Infectious Disease Physicians Research Articles

Remote Practice of Infectious Diseases Through Telemedicine: Improving Access for Patients and Appeal for Physicians

Abstract The specialty of Infectious Diseases (ID) is facing headwinds in attracting new physicians into training and clinical practice, leading to workforce shortage and rising burnout among existing ID physicians. The distribution of ID physicians across the country is skewed and many Americans do not have access to ID expertise. Novel care models are needed to ensure the longevity of the ID specialty and patient access to ID care. ID telemedicine provides a new opportunity for ID physicians with the benefits of residing in one’s preferred geographic location, eliminating the need to commute, and structuring the workday to improve work-life balance. This viewpoint, which includes personal experiences in transitioning from in-person to remote ID practice, describes the extent of challenges facing the ID specialty, and how telemedicine can reduce burnout among ID physicians, attract more physicians into the specialty, and improve access to ID care.

Gauging Medical Students' Interests in Infectious Diseases.

Infectious diseases is a crucial specialty in medicine, yet applications for fellowship have declined even as the United States faces an imminent shortage of infectious disease physicians. Career interests often develop in medical school, but little is known about which interests and experiences are associated with interest in ID. Evaluate interest in ID among medical students and identify factors associated with interest and disinterest in ID careers. We developed a 26-question survey to gauge interest in infectious diseases (ID). All 16 medical schools in Texas were contacted and invited to participate. A total of 262 students across 9 medical school campuses completed the survey. Those interested in ID as a career had a significantly higher interest in public health (p<0.0001) and global (p<0.0003) health. The presence of an ID campus interest group (p<0.0015) and direct experience with the ID profession (p<0.0001) were also associated with interest. The most common reasons for lack of interest were lack of interest in pursuing internal medicine or pediatric residency, lack of compensation, and lack of procedures. Those interested in ID expressed interest in a wide variety of career pathways within ID, the most common being general inpatient and outpatient ID, as well as medical microbiology and global health/tropical medicine/travel medicine. Based on this survey, recruitment efforts for new ID fellows might include focusing on students with interests in public and global health, as well as increasing direct exposure to ID at the medical school level.

Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus (Version 2024).

The Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus, developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019, serves as a valuable reference for standardizing the prevention of mother-to-child transmission in China. As new evidence continues to emerge, it is essential to update these guidelines regularly to optimize clinical practice and research. To this end, the Infectious Disease Physician Branch of the Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of the Chinese Medical Association, in collaboration with multidisciplinary experts, have updated the guidelines based on the latest domestic and international research advancements and clinical practices, providing up-to-date guidance for clinicians and maternal and child healthcare workers.

Scoping Review of Pre-Exposure Prophylaxis and Post-Exposure Prophylaxis in HIV Prevention in Türkiye

Abstract Background Pre-Exposure Prophylaxis (PrEP) is a medical -antiretroviral- prevention method that reduces the risk of HIV transmission during sexual intercourse or injection drug use. Post-exposure prophylaxis (PEP) refers to taking medicine after risky exposure. The European Centre for Disease Prevention and Control (ECDC) has recommended the integration of PrEP into the existing HIV prevention packages since 2015. In Türkiye, first PrEP Guideline was published in 2022. The aim of this study is to evaluate the literature gap on the PrEP and PEP for HIV prevention research in Türkiye. Methods This study was conducted in October 2023. Searches were performed using the keywords ‘HIV, AIDS’ and ‘Pre-exposure prophylaxis, PrEP, Post-exposure prophylaxis, PEP’ in PubMed, Web of Science, Scopus, TRDizin, and Dergipark for all years. ‘Türkiye, Turkey, Turkish’ were added into the keywords in international indexes, without using country filters. Inclusion criteria were research on PrEP or PEP for HIV, research conducted in or using data from Türkiye, publications in English/Turkish. Exclusion criteria were non-HIV topics, non-Turkish data, non-English/Turkish publications. Lists were merged, duplicates were removed. Inclusion-exclusion criteria were conducted at title and abstract level. Full texts of the included articles examined for bibliometric characteristics, study types, and key results. Results 1014 publications yielded, 993 evaluated, and 17 fully reviewed. Four discussed Türkiye’s PrEP practices (2018-2023); three analyzed PEP regimens; three were reviews on PrEP/PEP in Türkiye (2016-2022). Two original research articles explored PrEP awareness among Türkiye’s men having sex with men (2022) and infectious disease physicians’ attitudes toward PrEP (2020). Studies showed gaps in PrEP information and service access. Conclusions There are limited studies published on PrEP and PEP in HIV prevention in Türkiye. This study highlights the need for local research on the topic. Key messages • Evaluation of Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) publications highlights gaps in HIV prevention research. • Limited literature on PrEP and PEP in HIV prevention emphasizing the need for further studies and improved access to PrEP information.

