Management of persistent bacteremia caused by methicillin-resistant Staphylococcus aureus: a survey of infectious diseases consultants.

We conducted a survey in 2005 of infectious diseases consultants and asked about persistent bacteremia due to methicillin-resistant Staphylococcus aureus. Many consultants perceived an increase in the frequency of illness, and, when presented with vancomycin minimum inhibitory concentrations approaching the limit of the susceptible range, most consultants indicated that they would switch to newer antimicrobial agents for treatment.

Experience of infectious diseases consultants with outpatient parenteral antimicrobial therapy: results of an emerging infections network survey.

BACKGROUND: Despite the increasing use of outpatient parenteral antimicrobial therapy (OPAT), little is known about the role of infectious diseases consultants in the process or their perceptions of OPAT. METHODS: In May 2004, the Infectious Diseases Society of America Emerging Infections Network (EIN) surveyed its members to characterize their involvement and experiences with OPAT. RESULTS: Of the 454 respondents (54%) who completed the questionnaire, 426 (94%) indicated that patients in their primary inpatient facility were "frequently" discharged while receiving OPAT, estimating that, on average, 19 patients are discharged from their hospitals while receiving OPAT each month. Although 86% of EIN members stated that they personally order OPAT for some patients, 18% indicated that they have no involvement, and 37% stated they only rarely or occasionally oversee OPAT. EIN members involved in OPAT estimated that approximately 90% of their patients who take OPAT received therapy at home, and the members described variable monitoring and oversight methods. Of the respondents, 68% of providers collectively estimated that they encountered 1951 infectious and serious noninfectious complications of OPAT in the past year. The most frequently used antibiotics included vancomycin, ceftriaxone, and cefazolin, most commonly used for bone and joint infections. CONCLUSIONS: These results testify to the pervasive use of OPAT in today's health care system, the variable role of infectious diseases consultants, and the heterogeneity in oversight and management practices. The widespread use of OPAT and its frequent complications indicate the need for additional studies to establish optimal methods of delivery and management to insure the quality and safety of the process.

A national survey of the Infectious Diseases Society of America Emerging Infections Network concerning neuraminidase inhibitor prescription practices and pandemic influenza preparations.

This report summarizes the findings of a national survey of infectious diseases consultants regarding their use of neuraminidase inhibitors and the status of their planning for an influenza pandemic. The respondents indicated that government stockpiles should be increased, that many have received requests for antiviral medications, and that additional recommendations regarding the appropriate use of antiviral medications would be helpful.

A national survey of severe influenza-associated complications among children and adults, 2003-2004.

This report summarizes findings of a national survey conducted among infectious diseases consultants to assess complications associated with influenza during the 2003-2004 influenza season. The survey identified severe complications, including secondary infection with Staphylococcus aureus and deaths among children and adults, as well as perceived shortages in rapid diagnostic tests and influenza vaccine.

Physicians' acceptable treatment failure rates in antibiotic therapy for coagulase-negative staphylococcal catheter-associated bacteremia: implications for reducing treatment duration.

BACKGROUND: Decreasing the duration of antimicrobial therapy is an attractive strategy for delaying the emergence of antimicrobial resistance. Limited data regarding optimal treatment durations for most clinical infections hinder the adoption of this approach and impair optimal physician-patient communication under the shared decision-making model. We aimed to identify acceptable failure rates among infectious disease consultants (IDCs) for treatment of central venous catheter-associated bacteremia. METHODS: A case scenario involving a representative patient who developed central venous catheter-associated bacteremia caused by coagulase-negative staphylococci and who received standard-of-care therapy was distributed to all nonpediatric IDC members of the Infectious Diseases Society of America's Emerging Infections Network in August 2003. Each member was suggested 1 of 10 treatment failure rates and asked whether he or she would accept or reject the given value. Logistic regression was used to evaluate the relationship between specific failure rates offered to respondents and their willingness to accept them using a methodology derived from contingent valuation. RESULTS: Among the 374 respondents (response rate, 54%), the median acceptable failure rate was 6.8%. Thus, one-half of the IDCs would have found a failure rate of 6.8% to be acceptable. Seventy-five percent of IDCs would have found a failure rate of 1.6% to be acceptable, and 25% of IDCs would have found a failure rate as high as 11.9% to be acceptable. CONCLUSIONS: The quantified acceptable failure rates, when used to interpret clinical trial or cohort study results, will help select optimal antimicrobial therapy durations for this specific condition. These findings are a critical step in the development of effective shared decision-making models.

