New research was presented at IDWeek 2015, the combined annual meeting of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, HIV Medicine Association, and Pediatric Infectious Diseases Society, from October 7-11 in San Diego. The features below highlight some of the studies that emerged from the conference. This is the first part of a two-part series of coverage from IDWeek 2015.
TB Biomarker Identified
The Particulars: Few studies have explored the possibility of biomarkers being helpful for diagnosing tuberculosis (TB) and making a prognosis for patients with the disease.
Data Breakdown: For a study, researchers collected and analyzed clean catch urine samples from untreated patients with TB. Data were also reviewed on a subset of patients who received the first 3 months of therapy for TB. Urine samples from patients with TB were compared with samples from matched healthy participants. One compound—the 490 urinary biomarker—was different across all data sets, with nearly 55,000 counts of the biomarker being seen in patients with active pulmonary TB compared with counts of just 7,500 in healthy participants. The average abundance of the 490 urinary biomarker decreased from nearly 76,000 counts to 18,000 counts after 2 months of treatment.
Take Home Pearl: The 490 urinary biomarker may potentially serve as a duel diagnostic and prognostic marker of active pulmonary TB.
Many Children & Adolescents Susceptible to Measles
The Particulars: Data are lacking on the estimated number of children and adolescents who are currently susceptible to measles infection.
Data Breakdown: Answers to a poll of healthcare provider-verified responses regarding children and adolescent immunization coverage were assessed for a study. Investigators found that 12.5% (8.7 million) of children and adolescents aged 17 or younger were at risk for measles. Among those aged 3 or younger, 24.7% were at risk for the disease. Also, nearly 5% of participants aged 17 had not received a measles vaccination.
Take Home Pearl: Data indicate that about one in eight children and adolescents is at risk for measles infection.
The Benefits of Reoffering HIV Testing
The Particulars: Early HIV detection and treatment has been shown in previous research to significantly decrease morbidity and mortality as well as reduce risks of transmitting the virus to others. However, studies also show that rates of HIV testing are less than ideal.
Data Breakdown: For a study, researchers examined the HIV screening rates of patients admitted to the internal medicine service of a hospital. Participants were assigned to groups that either 1) received basic HIV testing services and were offered HIV testing by trained counselors before the second day of their hospital stay (intervention group) or 2) received screening for HIV regardless of whether they were screened before or on the second day of their hospital stay (control group). HIV testing rates were 10.3% for the control group and 65.4% for the intervention group.
Take Home Pearl: Rates of HIV testing appear to be significantly higher when patients are offered these screenings by trained counselors on the second day of admission when compared with when patients are offered testing only at the point of entry to care.
Age Has Little Impact on CDI Risk
The Particulars: Studies are lacking on whether or not the increased of incidence in Clostridium difficile infection (CDI) with age is due to chronologic age or biologic age.
Data Breakdown: Patients aged 66 and older who were diagnosed with new-onset CDI in 2011 were compared with control patients without CDI for a study. The research team found that Caucasians had a higher risk for CDI when compared with other races, and women were at greater risk than men. Chronic renal failure, rheumatoid arthritis, lymphoma/leukemia, metastatic cancer, deficiency anemia, and dementia increased risks for CDI. Infections in the 3 months prior to CDI that increased the risk for CDI included septicemia, pneumonia, osteomyelitis, surgical site infections, urinary tract infections, skin/soft tissue infections, oral infections, and viral infections. Emergent hospitalization, elective hospitalization, treat-and-release ED visits, nursing home residence, short-term skilled nursing facility care, and invasive procedures also correlated with higher risks for CDI. When the researchers controlled for the variety of different exposures in the prior year, any association between age and CDI risk was almost completely removed.
Take Home Pearl: Overall health status—rather than chronological age—appears to be the most important determinant of CDI risk.
Needle Exchange Reduces Risk Behavior
The Particulars: Needle exchange programs have been used as a key component of HIV outbreak response initiatives. However, data are lacking on the ability of these programs to reduce the frequency of syringe sharing among injection drug users (IDUs) at risk for HIV infection.
Data Breakdown: In January 2015, health officials in Indiana began investigating an HIV outbreak among more than 500 syringe-sharing members or a rural community. Following the provision of a needle exchange program, study investigators examined injection-related risk behaviors reported over time among participants in the program. Participants received sterile syringes, a wound kit, harm reduction education, and referrals to health and substance use treatment services. They also completed surveys about their current risk behaviors. Among the findings:
|First visit||Last visit|
|Proportion of IDUs sharing syringes||18%||5%|
|Average frequency of IDUs reusing the same syringe||Two times||One time|
|Average number of syringes returned||0||57|
|Average number of new syringed distributed||35||63|
|Percentage of IDUs sharing syringes to divide drugs||19%||4%|
|Percentage of IDUs sharing other injection equipment||24%||5%|
Take Home Pearl: Needle exchange programs appear to significantly reduce the sharing of syringes among IDUs during an HIV outbreak.