Advancing Public Health Equity through Expanded Vaccination Services in prison: case studies from Italy and France

Abstract In Montpellier prison in France and San Vittore remand house in Italy, the provision of expanded, age-appropriate, coercion-free, and tailored vaccination services to PLP has emerged as a cornerstone in improving health outcomes within prison settings. The implementation of life course vaccination programs required the full integration of prison health into public health systems building on existing vaccination services covering HBV, flu and COVID-19. In San Vittore, a vaccination clinic aimed at people living in prison was set-up. Universal vaccination status assessment and vaccination catch-up was introduced targeting people admitted into prison. The vaccination clinic-related activities included information and awareness sessions on vaccination and health literacy offered regularly to PLP: increased vaccination knowledge is effective to enhance uptake. The vaccination clinic team consisted of infectious diseases physicians and a health assistant with an anthropological background, who ran the information and awareness sessions combining and adapting core content on vaccination with individual and community social and cultural contexts. Besides seasonal flu vaccination and anti-SARS-CoV-2 immunisation campaigns, vaccinations against pneumococcal pneumonia and herpes zoster were also offered to older and fragile individuals as per national immunization plan. One of the priority objectives of the vaccination clinic was the increase in vaccination coverage against HBV and HPV, not only as a tool for the prevention of infectious diseases, but as an innovative and effective tool of cancer prevention. As part of a more ambitious program to protect sexual health in prison and related to updated screening tools for the early diagnosis of lesions due to HPV infection, vaccination against HPV was also offered as part of a health empowerment project tailored to women in detention, with the aim of building self-awareness of their own health needs.

Paederus Dermatitis: Two Outbreaks of an Entomologic Disease in Austere Expeditionary Care.

Paederus dermatitis, also known as dermatitis linearis, is an acute cutaneous condition caused by contact with the potent vesicant toxin paederin, produced by endosymbiotic Pseudomonas-like bacteria within Paederus spp. beetles. Paederin is a protein synthesis inhibitor that halts cell division, leading to vesiculation and necrotic breakdown of the epidermis. The resultant damage facilitates secondary infection, especially in austere conditions. Between October 2022 and July 2023, several US special operations teams forward deployed to various countries in East Africa reported over 17 cases of painful, blistering skin eruptions consistent with Paederus dermatitis, 2 of which are summarized in this report. To confirm the best treatment approach, 1 team's medic reached back to a deployed infectious disease physician in the same Combatant Command as well as through the DoD ADVISOR line to a dermatologist in the United States. All cases were managed with irrigation, followed by a combination of topical steroid and antibacterial ointments, with resolution occurring after 3 to 7 days, whereas 38% of the cases in July 2023 developed secondary cellulitis by day 7, requiring oral antibiotic treatment. Strict preventative measures were implemented to limit exposure while carefully observing each case, as this was critical to optimize medical readiness of the team. Ultimately, we seek to highlight the identification of beetles specific to East Africa, seasonal prevalence, and the importance of preventative measures as they vary depending on specific beetle characteristics. Additionally, we reiterate classic presentation features that help avoid misdiagnosis for cases that occur outside of the typical epidemiologic criteria.

Chinese expert consensus on diagnosis, treatment and prevention of pulmonary infection in patients with solid tumors (2024 edition)

Patients with solid tumors have an increased risk of developing pneumonia during the management of tumor. The prevention, diagnosis, and treatment of pneumonia in these patients have different characteristics compared to the general population, such as the correction of specific risk factors for pneumonia and the rational use of prophylactic antimicrobial drugs, the strategy of invasive sampling diagnostic techniques application, differential diagnosis from anti-tumor treatment associated pulmonary conditions, and consideration of pathogens and drug resistance in empirical antimicrobial treatment. In order to standardize the diagnosis, treatment, and prevention of pneumonia in patients with solid tumors, Oncology Respiratory Disease Committee initiated the "Chinese expert consensus on the diagnosis and treatment of pneumonia in patients with solid tumors". Based on a review of the latest evidence in this field, the consensus provides diagnostic and treatment pathways as well as recommendations. This consensus applies to oncologists, pulmonologists, infectious disease physicians, surgeons, emergency medicine physician, and general practice healthcare professionals involved in the management of solid tumors in adults.