Management of inpatients colonized or infected with antimicrobial-resistant bacteria in hospitals in the United States.

BACKGROUND: Although guidelines for multidrug-resistant organisms generally include recommendations for contact precautions and surveillance cultures, it is not known how frequently U.S. hospitals implement these measures on a routine basis and whether infectious diseases consultants endorse their use. METHODS: The Emerging Infections Network surveyed its members, infectious diseases consultants, to assess their use of and support for contact precautions and surveillance cultures for routine management of multidrug-resistant organisms in their principal inpatient workplace. Specifically, members were asked about use of these strategies for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant, gram-negative bacilli on general wards, ICUs, and transplant units. RESULTS: Overall, 400 (86%) of 463 respondents supported the routine use of contact precautions to control one or more multidrug-resistant organisms in at least one unit, and 89% worked in hospitals that use them. In contrast, 50% of respondents favored routine use of surveillance cultures to manage at least one multidrug-resistant organism in any unit, and 30% of respondents worked in hospitals that use them routinely in any unit. Members favored routine use of surveillance cultures significantly more in ICUs and transplant units than in general wards for each multidrug-resistant organism (P < .001). CONCLUSIONS: Most of the infectious diseases consultants endorsed the use of contact precautions for routine management of patients colonized or infected with multidrug-resistant organisms and work in hospitals that have implemented them. In contrast, infectious diseases consultants are divided about the role of routine surveillance cultures in multidrug-resistant organism management, and few work in hospitals that use them.

Role of infectious diseases consultants in management of antimicrobial use in hospitals.

The Infectious Diseases Society of America Emerging Infections Network (EIN) surveyed its members to characterize antimicrobial restriction policies in their hospitals and the involvement of infectious diseases consultants in this process. Of the 502 respondents (73%), 250 (50%) indicated that their hospital pharmacies would not dispense certain antimicrobials without approval of infectious diseases consultants. Moreover, 89% agreed that infectious diseases consultants need to be directly involved in the approval process. At hospitals with control policies, commonly restricted agents included lipid formulations of amphotericin B, carbapenems, fluoroquinolones, piperacillin-tazobactam, and vancomycin. Only 46 EIN members (18%) reported remuneration of infectious diseases consultants for participation in the approval process. Pediatric infectious diseases consultants were more likely to practice in hospitals with restriction policies than were adult infectious diseases consultants (64% vs. 45%; P<.001). Similarly, teaching hospitals were more likely to have antimicrobial-control policies than were nonteaching facilities (60% vs. 17%; P<.001).

Bacterial infections associated with blood transfusion: experience and perspective of infectious diseases consultants.

BACKGROUND: On March 1, 2004, the AABB adopted a new standard that requires member blood banks and transfusion services to implement measures to limit and detect bacterial contamination in all platelet (PLT) components. The AABB has since developed several guidelines to assist blood transfusion services and blood banks in this area, some of which are relevant to clinical practice. Knowledge and experience among clinicians (including infectious disease consultants, who can play an important role in managing patients with sepsis) concerning risk of bacterial infections associated with transfusion, however, are unknown. STUDY DESIGN AND METHODS: Experience concerning management and prevention of transfusion-associated bacterial infection, including knowledge of the AABB standard requiring bacterial screening of PLTs, was assessed through an Infectious Diseases Society of America Emerging Infections Network (IDSA/EIN) survey. RESULTS: Overall, 405 (47%) EIN members responded to the survey; of those responding, 12 percent of respondents had encountered transfusion reactions potentially due to bacterial contamination in the prior 10 years, 36 percent were aware of the transmission risk of bacteria through blood transfusion, and 20 percent were aware of the new AABB standard for bacterial screening of PLTs. CONCLUSIONS: Understanding by EIN infectious disease consultants of the significance of transfusion-associated bacterial infection and associated AABB standards and guidelines may indicate lack of other clinicians' awareness on these issues. Improving awareness of the risk of bacterial contamination of PLTs appears warranted to improve clinical management of infected blood donors or recipients, particularly when follow-up for transfusion of a culture-positive PLT unit is needed.