IDWeek 2011

BOSTON – Initial antibiotic therapy failed in nearly 25% of 3,535 adults with acute bacterial skin and skin structure infections in U.S. hospitals between 2000 and 2009, according to a retrospective analysis of data from multiple hospitals.

Initial treatment failure was associated with significantly higher mortality, longer hospital stays, and higher costs of care, Xing-Yue Huang, Ph.D., reported at the annual meeting of the Infectious Diseases Society of America. The case-fatality rate was 1.3% in the 532 patients in the early treatment failure subgroup and 0.2% in the 3,003 successful treatment patients, a significant difference. The mean length of stay and total hospital charges were also significantly increased, at 8.1 days vs. 4.6 days and at $23,383 vs. $12,393, respectively.

The costs and benefits of initial treatment with broad-spectrum and narrower-spectrum regimens needs to be evaluated, Dr. Huang said. "Broad spectrum regimens are generally most effective but their benefits have to be measured against their higher cost. Narrower-spectrum regimens are less expensive but they may pose a higher risk of treatment failure."

Dr. Huang and colleagues used a database to identify all adult patients hospitalized for acute bacterial skin and skin structure infections (ABSSSI), such as abscess, cellulitis, and surgical site infection, between Jan. 1, 2000 and June 30, 2009. All patients in the analysis had at least one positive isolate from skin, wound, or blood cultures within 24 hours of initial clinical presentation. All received parenteral antibiotics for at least 48 hours beginning within 24 hours of hospital admission.

"More than half of the patients received initial regimens – usually multi-drug – that provided coverage for MRSA."

All antibiotics received within 24 hours of admission were considered initial therapy, said Dr. Huang of Forest Research Institute in Jersey City, N.J. "We limited our attention to patients who received any of the 40 regimens most commonly used in calendar year 2009," he explained, noting that, for all of the ABSSSI patients identified, 79% received 1 of the 40 regimens.

Patients were excluded from the study sample if they had a secondary diagnosis of infections of other body sites or organs, except septicemia/bacteremia and systemic inflammatory response syndrome; necrotizing fasciitis; gangrene; ecthyma gangrenosum; osteomyelitis; complications of pregnancy, childbirth, and the puerperium; or impetigo, or if they had plasmapheresis or hemoperfusion performed, he said.

Per study protocol, initial treatment was considered a failure if a patient received a new parenteral antibiotic more than 24 hours following hospital admission, excluding substitution of a similar or narrower spectrum regimen or if a patient underwent drainage, debridement, or amputation more than 72 hours after admission, said Dr. Huang.

The researchers used multivariate logistic regression analysis to predict failure of initial therapy and for significance testing for differences in mortality. They used covariance model analysis to compare hospital length of stay and total inpatient charges. All models were adjusted for covariates, including patient age, sex, comorbidities, clinical status at admission, and hospital characteristics, Dr. Huang stated. All analyses were repeated with initial therapy failure limited to the 72-hour post-admission window to characterize "early" treatment failure, because later failure could be the result of nosocomial infections in patients with long hospitalizations, which would skew cause and effect, he said.

Of the 3,535 patients (mean age 52 years) included in the study sample, 797 (22.5%) experienced initial treatment failure, 66.8% of which occurred within 72 hours of admission, Dr. Huang reported. The most commonly identified pathogens were Staphylococcus aureus (of which 68.4% were methicillin resistant), Pseudomonas aeruginosa, Streptococcus agalactiae, and Escherichia coli. The most frequently prescribed initial antibiotic regimens were vancomycin (22%), cefazolin (14%), and ampicillin/sulbactam (12%). "More than half of the patients [56%] received initial regimens – usually multi-drug – that provided coverage for MRSA [methicillin-resistant Staphylococcus aureus]," he said.

Significant predictors of initial treatment failure were older age, peripheral vascular disease, septicemia/bacteremia, leukopenia, uremia, and hospitalization within the previous 30 days, Dr. Huang reported. Regarding the clinical and economic consequences, initial antibiotic failure was associated with a sevenfold higher rate of death, 5.1 additional hospital days, and additional hospital charges of $13,731, he said.

Dr. Huang acknowledged some of the study’s limitations, including its retrospective design, the inclusion of only those patients receiving the 40 most frequently used regimens, the exclusion of patients with ABSSSI of unknown etiology, and the fact that initial treatment failure could reflect multiple factors, such as the presence of causative organisms that are resistant to the antibiotics that were chosen, the severity of the infection, compromised host immunity, or adverse events.

Dr. Huang is an employee of Forest Research Institute which supported this investigation.

BOSTON – Initial antibiotic therapy failed in nearly 25% of 3,535 adults with acute bacterial skin and skin structure infections in U.S. hospitals between 2000 and 2009, according to a retrospective analysis of data from multiple hospitals.

Initial treatment failure was associated with significantly higher mortality, longer hospital stays, and higher costs of care, Xing-Yue Huang, Ph.D., reported at the annual meeting of the Infectious Diseases Society of America. The case-fatality rate was 1.3% in the 532 patients in the early treatment failure subgroup and 0.2% in the 3,003 successful treatment patients, a significant difference. The mean length of stay and total hospital charges were also significantly increased, at 8.1 days vs. 4.6 days and at $23,383 vs. $12,393, respectively.

The costs and benefits of initial treatment with broad-spectrum and narrower-spectrum regimens needs to be evaluated, Dr. Huang said. "Broad spectrum regimens are generally most effective but their benefits have to be measured against their higher cost. Narrower-spectrum regimens are less expensive but they may pose a higher risk of treatment failure."

Dr. Huang and colleagues used a database to identify all adult patients hospitalized for acute bacterial skin and skin structure infections (ABSSSI), such as abscess, cellulitis, and surgical site infection, between Jan. 1, 2000 and June 30, 2009. All patients in the analysis had at least one positive isolate from skin, wound, or blood cultures within 24 hours of initial clinical presentation. All received parenteral antibiotics for at least 48 hours beginning within 24 hours of hospital admission.

"More than half of the patients received initial regimens – usually multi-drug – that provided coverage for MRSA."

All antibiotics received within 24 hours of admission were considered initial therapy, said Dr. Huang of Forest Research Institute in Jersey City, N.J. "We limited our attention to patients who received any of the 40 regimens most commonly used in calendar year 2009," he explained, noting that, for all of the ABSSSI patients identified, 79% received 1 of the 40 regimens.

Patients were excluded from the study sample if they had a secondary diagnosis of infections of other body sites or organs, except septicemia/bacteremia and systemic inflammatory response syndrome; necrotizing fasciitis; gangrene; ecthyma gangrenosum; osteomyelitis; complications of pregnancy, childbirth, and the puerperium; or impetigo, or if they had plasmapheresis or hemoperfusion performed, he said.

Per study protocol, initial treatment was considered a failure if a patient received a new parenteral antibiotic more than 24 hours following hospital admission, excluding substitution of a similar or narrower spectrum regimen or if a patient underwent drainage, debridement, or amputation more than 72 hours after admission, said Dr. Huang.