A national study of infective endocarditis models of care in Australia.

Multidisciplinary endocarditis team (MDET) management is supported by current evidence and recommended in international society guidelines. The extent to which this recommendation has been implemented in Australian centres and the attitudes, barriers and facilitators of this model are unclear. To describe current infective endocarditis (IE) models of care in Australian specialist referral centres and evaluate facilitators, barriers and attitudes towards MDET implementation. Aims were addressed using two online surveys. Survey 1 audited IE models of care and was distributed to infectious disease physicians at specialist referral centres. Survey 2 assessed barriers, facilitators and attitudes towards MDETs and was distributed via societal email listings. From 56 identified cardiac surgery centres, survey 1 received 47 responses (84%). A total of 28% (13/47) of participating institutions had an existing MDET. A total of 85% (11/13) of MDETs were in public hospitals and 85% (11/13) were in high IE volume centres. Survey 2 had 109 respondents from seven specialties. Attitudes towards MDET implementation were generally favourable. Identified barriers to MDET implementation included a lack of funding, resources, expertise, time and collaboration. Facilitators included strong leadership, engagement from key stakeholders and tangible benefits. Even though it is recommended in international guidelines, the MDET model is used by less than one-third of Australian specialist referral centres. Stakeholders in IE care have generally favourable attitudes towards MDET implementation but cite a lack of resources, funding, collaboration and time as barriers to this. Dedication of financial and administrative support and leadership from key stakeholders are required to increase MDET utilisation.

7487 Iatrogenic Cushing’s Syndrome In A Patient On Prezcobix And Fluticasone

Abstract Disclosure: A.N. Davis: None. M. Nicholson: None. Introduction: The HIV medication Prezcobix contains darunavir, a protease inhibitor which is known to inhibit the hepatic enzyme CYP3A4. This may lead to accumulation of some medications in the blood, including fluticasone. We present a patient with iatrogenic Cushing’s syndrome while on Prezcobix and fluticasone. Case: Patient is a 55-year-old man who presented to clinic 3/13/23 for evaluation for cushingoid appearance at the request of his infectious disease (ID) physician. The patient has history of HIV, asthma, and seasonal allergies and had been taking Prezcobix, inhaled fluticasone, and intranasal fluticasone for over 3 years. Patient noted easy bruising and difficulty with weight loss. Vital signs were remarkable for elevated blood pressure at 165/86 despite taking amlodipine, HCTZ, and carvedilol. He was overweight with BMI 27.2. Physical exam revealed a somewhat rounded face, mild central obesity, no dorsocervical or supraclavicular fat pads, and no purple striae. Labs on 3/8/23 were remarkable for cortisol level &amp;lt;0.40mcg/dL at 4:10PM. Labs on 3/13/23 were remarkable for cortisol &amp;lt;0.40mcg/dL, ACTH level &amp;lt;5.0pg/mL, and urine fluticasone 17-beta carboxylic acid elevated at 540pg/mL (&amp;lt;10pg/mL) at 3:57PM. His ID physician planned to transition the patient off of Prezcobix and onto Tivicay, so patient was started on hydrocortisone 15mg PO daily at 8AM and 5mg daily at 2PM on the day he switched to Tivicay. He was gradually tapered off of hydrocortisone over a 2-3 month period without any symptoms concerning for adrenal insufficiency. His Cortisol level on 7/10/23 off hydrocortisone was 4.98mcg/dL at 7:56AM. Discussion: Prezcobix contains darunavir which is known to inhibit CYP3A4. With most patients, use of inhaled and intranasal fluticasone does not result in physiologically meaningful systemic levels of fluticasone. However, metabolism of fluticasone is dependent on CYP3A4, so systemic levels may increase with use of inhaled fluticasone with Prezcobix resulting in excess of corticosteroids and suppression of the native hypothalamic-pituitary-adrenal (HPA) axis. Fluticasone 17-beta carboxylic acid is a metabolite of fluticasone which is detectable in the urine. Sudden cessation of Prezcobix after prolonged use may result in secondary adrenal insufficiency from prolonged HPA axis suppression. Our case demonstrates how the use of Prezcobix with fluticasone may result in iatrogenic Cushing’s syndrome. Additionally, our case demonstrates that anticipation of secondary adrenal insufficiency after stopping Prezcobix allows for implementation of a safe transition plan. Presentation: 6/1/2024

