Practice Of Infectious Diseases Research Articles

Waning Interest in Infectious Diseases Among Trainees: Is Medicine Pulling the Goalie?

Abstract Relatively low salaries in infectious diseases (ID) compared to other medical specialties, in a world where cost of living is skyrocketing, are an easy explanation for unmet needs of ID training programs to fill their positions. However, the interest in ID falling short of expectations may reflect that some features of the ID specialty are counter to select pervasive tendencies of modern culture, including (1) slow uptake of innovation into daily routines of ID practitioners, (2) the emphasis of clinical mastery of ID practitioners in an environment of medical corporatization and increased focus on revenue generation, and (3) the fact that ID practice takes societal interests into consideration (eg, prevention of antibiotic resistance) in a world dominated by rights of individuals, frequently at the expense of the common good. This article reflects on these possibilities to determine what steps can be taken to resurrect interest in our specialty.

Impact of Cytomegalovirus (CMV) on an Academic Pediatric Infectious Diseases Outpatient Clinic Referral Population, 2005-2020: Will the Advent of Universal Congenital CMV (cCMV) Screening Change Clinical Practice Referral Patterns?

Cytomegalovirus (CMV) infections exert a substantial impact on the practice of pediatric infectious diseases. Although most infections in children are minimally symptomatic, several populations are at risk for CMV-associated disease, including immunosuppressed children, children with HIV infection, and, most significantly, children with congenital CMV (cCMV) infection. In spite of the ubiquitous nature of CMV infection, few studies have quantified the impact of CMV-associated care in a pediatric outpatient clinic setting. We evaluated the impact of CMV on clinical care in an outpatient clinic setting over a fifteen-year period at the University of Minnesota (UMN) Masonic Children's Hospital Pediatric Infectious Diseases (PID) Clinic. A retrospective review of clinic appointments identified 253 unique patients specifically evaluated over this time period for consideration of CMV infection. Of these, 242 were pediatric patients. The majority of the pediatric patients evaluated in the PID clinic were referred for either confirmed or suspected cCMV infection, including children referred for consideration of CMV as a potential reason for a failed newborn hearing screen (NHS) and/or for evaluation of CMV as a possible etiology for documented hearing loss. In total, 116 of the children evaluated during this time period (48%) were unequivocally confirmed as having cCMV infection, with an additional 37 (15%) presenting with presumed, probable, or possible cCMV infection. A total of 16 (7%) of the pediatric CMV cases were confirmed to be post-natally acquired infections. Of the 253 total patients, 11 (4%) of the referrals were for pregnant patients seeking advice about potential therapies in the setting of a known or suspected primary maternal infection during their pregnancies, with an attendant risk of fetal CMV infection. This overview of the demographics and referral patterns for patients evaluated for known or suspected CMV infections in a tertiary care center outpatient PID clinic will serve as a useful baseline assessment, even as future patterns of outpatient care are highly likely to evolve. We predict that PID clinic referrals for newborns identified by universal cCMV screening programs will result in a shift of the CMV outpatient population to healthier infants with clinically inapparent infections, and care will need to be taken by practitioners not to over-medicalize management for these asymptomatic newborns.

Presentations for HIV post-exposure prophylaxis in emergency departments: guideline and recommendations

Patients often present to emergency departments after potential or confirmed exposure to human immunodeficiency virus (HIV) asking for recommendations concerning the initiation of post-exposure prophylaxis (PEP). These presentations may occur after occupational as well as non-occupational exposure. PEP entails taking atriple antiretroviral therapy for 28-30days. If taken early (ideally within 2 h, but no later than 72 h) and as indicated, HIV infection can be prevented with ahigh level of probability. Since these presentations occur around the clock, they require basic expertise on the part of the emergency department staff regarding its indication and its side effects as well as standardized procedures in the emergency department to not delay initiation. Patients should present to an infectious disease outpatient clinic or practice specialized in HIV in order to have the indication reviewed by aspecialist and, if necessary, adapted to complex cases with the aim of making individual case decisions. This review article aims to summarize core statements of the 2022 German-Austrian guideline on HIV post-exposure prophylaxis and to give emergency department staff necessary knowledge to safely and correctly begin PEP.

