{"id":8411,"date":"2017-09-04T12:35:33","date_gmt":"2017-09-04T16:35:33","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8411"},"modified":"2019-01-18T15:15:27","modified_gmt":"2019-01-18T20:15:27","slug":"meropenem-vaborbactam-zika-cases-decline-gas-station-nachos-and-more-an-end-of-summer-id-link-o-rama","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/meropenem-vaborbactam-zika-cases-decline-gas-station-nachos-and-more-an-end-of-summer-id-link-o-rama\/2017\/09\/04\/","title":{"rendered":"Meropenem-Vaborbactam, Zika Cases Decline, Gas Station Nachos, and More &#8212; An End-of-Summer ID Link-o-Rama"},"content":{"rendered":"<div id=\"attachment_8457\" style=\"width: 310px\" class=\"wp-caption alignright\"><a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/09\/Labor-Day-CO-1940.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-8457\" class=\"wp-image-8457 size-medium\" src=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/09\/Labor-Day-CO-1940-300x212.jpg\" alt=\"\" width=\"300\" height=\"212\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/09\/Labor-Day-CO-1940-300x212.jpg 300w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/09\/Labor-Day-CO-1940-768x542.jpg 768w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/09\/Labor-Day-CO-1940.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-8457\" class=\"wp-caption-text\">Labor Day amusement, 1940.<\/p><\/div>\n<p>There&#8217;s <em>so much<\/em> interesting ID material out there.<\/p>\n<p>The only solution &#8212; an ID Link-o-Rama, especially curated for the long Labor Day weekend.<\/p>\n<p>(Actually, not really, but that sounded good.)<\/p>\n<p>Off we go!<\/p>\n<ul>\n<li><a href=\"https:\/\/academic.oup.com\/cid\/article-abstract\/doi\/10.1093\/cid\/cix468\/3836421\/Influenza-Vaccination-Modifies-Disease-Severity?redirectedFrom=fulltext\" target=\"_blank\" rel=\"noopener\"><strong>Even if it doesn&#8217;t provide 100% protection, the flu vaccine may reduce the severity of influenza.<\/strong><\/a> Good to have this paper handy as clinics start to ramp up immunizations.<\/li>\n<li><a href=\"http:\/\/www.wbur.org\/commonhealth\/2017\/08\/31\/lyme-disease-reporting-lessons\" target=\"_blank\" rel=\"noopener\"><strong>Here are several sensible observations about Lyme Disease from a local physician.<\/strong><\/a>\u00a0Not surprisingly, the first comments from readers are various forms of criticism. Sigh.<\/li>\n<li><a href=\"https:\/\/www.fda.gov\/NewsEvents\/Newsroom\/PressAnnouncements\/ucm573955.htm\" target=\"_blank\" rel=\"noopener\"><strong>The FDA approved meropenem-vaborbactam (Vabormere) for complicated urinary tract infections.<\/strong><\/a> Based on the clinical trials of this agent, however, its true indication should be treatment of carbapenem-resistant\u00a0enterobacteriaceae (CRE). Take it from Brad Spellberg (who emphatically will <em>not<\/em> be in charge of marketing this drug):<\/li>\n<\/ul>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\">FDA indication only relevant to control marketing. This is a CRE drug &amp; that&#39;s what it should be used for. Any other use borders on criminal<\/p>\n<p>&mdash; Brad Spellberg (@BradSpellberg) <a href=\"https:\/\/twitter.com\/BradSpellberg\/status\/903086328396431361?ref_src=twsrc%5Etfw\">August 31, 2017<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<ul>\n<li><a href=\"https:\/\/www.cdph.ca.gov\/Programs\/OPA\/Pages\/NR17-047.aspx\" target=\"_blank\" rel=\"noopener\"><strong>One person died, 9 others were sickened by botulism from gas station nachos.<\/strong><\/a>\u00a0As if we needed any other reason to avoid <em>gas station nachos. <\/em>Yuck.<\/li>\n<li><a href=\"https:\/\/www.newyorker.com\/tech\/elements\/is-zika-gone-for-good\" target=\"_blank\" rel=\"noopener\"><strong>The incidence of Zika in endemic areas is dropping rapidly.<\/strong><\/a> But it&#8217;s not gone, and Zika&#8217;s permanent departure cannot be counted on. This is a nice quick summary of the mysterious coming and going of an epidemic, with the best explanation for its decline the effects of &#8220;herd immunity&#8221; &#8212; many got infected, never got sick, and are now protected from reinfection. As a result, they don&#8217;t pass Zika on to mosquitos or other people.