During the first week of October, the Infectious Diseases Society of America (IDSA) hosted its’ annual Infectious Diseases conference (IDWeek) in San Francisco, California.
There are a variety of reviews of the conference on the internet (the most famous being the Mini Really Rapid Review by Dr. Paul Sax) but I want to highlight the studies that are pertinent to physicians in other specialties outside of ID.
- Two major studies highlighted the ongoing pressures and scope for over-prescription of antibiotics and need for antimicrobial stewardship
In one study, 66.1% of patients were prescribed antibiotics for respiratory tract infections and antibiotic prescribing was associated with higher patient satisfaction. Given that most respiratory tract infections are viral, 66% is a lot!
Another study showed that 20% of antibiotics are prescribed without an in-person visit. Of all the 509,534 antibiotic prescriptions, 46% were not associated with an infection-related diagnosis. This highlights the need for better provider and patient education in antibiotic stewardship.
- Longer post-operative antibiotic prophylaxis did not lead to reduced rates of surgical site infections, but did lead to increased odds of acute kidney injury and C.diff.
And another study to demonstrate that unnecessary antibiotics can lead to harmful adverse effects and that they should not be prescribed except when indicated.
- Treatment of HCV infection is associated with reduced risk of cardiovascular events at 30 months of follow up.
Proof that cardiologists should care about infectious diseases too! Identify the patients who fit criteria for HCV screening, check for HCV infection, and treat/refer for treatment everyone with HCV infection (even if they are still using drugs, drinking alcohol, etc.).
- Universal HCV screening increases diagnosis of active HCV infection.
36% of patients with active infection were born outside of the age cohort recommendation for screening and did not report IV drug use. Given the ease with which HCV can now be treated and prevent future complications, universal screening may not be a bad idea.
- Among the elderly, high-dose influenza vaccine showed a relative, but non-significant benefit in protecting against influenza-associated hospitalizations.
This study only looked at hospitalizations, not the overall incidence of influenza illness. The high dose influenza vaccine works – here is the NEJM paper that looks at safety and efficacy of the vaccine in the elderly.
And it seems like there may be a broader, more effective high-dose influenza vaccine on the way.
- This study showed that within a cohort of healthcare workers with a 45% vaccination rate, 22% were diagnosed with laboratory-confirmed influenza infection, of which 68% were completely asymptomatic.
Get your flu shot! Do it for your patients.
- Phase 3 randomized controlled trial shows that recombinant zoster vaccine is effective and safe in patients with hematologic malignancies.
Helpful study that makes me feel more confident about prescribing this vaccine to our hematologic oncology patients.
- Preemptive therapy associated with lower incidence of CMV disease at 12 months than prophylaxis in D+/R- liver transplant recipients. There was no statistical difference in 1-yr and 3-yr mortality.
Most of the CMV disease in the prophylaxis group occurred after cessation of prophylaxis therapy. Interesting study that may be part of changing practices in the future.
- Patients with acute leukemia remain at risk for invasive fungal infections despite use of antifungal prophylaxis.
Moreover, use of posaconazole as prophylaxis was independently associated with breakthrough invasive fungal infections, with 8 out of 11 who died dying from the fungal infection itself. We’re definitely in need of some new antifungals right now…like this one.
- The sensitivity of bronchoalveolar lavage GMS stain for pneumocystis jiroveci is 46% in HIV-negative immunocompromised hosts.
In these patients, a negative BAL stain for pneumocystis jiroveci is not enough to rule out pneumocystis pneumonia and evaluation of other clinical factors (clinical pre-test probability, beta-D-glucan test, PCR testing, and histopathology) may be necessary to make the diagnosis.
- IV drug use may be an independent risk factor for candidemia.
This study showed an increasing incidence of candidemia and higher numbers of patients with candidemia who are persons who inject drugs without other risk factors. Something to keep in mind when you see patients who inject drugs in your hospital.
And for those of you in San Francisco, watch out for these microbes:
- Increased rates of invasive Group A Streptococcal infections in the homeless population in San Francisco, California
Watch out for necrotizing fasciitis (commonly caused by Group A strep!)
- Increased rates of cyclosporiasis cases seen in San Francisco, California
Consider testing in those with persistent diarrhea. Also remember that it is not part of the routine ova & parasite stool order and you need to specifically ask the microbiology lab to send it.
It’s impossible to cover everything so if you attended IDWeek and have other studies to suggest to everyone, let us know in the comments.