The researchers used multivariate logistic regression analysis to predict failure of initial therapy and for significance testing for differences in mortality. They used covariance model analysis to compare hospital length of stay and total inpatient charges. All models were adjusted for covariates, including patient age, sex, comorbidities, clinical status at admission, and hospital characteristics, Dr. Huang stated. All analyses were repeated with initial therapy failure limited to the 72-hour post-admission window to characterize "early" treatment failure, because later failure could be the result of nosocomial infections in patients with long hospitalizations, which would skew cause and effect, he said.

Of the 3,535 patients (mean age 52 years) included in the study sample, 797 (22.5%) experienced initial treatment failure, 66.8% of which occurred within 72 hours of admission, Dr. Huang reported. The most commonly identified pathogens were Staphylococcus aureus (of which 68.4% were methicillin resistant), Pseudomonas aeruginosa, Streptococcus agalactiae, and Escherichia coli. The most frequently prescribed initial antibiotic regimens were vancomycin (22%), cefazolin (14%), and ampicillin/sulbactam (12%). "More than half of the patients [56%] received initial regimens – usually multi-drug – that provided coverage for MRSA [methicillin-resistant Staphylococcus aureus]," he said.

Significant predictors of initial treatment failure were older age, peripheral vascular disease, septicemia/bacteremia, leukopenia, uremia, and hospitalization within the previous 30 days, Dr. Huang reported. Regarding the clinical and economic consequences, initial antibiotic failure was associated with a sevenfold higher rate of death, 5.1 additional hospital days, and additional hospital charges of $13,731, he said.

Dr. Huang acknowledged some of the study’s limitations, including its retrospective design, the inclusion of only those patients receiving the 40 most frequently used regimens, the exclusion of patients with ABSSSI of unknown etiology, and the fact that initial treatment failure could reflect multiple factors, such as the presence of causative organisms that are resistant to the antibiotics that were chosen, the severity of the infection, compromised host immunity, or adverse events.

Dr. Huang is an employee of Forest Research Institute which supported this investigation.

BOSTON – Initial antibiotic therapy failed in nearly 25% of 3,535 adults with acute bacterial skin and skin structure infections in U.S. hospitals between 2000 and 2009, according to a retrospective analysis of data from multiple hospitals.

Initial treatment failure was associated with significantly higher mortality, longer hospital stays, and higher costs of care, Xing-Yue Huang, Ph.D., reported at the annual meeting of the Infectious Diseases Society of America. The case-fatality rate was 1.3% in the 532 patients in the early treatment failure subgroup and 0.2% in the 3,003 successful treatment patients, a significant difference. The mean length of stay and total hospital charges were also significantly increased, at 8.1 days vs. 4.6 days and at $23,383 vs. $12,393, respectively.

The costs and benefits of initial treatment with broad-spectrum and narrower-spectrum regimens needs to be evaluated, Dr. Huang said. "Broad spectrum regimens are generally most effective but their benefits have to be measured against their higher cost. Narrower-spectrum regimens are less expensive but they may pose a higher risk of treatment failure."

Dr. Huang and colleagues used a database to identify all adult patients hospitalized for acute bacterial skin and skin structure infections (ABSSSI), such as abscess, cellulitis, and surgical site infection, between Jan. 1, 2000 and June 30, 2009. All patients in the analysis had at least one positive isolate from skin, wound, or blood cultures within 24 hours of initial clinical presentation. All received parenteral antibiotics for at least 48 hours beginning within 24 hours of hospital admission.

"More than half of the patients received initial regimens – usually multi-drug – that provided coverage for MRSA."

All antibiotics received within 24 hours of admission were considered initial therapy, said Dr. Huang of Forest Research Institute in Jersey City, N.J. "We limited our attention to patients who received any of the 40 regimens most commonly used in calendar year 2009," he explained, noting that, for all of the ABSSSI patients identified, 79% received 1 of the 40 regimens.

Patients were excluded from the study sample if they had a secondary diagnosis of infections of other body sites or organs, except septicemia/bacteremia and systemic inflammatory response syndrome; necrotizing fasciitis; gangrene; ecthyma gangrenosum; osteomyelitis; complications of pregnancy, childbirth, and the puerperium; or impetigo, or if they had plasmapheresis or hemoperfusion performed, he said.

Per study protocol, initial treatment was considered a failure if a patient received a new parenteral antibiotic more than 24 hours following hospital admission, excluding substitution of a similar or narrower spectrum regimen or if a patient underwent drainage, debridement, or amputation more than 72 hours after admission, said Dr. Huang.

The researchers used multivariate logistic regression analysis to predict failure of initial therapy and for significance testing for differences in mortality. They used covariance model analysis to compare hospital length of stay and total inpatient charges. All models were adjusted for covariates, including patient age, sex, comorbidities, clinical status at admission, and hospital characteristics, Dr. Huang stated. All analyses were repeated with initial therapy failure limited to the 72-hour post-admission window to characterize "early" treatment failure, because later failure could be the result of nosocomial infections in patients with long hospitalizations, which would skew cause and effect, he said.

Of the 3,535 patients (mean age 52 years) included in the study sample, 797 (22.5%) experienced initial treatment failure, 66.8% of which occurred within 72 hours of admission, Dr. Huang reported. The most commonly identified pathogens were Staphylococcus aureus (of which 68.4% were methicillin resistant), Pseudomonas aeruginosa, Streptococcus agalactiae, and Escherichia coli. The most frequently prescribed initial antibiotic regimens were vancomycin (22%), cefazolin (14%), and ampicillin/sulbactam (12%). "More than half of the patients [56%] received initial regimens – usually multi-drug – that provided coverage for MRSA [methicillin-resistant Staphylococcus aureus]," he said.

Significant predictors of initial treatment failure were older age, peripheral vascular disease, septicemia/bacteremia, leukopenia, uremia, and hospitalization within the previous 30 days, Dr. Huang reported. Regarding the clinical and economic consequences, initial antibiotic failure was associated with a sevenfold higher rate of death, 5.1 additional hospital days, and additional hospital charges of $13,731, he said.

Dr. Huang acknowledged some of the study’s limitations, including its retrospective design, the inclusion of only those patients receiving the 40 most frequently used regimens, the exclusion of patients with ABSSSI of unknown etiology, and the fact that initial treatment failure could reflect multiple factors, such as the presence of causative organisms that are resistant to the antibiotics that were chosen, the severity of the infection, compromised host immunity, or adverse events.

Dr. Huang is an employee of Forest Research Institute which supported this investigation.

BOSTON – A hospital-wide algorithm for diagnosing and managing complicated bacterial pneumonia in children led to a marked cut in unnecessary chest CT examinations and a reduced number of surgical interventions. It also produced better outcomes, with fewer readmissions and no change in average length of stay or vancomycin use.

A key element of the management algorithm, implemented 3 years ago for children with a pleural effusion, empyema, or both complicating community-acquired bacterial pneumonia, was the emphasis on assessing children with ultrasound rather than with CT. This change produced a drop in chest CT examinations in these patients from 60% before the algorithm became hospital policy to 17% after.

The algorithm called for preferentially using ultrasound to assess these cases. During the first 15 months of its use, chest ultrasounds in these patients was performed in 71% of cases, compared with 27% of cases before the algorithm, Dr. Roberta L. DeBiasi said at the meeting.