<\/li>\n<li><a href=\"https:\/\/www.statnews.com\/2017\/09\/02\/sanofi-zika-vaccine\/\" target=\"_blank\" rel=\"noopener\"><strong>With Zika incidence down, one company has pulled its plans to develop a vaccine.<\/strong><\/a> Difficult to test a vaccine&#8217;s efficacy when people are no longer acquiring the infection &#8212; how do you prove it&#8217;s working? And of course the market will be uncertain, to put it mildly.<\/li>\n<li><strong><a href=\"http:\/\/www.ccsenet.org\/journal\/index.php\/jfr\/article\/view\/67217\/37099\" target=\"_blank\" rel=\"noopener\">Blowing out birthday candles increases bacterial transfer to the cake by 1400%.<\/a>\u00a0<\/strong>The findings from this study represent either an unrecognized major health hazard or, conversely, a perfect example of why ID doctors are sometimes the deserved subject of ridicule. And in case you want another &#8220;germs are everywhere&#8221; study, which are irresistible click-bait, here&#8217;s more:<\/li>\n<li>\n<div id=\"attachment_8458\" style=\"width: 310px\" class=\"wp-caption alignright\"><a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/09\/spongebob.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-8458\" class=\"wp-image-8458 size-full\" src=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/09\/spongebob.jpg\" alt=\"\" width=\"300\" height=\"300\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/09\/spongebob.jpg 300w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/09\/spongebob-150x150.jpg 150w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/09\/spongebob-144x144.jpg 144w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-8458\" class=\"wp-caption-text\">SpongeBob SquarePants, thrilled by latest microwave study.<\/p><\/div>\n<p><a href=\"https:\/\/www.nature.com\/articles\/s41598-017-06055-9\" target=\"_blank\" rel=\"noopener\"><strong>Microwaving your sponge increases the growth of potentially harmful bacteria.<\/strong><\/a>\u00a0Not only that, it&#8217;s terrible for browning &#8212; to get good, crisp, golden-brown sponge skin, I suggest roasting or pan-searing.<\/li>\n<li><a href=\"https:\/\/academic.oup.com\/ofid\/article\/4\/2\/ofx084\/3778088\/Ceftaroline-for-Severe-Methicillin-Resistant#89361769\" target=\"_blank\" rel=\"noopener\"><strong>Ceftaroline may be an effective option for severe MRSA infections.<\/strong><\/a>\u00a0This is a welcome review (disclosure, done by colleagues of mine), especially since there are no prospective studies of ceftaroline for this indication. A ceftaroline plus daptomycin vs vancomycin comparative study for MRSA bacteremia would be optimal &#8212; though doubt it will ever happen.<\/li>\n<li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28825943\" target=\"_blank\" rel=\"noopener\"><strong>Does switching to a dolutegravir-based regimen cause weight gain?\u00a0<\/strong><\/a>This is the second published paper implying such an effect (the first is <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28574967\" target=\"_blank\" rel=\"noopener\">here<\/a>). Hard to come up with a plausible mechanism. Still, weight gain from HIV therapy <em>in general<\/em> remains a knotty unsolved problem.<\/li>\n<li><a href=\"https:\/\/academic.oup.com\/cid\/article-abstract\/64\/10\/1374\/3055687\/Echinocandins-Compared-to-Fluconazole-for?redirectedFrom=fulltext\" target=\"_blank\" rel=\"noopener\"><strong>In candidemia from a urinary source, early drainage improves outcome.<\/strong><\/a> A reminder that the vast majority of these cases relate to obstruction of some sort that needs remediation (surgical, percutaneous, or endoscopic).<\/li>\n<li><a href=\"https:\/\/academic.oup.com\/cid\/article-abstract\/64\/6\/810\/2747460\/Occupational-HIV-Infection-in-a-Research?redirectedFrom=fulltext\" target=\"_blank\" rel=\"noopener\"><strong>A researcher contracted HIV in a laboratory despite no known breach of infection control.