A-241 Verification and Validation Study for a Host Response Assay Based on TRAIL, IP-10, and CRP: Application to Pediatric Emergency Department

Abstract Background Acute febrile illnesses (AFIs) represent a significant disease burden globally; however, the lack of reliable, rapid point-of-care testing makes diagnosis difficult. A simple tool for distinguishing bacterial versus non-bacterial infections would radically improve patient management and reduce indiscriminate antibiotic use. MeMed BV® (MMBV) is a blood test to reliably differentiate between viral and bacterial infections. Three host proteins (TRAIL, IP-10, and CRP) are measured quantitatively and a combinational score (0-100) is computed that indicates the likelihood of bacterial infection (or co-infection) versus viral infection (BV Score). MMBV time to result is 15 min on the MeMed Key® analyzer that conducts chemiluminescence-based immunoassays to measure protein concentrations and calculates the test score, using 100 µL of serum. Methods The verification study design was a comparison of known results to on-site testing for contrived samples. The validation study design was a prospective, single-center, observational, blinded diagnostic accuracy study conducted between 8/3/22 to 5/30/23. The population was pediatric patients with suspected serious infections presenting to Geisinger’s quaternary care Pediatric Emergency Dept. in Danville, PA. The comparator was a clinical chart review and adjudication of over 60 clinical and laboratory variables related to systemic infections. The data review team consisted of one pediatric emergency department physician, one pediatric infectious disease physician, and one microbiology laboratory director. If clinical decisions differed among the three, the team adjudicated with a full chart review including knowledge of the eventual outcome, which served as the final reference standard result. The study aims were to assess the analytical and clinical accuracy of MMBV testing and to assess the test’s potential impact to further inform the provider’s decision to admit or discharge the patient. Results Of 60 contrived samples there was three failed tests (5% failure rate) and 2 discordant results. Analytical accuracy was 55/57 (96.5%) for 28 bacterial, 26 viral, and 1 equivocal control. Of 50 pediatric patients recruited, 8 were excluded because they were trauma patients. Among 42 patients tested, 22/42 (52.4%) were interpreted as bacterial or co-infection, 16/42 (38.1%) as viral or non-infectious, and 4/42 (9.5%) as equivocal. For 37/38 (97.3%) of patients with bacterial/viral MMBV results, the result was concordant with expert adjudication. Of the 42 patients for which potential utility was assessed, all results were in alignment with the clinical decisions made for admission or discharge. Conclusions MMBV performed accurately in pediatric ED patients with symptoms of severe infection, both clinically and analytically. A larger sample size will be tested to assess the utility in ED admission and discharge decisions and antimicrobial stewardship. The prevalence of viral and bacterial or coinfection cases within the sample population is representative of the pediatric population samples.

British Cardiovascular Society survey of the provision and structure of cardiology multidisciplinary meetings in England

Multidisciplinary meetings (MDMs) are central to clinical decision-making in many areas of cardiology. This study assessed current provision and structure of cardiology MDMs in England in comparison with national guidelines.British Cardiovascular Society (BCS) members were surveyed regarding frequency, core attendees, and organisational aspects of cardiology MDMs for myocardial revascularisation, endocarditis, heart failure, aortic valve, mitral and tricuspid valve MDMs, whether local, regional or outside of the region. Access to electrophysiology (EP), inherited cardiac conditions, and adult congenital heart disease (ACHD) MDMs was also assessed.Survey responses were received from 64 hospitals across England, of which 40 (62%) were secondary care centres and 24 (38%) were tertiary care centres. All units had access to revascularisation MDMs, although 6% of them (all in secondary care centres) lacked any surgical representation. Heart failure MDMs were available in 94% of centres, but 7% reported no attendance by a cardiologist with specialist interest in heart failure, and 23% reported no attendance by a device specialist. 61% of centres had access to dedicated endocarditis MDMs; however, 11% were not attended by a microbiologist or infectious disease physician, and 22% were not attended by a surgeon. Aortic valve MDMs were available in 69% of centres, while mitral and tricuspid valve MDMs were available in 56% of centres. One quarter of centres reported no access to EP, and one third of centres reported no access to ICC or ACHD MDMs.Substantial improvements in provision and structure of cardiology MDMs in England are needed in order to meet national guidance.