The preferential use of more ultrasound examinations in children with a pleural-space infection meant that fewer children received the large radiation dose delivered by a CT exam, and the sedation required for CT. While safer, ultrasound also produces better imaging than CT in these patients "to sort out who has a loculated empyema that needs VATS [video-assisted lung surgery] and who has a nonloculated effusion that generally doesn’t need VATS," said Dr. DeBiasi, a pediatric infectious diseases specialist on the staff of Children’s National Medical Center in Washington, D.C.

Creation of a new algorithm for the hospital depended on getting physicians and surgeons from all the divisions and departments involved in managing these children – infectious diseases, surgery, radiology, hospitalists, pulmonology, and emergency department – together to decide on the best management approach and make it hospital policy.

"We asked, don’t you realize there are data that ultrasound is preferable, so why use CT so often? The answer was that an ultrasound technician wasn’t available at night in the emergency room." After seeing the data, the radiologists agreed that having ultrasound available 24/7 was important and so arranged it, she said in an interview. The hospital gets on average one or two patients a week with community-acquired bacterial pneumonia complicated by a pleural space infection.

Although no society guidelines existed in November 2008 when the revised algorithm went into effect, last August the Pediatric Infectious Diseases Society and the Infectious Diseases Society of American issued joint recommendations on the management of community-acquired pneumonia in children and included a recommended approach similar to the Children’s National algorithm, Dr. DeBiasi said (Clin. Infect. Dis. 2011 Aug. 30 [doi: 10.1093/cid/cir531]). The only difference was that her hospital’s guidelines are more specific, and guide the staff through the local protocol step by step. For example, the new society recommendations say that either video-assisted lung surgery or fibrinolytic therapy are appropriate options for managing loculated empyema. Because surgeons at Children’s National Medical Center do not use fibrinolytic therapy on these cases, the algorithm specifies VATS only, she said.

"We asked, don’t you realize there are data that ultrasound is preferable, so why use CT so often?"

To examine the impact of the algorithm, Dr. DeBiasi and her associates analyzed patient management and outcomes during the 15 months before the revised algorithm went into effect and then during the first 15 months after. The review showed that the 83 patients managed before November 2008 were an average of 6 years old, similar to the 87 patients treated during the first 15 months using the algorithm, who were an average of 5 years old.

The reduced number of CT exams and increased ultrasound use led to a reduction of VATS from 45% of cases before the algorithm to 29% after. Patient outcomes were better – with a "nice," statistically significant drop in readmission rates from 8% before the algorithm to none during the period after – but during both periods, vancomycin use and average length of stay remained constant (35% and 8 days, respectively), Dr. DeBiasi noted.

"Our [inference] is that some patients didn’t need VATS, and so the algorithm reduced unnecessary interventions. These patients were just managed medically," Dr. DeBiasi said. "I think it was the ultrasound that led to less VATS, because ultrasound is better than CT to see who needs VATS and who doesn’t."

Dr. DeBiasi said that she did not have any disclosures.

BOSTON – A hospital-wide algorithm for diagnosing and managing complicated bacterial pneumonia in children led to a marked cut in unnecessary chest CT examinations and a reduced number of surgical interventions. It also produced better outcomes, with fewer readmissions and no change in average length of stay or vancomycin use.

A key element of the management algorithm, implemented 3 years ago for children with a pleural effusion, empyema, or both complicating community-acquired bacterial pneumonia, was the emphasis on assessing children with ultrasound rather than with CT. This change produced a drop in chest CT examinations in these patients from 60% before the algorithm became hospital policy to 17% after.

The algorithm called for preferentially using ultrasound to assess these cases. During the first 15 months of its use, chest ultrasounds in these patients was performed in 71% of cases, compared with 27% of cases before the algorithm, Dr. Roberta L. DeBiasi said at the meeting.

The preferential use of more ultrasound examinations in children with a pleural-space infection meant that fewer children received the large radiation dose delivered by a CT exam, and the sedation required for CT. While safer, ultrasound also produces better imaging than CT in these patients "to sort out who has a loculated empyema that needs VATS [video-assisted lung surgery] and who has a nonloculated effusion that generally doesn’t need VATS," said Dr. DeBiasi, a pediatric infectious diseases specialist on the staff of Children’s National Medical Center in Washington, D.C.

Creation of a new algorithm for the hospital depended on getting physicians and surgeons from all the divisions and departments involved in managing these children – infectious diseases, surgery, radiology, hospitalists, pulmonology, and emergency department – together to decide on the best management approach and make it hospital policy.

"We asked, don’t you realize there are data that ultrasound is preferable, so why use CT so often? The answer was that an ultrasound technician wasn’t available at night in the emergency room." After seeing the data, the radiologists agreed that having ultrasound available 24/7 was important and so arranged it, she said in an interview. The hospital gets on average one or two patients a week with community-acquired bacterial pneumonia complicated by a pleural space infection.

Although no society guidelines existed in November 2008 when the revised algorithm went into effect, last August the Pediatric Infectious Diseases Society and the Infectious Diseases Society of American issued joint recommendations on the management of community-acquired pneumonia in children and included a recommended approach similar to the Children’s National algorithm, Dr. DeBiasi said (Clin. Infect. Dis. 2011 Aug. 30 [doi: 10.1093/cid/cir531]). The only difference was that her hospital’s guidelines are more specific, and guide the staff through the local protocol step by step. For example, the new society recommendations say that either video-assisted lung surgery or fibrinolytic therapy are appropriate options for managing loculated empyema. Because surgeons at Children’s National Medical Center do not use fibrinolytic therapy on these cases, the algorithm specifies VATS only, she said.

"We asked, don’t you realize there are data that ultrasound is preferable, so why use CT so often?"

To examine the impact of the algorithm, Dr. DeBiasi and her associates analyzed patient management and outcomes during the 15 months before the revised algorithm went into effect and then during the first 15 months after. The review showed that the 83 patients managed before November 2008 were an average of 6 years old, similar to the 87 patients treated during the first 15 months using the algorithm, who were an average of 5 years old.

The reduced number of CT exams and increased ultrasound use led to a reduction of VATS from 45% of cases before the algorithm to 29% after. Patient outcomes were better – with a "nice," statistically significant drop in readmission rates from 8% before the algorithm to none during the period after – but during both periods, vancomycin use and average length of stay remained constant (35% and 8 days, respectively), Dr. DeBiasi noted.

"Our [inference] is that some patients didn’t need VATS, and so the algorithm reduced unnecessary interventions. These patients were just managed medically," Dr. DeBiasi said. "I think it was the ultrasound that led to less VATS, because ultrasound is better than CT to see who needs VATS and who doesn’t."

Dr. DeBiasi said that she did not have any disclosures.

BOSTON – A hospital-wide algorithm for diagnosing and managing complicated bacterial pneumonia in children led to a marked cut in unnecessary chest CT examinations and a reduced number of surgical interventions. It also produced better outcomes, with fewer readmissions and no change in average length of stay or vancomycin use.

A key element of the management algorithm, implemented 3 years ago for children with a pleural effusion, empyema, or both complicating community-acquired bacterial pneumonia, was the emphasis on assessing children with ultrasound rather than with CT. This change produced a drop in chest CT examinations in these patients from 60% before the algorithm became hospital policy to 17% after.

