{"id":316,"date":"2009-03-25T19:44:04","date_gmt":"2009-03-26T00:44:04","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=316"},"modified":"2015-06-04T15:31:06","modified_gmt":"2015-06-04T19:31:06","slug":"march-guideline-madness","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/march-guideline-madness\/2009\/03\/25\/","title":{"rendered":"March (Guideline) Madness &#8230;"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2009\/03\/mmbracket_march71.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-thumbnail wp-image-318\" title=\"mmbracket_march7\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2009\/03\/mmbracket_march71.jpg\" alt=\"\" width=\"150\" height=\"109\" \/><\/a>A couple of interesting ID guidelines out this week.\u00a0 For those of you <a href=\"http:\/\/www.voanews.com\/english\/2009-03-25-voa66.cfm\" target=\"_blank\">too busy with basketball<\/a>, here are the relevant links:<\/p>\n<ul>\n<li><a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm5810a4.htm\" target=\"_blank\">Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities.<\/a> Identified in 24 states and now found &#8220;routinely&#8221; in New York and New Jersey, these carbapenem-resistant <em>Enterobacteriaceae <\/em>(&#8220;CPE&#8221; is <em>much <\/em>easier to write and say) are resistant to virtually every available antibiotic.\u00a0 Although these guidelines say that micro labs must do the so-called modified Hodge test (MHT) on enteric gram negatives that have elevated MICs to carbapenems &#8212; but still are within the susceptible range &#8212; it&#8217;s been shown that <a href=\"http:\/\/www.pubmedcentral.nih.gov\/articlerender.fcgi?artid=1951220\" target=\"_blank\">ertapenem resistance provides a surrogate marker<\/a> for this carbapenemase production.\u00a0 Nice recent review of the (scary) topic <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/extract\/300\/24\/2911\" target=\"_blank\">here<\/a>; quick summary of the guidelines <a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm5810a4.htm#box\" target=\"_blank\">here<\/a>.<\/li>\n<li><a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/rr58e324a1.htm\" target=\"_blank\">Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents<\/a>.\u00a0 This massive tome (<em>only<\/em> 207 pages, 1,391 references) was originally released in an on-line version this past summer at <a href=\"http:\/\/www.aidsinfo.nih.gov\/default.aspx\" target=\"_blank\">aidsinfo.nih.gov<\/a>, and I commented on it then in <a href=\"http:\/\/aids-clinical-care.jwatch.org\/cgi\/content\/full\/2008\/721\/1\" target=\"_blank\"><em>AIDS Clinical Care<\/em><\/a>.\u00a0 It is an absolutely critical resource, so valuable that I&#8217;ve referred to it numerous times since then.\u00a0 But to spare you the task of reading through the whole thing again for revisions, I have gone right to the source &#8212; one of the people closely involved in putting the guidelines together &#8212; and asked him, so what&#8217;s changed since the summer?\u00a0 Here&#8217;s his answer:\u00a0 &#8220;The current published document notes that in  HIV-infected adults who need treatment for HBV infection, treatment for both HIV  and HBV infections should be initiated regardless of CD4 cell count.\u00a0 For  persons who wish\u00a0to defer\u00a0HIV therapy, only anti-HBV agents without  any HIV-activity should be used.\u00a0 Oh yeah, and some typos were corrected.&#8221;<\/li>\n<\/ul>\n<p>Happy reading.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A couple of interesting ID guidelines out this week.\u00a0 For those of you too busy with basketball, here are the relevant links: Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities. Identified in 24 states and now found &#8220;routinely&#8221; in New York and New Jersey, these carbapenem-resistant Enterobacteriaceae (&#8220;CPE&#8221; is [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,7,8],"tags":[44,53,67,78,143,326,336,423,450,498,618,678,700,750,756,801,887,911,943],"class_list":["post-316","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-misc","category-patient-care","tag-aids","tag-aidsinfo-nih","tag-antibiotic","tag-antiretrovirals","tag-carbapenem","tag-enterobacteriaceae","tag-ertapenem","tag-hiv","tag-hiv-therapy","tag-infectious-diseases","tag-mics","tag-opportunistic-infections-in-hiv","tag-patient-care","tag-prevention","tag-prognosis","tag-resistance","tag-surrogate-marker","tag-test","tag-treatment"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/316","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=316"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/316\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=316"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=316"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=316"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}