Clinical Management of Hospitalized Patients With High-Consequence Infectious Diseases in England.

Infectious disease physicians in England have been diagnosing and managing occasional cases of viral hemorrhagic fever since 1971, including the United Kingdom's first case of Ebola virus disease in 1976. Specialist isolation facilities to provide safe and effective care have been present since that time. Following the emergence of Middle East respiratory syndrome (MERS) in 2012, and the avian influenza A (H7N9) outbreak in 2013, and the 2014-2016 Ebola virus disease outbreak in West Africa, clinical and public health preparedness and response pathways in England have been strengthened for these types of diseases, now called high-consequence infectious diseases (HCIDs). The HCID program, led by NHS England and Public Health England between 2016 and 2018, helped to deliver these enhancements, which have since been used on multiple occasions for new UK cases and outbreaks of MERS, mpox, avian influenza, and Lassa fever. Additionally, HCID pathways were activated for COVID-19 during the first 3 months of 2020, before the pandemic had been declared and little was known about COVID-19 but HCID status had been assigned temporarily to COVID-19 as a precaution. The HCID program also led to the commissioning of a network of new airborne HCID treatment centers in England, to supplement the existing network of contact HCID treatment centers, which includes the United Kingdom's only 2 high-level isolation units. In this case study, the authors describe the airborne and contact HCID treatment center networks in England, including their formation and structures, their approach to safe and effective clinical management of patients with HCIDs in the United Kingdom, and challenges they may face going forward.

Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-Child Transmission of Hepatitis B Virus (Version 2024)

Abstract The Chinese Clinical Practice Guidelines for the prevention and treatment of mother-to-child transmission of hepatitis B virus, developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019, serves as a valuable reference for standardizing the process of preventing mother-to-child transmission in China. As new evidence emerges, it is crucial that timely and regular updates are made to the clinical practice guidelines so as to optimize guidance for clinical practice and research. To this end, the Infectious Disease Physician Branch of Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of Chinese Medical Association, in collaboration with multidisciplinary experts, have updated the guidelines based on the latest domestic and international research advancements and clinical practice, in order to provide guidance and reference for clinicians and maternal and child healthcare workers.

Evaluation of infectious diseases physicians’ attitudes to dyslipidemia management in PLWH

ABSTRACT Objectives Dyslipidemia is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD). ASCVD prevalence among people living with HIV (PLWH) is twice that of the general population. This study aimed to evaluate the infectious diseases (ID) physicians’ attitudes on dyslipidemia management in PLWH. Methods This observational, cross-sectional study was conducted as online survey among ID physicians between November 2023 and February 2024. An e-mail with the survey link, title and purpose of the study was sent to physicians through the local ID societies. The survey included questions about physicians’ demographic characteristics and their attitudes toward treating dyslipidemia in PLWH. Results A total of 242 physicians responded to the survey, of whom 59.9% (n = 145) were ID specialists and 40.1% (n = 97) were ID residents. Forty-one percent (n = 100) of physicians reported that they did not follow a guideline, and 26% of physicians reported that they did not use a cardiovascular risk calculator in their clinical practice. Specialists (69%) were more likely than residents (43.3%) to follow clinical guidelines for dyslipidemia management (p < 0.001). Seventy-two percent (n = 174) of physicians doubted the need to treat dyslipidemia, and 73% (n = 177) of physicians were affected by the patient skepticism. Workload and lack of time were identified by 68.6% of physicians as barriers to implementing dyslipidemia guideline recommendations. Conclusion A considerable number of Turkish ID physicians did not prefer using clinical guidelines for dyslipidemia and ASCVD risk calculators. Statin prescribing of physicians was influenced by workload, lack of time, patient skepticism, and lack of knowledge. Training ID physicians in primary prevention of ASCVD and management of dyslipidemia in PLWH is paramount.

Chinese practice guidelines for the prevention and treatment of mother-to-child transmission of hepatitis B virus (version 2024)

The Chinese Clinical Practice Guidelines for the prevention and treatment of mother-to-child transmission of hepatitis B virus, developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019, serves as a valuable reference for standardizing the process of preventing mother-to-child transmission in China. As new evidence emerges, it is crucial that timely and regular updates are made to the clinical practice guidelines so that to optimize guidance for clinical practice and research. To this end, the Infectious Disease Physician Branch of Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of Chinese Medical Association, in collaboration with multidisciplinary experts, have updated the guidelines based on the latest domestic and international research advancements and clinical practice, in order to provide guidance and reference for clinicians and maternal and child healthcare workers.