<\/strong><\/a>\u00a0Exactly how this happened remains unclear, but the phylogenetic analysis of the virus supports this was a lab-based isolate. Transmission of HIV in the lab or hospital setting is (fortunately) so rare that any such event deserves special scrutiny.<\/li>\n<li><a href=\"https:\/\/www.economist.com\/blogs\/graphicdetail\/2016\/10\/daily-chart-7\" target=\"_blank\" rel=\"noopener\"><strong>Compared to 1990, global deaths due to communicable diseases are down substantially.<\/strong> <\/a>The only condition showing an increase is HIV\/AIDS &#8212; and if we looked at death rates since the expansion of ART in the early 2000s, these are down too.<\/li>\n<li><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMp1706492#t=article\" target=\"_blank\" rel=\"noopener\"><strong>Taking responsibility for treating opiate addiction is a natural fit for some ID doctors.<\/strong><\/a> It&#8217;s not easy, and requires additional training, but among the various medical subspecialists, who better than ID? This <a href=\"http:\/\/www.bostonglobe.com\/metro\/2017\/09\/01\/infectious-disease-doctors-join-fight-against-opioid-addiction\/LhdOlb2CUqeGoIAr6U5VqJ\/story.html?event=event12\" target=\"_blank\" rel=\"noopener\">follow-up piece in the Boston Globe<\/a> makes the excellent point that, like treating HIV, our field is taking on a highly stigmatized illness (opiate use disorder) &#8212; one with numerous infectious complications.<\/li>\n<li><a href=\"https:\/\/harpers.org\/archive\/2017\/09\/public-enemy\/\" target=\"_blank\" rel=\"noopener\"><strong>Martin Shkreli, the guy responsible for increasing the price of pyrimethamine 5000%, isn&#8217;t well liked.<\/strong> <\/a>\u00a0I know, shocking. Still, reading this transcript from his recent jury selection is quite something. Imagine if this were your legacy.<\/li>\n<li><a href=\"https:\/\/academic.oup.com\/jac\/article\/4076634\/Dental-staining-after-doxycycline-use-in-children\" target=\"_blank\" rel=\"noopener\"><strong>Maybe doxycycline doesn&#8217;t cause dental staining in children after all.<\/strong><\/a> It&#8217;s a small study (n=38), but the results are reassuring &#8212; especially in a highly Lyme- and anaplasma-endemic region like this one!<\/li>\n<li><a href=\"https:\/\/academic.oup.com\/ofid\/article\/4\/3\/ofx147\/3982949\/Clofazimine-in-Nontuberculous-Mycobacterial#95186959\" target=\"_blank\" rel=\"noopener\"><strong>Clofazimine has a growing role in treating non-tuberculous mycobacteria.<\/strong><\/a>\u00a0Unfortunately, obtaining clofazimine for\u00a0each patient who needs it is the very definition of burdensome. Time to change this difficult access problem!<\/li>\n<li><a href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/gunshot-injury-paraplegicsa-population-dying-a-slow-irreversible-and-expensive-deatha-viewpoint-on-preventing-pressure-ulcers\/5F7A669050AFE07CE26957553080974F\" target=\"_blank\" rel=\"noopener\"><strong>Gunshot-related spinal cord injuries and infected pressure ulcers &#8212; a highly complex, dangerous, and expensive combination. <\/strong><\/a>In this perspective, the authors state that people with this condition experience &#8220;slow but irreversible and expensive death sentences,&#8221; sadly all too true. They call for a multidisciplinary approach, meaning investing resources upfront to avoid complications and costly hospitalizations.<\/li>\n<\/ul>\n<p>And now, a non-ID section, some medically related, some not:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.nytimes.com\/2017\/09\/01\/health\/medicare-observation-hospitals.html?&amp;moduleDetail=section-news-2&amp;action=click&amp;contentCollection=Health&amp;region=Footer&amp;module=MoreInSection&amp;version=WhatsNext&amp;contentID=WhatsNext&amp;pgtype=article\" target=\"_blank\" rel=\"noopener\"><strong>&#8220;Admit to observation&#8221; can saddle a patient with enormous uncovered hospital or rehabilitation facility charges.<\/strong><\/a> This is an excellent example of the strange incentives in our healthcare &#8220;system&#8221;. Check out the reader comments to get a sense of how difficult it can be when someone &#8220;admitted&#8221; to the hospital actually isn&#8217;t considered admitted at all.