The algorithm called for preferentially using ultrasound to assess these cases. During the first 15 months of its use, chest ultrasounds in these patients was performed in 71% of cases, compared with 27% of cases before the algorithm, Dr. Roberta L. DeBiasi said at the meeting.

The preferential use of more ultrasound examinations in children with a pleural-space infection meant that fewer children received the large radiation dose delivered by a CT exam, and the sedation required for CT. While safer, ultrasound also produces better imaging than CT in these patients "to sort out who has a loculated empyema that needs VATS [video-assisted lung surgery] and who has a nonloculated effusion that generally doesn’t need VATS," said Dr. DeBiasi, a pediatric infectious diseases specialist on the staff of Children’s National Medical Center in Washington, D.C.

Creation of a new algorithm for the hospital depended on getting physicians and surgeons from all the divisions and departments involved in managing these children – infectious diseases, surgery, radiology, hospitalists, pulmonology, and emergency department – together to decide on the best management approach and make it hospital policy.

"We asked, don’t you realize there are data that ultrasound is preferable, so why use CT so often? The answer was that an ultrasound technician wasn’t available at night in the emergency room." After seeing the data, the radiologists agreed that having ultrasound available 24/7 was important and so arranged it, she said in an interview. The hospital gets on average one or two patients a week with community-acquired bacterial pneumonia complicated by a pleural space infection.

Although no society guidelines existed in November 2008 when the revised algorithm went into effect, last August the Pediatric Infectious Diseases Society and the Infectious Diseases Society of American issued joint recommendations on the management of community-acquired pneumonia in children and included a recommended approach similar to the Children’s National algorithm, Dr. DeBiasi said (Clin. Infect. Dis. 2011 Aug. 30 [doi: 10.1093/cid/cir531]). The only difference was that her hospital’s guidelines are more specific, and guide the staff through the local protocol step by step. For example, the new society recommendations say that either video-assisted lung surgery or fibrinolytic therapy are appropriate options for managing loculated empyema. Because surgeons at Children’s National Medical Center do not use fibrinolytic therapy on these cases, the algorithm specifies VATS only, she said.

"We asked, don’t you realize there are data that ultrasound is preferable, so why use CT so often?"

To examine the impact of the algorithm, Dr. DeBiasi and her associates analyzed patient management and outcomes during the 15 months before the revised algorithm went into effect and then during the first 15 months after. The review showed that the 83 patients managed before November 2008 were an average of 6 years old, similar to the 87 patients treated during the first 15 months using the algorithm, who were an average of 5 years old.

The reduced number of CT exams and increased ultrasound use led to a reduction of VATS from 45% of cases before the algorithm to 29% after. Patient outcomes were better – with a "nice," statistically significant drop in readmission rates from 8% before the algorithm to none during the period after – but during both periods, vancomycin use and average length of stay remained constant (35% and 8 days, respectively), Dr. DeBiasi noted.

"Our [inference] is that some patients didn’t need VATS, and so the algorithm reduced unnecessary interventions. These patients were just managed medically," Dr. DeBiasi said. "I think it was the ultrasound that led to less VATS, because ultrasound is better than CT to see who needs VATS and who doesn’t."

Dr. DeBiasi said that she did not have any disclosures.

BOSTON – Although copper is not officially considered a precious metal, its antimicrobial properties suggest it may be priceless in the fight against the growing threat of hospital-acquired infections, according to new data presented at the annual meeting of the Infectious Diseases Society of America.

Previously shown to reduce the environmental bioburden when placed into medical intensive care unit (MICU) patient rooms, copper surfaces significantly reduced the acquisition rate of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus relative to standard-material surfaces in a randomized controlled trial. The study compared the effect of both types of surfaces on the rates of hospital-acquired infections (HAI) in 564 medical intensive care unit patients, reported Dr. Cassandra Salgado of the Medical University of South Carolina in Charleston.

"Environmental surfaces harbor micro-organisms. In an earlier study, we reported that copper surfaces, including bedrails, intravenous poles, overbed tables, chairs, computer monitor bezel, and call button or computer mouse, reduced the median environmental bioburden by more than 97% compared with noncopper surfaces, such as plastic, wood, stainless steel, and chrome, in MICU patient rooms," Dr. Salgado noted. "In this study, our goal was to document the effect of copper surfaces on the rate of health care–acquired infections specifically."

Toward this end, the investigators randomly placed 564 patients admitted to the MICU of three hospitals between July 12, 2010, and May 13, 2011, into rooms with either standard or copper surfaces and followed them prospectively for the development of HAIs, defined by the National Healthcare Safety Network (NHSN), or for new MRSA or VRE colonizations. The clinical characteristics of patients in both groups were similar with respect to age, gender, race, APACHE II score, presence of infection on admission, or MICU length of stay, Dr. Salgado noted. Standard hand washing and environmental cleaning protocols were monitored and maintained throughout the study and there were no differences between the uses of these practices in either setting, she said.

Over the course of the study, 47 patients (8.3%) developed an HAI, including 29 (5.1%) identified as MRSA or VRE, Dr. Salgado reported. The overall incidence of HAI per 1,000 patient days was 12.23, with significantly lower rates observed in copper vs. standard rooms, at 8.95 vs. 15.16 per 1,000 patient days, respectively, she said. In addition, the overall rate of MRSA or VRE acquisition was 7.55 per 1,000 patient days and was significantly lower in copper vs. standard rooms, at 6.12 vs. 8.8 per 1,000 patient days.

In a subpopulation of patients admitted to rooms where all 6 copper-surface objects remained in the room during the entire MICU stay, "there was an even greater effect on reduction of [HAIs] compared with those never exposed to the copper surfaces," Dr. Salgado said. Specifically, the HAI acquisition rate per 1,000 patient days was 6.88 among patients in the full-time copper surface rooms compared with 15.72 among those not exposed to the copper surfaces.

The antimicrobial action of copper is attributed to the release of ions that penetrate the cell walls of microbes and disrupt their ability to function and reproduce, Dr. Salgado explained. Importantly, she added, the effect is continuous, even when combined with other metals.

Considering the contribution of environmental bioburden on the risk of hospital-acquired infections in the MICU as demonstrated by this investigation, efforts to reduce the bioburden, including the replacement of standard surface objects with copper surface alternatives, are warranted, Dr. Salgado stated.

This study was supported by a research grant from the U.S. Department of Defense. Dr. Salgado disclosed no additional conflicts of interest.

BOSTON – Although copper is not officially considered a precious metal, its antimicrobial properties suggest it may be priceless in the fight against the growing threat of hospital-acquired infections, according to new data presented at the annual meeting of the Infectious Diseases Society of America.

Previously shown to reduce the environmental bioburden when placed into medical intensive care unit (MICU) patient rooms, copper surfaces significantly reduced the acquisition rate of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus relative to standard-material surfaces in a randomized controlled trial. The study compared the effect of both types of surfaces on the rates of hospital-acquired infections (HAI) in 564 medical intensive care unit patients, reported Dr. Cassandra Salgado of the Medical University of South Carolina in Charleston.