Preventability of Hospital Deaths in Patients with Non-Ventilator Hospital-Acquired Pneumonia.

Crude and adjusted mortality rates for patients with non-ventilator hospital-acquired pneumonia (NV-HAP) are amongst the highest of all healthcare-associated infections, leading to calls for greater prevention. Patients prone to NV-HAP, however, tend to be severely ill at baseline making it unclear whether their high mortality rates are due to NV-HAP, underlying conditions, or both. Two infectious disease physicians conducted detailed medical record reviews on 150 randomly selected adults from 4 hospitals who died in-hospital following an NV-HAP event between April 2016 and May 2021. Reviewers abstracted risk factors, estimated the preventability of NV-HAP, identified causes of death, and adjudicated the preventability of death. Patients' median age was 69.3 (IQR 60.7-77.4) and 43.3% were female. Comorbidities were common: 57% had cancer, 30% chronic kidney disease, 29% chronic lung disease, and 27% heart failure. At least one hospice-eligible condition was present before NV-HAP in 54% and "Do Not Resuscitate" orders in 24%. Most (99%) had difficult-to-modify NV-HAP risk factors: 76% altered mental status, 35% dysphagia, and 27% nasogastric/orogastric tubes. NV-HAP was deemed possibly or probably preventable in 21% and hospital death likely or very likely preventable in 8.6%. Most patients who die following NV-HAP have multiple, severe underlying comorbidities and difficult-to-modify risk factors for NV-HAP. Only 1 in 5 NV-HAPs that culminated in death and 1 in 12 deaths following NV-HAP were judged potentially preventable. This does not diminish the importance of NV-HAP prevention programs but informs expectations about the potential magnitude of their impact on hospital deaths.

Long-acting injectable antiretrovirals for HIV treatment in the ICONA cohort: physicians' and nurses' points of view.

Implementation level of long-acting injectable agents cabotegravir/rilpivirine (LAI CAB/RPV) for human immunodeficiency virus (HIV) treatment in Italy is still not known. The aim of this study is to identify the status of implementation of LAI CAB-RPV and its barriers. A cross-sectional online survey was conducted among infectious diseases (ID) physicians and nurses belonging to the ICONA network in Italy. Three validate 4-items measures were used: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Out of 61 ICONA centres, 38 (62%) completed the survey: 57.9% were academic centres, 42.1% were hospital-based. In total, 104 respondents were ID physicians (57.4%), 77 were nurses (42.5%); 4.5% of all PWH followed at the 38 centres started LAI CAB/RPV at time of study. Centres taking care of >1000 PWH reported 95% application of procedures for LA implementation, higher than other centres (P = 0.009). Mean score of AIM was (16.0, standard deviation, SD, 3.3), of IAM (16.0, SD 3.0) and FIM (16.0, SD 2.9). A linear correlation was found between AIM and the number of people with HIV who started LAI CAB/RPV (25-50 versus <25, coefficient of correlation [b] 2.57, 95%CI 0.91-4.60, P = 0.004), academic versus hospital-based centres (b -1.59, 95%CI -2.76-0.110044, P = 0.007) and the absence of preliminary systematic assessment of staff (b -1.98, 95%CI -3.31-0.65, P = 0.004). Implementation barriers were not significantly different according to the number of PWH/centre. LAI CAB/RPV implementation was low, with a great variability according to centre size. Tailored and centre-specific interventions to address barriers and to optimize the LA treatment implementation should be designed.

Routine Infectious Diseases Consultations on a Pediatric Cardiac Unit to Improve Positive Blood Culture Management.