<\/li>\n<li><a href=\"https:\/\/www.washingtonpost.com\/opinions\/americas-waning-romance-with-football\/2017\/09\/01\/5e26a344-8e7b-11e7-91d5-ab4e4bb76a3a_story.html?tid=ss_tw&amp;utm_term=.8d3c68aacc10\" target=\"_blank\" rel=\"noopener\"><strong>Is our national obsession with football fading?<\/strong><\/a>\u00a0Longtime columnist George Will and I don&#8217;t always see things the same way, but with this piece he&#8217;s hit a real home run (metaphor chosen intentionally). The opening sentence alone will bring smiles to English majors and football haters across America.<\/li>\n<li><a href=\"https:\/\/www.nytimes.com\/2017\/09\/03\/arts\/music\/walter-becker-dead-steely-dan.html?hp&amp;action=click&amp;pgtype=Homepage&amp;clickSource=story-heading&amp;module=second-column-region&amp;region=top-news&amp;WT.nav=top-news\" target=\"_blank\" rel=\"noopener\"><strong>So long, Walter Becker, co-founder of Steely Dan!<\/strong><\/a>\u00a0The band&#8217;s jazz-influenced rock and slick studio sound have always polarized my friends, eliciting rapturous praise, active dislike, or complete indifference. Count me as part of the cheering section.<\/li>\n<li><a href=\"http:\/\/www.fangraphs.com\/blogs\/joey-votto-went-0-for-0-with-five-walks\/\" target=\"_blank\" rel=\"noopener\"><strong>In a recent game, Joey Votto of the Cincinnati Reds went 0 for 0 with 5 walks.<\/strong><\/a> Joey Votto is the <a href=\"https:\/\/www.baseball-reference.com\/players\/v\/vottojo01.shtml\" target=\"_blank\" rel=\"noopener\">best baseball player you&#8217;ve never heard of.<\/a>\u00a0In case you&#8217;re wondering what makes him so good, the most important skill a hitter can have is <em>getting on base.\u00a0<\/em>So 0 for 0 with 5 walks is a very good game indeed &#8212; it&#8217;s just a quirk of baseball scoring that it&#8217;s not called 5 for 5.<\/li>\n<li><a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(17)32252-3\/fulltext?elsca1=tlxpr\" target=\"_blank\" rel=\"noopener\"><strong>Most of the dietary advice we got growing up was wrong.<\/strong><\/a> That&#8217;s the inevitable conclusion of this large cohort study, which found that high carb, low fat diets were associated with a higher risk of death, while total fat intake was related to lower mortality. Doesn&#8217;t it always come back to Michael Pollan&#8217;s <a href=\"http:\/\/michaelpollan.com\/books\/in-defense-of-food\/\" target=\"_blank\" rel=\"noopener\">brilliantly simple formulation?<\/a>\u00a0<em>Eat food. Not too much. Mostly plants.<\/em><\/li>\n<li><a style=\"font-weight: bold\" href=\"http:\/\/www.biancabosker.com\/cork-dork\/\" target=\"_blank\" rel=\"noopener\">If you want to know what makes wine fanatics tick, &#8220;Cork Dork&#8221; is an interesting, funny, and entertaining read.<\/a> Terrific title, too. Warning &#8212; ordering wine at a restaurant will never be the same!<\/li>\n<\/ul>\n<p>For Steely Dan fans out there, a personal favorite, this relatively obscure track:<\/p>\n<p><iframe loading=\"lazy\" title=\"Steely Dan - Bad Sneakers\" width=\"500\" height=\"375\" src=\"https:\/\/www.youtube.com\/embed\/xy2G6TlRMUQ?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/p>\n","protected":false},"excerpt":{"rendered":"<p>There&#8217;s so much interesting ID material out there. The only solution &#8212; an ID Link-o-Rama, especially curated for the long Labor Day weekend. (Actually, not really, but that sounded good.) Off we go! Even if it doesn&#8217;t provide 100% protection, the flu vaccine may reduce the severity of influenza. Good to have this paper handy [&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":[565],"class_list":["post-8411","post","type-post","status-publish","format-standard","hentry","category-health-care","tag-link-o-rama"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8411","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=8411"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8411\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=8411"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=8411"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=8411"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}