Archive for February 28, 2014

Primary Care Guidelines for the Management of Persons Infected With HIV: 2013 Update by the HIV Medicine Association of the Infectious Diseases Society of America

Clinical Infectious Diseases January 1, 2014 V.58 N.1 P.1-10

IDSA GUIDELINES

Judith A. Aberg1, Joel E. Gallant2,3, Khalil G. Ghanem3, Patricia Emmanuel4, Barry S. Zingman5, and Michael A. Horberg6

1Division of Infectious Diseases and Immunology, New York University School of Medicine, Bellevue Hospital Center, New York

2Southwest CARE Center, Santa Fe, New Mexico

3Johns Hopkins University School of Medicine, Baltimore, Maryland

4Department of Pediatrics, University of South Florida Health, Tampa

5Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York

6Mid-Atlantic Permanente Research Institute, Rockville, Maryland

Correspondence: Judith A. Aberg, MD, New York University School of Medicine, 550 First Ave, BCD 5 (Rm 558), New York, NY 10016 (judith.aberg@nyumc.org).

Evidence-based guidelines for the management of persons infected with human immunodeficiency virus (HIV) were prepared by an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America.

These updated guidelines replace those published in 2009. The guidelines are intended for use by healthcare providers who care for HIV-infected patients. Since 2009, new antiretroviral drugs and classes have become available, and the prognosis of persons with HIV infection continues to improve.

However, with fewer complications and increased survival, HIV-infected persons are increasingly developing common health problems that also affect the general population. Some of these conditions may be related to HIV infection itself or its treatment. HIV-infected persons should be managed and monitored for all relevant age- and sex-specific health problems.

New information based on publications from the period 2009–2013 has been incorporated into this document.

PDF

http://cid.oxfordjournals.org/content/58/1/1.full.pdf+html

February 28, 2014 at 9:41 pm

Effect of Influenza Vaccination of Healthcare Personnel on Morbidity and Mortality Among Patients: Systematic Review and Grading of Evidence

Clinical Infectious Diseases January 1, 2014 V.58 N.1 P.50-57

Faruque Ahmed1, Megan C. Lindley1, Norma Allred1, Cindy M. Weinbaum2, and Lisa Grohskopf3

1Immunization Services Division, National Center for Immunization and Respiratory Diseases

2Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases

3Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Correspondence: Faruque Ahmed, PhD, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-19, Atlanta, GA 30333 (fahmed@cdc.gov).

Background.

Influenza vaccination of healthcare personnel (HCP) is recommended in >40 countries. However, there is controversy surrounding the evidence that HCP vaccination reduces morbidity and mortality among patients. Key factors for developing evidence-based recommendations include quality of evidence, balance of benefits and harms, and values and preferences.

Methods.

We conducted a systematic review of randomized trials, cohort studies, and case-control studies published through June 2012 to evaluate the effect of HCP influenza vaccination on mortality, hospitalization, and influenza cases in patients of healthcare facilities. We pooled trial results using meta-analysis and assessed evidence quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results.

We identified 4 cluster randomized trials and 4 observational studies conducted in long-term care or hospital settings. Pooled risk ratios across trials for all-cause mortality and influenza-like illness were 0.71 (95% confidence interval [CI], .59–.85) and 0.58 (95% CI, .46–.73), respectively; pooled estimates for all-cause hospitalization and laboratory-confirmed influenza were not statistically significant. The cohort and case-control studies indicated significant protective associations for influenza-like illness and laboratory-confirmed influenza. No studies reported harms to patients. Using GRADE, the quality of the evidence for the effect of HCP vaccination on mortality and influenza cases in patients was moderate and low, respectively. The evidence quality for the effect of HCP vaccination on patient hospitalization was low. The overall evidence quality was moderate.

Conclusions.

The quality of evidence is higher for mortality than for other outcomes. HCP influenza vaccination can enhance patient safety.

PDF

http://cid.oxfordjournals.org/content/58/1/50.full.pdf+html

 

Editorial Commentary

Influenza Vaccination of Healthcare Workers: Making the Grade for Action

Marie R. Griffin

Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee

Correspondence: Marie R. Griffin, MD, MPH, Department of Preventive Medicine, Vanderbilt University Medical Center, 1500 21st Ave S, Nashville, TN 37212 (marie.griffin@vanderbilt.edu)

It is reasonable to ask what type of evidence is needed to recommend or require annual influenza vaccination of healthcare workers to help prevent transmission of influenza to vulnerable hospitalized patients and to residents of long-term care facilities. To make such a recommendation, one would want to know the risks and consequences of influenza in such patients, the safety of the vaccine and its efficacy in preventing influenza in healthcare workers, and the likelihood that vaccinating such workers could prevent the spread of influenza within these facilities in addition to costs and feasibility….