Bacteremia can be life-threatening, and highly medicalized patients, such as those with complex congenital heart disease, are at high risk. Infectious diseases (ID) consultation is associated with improved outcomes in bacteremia. We noted an opportunity for improvement in management of positive blood cultures in our cardiac care unit (CCU). We completed a quality improvement project that included a single plan-do-study-act cycle consisting of a policy of routine ID consultation for all positive blood cultures events in the CCU. Our outcome measure of interest was percentage of appropriately managed blood culture events, the process measure was percentage of blood culture events for which the ID service was formally consulted, and the balancing measure was number of individual patients for whom the ID service was formally consulted. Appropriate antimicrobial management was determined via chart review by an ID physician. Data were analyzed via run chart and simple statistics. Following the intervention, the rate of appropriately managed positive blood culture events increased from a baseline of 86% to 98%, and the rate of ID consultation for these events increased from 75% to 98%. A shift was noted in run charts for both the outcome and process measures. There was an increase in patients for whom the ID service was consulted throughout the entire study period. We successfully implemented mandatory ID consultations in a CCU to increase proportion of appropriately managed blood cultures. While this intervention cannot be universally applied, others may find it useful in selected scenarios.

Workplace support for physicians during the COVID-19 Pandemic: Did it affect burnout?

BackgroundA concern before 2020, physician burnout worsened during the COVID-19 pandemic. Little empirical data are available on pandemic workplace support interventions or their influence on burnout. We surveyed a national sample of frontline physicians on burnout and workplace support during the pandemic.MethodsWe surveyed a stratified random sample of 12,833 US physicians most likely to care for adult COVID-19 patients from the comprehensive AMA Physician Professional Data ™ file. The sample included 6722 primary care physicians (3331 family physicians, 3391 internists), 880 hospitalists, 1783 critical care physicians (894 critical care physicians, 889 pulmonary intensivists), 2548 emergency medicine physicians, and 900 infectious disease physicians. The emailed survey elicited physicians’ perceptions of organizational interventions to provide workplace support and/or to address burnout. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Proportional specialty representation and response bias were addressed by survey weighting. Logistic regression assessed the association of physician characteristics and workplace interventions with burnout.ResultsAfter weighting, respondents were representative of the total sample. Overall physician burnout was 45.4%, significantly higher than in our previous survey. Open-ended responses mentioned that staffing shortages (physician, nursing, and other staff) combined with the increased volume, complexity, and acuity of patients during the pandemic increased job demands. The most frequent workplace support interventions were direct pandemic control measures (increased access to personal protective equipment, 70.0%); improved telehealth functionality (43.4%); and individual resiliency tools (yoga, meditation, 30.7%). Respondents placed highest priority on workplace interventions to increase financial support and increase nursing and clinician staffing. Factors significantly associated with lower odds of burnout were practicing critical care (compared with emergency medicine) OR 0.33 (95% CI 0.12 – 0.93), improved telehealth functionality OR 0.47 (95% CI 0.23 – 0.97) and being in practice for 11 years or longer OR 0.44 (95% CI 0.19–0.99).ConclusionsBurnout across frontline specialties increased during the pandemic. Physician respondents focused on inadequate staffing in the context of caring for more and sicker patients, combined with the lack of administrative efforts to mitigate problems. Burnout mitigation requires system-level interventions beyond individual-focused stress reduction programs to improve staffing, increase compensation, and build effective teams.

Live Vaccine and Varicella Postexposure Prophylaxis in Pediatric Liver Transplant Recipients: A Survey of Practice in Australia and New Zealand.

Administration of live vaccines following liver transplant (LT) has historically not been recommended due to concerns regarding risk of vaccine-attenuated disease. However, there is evidence suggesting that in select transplant recipients live vaccinations can be administered safely. Studies in other regions have indicated that despite this evidence many clinicians remain hesitant to administer live vaccinations. A REDCap survey was distributed to gastroenterologists, pediatricians, and infectious diseases physicians at pediatric centers across Australia and New Zealand via email between September and November 2023. The survey included a series of questions regarding live vaccine and varicella postexposure prophylaxis (PEP) practices in pediatric LT recipients and barriers to live vaccine administration in this cohort. There was a total of 16 responses to the survey, from 10 different pediatric centers, including 10/11 pediatric gastroenterology centers and all four pediatric LT centers in the region. Only 31% (5/16) of respondents (from 3/10 different centers) offer live vaccines. The main barrier to live vaccine administration was clinician reluctance and the main reason for not offering live vaccines was insufficient safety data. Sixty-nine percent (11/16) of respondents take vaccination status and/or serology into account when deciding whether to offer varicella PEP to this cohort. Respondents universally offer varicella zoster immunoglobulin as PEP, though 31% (5/16) also offer antiviral medication. Many clinicians in our region remain hesitant to provide live vaccines to pediatric LT recipients, with concerns regarding insufficient safety data. Updated local guidelines may help to address this.