Top Infectious Disease News of the Week—December 1, 2019

#5: INSTI-Based ART Associated with Weight Gain, Systolic Blood Pressure Increases

Treatment-naive patients who are prescribed the most common first-line type of antiretroviral therapy (ART) face an elevated risk of increased systolic blood pressure (SBP) and weight gain in the months following the initiation of treatment, according to results of a new study.

The research, published in Open Forum Infectious Diseases, offers new clear data on the impact of integrase strand transfer inhibitor-based ART (INSTI-based ART).

“There were previous data suggesting weight gain associated with INSTI, both in switch and in naïve persons,” said Ronald Galdamez, MD, MSc, the study’s corresponding author. “We aimed to compare specific changes in body mass index in treatment naïve persons initiating different non-INSTI-based ART regimens with INSTI-based ART in which the data was scarce.”

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#4: Household Environments Are a Key Reservoir for MRSA Transmission

Household environments serve as a key reservoir for the transmission of methicillin-resistant Staphylococcus aureus (MRSA), and common interventions such as frequent hand washing can help stop the spread. This is according to a new study that examined household surfaces, family members and pets for a detailed look at how the disease spreads.

The study, published in The Lancet Infectious Diseases, was conducted by investigators at the University of Chicago and Washington University School of Medicine who set out to better understand recurring infections and how MRSA affected multiple family members. The study team followed 692 individuals and 154 cats and dogs in 150 households that included children who had been treated for Staph infections between 2012 through 2015. Each home was visited 5 times within a 1-year period, with people, pets and household surfaces tested for MRSA.

“The level of detail engendered by this study is extremely unique,” corresponding author Stephanie A. Fritz, MD, MSCI, FAAP, FIDSA, FPIDS, associate professor of pediatrics at Washington University School of Medicine, told Contagion^®.

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#3: Entering the Ring: Oral Vancomycin Versus Metronidazole for C difficile Infection and the Risk of Vancomycin-Resistant Enterococcus

Clostridioides difficile infection (CDI) continues to be a tough arena among health care-associated infections and is classified as a major health threat by the US Centers for Disease Control and Prevention. Traditionally, to combat CDI, oral metronidazole was a top contender, recommended as first-line therapy for mild to moderate cases (now known as nonsevere), reserving oral vancomycin for severe CDI.¹ In 2017, however, a guideline update stripped metronidazole of its first-line therapy designation and crowned oral vancomycin as initial therapy for all CDI cases.²

Some providers already regarded oral vancomycin as the champion treatment, but others had concerns about increased indi­vidual and health care costs and emergence of vancomycin-resistant Enterococcus (VRE) from routine use of oral vancomycin. In litera­ture, a link between vancomycin exposure and an increased risk of VRE has been suggested, but these studies have many limitations, such as small populations, heterogeneity, and little to no oral vancomycin representation.^3-5 Oral metronidazole has also been associated with VRE growth and colonization, further clouding predictions of the effect of a widespread prac­tice change.^5,6

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#2: Get Off the SOFA! Introducing the Quick Pitt Bacteremia Score

Scoring systems have been devel­oped and used for decades across a wide variety of ages and illnesses. These scores are intended to measure the degree of illness and provide meaningful predictions for clin­ical outcomes in order to allo­cate resources and guide care. Such systems are commonly used in infectious diseases to predict risks and severity of surgical site or Clostridioides difficile infections or assist clinicians at the point of care for diseases such as pneumonia, sepsis, or bacteremia.^1-9

The focus of this article continues with the number of scoring systems that have been used in bacteremia and sepsis, in particular. Table 1 offers an overview of the clinical and laboratory criteria for select, commonly encountered scoring systems for acute severity of illness.^4-11 Each scoring system brings certain advantages and disadvan­tages for clinical decision making (Table 2). The evolution of these scores has been observed in peer-reviewed litera­ture and national guidelines, most recently with the advent of the quick Sequential Organ Failure Assessment (qSOFA) score supported in the 2016 Surviving Sepsis Campaign.^9-11 Although this is a simple bedside scoring system with no laboratory values required, there is a lack of universal support for this score among leading experts in the field.¹² We will describe the development of a simplified bedside scoring tool derived from the original Pitt bacteremia score (PBS), also referred to as the quick PBS or qPitt.

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#1: Teaching Old Dogs New Tricks: Make the Most of Twitter to Boost ID Education, Engagement, and Advocacy

“Tell me and I forget. Teach me and I remember. Involve me and I learn.” These time-honored words of wisdom from Benjamin Franklin hold true today in medical and pharmacy education as the field advances into social media. Twitter represents a significant evolution in how information is developed and shared, including between people who otherwise would not have been able to connect. Twitter flattens the existent hierarchy, is immediate, and allows timely dissemination of relevant infectious diseases (ID) informa­tion beyond the reach of traditional education methods. Twitter can be an appropriate peda­gogical tool to foster collaborative learning, engagement, and advocacy.

The way students and residents learn is rapidly changing. Currently, most medical and pharmacy students, residents, and early career physicians and pharmacists belong to the millennial generation, consisting of individ­uals born between 1980 and 1999. Millennials prefer a broad spectrum of learning strategies, with fewer lectures and more collaboration with peers.¹

Millennials grew up with social media as an integral part of life. Facebook, Twitter, Instagram, and Snapchat were founded between 2004 and 2011. Most ID mentors and educators are from the baby boomer generation, born from 1946 to 1964. An “old dog” mentor must be willing to learn “new tricks” to educate the next generation of health care providers. Our purpose is to review how we use Twitter to educate, advocate, and engage others in various ID topics. Take a look at our list of popular accounts (Table 1) and a list of handles for the accounts of relevant and influential clinicians and advocates in the space (Table 2).

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