The 50th Interscience Conference on Antimicrobial Agents and Chemotherapy, or ICAAC, held its 2010 annual meeting from September 12 to 15 in Boston. Among the news emerging from the meeting was the risk of invasive aspergillosis in non-traditional patients, the continuing danger of sharps injuries, and a new potential treatment for recurrent CDI.

Soap & Water Wipes Reduce Wrestlers’ Skin Infections
A Potential New Treatment for Recurrent CDI
Looking at the Effect of Public Data on Performance
Patients Shed H1N1 Virus Longer
Risk of Invasive Aspergillosis in Non-Traditional Patients
Sharps Injuries Still a Danger

Water Wipes Reduce Wrestlers’ Skin Infections

The Particulars: Skin infections are common among high school wrestlers. The vast majority arise within 1 week following exposure, including tinea corporus, folliculitis/impetigo, and herpetic infections. Weekend tournaments that extend over a 10- to 12-hour period allow for long periods of potential exposure to pathogens that may cause these infections to propagate.

Data Breakdown: A study of 151 high school wrestlers found that those who used soap and water wipes following a match reduced their risk of skin infection by 97% when compared with athletes who used a 75% alcohol wipe or no wipe at all. Those who used soap and water wipes had only one instance of bacterial infection, with an odds ratio (OR) of 0.089. Those in the alcohol wipe group had three bacterial infections and one herpes infection (OR, 0.44). Wrestlers who did not wipe off after a match had four instances of tinea corporis, two bacterial infections, and two outbreaks of herpes.

Take Home Pearl: High school wrestlers may be able to significantly reduce their risk for picking up skin infections during matches by cleaning exposed skin with soap and water wipes after matches.

A Potential New Treatment for Recurrent CDI [back to top]

The Particulars: Clostridium difficile infection (CDI) recurrence occurs in approximately 25% of patients treated with existing therapies. Two phase III clinical studies were designed to evaluate the safety of using fidaxomicin by comparing it with vancomycin, the only FDA-approved product for the treatment of CDI.

Data Breakdown: The multi-center, randomized, double-blind trials enrolled a total of 1,164 adult subjects to evaluate the response to treatment during and after a 10-day course of therapy. Subjects with confirmed CDI received either fidaxomicin (200 mg q12h) or vancomycin (125 mg q6h). Fidaxomicin achieved its primary endpoint of non-inferiority, compared to vancomycin. Fidaxomicin was also statistically superior to vancomycin in global cure rate and in reducing recurrences of CDI.

Take Home Pearl: Phase III clinical trials show that fidaxomicin appears to be superior to vancomycin in the treatment of recurrent CDI and in the prevention of CDI recurrence.

Looking at the Effect of Public Data on Performance [back to top]

The Particulars: Some health plans use public physician report cards and tiered physician networks to direct members toward higher-quality care physicians. However, most patients do not have access to physician quality measures. As a result, they are often encouraged to use publicly available proxies for clinical performance.

Data Breakdown: Researchers used claims data from 1.13 million adults to calculate overall performance scores on 124 quality measures for each of 10,408 Massachusetts physicians. The patients were enrolled in four commercial health plans from 2004 to 2005. The average overall performance score for physicians was 62.5% on all the quality measures, with a range of 48.2% to 74.9% between the 5th and 95th percentile. Of the physician characteristics, three were independently associated with higher overall performance: female sex, board certification, and graduation from a domestic medical school. Although the three characteristics were significant, they had small effects on performance. There was no significant association between performance and malpractice claims or disciplinary actions.

Take Home Pearl: Publicly available data about doctors—including education, sex, board certification, and years of experience—appear to bear little relationship to the performance on clinical quality measures.

Patients Shed H1N1 Virus Longer [back to top]

The Particulars: The CDC currently recommends that people who are infected with the H1N1 flu virus wait at least 1 day after their fever subsides and usually 3 or 4 days after the onset of symptoms before resuming normal activities. Researchers assessed whether patients should consider a longer stay-at-home period to reduce the risk of spreading the infection.

Data Breakdown: Investigators evaluated 70 patients treated in the hospital after they showed signs of the pandemic flu. They found that 80% of patients were still shedding the virus after 5 days of illness, compared with a 40% rate after 7 days and a 10% rate after 10 days. The longest period during which a patient shed virus was 12 days from the start of symptoms. It is still unclear whether shedding the virus following the end of a fever means that patients remain contagious.

Take Home Pearl: People infected with the H1N1 pandemic flu strain appear to continue to shed the virus and may be contagious after the point where current recommendations say they can go back to work or school.

Risk of Invasive Aspergillosis in Non-Traditional Patients [back to top]

The Particulars: Invasive aspergillosis is a serious and potentially deadly infection caused by Aspergillus. It can affect numerous organs throughout the body, including the brain. There is a need for a better understanding of risk factors in patients who are traditionally considered at low risk for the infection so that prompt, specific antifungal therapy can be initiated.

Data Breakdown: A study evaluated 36 patients who were previously considered as low risk for invasive fungal infections and who had invasive fungal infections with Aspergillus over a 5-year period. It found that the most common risk factors associated with the diagnosis of invasive aspergillosis included: steroid use (69%), stays in ICUs (53%), use of immunosuppressive agents (39%), solid organ transplants (33%), diabetes (28%), and chronic obstructive lung disease (22%). Most patients received first-line antifungal treatment with voriconazole. At 90 days after the diagnosis was made and antifungal treatment was initiated, clinical success was observed in 72% of patients.

Take Home Pearls: Infection caused by Aspergillus may be more common than previously thought among patients traditionally considered to be at low risk for the infection. Voriconazole appears to be effective first-line antifungal therapy.

Sharps Injuries Still a Danger  [back to top]

The Particulars: Federal legislation designed to reduce needlesticks and other injuries caused by sharp instruments has had only a modest impact on incidence, with many sharps exposures now occurring even with the use of safety devices.

Data Breakdown: A study was conducted involving 3,117 reports on sharps injuries filed with UCLA’s occupational health office from 1997 to 2009. Of the reports analyzed, researchers found that 426 involved instruments used on patients were seropositive for at least one blood-borne infection. Hepatitis C was the most common, followed by HIV/AIDS and hepatitis B. Nurses had 32% of the exposures involving seropositive patients, with medical interns, residents, and fellows the next most-affected groups, amounting to 23% of exposures; 13% involved dental students. Sharps safety devices were also mishandled often. About half of injuries involving such devices occurred before their safety features were activated.

Take Home Pearls: The majority of all exposures to sharps injuries appears to involve devices that lack safety features. Many medical devices associated with needlestick and sharps injuries do not have engineered safety features. Better device design and more training for hospital workers are recommended.

References

For more information on the news emerging from the 50th ICAAC 2010 annual meeting, as well as further data on the studies presented in this feature story, go to http://www.icaac.org.