"Environmental surfaces harbor micro-organisms. In an earlier study, we reported that copper surfaces, including bedrails, intravenous poles, overbed tables, chairs, computer monitor bezel, and call button or computer mouse, reduced the median environmental bioburden by more than 97% compared with noncopper surfaces, such as plastic, wood, stainless steel, and chrome, in MICU patient rooms," Dr. Salgado noted. "In this study, our goal was to document the effect of copper surfaces on the rate of health care–acquired infections specifically."

Toward this end, the investigators randomly placed 564 patients admitted to the MICU of three hospitals between July 12, 2010, and May 13, 2011, into rooms with either standard or copper surfaces and followed them prospectively for the development of HAIs, defined by the National Healthcare Safety Network (NHSN), or for new MRSA or VRE colonizations. The clinical characteristics of patients in both groups were similar with respect to age, gender, race, APACHE II score, presence of infection on admission, or MICU length of stay, Dr. Salgado noted. Standard hand washing and environmental cleaning protocols were monitored and maintained throughout the study and there were no differences between the uses of these practices in either setting, she said.

Over the course of the study, 47 patients (8.3%) developed an HAI, including 29 (5.1%) identified as MRSA or VRE, Dr. Salgado reported. The overall incidence of HAI per 1,000 patient days was 12.23, with significantly lower rates observed in copper vs. standard rooms, at 8.95 vs. 15.16 per 1,000 patient days, respectively, she said. In addition, the overall rate of MRSA or VRE acquisition was 7.55 per 1,000 patient days and was significantly lower in copper vs. standard rooms, at 6.12 vs. 8.8 per 1,000 patient days.

In a subpopulation of patients admitted to rooms where all 6 copper-surface objects remained in the room during the entire MICU stay, "there was an even greater effect on reduction of [HAIs] compared with those never exposed to the copper surfaces," Dr. Salgado said. Specifically, the HAI acquisition rate per 1,000 patient days was 6.88 among patients in the full-time copper surface rooms compared with 15.72 among those not exposed to the copper surfaces.

The antimicrobial action of copper is attributed to the release of ions that penetrate the cell walls of microbes and disrupt their ability to function and reproduce, Dr. Salgado explained. Importantly, she added, the effect is continuous, even when combined with other metals.

Considering the contribution of environmental bioburden on the risk of hospital-acquired infections in the MICU as demonstrated by this investigation, efforts to reduce the bioburden, including the replacement of standard surface objects with copper surface alternatives, are warranted, Dr. Salgado stated.

This study was supported by a research grant from the U.S. Department of Defense. Dr. Salgado disclosed no additional conflicts of interest.

BOSTON – Although copper is not officially considered a precious metal, its antimicrobial properties suggest it may be priceless in the fight against the growing threat of hospital-acquired infections, according to new data presented at the annual meeting of the Infectious Diseases Society of America.

Previously shown to reduce the environmental bioburden when placed into medical intensive care unit (MICU) patient rooms, copper surfaces significantly reduced the acquisition rate of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus relative to standard-material surfaces in a randomized controlled trial. The study compared the effect of both types of surfaces on the rates of hospital-acquired infections (HAI) in 564 medical intensive care unit patients, reported Dr. Cassandra Salgado of the Medical University of South Carolina in Charleston.

"Environmental surfaces harbor micro-organisms. In an earlier study, we reported that copper surfaces, including bedrails, intravenous poles, overbed tables, chairs, computer monitor bezel, and call button or computer mouse, reduced the median environmental bioburden by more than 97% compared with noncopper surfaces, such as plastic, wood, stainless steel, and chrome, in MICU patient rooms," Dr. Salgado noted. "In this study, our goal was to document the effect of copper surfaces on the rate of health care–acquired infections specifically."

Toward this end, the investigators randomly placed 564 patients admitted to the MICU of three hospitals between July 12, 2010, and May 13, 2011, into rooms with either standard or copper surfaces and followed them prospectively for the development of HAIs, defined by the National Healthcare Safety Network (NHSN), or for new MRSA or VRE colonizations. The clinical characteristics of patients in both groups were similar with respect to age, gender, race, APACHE II score, presence of infection on admission, or MICU length of stay, Dr. Salgado noted. Standard hand washing and environmental cleaning protocols were monitored and maintained throughout the study and there were no differences between the uses of these practices in either setting, she said.

Over the course of the study, 47 patients (8.3%) developed an HAI, including 29 (5.1%) identified as MRSA or VRE, Dr. Salgado reported. The overall incidence of HAI per 1,000 patient days was 12.23, with significantly lower rates observed in copper vs. standard rooms, at 8.95 vs. 15.16 per 1,000 patient days, respectively, she said. In addition, the overall rate of MRSA or VRE acquisition was 7.55 per 1,000 patient days and was significantly lower in copper vs. standard rooms, at 6.12 vs. 8.8 per 1,000 patient days.

In a subpopulation of patients admitted to rooms where all 6 copper-surface objects remained in the room during the entire MICU stay, "there was an even greater effect on reduction of [HAIs] compared with those never exposed to the copper surfaces," Dr. Salgado said. Specifically, the HAI acquisition rate per 1,000 patient days was 6.88 among patients in the full-time copper surface rooms compared with 15.72 among those not exposed to the copper surfaces.

The antimicrobial action of copper is attributed to the release of ions that penetrate the cell walls of microbes and disrupt their ability to function and reproduce, Dr. Salgado explained. Importantly, she added, the effect is continuous, even when combined with other metals.

Considering the contribution of environmental bioburden on the risk of hospital-acquired infections in the MICU as demonstrated by this investigation, efforts to reduce the bioburden, including the replacement of standard surface objects with copper surface alternatives, are warranted, Dr. Salgado stated.

This study was supported by a research grant from the U.S. Department of Defense. Dr. Salgado disclosed no additional conflicts of interest.

BOSTON – Comprehensive HIV care in the United States has resulted in a dramatic reduction in AIDS-related morbidity and mortality, but the future of that care is clouded by uncertainties surrounding health care reform and financing, HIV specialists said at the annual meeting of the Infectious Diseases Society of America.

While they applaud expanded access to care, members of the HIV Medicine Association of the IDSA and the Ryan White Medical Providers Coalition expressed concern that the quality of care for HIV-positive patients could suffer if that care was moved out of Ryan White clinics and into Medicaid-based community health centers without clinical expertise in HIV, said Dr. Joel Gallant from the division of infectious diseases at Johns Hopkins University, Baltimore.

"The multidisciplinary integrated care provided by these clinics has really been critical to their success, and they have become models of high-quality health care for underserved people and for the concept of the medical home. Unfortunately, this model is now in jeopardy, in part because of the current economic climate and in part because of the potential successes of health care reform," he said at a briefing discussing the groups’ joint policy statement on the essential components of effective HIV care.

The Ryan White program, established by Congress in 1990, is the third largest funder of HIV care in the United States, after Medicare and Medicaid. According to the Kaiser Family Foundation, the program serves more than 500,000 people with HIV each year, and pays for the care of people with limited or no insurance or other financial resources.

In their policy statement, the authors optimistically state that President Obama’s health care reform plan "provides an unprecedented opportunity to improve access to HIV care and develop more sustainable funding streams that can be used to expand access to the effective HIV care model developed by the Ryan White program."

But if such change is to succeed – and it’s a very big "if" – Dr. Gallant and colleagues acknowledged that it "will require Medicaid, Medicare, and private insurers to adopt delivery systems and risk-adjusted payment mechanisms that support access to effective HIV care."