Curriculum and Competency Guidelines for the Advanced Care Practitioner in Infectious Disease.

Changes in the health care delivery system have altered the way internal medicine (IM) is practiced, with inclusion of subspecialty advanced care practitioners (ACPs) as vital members of the health care team. ACPs are provided the clinical settings and educational resources within an academic center to become competent in recognizing and managing common and complicated infectious diseases (ID). The ID ACP will be given progressive responsibility with expectations for achievement of milestones as they develop into competent practitioners. We seek to ensure quality, cost-effective, and comprehensive patient-centered care on the ID service in the inpatient and ambulatory settings in compliance with national standards and scope of practice recommendations and regulations. In recognition of the expanding role of ACPs, we developed a curriculum and guidelines in the subspecialty of ID. Our proposal greatly adds to the available literature for ACPs to provide the full spectrum of ID practice.

2200. The Antibiotic Steward's Nightmare: Long-Term Antibiotics in An Infectious Disease Practice

Abstract Background The effects of long-term antibiotic use, including the frequency of recurrent infections and new-onset resistant infections, are not fully understood. The role of antibiotics in the disruption of the gut microbiota has been well-described, impacting insulin susceptibility and lipid deposition. Prolonged antibiotic use may have potential to be implicated in obesity, diabetes, and hyperlipidemia. There may also be an effect on the incidence of secondary infections with new organisms, the frequency of breakthrough infections from the index organism, and the selection for resistant infections. Methods This retrospective study evaluated 78 patients seen at an outpatient infectious disease practice. Inclusion criteria were patients with prescription of an oral antibiotic for 90 or more consecutive days between 9/1/18 and 12/31/2019, who utilize a health system pharmacy. Data was collected from patient charts at baseline prior to antibiotic initiation, and at time of most recent follow up after the initiation of antibiotic. Results Cephalexin (37.2%), azithromycin (34.6%) and amoxicillin (12.8%) were the most common antibiotics prescribed. Mean patient age was 69.4 years. Indications for antibiotic use included NTM infections (34.6% of cases), prosthetic joint infections (21.8%), recurrent UTIs (10.3%), and prosthetic valve infection (7.7%). 23.4% of patients experienced breakthrough infection with the index organism, while 21.8% experienced new, unrelated infection during follow-up, of which 52.9% had a resistant organism isolated. Mean BMI at baseline was 26.9, and BMI at follow-up was 27.3. The difference between baseline and follow-up BMI was not statistically significant (p=0.177). A1C, LDL, and cholesterol rose from baseline to follow-up, but did not reach statistical significance. Conclusion Patients on long-term antibiotics had a numerical increase in BMI, A1C, LDL, and cholesterol values following initiation, but those increases were not statistically significant. Recurrence of infection and emergence of resistance was common. The small sample size and limitation of studying patients from one practice within one health system pharmacy are limitations of the study. Further studies with larger sample sizes and comparative groups by diagnosis are needed. Disclosures All Authors: No reported disclosures

Influence of the coronavirus infectious disease 2019 pandemic on infectious disease practice and infection control in Japan: A web questionnaire survey

