{"id":8137,"date":"2016-07-31T15:29:02","date_gmt":"2016-07-31T19:29:02","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8137"},"modified":"2020-09-04T10:00:50","modified_gmt":"2020-09-04T14:00:50","slug":"summer-id-link-o-rama","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/summer-id-link-o-rama\/2016\/07\/31\/","title":{"rendered":"Summertime Pre-Olympics ID Link-o-Rama"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/07\/28188787890_1be3985223_o.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-8138\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/07\/28188787890_1be3985223_o.jpg\" alt=\"28188787890_1be3985223_o\" width=\"300\" height=\"439\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/07\/28188787890_1be3985223_o.jpg 700w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/07\/28188787890_1be3985223_o-205x300.jpg 205w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a>If you&#8217;re wondering what to do between the end of the presidential conventions, the baseball trade deadline tomorrow, and the start of the\u00a0Summer Olympics, here are a few ID\/HIV related items to contemplate:<\/p>\n<ul>\n<li><strong><a href=\"http:\/\/www.cdc.gov\/media\/releases\/2016\/p0729-florida-zika-cases.html\" target=\"_blank\" rel=\"noopener noreferrer\">Non-travel related Zika arrives in Florida<\/a>.\u00a0<\/strong>Start getting used to seeing more of\u00a0that\u00a0obscure word\u00a0<strong><a href=\"http:\/\/www.merriam-webster.com\/dictionary\/autochthonous\" target=\"_blank\" rel=\"noopener noreferrer\">&#8220;autochthonous&#8221;<\/a>.<strong>\u00a0<\/strong><\/strong> The uncertainty\u00a0was not <em>whether<\/em> Zika\u00a0cases would occur here &#8212; that was inevitable &#8212; but <em>when<\/em> they would happen. Most experts still don&#8217;t think we&#8217;ll have a Brazil-sized outbreak; nonetheless, other southern states will have cases, and until we have better and more widely available\u00a0tests, there will be tremendous anxiety in all affected regions. Meanwhile, we ID doctors<strong>\u00a0<\/strong>continue to wonder why it&#8217;s <strong><a href=\"http:\/\/time.com\/4422580\/cdc-tom-frieden-zika-virus\/?xid=tcoshare\" target=\"_blank\" rel=\"noopener noreferrer\">so hard to get consensus on emergency funding for ID outbreaks.<\/a>\u00a0<\/strong><\/li>\n<li><strong><a href=\"http:\/\/www.nature.com\/nature\/journal\/v535\/n7613\/full\/nature18634.html\" target=\"_blank\" rel=\"noopener noreferrer\">Your nose may harbor antibiotic-producing bacteria.<\/a><\/strong>\u00a0 Tons of media attention for this story! Maybe because that\u00a0old favorite of ID rounds, <em><strong><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/id-learning-unit-coagulase-negative-staph-and-the-anti-zebra-residents-report\/2015\/03\/21\/\" target=\"_blank\" rel=\"noopener noreferrer\">Staph lugdunensis<\/a><\/strong>,\u00a0<\/em>is kindly providing\u00a0the anti-MRSA agent, something the authors call &#8220;lugdunin&#8221;. (Not to be confused, of course, with\u00a0<em>laudanum<\/em>.) This is yet another example of &#8220;colonization resistance&#8221;, a term of increasing relevance all the time.<\/li>\n<li><a href=\"http:\/\/ofid.oxfordjournals.org\/content\/early\/2016\/07\/22\/ofid.ofw155.abstract\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Training ID fellows to do penicillin allergy skin testing in hospitalized patients improved antibiotic use.<\/strong><\/a>\u00a0It&#8217;s always such a relief to remove penicillin allergy from a patient&#8217;s problem list, especially since it&#8217;s a label usually based more on family lore than reality.\u00a0(&#8220;My mother always told me I\u00a0was allergic&#8221;, say even adults of advanced age.) This novel ID (not Allergy) -driven program yielded impressive implementation and outcomes data\u00a0&#8212;\u00a0more than half the patients\u00a0who underwent skin testing then had\u00a0optimization of their antibiotic regimens (narrower spectrum, more cost-effective).<\/li>\n<li><a href=\"http:\/\/aac.asm.org\/content\/60\/8\/4684.abstract?etoc\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Cefazolin is as good (if not\u00a0better)\u00a0than nafcillin for MSSA bacteremia.<\/strong><\/a>\u00a0Yet another study supporting the benefits of cefazolin over nafcillin (or oxacillin). The data from this and prior papers make it abundantly clear that this easier, safer treatment (cefazolin) should\u00a0be chosen in most cases once patients are\u00a0stable. We really do need a randomized clinical trial comparing cefazolin vs nafcillin\/oxacillin for up-front therapy &#8212;\u00a0who&#8217;s going to pay for it?<\/li>\n<li><strong><a href=\"http:\/\/www.fda.gov\/Safety\/MedWatch\/SafetyInformation\/SafetyAlertsforHumanMedicalProducts\/ucm513065.htm\" target=\"_blank\" rel=\"noopener noreferrer\">FDA labels on fluoroquinolones updated to include &#8220;disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system.&#8221;<\/a><\/strong> It is truly remarkable how far these drugs have fallen from their perch just a few years ago as the &#8220;Cadillac of Antibiotics&#8221; (am quoting a patient of mine commenting\u00a0on ciprofloxacin &#8212; I guess even the car reference is a bit stale). It is critical\u00a0to have more data on the frequency and risk factors for these rare but serious quinolone side effects, as this class of drugs is still quite useful.<\/li>\n<li><a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S2352396416303309\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Treatment of acute HIV lowers the HIV &#8220;reservoir setpoint&#8221;,<\/strong><\/a> at least as measured by cell associated HIV DNA. These are the strongest data to date on this potential benefit of <em>very<\/em> early HIV treatment. I write &#8220;potential&#8221; benefit since such early treated patients are those most likely to be amenable to HIV cure strategies.