The authors say that whatever shape health care takes in the future, the elements required for effective HIV care include access to:

• Routine HIV testing.

• Early diagnosis.

• Care provided by an expert in HIV.

• Subspecialists with HIV experience.

• HIV medications.

• Support for adherence to treatment and health care.

• Access to social work services, substance abuse treatment, and mental health services.

"Weakening of this model by fragmenting care, decreasing access to essential services or decreasing provider expertise could really have devastating consequences to infected individuals and to society as a whole," Dr. Gallant said.

"[The HIV care] model is now in jeopardy, in part because of the current economic climate and in part because of the potential successes of health care reform."

He noted that although HIV medications are expensive, they are life-saving, highly cost-effective, and prevent illness, disability, hospitalization, and death when properly used.

"In addition, now we know that successful HIV treatment prevents transmission. In the recently published HPTN 052 study, treating the affected partner in a sero-discordant partner reduced transmission to the uninfected partner by 96%, so providing quality HIV care to HIV-infected is really critical to our efforts to reduce the size of the epidemic in this country," he added (N. Engl. J. Med. 2011;365:493-505).

The Ryan White model also has broader application to the treatment of other chronic conditions, commented coauthor Dr. Mari Kitahata from the department of medicine at the University of Washington, Seattle.

"A key component is coordination of care, and a care coordinator could be a qualified nurse, case manager or social worker responsible for communicating and coordinating with other providers, as well as bringing access to services throughout the continuum. Medication management is an essential component of primary care, as it is in other chronic diseases," she said.

The policy statement was developed by a joint working group of the HIV Medicine Association’s board of directors and the Ryan White Medical Providers Coalition with support from HIV Medicine Association staff.

Dr. Gallant disclosed that he has received honoraria or consulting fees from Bristol-Myers Squibb, Merck, Janssen Therapeutics, RAPID Pharmaceuticals and Gilead Sciences, and payment for review activities from Gilead and Sangamo Biosciences. Dr. Kitahata disclosed no potential conflicts of interest.

BOSTON – Comprehensive HIV care in the United States has resulted in a dramatic reduction in AIDS-related morbidity and mortality, but the future of that care is clouded by uncertainties surrounding health care reform and financing, HIV specialists said at the annual meeting of the Infectious Diseases Society of America.

While they applaud expanded access to care, members of the HIV Medicine Association of the IDSA and the Ryan White Medical Providers Coalition expressed concern that the quality of care for HIV-positive patients could suffer if that care was moved out of Ryan White clinics and into Medicaid-based community health centers without clinical expertise in HIV, said Dr. Joel Gallant from the division of infectious diseases at Johns Hopkins University, Baltimore.

"The multidisciplinary integrated care provided by these clinics has really been critical to their success, and they have become models of high-quality health care for underserved people and for the concept of the medical home. Unfortunately, this model is now in jeopardy, in part because of the current economic climate and in part because of the potential successes of health care reform," he said at a briefing discussing the groups’ joint policy statement on the essential components of effective HIV care.

The Ryan White program, established by Congress in 1990, is the third largest funder of HIV care in the United States, after Medicare and Medicaid. According to the Kaiser Family Foundation, the program serves more than 500,000 people with HIV each year, and pays for the care of people with limited or no insurance or other financial resources.

In their policy statement, the authors optimistically state that President Obama’s health care reform plan "provides an unprecedented opportunity to improve access to HIV care and develop more sustainable funding streams that can be used to expand access to the effective HIV care model developed by the Ryan White program."

But if such change is to succeed – and it’s a very big "if" – Dr. Gallant and colleagues acknowledged that it "will require Medicaid, Medicare, and private insurers to adopt delivery systems and risk-adjusted payment mechanisms that support access to effective HIV care."

The authors say that whatever shape health care takes in the future, the elements required for effective HIV care include access to:

• Routine HIV testing.

• Early diagnosis.

• Care provided by an expert in HIV.

• Subspecialists with HIV experience.

• HIV medications.

• Support for adherence to treatment and health care.

• Access to social work services, substance abuse treatment, and mental health services.

"Weakening of this model by fragmenting care, decreasing access to essential services or decreasing provider expertise could really have devastating consequences to infected individuals and to society as a whole," Dr. Gallant said.

"[The HIV care] model is now in jeopardy, in part because of the current economic climate and in part because of the potential successes of health care reform."

He noted that although HIV medications are expensive, they are life-saving, highly cost-effective, and prevent illness, disability, hospitalization, and death when properly used.

"In addition, now we know that successful HIV treatment prevents transmission. In the recently published HPTN 052 study, treating the affected partner in a sero-discordant partner reduced transmission to the uninfected partner by 96%, so providing quality HIV care to HIV-infected is really critical to our efforts to reduce the size of the epidemic in this country," he added (N. Engl. J. Med. 2011;365:493-505).

The Ryan White model also has broader application to the treatment of other chronic conditions, commented coauthor Dr. Mari Kitahata from the department of medicine at the University of Washington, Seattle.

"A key component is coordination of care, and a care coordinator could be a qualified nurse, case manager or social worker responsible for communicating and coordinating with other providers, as well as bringing access to services throughout the continuum. Medication management is an essential component of primary care, as it is in other chronic diseases," she said.

The policy statement was developed by a joint working group of the HIV Medicine Association’s board of directors and the Ryan White Medical Providers Coalition with support from HIV Medicine Association staff.

Dr. Gallant disclosed that he has received honoraria or consulting fees from Bristol-Myers Squibb, Merck, Janssen Therapeutics, RAPID Pharmaceuticals and Gilead Sciences, and payment for review activities from Gilead and Sangamo Biosciences. Dr. Kitahata disclosed no potential conflicts of interest.

BOSTON – Comprehensive HIV care in the United States has resulted in a dramatic reduction in AIDS-related morbidity and mortality, but the future of that care is clouded by uncertainties surrounding health care reform and financing, HIV specialists said at the annual meeting of the Infectious Diseases Society of America.

While they applaud expanded access to care, members of the HIV Medicine Association of the IDSA and the Ryan White Medical Providers Coalition expressed concern that the quality of care for HIV-positive patients could suffer if that care was moved out of Ryan White clinics and into Medicaid-based community health centers without clinical expertise in HIV, said Dr. Joel Gallant from the division of infectious diseases at Johns Hopkins University, Baltimore.

"The multidisciplinary integrated care provided by these clinics has really been critical to their success, and they have become models of high-quality health care for underserved people and for the concept of the medical home. Unfortunately, this model is now in jeopardy, in part because of the current economic climate and in part because of the potential successes of health care reform," he said at a briefing discussing the groups’ joint policy statement on the essential components of effective HIV care.

The Ryan White program, established by Congress in 1990, is the third largest funder of HIV care in the United States, after Medicare and Medicaid. According to the Kaiser Family Foundation, the program serves more than 500,000 people with HIV each year, and pays for the care of people with limited or no insurance or other financial resources.

In their policy statement, the authors optimistically state that President Obama’s health care reform plan "provides an unprecedented opportunity to improve access to HIV care and develop more sustainable funding streams that can be used to expand access to the effective HIV care model developed by the Ryan White program."