IntroductionInfection and mortality rates caused by the coronavirus infectious disease 2019 (COVID-19) pandemic were high. However, the influence of the COVID-19 pandemic on the clinical burden in medical facilities remains to be clarified in Japan. Materials and methodsThis study used a questionnaire-based web survey to clarify how the COVID-19 pandemic affected infectious disease practice and infection control. The questionnaire was sent to healthcare professionals at nationwide medical facilities between January 13, 2023, and February 15, 2023. ResultsResponses were obtained from 1784 healthcare professionals throughout Japan. Hospital management of COVID-19 patients was the responsibility of 96.5% of respondents. Furthermore, 75.1% had experienced nosocomial spread of COVID-19. Manuals and infection control measures for COVID-19 have been arranged in most facilities. In many facilities, the timing of an infected employee's return to work was determined in accordance with the isolation period for coronavirus-positive patients with symptoms established by the Ministry of Health, Labor and Welfare in Japan. Approximately 30% of respondents reported that caring for COVID-19 patients, including the use of personal protective equipment, was their most stressful job. Approximately 50% of the respondents reported an increase in overtime hours. Approximately 90% of facilities are now capable of performing COVID-19 testing onsite. ConclusionInfection control for COVID-19 has been improved, and testing equipment for SARS-CoV-2 has been prepared. Patient care-related burdens and burdens caused by having to compensate for vacancies due to infected staff members have increased. In the future, a reduction in workload and role sharing should be considered.

Qualitative analysis of healthcare provider perspectives to evaluating beta-lactam allergies

There's a lack of understanding of the barriers reported by healthcare providers when evaluating beta-lactam allergies, but knowledge of these barriers is required for practical and effective implementation interventions. We interviewed twenty-five healthcare providers, consisting of physicians, nurses, and pharmacists practicing in the areas of intensive care, emergency medicine, infectious disease, and general hospital practice. Interviews occurred between Sept 2021-July 2023. Twenty-three of the providers were practicing in the United States. A semi-structured interview guide grounded in the theoretical domain framework was used for the interviews. Deductive and inductive analysis was performed on the interview transcripts and translated into intervention recommendations using the Behavior Change Wheel. Widely held beliefs included a lack of clear policy for allergy evaluation, confusing or missing documentation of allergy information, confidence in personal and colleague abilities to evaluate allergies when information is available, and pharmacists as the provider most equipped to evaluate beta-lactam allergies. Health systems should adopt and disseminate policies for beta-lactam allergy evaluation and promote the use of pharmacists in drug allergy evaluation when possible. Allergy sections of electronic health records should be reworked to encourage unambiguous documentation of allergy reactions and support using previously tolerated beta-lactam antibiotics.

Next-generation sequencing: what are the needs in routine clinical microbiology? A survey among clinicians involved in infectious diseases practice.

The translation of Next-Generation Sequencing (NGS) from research to clinical microbiology is increasing rapidly, but its integration into routine clinical care struggles to catch-up. A challenge for clinical laboratories is that the substantial investments made in the required technologies and resources must meet both current and forthcoming needs. To get a clinical perspective of these needs, we have sent a survey to infectious diseases clinicians of five hospitals, covering the following topics: NGS knowledge, expected syndromes and patients foreseen to benefit from NGS, and expected impact on antimicrobial prescription. According to clinicians, benefits of NGS are mostly expected in neurological and respiratory infections diagnostics. A better dialog between microbiologists and clinicians about hopes and limits of NGS in microbiology may help identifying key investments needed for clinical laboratories, today and tomorrow.

Penser le dossier patient informatisé comme un outil pour les infectiologues: une démarche nécessaire pour le futur de la discipline

This expert perspective scrutinizes our engagement with electronic patient records, a vital instrument for infectious disease specialists in both patient care and the prudent use of anti-infectives. The authors propose the potential for enhancing these tools through user-centered design and system workflow improvements, along with the implementation of best practices gleaned from the scientific management of information systems. Such transformations could be expedited with the coordinated participation of the discipline professionals to assist in articulating needs and conducting evaluations in active partnership with the creators of these technologies. Concluding, the article presents a series of contemplations on possible advancements of new generations of electronic patient record components, particularly beneficial for infectious disease practice. These include tools specifically dedicated to the management of anti-infective treatments, the reporting of microbiological results, the synthesis of infectious disease medical data, vaccination management, epidemic management, and prevention of infectious risk.