PDF

http://cid.oxfordjournals.org/content/58/1/58.full.pdf+html

February 28, 2014 at 9:39 pm

Infectious Diseases Specialty Intervention Is Associated With Decreased Mortality and Lower Healthcare Costs

Clinical Infectious Diseases January 1, 2014 V.58 N.1 P.22-28

Steven Schmitt1, Daniel P. McQuillen2, Ronald Nahass3, Lawrence Martinelli4, Michael Rubin5, Kay Schwebke6, Russell Petrak7, J. Trees Ritter8, David Chansolme9, Thomas Slama10, Edward M. Drozd11, Shamonda F. Braithwaite11, Michael Johnsrud12, and Eric Hammelman11

1Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Ohio

2Center for Infectious Diseases and Prevention, Lahey Hospital & Medical Center, Tufts University School of Medicine, Burlington, Massachusetts

3ID Care, Hillsborough, New Jersey

4Covenant Health, Lubbock, Texas

5Divisions of Clinical Epidemiology and Infectious Diseases, University of Utah School of Medicine, Salt Lake City

6OptumInsight, Eden Prairie, Minnesota

7Metro ID Consultants, LLC, Burr Ridge, Illinois

8French Hospital Medical Center, San Luis Obispo, California

9Infectious Disease Consultants of Oklahoma City, Oklahoma

10Indiana University School of Medicine, Indianapolis, Indiana

11Data Analytics

12Health Economics and Outcomes Research, Avalere Health, Washington, D.C.

Correspondence: Steven Schmitt, MD, 9500 Euclid Ave., Desk G-21, Cleveland, OH 44195, USA (schmits@ccf.org).

Background

Previous studies, largely based on chart reviews with small sample sizes, have demonstrated that infectious diseases (ID) specialists positively impact patient outcomes. We investigated how ID specialists impact mortality, utilization, and costs using a large claims dataset.

Methods

We used administrative fee-for-service Medicare claims to identify beneficiaries hospitalized from 2008 to 2009 with at least 1 of 11 infections. There were 101 991 stays with and 170 336 stays without ID interventions. Cohorts were propensity score matched for patient demographics, comorbidities, and hospital characteristics. Regression models compared ID versus non-ID intervention and early versus late ID intervention. Risk-adjusted outcomes included hospital and intensive care unit (ICU) length of stay (LOS), mortality, readmissions, hospital charges, and Medicare payments.

Results

The ID intervention cohort demonstrated significantly lower mortality (odds ratio [OR], 0.87; 95% confidence interval [CI], .83 to .91) and readmissions (OR, 0.96; 95% CI, .93 to .99) than the non-ID intervention cohort. Medicare charges and payments were not significantly different; the ID intervention cohort ICU LOS was 3.7% shorter (95% CI, −5.5% to −1.9%). Patients receiving ID intervention within 2 days of admission had significantly lower 30-day mortality and readmission, hospital and ICU length of stay, and Medicare charges and payments compared with patients receiving later ID interventions.

Conclusions

ID interventions are associated with improved patient outcomes. Early ID interventions are also associated with reduced costs for Medicare beneficiaries with select infections.

PDF

http://cid.oxfordjournals.org/content/58/1/22.full.pdf+html

Editorial Commentary

Infectious Diseases: A Friend in Need

Emilio Bouza

Department of Microbiology and Infectious Diseases, Hospital General Gregorio Marañón

Department of Medicine, Universidad Complutense, Madrid, Spain

Correspondence: Emilio Bouza, MD, PhD, Servicio de Microbiología y E. Infecciosas, Hospital General Universitario Gregorio Marañón, Dr Esquerdo 46, 28007 Madrid (ebouza@microb.net).

Schmitt et al must be congratulated for their effort to provide evidence to third-party payers on the convenience and advantages to consult infectious diseases specialists early, at least for patients with severe, nosocomially acquired infectious complications [1]. In a very interesting article published in this issue of the journal, they demonstrated that “ID interventions are associated with improved patient outcomes … and reduced costs” [1]. Their article has the added value of raising old and new issues that are not always approached similarly in different countries and in different situations.

The first issue that I would consider is the need for infectious diseases specialists at the present time. We are far from the years in which, in the pages of this very journal, prestigious physicians such as Petersdorf and Beeson bitterly discussed the need for more infectious diseases specialists [2–4]. In 1980, Beeson [5] claimed that our specialty lacks every attribute needed for successful practice: special technology, chronicity of disease, and balanced remuneration. Petersdorf, at that same time, suggested, “It is my conclusion that infectious disease is destined to function best as an academic specialty whose trainees should pursue careers …

PDF

http://cid.oxfordjournals.org/content/58/1/29.full.pdf+html

February 28, 2014 at 9:38 pm


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