participating in select pre-meeting workshops.

Journal Club

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.

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Using Patient Financial Incentives to Improve Linkage to HIV Care and Viral Suppression

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.

(El-Sadr et al. JAMA Intern Med. 2017;177(8):1083-1092.)

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Is Antibiotic Therapy Really Needed for Acute, Uncomplicated Diverticulitis?

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.)

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MRSA Decolonization in Neonates: Is It Safe?

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.

(Pierce et al. Infect Control Hosp Epidemiol. 2017;38:930–936.)

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Targeting Travel Clinics to Improve MMR Vaccination Rates: We Must Do Better

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.

(Hyle et al. Ann Intern Med. 2017;167:77–84.)

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Treating Sepsis with Continuous Beta-Lactam Infusions: Can We Reduce Mortality?

Reviewed by A. Krishna Rao, MD, MS

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.

(Roberts et al. Am J Respir Crit Care Med. 2016;194:681-91.)

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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:

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