Impact of practice quizzes on student perceptions and assessment outcomes of a third-year pharmacotherapy course

Background: Practice quizzes have been associated with student learning, comprehension, and retention. This study aims to assess the impact of practice quiz utilisation for an infectious disease (ID) pharmacotherapy course. Methods: Student performance data for practice quizzes and assessments were collected. A survey was administered regarding student perception information of the practice quizzes. Results: Most students (95%) completed at least one quiz. For most of the quizzes (15/20), the number of quiz attempts among students who met the 80% competency bar was statistically higher than that of those who did not meet competency on course tests. Most students agreed/strongly agreed the quizzes impacted examination study behaviours (86%), performance (89%), and confidence (90%). Students supported additional course implementation of quizzes (97%), planned to utilise available practice quizzes in the future (96%), and would recommend them to other students (91%). Conclusion: ID practice quizzes were well received by students and may be a valuable learning tool.

Impacts of routine varicella vaccination program and COVID-19 pandemic on varicella and herpes zoster incidence and health resource use among children in Japan

PurposeTo determine the epidemiological trends in pediatric varicella and herpes zoster incidence and changes in healthcare resource use from 2005 to 2022 using a nationally representative database in Japan. Materials and methodsWe conducted a retrospective observational study consisting of 3.5 million children with 177 million person-months during 2005–2022 using Japan Medical Data Center (JMDC) claims database in Japan. We investigated trends in incidence rates of varicella and herpes zoster and changes in healthcare resource use (e.g., antiviral use, office visits, and healthcare costs) over 18 years. Interrupted time-series analyses were used to investigate the impact of the routine varicella vaccination program in 2014 and infection prevention measures against COVID-19 on incidence rates of varicella and herpes zoster and related healthcare utilization. ResultsAfter the introduction of the routine immunization program in 2014, we observed level changes in incidence rates (45.6 % reduction [95 %CI, 32.9–56.0] of varicella cases, antiviral use (40.9 % reduction [95 %CI, 25.1–53.3]), and relevant healthcare costs (48.7 % reduction [95 %CI, 38.2–57.3]). Furthermore, infection prevention measures against COVID-19 were associated with additional level changes in varicella rates (57.2 % reduction [95 %CI, 44.5–67.1]), antiviral use (65.7 % reduction [59.7–70.8]), and healthcare costs (49.1 % [95 %CI, 32.7–61.6]). In contrast, the changes in incidence and healthcare costs for herpes zoster were relatively small, which showed 9.4 % elevated level change with a decreasing trend and 8.7 % reduced level change with a decreasing trend after the vaccine program and the COVID-19 pandemic. The cumulative incidence of herpes zoster in children born after 2014 was lower than that before 2014. ConclusionsVaricella incidence and healthcare resource use were largely affected by the routine immunization program and infection prevention measures against COVID-19, while these impacts on herpes zoster were relatively small. Our study indicates that immunization and infection prevention measures largely changed pediatric infectious disease practices.

Editorial introductions.

Editorial introductions.

Treatment decisions in VRE bacteraemia: a survey of infectious diseases pharmacists.

VRE infections increased in 2020. High-dose daptomycin (≥10 mg/kg) has shown mortality benefit over other regimens, though daptomycin resistance is increasing. Limited data exist on the practice patterns of ID pharmacists for VRE bloodstream infections (VRE BSIs). To describe practice patterns for VRE BSI in ID pharmacists. A 22-question REDCap survey was distributed to ID pharmacist members of the American College of Clinical Pharmacy (ACCP) Infectious Diseases Practice and Research Network (ID PRN) via e-mail listserv. The survey was distributed on 7 April 2022 and remained open for 4 weeks. Sixty-eight pharmacists responded. All pharmacists completed additional training or certification in infectious diseases past their PharmD, and most (70.5%) had been practising for 10 years or less. Pharmacists at academic medical centres (80.0%) were more likely (P = 0.001) to have implemented the updated CLSI breakpoints than pharmacists at other types of institutions (55.2%). Daptomycin was the preferred drug for VRE BSI (92.6%), with 10 mg/kg (72.1%) being the preferred dose. Adjusted body weight was the most common weight (61.2%) used for obese patients. Fourteen days (76.1%) was the most common treatment duration for VRE BSI. Pharmacists defined persistent VRE BSI as 5 days (68.7%) after first blood culture. ID pharmacists overwhelmingly selected high-dose daptomycin for VRE BSI. There were variations in practice and response rate when selecting combination therapy, managing persistent bacteraemia, and treating patients with high daptomycin MICs or previous exposure to daptomycin.