<\/li>\n<li><a href=\"http:\/\/ir.serestherapeutics.com\/phoenix.zhtml?c=254006&amp;p=irol-newsArticle&amp;ID=2190006\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>A &#8220;microbiome&#8221; treatment for C diff failed to prevent recurrences better than placebo.<\/strong><\/a>\u00a0Called SER-109, it is a &#8220;rationally designed ecology of bacterial spores enriched from stool donations obtained from healthy, screened donors.&#8221; It just could be that the natural stuff (ok, poop) has some unquantifiable healthy factors that just can&#8217;t be captured artificially. You know, kind of like real food vs extracted micronutrients given separately as pills, shots, whatever. Real food always wins.<\/li>\n<li><strong><a href=\"http:\/\/journals.cambridge.org\/action\/displayAbstract?fromPage=online&amp;aid=10427050&amp;fileId=S0899823X16001562\" target=\"_blank\" rel=\"noopener noreferrer\">Elimination of routine contact precautions for MRSA and VRE did not increase the rate of these infections.<\/a>\u00a0<\/strong>It&#8217;s a retrospective study, and the hospitals also increased chlorhexidine bathing, but still &#8211;hospital-based clinicians are eagerly awaiting the moment when the futility of\u00a0contact precautions is proven, and subsequently abandoned. Here&#8217;s hoping.<\/li>\n<li><strong><a href=\"https:\/\/www.conversationsforhealth.com\/\" target=\"_blank\" rel=\"noopener noreferrer\">This &#8220;patient simulation&#8221; expertly guides outpatient providers\u00a0on how to avoid prescribing unnecessary antibiotics.<\/a>\u00a0<\/strong>Note that it tries to do so <em>without<\/em> making your patients mad at you, a tough challenge.\u00a0One of our <strong><a href=\"http:\/\/bwhglobalhealthhub.org\/?author=11\" target=\"_blank\" rel=\"noopener noreferrer\">superb social workers<\/a><\/strong> is a <em>huge<\/em>\u00a0fan of motivational interviewing &#8212;\u00a0she\u00a0most definitely would approve.<\/li>\n<li><a href=\"http:\/\/cid.oxfordjournals.org\/content\/early\/2016\/07\/06\/cid.ciw360.full\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Guidelines for treatment of coccidioidomycosis updated.<\/strong><\/a> If you live outside of a cocci-endemic area &#8212; which emphatically includes all of us who work\u00a0in New England &#8212; good treatment guidelines and the email address of the lead author, John Galgiani, are <em>essential items. <\/em>Always makes sense to get help from those who see a lot of this sometimes serious fungal infection.<\/li>\n<li><strong><a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=2536189#Abstract\" target=\"_blank\" rel=\"noopener noreferrer\">Antibiotics for pneumonia can be stopped after 5 days<\/a>, <\/strong>provided patients are\u00a0stable and fever-free for 48 hours.\u00a0Two reasons why short course therapy works: 1) The immune system is probably doing most of the work once patients start to improve; 2) Many cases of CAP aren&#8217;t caused by bacteria anyway!<\/li>\n<li><a href=\"https:\/\/malegislature.gov\/Bills\/189\/House\/H901\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>A bill added to\u00a0the Massachusetts state budget would mandate insurance coverage for long-term antibiotic treatment of Lyme disease.<\/strong><\/a>\u00a0As I&#8217;ve written before, the optimal therapy for patients with residual symptoms after Lyme treatment is anything but clear. Seems legislating coverage in an area of such clinical controversy is not the right move, and <strong><a href=\"http:\/\/www.bostonherald.com\/opinion\/editorials\/2016\/07\/editorial_a_better_lyme_bill\" target=\"_blank\" rel=\"noopener noreferrer\">Gov. Charlie Baker fortunately agrees.<\/a>\u00a0<\/strong><\/li>\n<\/ul>\n<p>Hey, <a href=\"http:\/\/worldhepatitisday.org\/\" target=\"_blank\" rel=\"noopener noreferrer\">World Hepatitis Day<\/a> was this past week (specifically, July 28). Do these &#8220;Diseases Awareness Days&#8221; (I made that term up)\u00a0actually\u00a0do anything? I can understand the motivation, but the cynic in me says that they are just preaching to the already aware. Maybe somebody has done a study of their usefulness?<\/p>\n<p>Oh, and the day after was\u00a0<a href=\"http:\/\/www.nationaldaycalendar.com\/national-lasagna-day-july-29\/\" target=\"_blank\" rel=\"noopener noreferrer\">National\u00a0Lasagna Day.<\/a><\/p>\n<p><em>(Photo source: Library of Congress)<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>If you&#8217;re wondering what to do between the end of the presidential conventions, the baseball trade deadline tomorrow, and the start of the\u00a0Summer Olympics, here are a few ID\/HIV related items to contemplate: Non-travel related Zika arrives in Florida.\u00a0Start getting used to seeing more of\u00a0that\u00a0obscure word\u00a0&#8220;autochthonous&#8221;.\u00a0 The uncertainty\u00a0was not whether Zika\u00a0cases would occur here &#8212; [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[1135,565,630,1136,1041,1118],"class_list":["post-8137","post","type-post","status-publish","format-standard","hentry","category-health-care","tag-acute-hiv","tag-link-o-rama","tag-mrsa","tag-penicillin-allergy","tag-staph-lugdunensis","tag-zika"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8137","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=8137"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8137\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=8137"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=8137"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=8137"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}