But if such change is to succeed – and it’s a very big "if" – Dr. Gallant and colleagues acknowledged that it "will require Medicaid, Medicare, and private insurers to adopt delivery systems and risk-adjusted payment mechanisms that support access to effective HIV care."

The authors say that whatever shape health care takes in the future, the elements required for effective HIV care include access to:

• Routine HIV testing.

• Early diagnosis.

• Care provided by an expert in HIV.

• Subspecialists with HIV experience.

• HIV medications.

• Support for adherence to treatment and health care.

• Access to social work services, substance abuse treatment, and mental health services.

"Weakening of this model by fragmenting care, decreasing access to essential services or decreasing provider expertise could really have devastating consequences to infected individuals and to society as a whole," Dr. Gallant said.

"[The HIV care] model is now in jeopardy, in part because of the current economic climate and in part because of the potential successes of health care reform."

He noted that although HIV medications are expensive, they are life-saving, highly cost-effective, and prevent illness, disability, hospitalization, and death when properly used.

"In addition, now we know that successful HIV treatment prevents transmission. In the recently published HPTN 052 study, treating the affected partner in a sero-discordant partner reduced transmission to the uninfected partner by 96%, so providing quality HIV care to HIV-infected is really critical to our efforts to reduce the size of the epidemic in this country," he added (N. Engl. J. Med. 2011;365:493-505).

The Ryan White model also has broader application to the treatment of other chronic conditions, commented coauthor Dr. Mari Kitahata from the department of medicine at the University of Washington, Seattle.

"A key component is coordination of care, and a care coordinator could be a qualified nurse, case manager or social worker responsible for communicating and coordinating with other providers, as well as bringing access to services throughout the continuum. Medication management is an essential component of primary care, as it is in other chronic diseases," she said.

The policy statement was developed by a joint working group of the HIV Medicine Association’s board of directors and the Ryan White Medical Providers Coalition with support from HIV Medicine Association staff.

Dr. Gallant disclosed that he has received honoraria or consulting fees from Bristol-Myers Squibb, Merck, Janssen Therapeutics, RAPID Pharmaceuticals and Gilead Sciences, and payment for review activities from Gilead and Sangamo Biosciences. Dr. Kitahata disclosed no potential conflicts of interest.

BOSTON – The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices on Oct. 25 will hear a recommendation that patients with diabetes receive immunization with the hepatitis B vaccine, following findings that U.S. adults with diabetes patients face a roughly twofold increased risk for hepatitis B infection.*

Results from CDC investigations identified inadequately cleaned blood glucose monitors as a major route of hepatitis B virus transmission among patients with diabetes, Meredith L. Reilly, a CDC epidemiologist, said while presenting a poster at the meeting.

"Over the past several years, we’ve observed outbreaks of hepatitis B among patients with diabetes in places where they undergo assisted blood glucose monitoring, with more than one person using the monitor," such as assisted-living facilities, physician offices, and at pharmacies, said Dr. Trudy V. Murphy, head of the vaccine unit in the Division of Viral Hepatitis at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in Atlanta. A total of 24 of 28 outbreaks at long-term care facilities identified different aspects of blood glucose monitoring as the source of the infection."

Dr. Murphy is scheduled to propose new recommendations on the use of hepatitis B vaccination before the Advisory Committee on Immunization Practices of the CDC at the ACIP’s meeting on Oct. 25, and her recommendations will include targeting the vaccine to patients with diabetes, both types 1 and 2, she said in an interview.

Although the CDC will also promote other steps to prevent hepatitis B transmission among patients with diabetes, such as greater attention to cleaning blood glucose monitors and avoiding the sharing of lancets or insulin needles, "Vaccination is an additional measure to ensure protection," she said.

Diabetes patients must also take other steps to avoid blood exposures because they also face infection threats from other blood-borne pathogens. However, hepatitis B poses a particular risk because it is highly infectious in residual blood and is relatively stable. An invisible drop of blood can contain enough virus to infect an exposed person, and the virus in that drop will remain infectious on a surface for 7 days, Dr. Murphy noted. In addition, blood glucose monitors can be very hard to completely clean of residual blood because of their design and because more thorough cleaning can damage the equipment.

Hepatitis B is the first blood-borne pathogen that has been proven to transmit among patients with diabetes through blood-contaminated equipment used in monitoring and treating diabetes, she added.

Following the outbreak investigations, the CDC reviewed acute hepatitis cases reported during 2009 and 2010 at eight U.S. sites in the CDC’s Emerging Infections Program. The review included 865 people with acute hepatitis B infections, including 95 with diabetes. In an analysis that controlled for gender, age, race and ethnicity, and other hepatitis B risk factors, the patients with diabetes who were 23-59 years old had a statistically significant, 2.1-fold higher risk of being infected with hepatitis B, compared with the people studied who did not have diabetes, Ms. Reilly reported in her poster. Among those aged 22 years or younger, the patients with diabetes had a significant, 1.9-fold increased risk for hepatitis B infection. Among those aged 60 years or older, the risk of hepatitis B infection was 50% higher in patients with diabetes, a difference that did not achieve statistical significance, reported Ms. Reilly, who also works in the CDC’s Division of Viral Hepatitis.

Ms. Reilly and Dr. Murphy said that they had no disclosures.

* Correction, 10/25/2011: An article dated Oct. 24 from the Annual Meeting of the Infectious Diseases Society of America incorrectly attributed a recommendation that patients with diabetes receive immunization with the hepatitis B vaccine to the Centers for Disease Control and Prevention. Dr. Murphy was making the recommendation to the CDC's Advisory Committee on Immunization Practices.

BOSTON – The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices on Oct. 25 will hear a recommendation that patients with diabetes receive immunization with the hepatitis B vaccine, following findings that U.S. adults with diabetes patients face a roughly twofold increased risk for hepatitis B infection.*

Results from CDC investigations identified inadequately cleaned blood glucose monitors as a major route of hepatitis B virus transmission among patients with diabetes, Meredith L. Reilly, a CDC epidemiologist, said while presenting a poster at the meeting.

"Over the past several years, we’ve observed outbreaks of hepatitis B among patients with diabetes in places where they undergo assisted blood glucose monitoring, with more than one person using the monitor," such as assisted-living facilities, physician offices, and at pharmacies, said Dr. Trudy V. Murphy, head of the vaccine unit in the Division of Viral Hepatitis at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in Atlanta. A total of 24 of 28 outbreaks at long-term care facilities identified different aspects of blood glucose monitoring as the source of the infection."

Dr. Murphy is scheduled to propose new recommendations on the use of hepatitis B vaccination before the Advisory Committee on Immunization Practices of the CDC at the ACIP’s meeting on Oct. 25, and her recommendations will include targeting the vaccine to patients with diabetes, both types 1 and 2, she said in an interview.

Although the CDC will also promote other steps to prevent hepatitis B transmission among patients with diabetes, such as greater attention to cleaning blood glucose monitors and avoiding the sharing of lancets or insulin needles, "Vaccination is an additional measure to ensure protection," she said.