Potential Use of Artificial Intelligence in Infectious Disease: Take ChatGPT as an Example

Over the past month, a new AI model called Chatbot Generative Pre-trained Transformer (ChatGPT), has received enormous attention in the media and scientific communities due to its ability to process and respond to commands in a humanistic fashion. As reported, five days after its launch, the number of registered users of ChatGPT exceeded one million, and its monthly active users had exceeded 100 million two months later, making it the most rapidly growing consumer application in history. The advent of ChatGPT has further brought about new ideas and challenges in the realm of infectious disease. In view of this, in order to evaluate the potential use of ChatGPT in clinical practice and scientific research of infectious disease, we conducted a brief online survey by using the publicly available ChatGPT webpage. Also, the present study also talks about the relevant social and ethical issues related to this program.

Transplantid.net: A Pilot Crowdsourced, Living, Online Library of Resources for the Teaching and Practice of Transplant Infectious Diseases.

The field of transplant infectious diseases is rapidly evolving, presenting a challenge for clinical practice and trainee education. Here we describe the construction of transplantid.net, a free online library, crowdsourced and continuously updated for the dual purpose of point-of-care evidence-based management and teaching.

2084. Importance of the Primary Care Physician in HIV PrEP Adherence During a Pandemic

Abstract Background In 2015 emtricitabine-tenofovir (PrEP) was approved for use as a pre-exposure prophylactic medication for preventing HIV infections. In 2017, WHO declared PrEP to be an essential medicine, gaining widespread acceptance for outpatient care. In 2020, the COVID-19 pandemic disrupted the healthcare system, with several studies showing lower rates of PrEP prescriptions during the pandemic particularly among Black and Latinx groups. Methods Medical records at Rutgers New Jersey Medical School (NJMS) were queried for PrEP prescriptions from 2017-2021. All duplicate entries, and all patients prescribed emtricitabine and tenofovir as part of HIV treatment were removed. Years 2017-2019 were defined as “pre-pandemic” and years 2020-2021 were defined as “pandemic.” Results Average annual prescriptions for PrEP at NJMS decreased by only 13% (157 to 137 p=0.53) for all ages and 25% (29 to 22 p=0.38) for adolescents and young adults (ages 16-24) (AYA) from pre-pandemic to pandemic years. The annual number of AYAs who had their PrEP prescribed by the Division of Adolescent and Young Adult Medicine practice (DAYAM) remained the same during the pandemic while the annual number of AYAs who had their PrEP prescribed by the Infectious Disease practice (IDP) decreased by over 50% (p = 0.07). PrEP prescriptions for trans-identifying individuals (over 90% prescribed by the IDP) increased by 15% (p = 0.58). PrEP Prescriptions for Adolescents and Young Adults All PrEP Prescriptions at Rutgers NJMS Conclusion Despite the national decline in PrEP prescriptions during the COVID-19 pandemic, NJMS experienced a non-statistically significant decrease in PrEP prescriptions despite serving a majority Black and Latinx population who have elsewhere suffered the most disruption in healthcare during the pandemic. At NJMS, the IDP provides primary care for trans-identifying individuals, and DAYAM provides primary care for AYAs. Average annual PrEP prescriptions for trans-identifying individuals increased and AYA PrEP prescriptions by the DAYAM remained the same throughout the pandemic emphasizing the key role primary care physicians have in PrEP access during the pandemic and may play a significant role in the strong continuation of PrEP program provided at NJMS throughout the pandemic. Disclosures All Authors: No reported disclosures.