Pediatric Antimicrobial Stewardship & CDI
The Particulars: Few studies have assessed the effect of pediatric antimicrobial stewardship programs on Clostridium difficile infection rates and costs.
Data Breakdown: Researchers analyzed data from before and after the initiation of an antimicrobial stewardship program at a children’s hospital. As part of the program, a pediatric infectious diseases specialist and pharmacist reviewed all patients receiving antimicrobials three times per week. The rate of CDIs decreased from 9.2 per 10,000 patient days before the program was started to 2.8 per 10,000 patient days after initiating the intervention. In addition, antibiotic-associated costs dropped by about 20% after starting the program.
Take Home Pearl: Pediatric antimicrobial stewardship programs appear to significantly reduce the rate of CDI and antibiotic-associated costs.
Bloodstream Infections After Live Transplantation
The Particulars: Studies of liver transplant recipients have yet not clearly described the incidence and impact of bloodstream infections.
Data Breakdown: Nearly 8,000 liver transplant recipients participated in a study in which investigators sought to determine the incidence of bloodstream infections after live transplantation. The authors also assessed factors associated with bloodstream infections and mortality among liver transplant recipients. Overall, the incidence of bloodstream infections was 29% after liver transplantation. The following factors were associated with bloodstream infections:
- Transplant failure/rejection.
- Post-transplant laparotomy.
- Increasing age.
- Female gender.
Patients with bloodstream infections had an adjusted hazard ratio of 4.7 for mortality. Patients with bloodstream infections had 1-year post-transplant hospital costs of $661,533, compared with costs of $344,766 for those who did not develop these infections.
Take Home Pearl: Bloodstream infections appear to be a common, deadly, and costly complication among patients who undergo liver transplants.
ACA’s Impact on HIV Patients
The Particulars: Prior to the Affordable Care Act (ACA), AIDS Drug Assistance Programs (ADAPs) in each state were among the most important providers of antiretroviral therapy to uninsured or underinsured patients with HIV. With the advent of the ACA, many ADAPs—including the one in Virginia—shifted their focus from providing medications directly to purchasing insurance. The impact of this shift is not well known.
Data Breakdown: Researchers conducted a study to characterize demographic and systems-level factors in ADAP clients from Virginia who enrolled in ACA. They then assessed the relationship between ACA enrollment and HIV viral suppression. Among those who enrolled in ACA health plans when they became available in 2014, 85.5% achieved viral suppression, compared with a rate of 78.7% that was observed among those who remained on older forms of HIV coverage. Patients aged 25 to 44, men, and African Americans were less likely to make the change from ADAPs to the ACA than their counterparts.
Take Home Pearl: Enrollment in healthcare plans under ACA appears to improve treatment outcomes for patients with HIV when compared with remaining on older forms of HIV coverage.
Chlamydia, Gonorrhea, & HIV in MSM
The Particulars: Previous research has shown that sexually transmitted diseases (STDs) are common among men who have sex with men (MSM). However, few studies have explored the rates of chlamydia and gonorrhea among MSM with HIV.
Data Breakdown: A sample of adult MSM with HIV who did not demonstrate symptoms of an STD infection and who did not receive chlamydia or gonorrhea treatment in the previous 3 weeks were examined for a study. Participants underwent urine, rectum, and oropharynx screening. Overall rates of chlamydia and gonorrhea infection were 18 and 17 times greater, respectively, than rates detected through public health screening in the surrounding community. The combined incidence rate for both infections was slightly more than 12%, with incidence rates of 11% for chlamydia and 3% for gonorrhea among study participants. The researchers found that 75% of chlamydia infections and 100% of gonorrhea infections would have been missed if participants had only undergone urine screenings.
Take Home Pearls: MSM with HIV appear to experience high rates of asymptomatic chlamydia and gonorrhea. Urine screening alone may miss the majority of these cases.
Falls & Coexisting Systemic Infections
The Particulars: Studies show that falls are frequently cited as a chief complaint among patients seeking medical care. Research has not established the characteristics of patients presenting with a fall who are subsequently found to have a coexisting systemic infection that might have served as a contributing factor to the fall.
Data Breakdown: Investigators in Boston conducted a retrospective study of hospital patients who had a fall as their chief complaint and a coexisting systemic infection at the time of presentation. The following infections were seen most commonly among the study participants:
|Urinary tract infection||42.2%|
|Respiratory tract infection||26.1%|
The authors noted, however, that coexisting systemic infection was not suspected in 40.5% of evaluable patients. Falls that were suspected of being the direct result of infection occurred in 13.9% of evaluable cases. Overall, fall patients had an in-hospital mortality rate of 18.0%.
Take Home Pearl: Coexisting systemic infections in patients presenting with a chief complaint associated with a fall appear to be common but are often not suspected by clinicians. Fall patients with coexisting infections also appear to have significant in-hospital mortality rates.
For more information on these studies and others that were presented at IDWeek 2015, visit http://www.idweekinternational.com.