Intensivists' perceptions and attitudes towards infectious diseases management in the ICU: An international survey.

Exploring infectious diseases (ID) practice in Intensive Care Unit (ICU) to identify gaps and opportunities. Online international survey (PRACT-INF-ICU) endorsed by the ESICM and open from July 30, 2019 to October 19, 2019. International study conducted in 78 countries. Physicians working in ICU. None. Practice variations were assessed according to respondents' countries income class, training, and years of practice. Univariate and multivariate ordinal logistic regression were used to estimate associations between respondents' characteristics and their perceptions regarding adequacy of training. 466 intensivists with a median practice of 10 years (interquartile range, 5-19) completed the survey. A third reported no antimicrobial stewardship program and 40% had no regular microbiological rounds in their ICUs. Intensivists were mostly the decision makers for the initial antimicrobial therapy which in 70% of cases were based on guidelines or protocols. Non-ICU expertise were sought more frequently on reviewing (48/72h, culture adjustment and discontinuation in 32%, 39% and 21% respectively) rather than antimicrobial therapy initiation (16%). Only 42% described ID training as adequate. Multivariate ordinal logistic regression showed that low- to middle-income countries (OR: 0.41, 95% CI: 0.28-0.61), ICU practice ≤10 years (OR: 0.55, 95% CI: 0.39-0.79), and dual training with anaesthesia (OR: 0.52, 95% CI: 0.34-0.79) or medicine (OR: 0.49, 95% CI: 0.32-0.76) were associated with less training satisfaction. ID practice is heterogeneous across ICUs while antimicrobial stewardship program is not universally implemented. From intensivists' perspective, ID training and knowledge need improvement.

AN UNUSUAL CASE OF SUBACUTE BACTERIAL ENDOCARDITIS PRESENTING WITH CATASTROPHIC SUBARACHNOID HEMORRHAGE

AN UNUSUAL CASE OF SUBACUTE BACTERIAL ENDOCARDITIS PRESENTING WITH CATASTROPHIC SUBARACHNOID HEMORRHAGE

A RARE CAUSE OF COMMUNITY-ACQUIRED BACTERIAL PNEUMONIA IN A PATIENT WITH POORLY CONTROLLED DIABETES

A RARE CAUSE OF COMMUNITY-ACQUIRED BACTERIAL PNEUMONIA IN A PATIENT WITH POORLY CONTROLLED DIABETES

Current state of antimicrobial stewardship in solid organ transplantation in Israel.

We aimed to review the current state, challenges, and needs of antimicrobial stewardship programs (ASPs) in adult solid organ transplantation (SOT) centers in Israel. We conducted a survey using electronic questionnaires sent during February 2022 to infectious disease (ID) consultants of SOT centers, encompassing general and organ-specific ASP issues. All six centers performing adult SOTs in Israel participated. The institutional ASPs in all centers included SOT recipients, and five centers had specific stewardship activities targeting SOT recipients. ASP activities were performed by ID consultants in all centers, with clinical pharmacists in most. ASP protocols and activity scope were highly variable. Formulary restriction with pre-authorization was used in all centers. Antibiotic allergy was addressed in ASP guidelines in half of the centers. Peri-transplantation antibiotic, antifungal, and antiviral prophylactic regimens varied based on center, transplanted organ, and patient risk group. Approaches to surveillance cultures, diagnosis and treatment of various graft infections were also variable. ASP outcome measurement was not performed in all centers. The main challenges and barriers to successful ASP implementation were difficulty in defining appropriate durations of therapy for certain infections, high rates of antimicrobial resistance (AMR), and lack of dedicated ASP teams. Antimicrobial stewardship in SOT centers in Israel is performed by ID consultants and practices vary. Challenges are related to high AMR rates, insufficient evidence to support practices, lack of dedicated ASP teams, and lack of outcome measurement. There is an urgent need to establish a national collaborative program including all SOT centers.