Diabetes patients must also take other steps to avoid blood exposures because they also face infection threats from other blood-borne pathogens. However, hepatitis B poses a particular risk because it is highly infectious in residual blood and is relatively stable. An invisible drop of blood can contain enough virus to infect an exposed person, and the virus in that drop will remain infectious on a surface for 7 days, Dr. Murphy noted. In addition, blood glucose monitors can be very hard to completely clean of residual blood because of their design and because more thorough cleaning can damage the equipment.

Hepatitis B is the first blood-borne pathogen that has been proven to transmit among patients with diabetes through blood-contaminated equipment used in monitoring and treating diabetes, she added.

Following the outbreak investigations, the CDC reviewed acute hepatitis cases reported during 2009 and 2010 at eight U.S. sites in the CDC’s Emerging Infections Program. The review included 865 people with acute hepatitis B infections, including 95 with diabetes. In an analysis that controlled for gender, age, race and ethnicity, and other hepatitis B risk factors, the patients with diabetes who were 23-59 years old had a statistically significant, 2.1-fold higher risk of being infected with hepatitis B, compared with the people studied who did not have diabetes, Ms. Reilly reported in her poster. Among those aged 22 years or younger, the patients with diabetes had a significant, 1.9-fold increased risk for hepatitis B infection. Among those aged 60 years or older, the risk of hepatitis B infection was 50% higher in patients with diabetes, a difference that did not achieve statistical significance, reported Ms. Reilly, who also works in the CDC’s Division of Viral Hepatitis.

Ms. Reilly and Dr. Murphy said that they had no disclosures.

* Correction, 10/25/2011: An article dated Oct. 24 from the Annual Meeting of the Infectious Diseases Society of America incorrectly attributed a recommendation that patients with diabetes receive immunization with the hepatitis B vaccine to the Centers for Disease Control and Prevention. Dr. Murphy was making the recommendation to the CDC's Advisory Committee on Immunization Practices.

BOSTON – The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices on Oct. 25 will hear a recommendation that patients with diabetes receive immunization with the hepatitis B vaccine, following findings that U.S. adults with diabetes patients face a roughly twofold increased risk for hepatitis B infection.*

Results from CDC investigations identified inadequately cleaned blood glucose monitors as a major route of hepatitis B virus transmission among patients with diabetes, Meredith L. Reilly, a CDC epidemiologist, said while presenting a poster at the meeting.

"Over the past several years, we’ve observed outbreaks of hepatitis B among patients with diabetes in places where they undergo assisted blood glucose monitoring, with more than one person using the monitor," such as assisted-living facilities, physician offices, and at pharmacies, said Dr. Trudy V. Murphy, head of the vaccine unit in the Division of Viral Hepatitis at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in Atlanta. A total of 24 of 28 outbreaks at long-term care facilities identified different aspects of blood glucose monitoring as the source of the infection."

Dr. Murphy is scheduled to propose new recommendations on the use of hepatitis B vaccination before the Advisory Committee on Immunization Practices of the CDC at the ACIP’s meeting on Oct. 25, and her recommendations will include targeting the vaccine to patients with diabetes, both types 1 and 2, she said in an interview.

Although the CDC will also promote other steps to prevent hepatitis B transmission among patients with diabetes, such as greater attention to cleaning blood glucose monitors and avoiding the sharing of lancets or insulin needles, "Vaccination is an additional measure to ensure protection," she said.

Diabetes patients must also take other steps to avoid blood exposures because they also face infection threats from other blood-borne pathogens. However, hepatitis B poses a particular risk because it is highly infectious in residual blood and is relatively stable. An invisible drop of blood can contain enough virus to infect an exposed person, and the virus in that drop will remain infectious on a surface for 7 days, Dr. Murphy noted. In addition, blood glucose monitors can be very hard to completely clean of residual blood because of their design and because more thorough cleaning can damage the equipment.

Hepatitis B is the first blood-borne pathogen that has been proven to transmit among patients with diabetes through blood-contaminated equipment used in monitoring and treating diabetes, she added.

Following the outbreak investigations, the CDC reviewed acute hepatitis cases reported during 2009 and 2010 at eight U.S. sites in the CDC’s Emerging Infections Program. The review included 865 people with acute hepatitis B infections, including 95 with diabetes. In an analysis that controlled for gender, age, race and ethnicity, and other hepatitis B risk factors, the patients with diabetes who were 23-59 years old had a statistically significant, 2.1-fold higher risk of being infected with hepatitis B, compared with the people studied who did not have diabetes, Ms. Reilly reported in her poster. Among those aged 22 years or younger, the patients with diabetes had a significant, 1.9-fold increased risk for hepatitis B infection. Among those aged 60 years or older, the risk of hepatitis B infection was 50% higher in patients with diabetes, a difference that did not achieve statistical significance, reported Ms. Reilly, who also works in the CDC’s Division of Viral Hepatitis.

Ms. Reilly and Dr. Murphy said that they had no disclosures.

* Correction, 10/25/2011: An article dated Oct. 24 from the Annual Meeting of the Infectious Diseases Society of America incorrectly attributed a recommendation that patients with diabetes receive immunization with the hepatitis B vaccine to the Centers for Disease Control and Prevention. Dr. Murphy was making the recommendation to the CDC's Advisory Committee on Immunization Practices.

BOSTON – Community-dwelling seniors who brush their teeth, keep as active as their infirmities permit, and shun cigarettes may be able to significantly lower their risk for serious pneumonia, investigators reported at the annual meeting of the Infectious Diseases Society of America.

Among 1,575 adults aged 70 years and older who were followed in an ongoing prospective study, a higher oral plaque burden was associated with a 1.43-fold greater risk for pneumonia that required hospitalization; the development of a mobility limitation was linked to 1.84-fold increased risk, and an active smoking status effectively doubled the risk (1.95-fold), reported Dr. Manisha Juthani-Mehta of Yale University in New Haven, Conn.

"The novel and interesting thing from this study is that these findings are consistent with the emerging theme linking oral bacteria (and therefore, potentially, the oral microbiome) to pneumonia risk in many different clinical settings – not only hospital-acquired pneumonia and ventilator-associated pneumonia, but now potentially ... community-acquired pneumonia, where aspiration may be a predominant mechanism for risk pneumonia in community-dwelling older adults as well," she said.

Dental plaque has been identified as a reservoir for respiratory pathogens implicated in hospital-acquired and ventilator-associated pneumonia, and her group has identified inadequate oral care as a risk factor for nursing home–acquired pneumonia, Dr. Juthani-Mehta said.

Whether dental plaque or poor oral hygiene also puts presumably healthy, community-dwelling older adults at greater risk for developing serious pneumonia was unclear, however.

The investigators hypothesized that in addition to inadequate dental care, modifiable risk factors for pneumonia would include lack of influenza and Pneumovax vaccinations, poor nutrition (body mass index loss), and cigarette smoking.

The overall Health ABC study cohort included 3,075 community-dwelling adults in Pittsburgh and Memphis who were aged 70-79 years at baseline. Of that group, 1,575 had a study interview within 6 months of a dental exam and had an available plaque score.

The authors defined poor oral hygiene as a mean oral plaque score of 1 or greater on a scale of 0-3 (0 = no plaque; 1 = plaque identified by a probe; 2 = visible plaque; 3 = abundant plaque).

The rate of pneumonia cases requiring hospitalization (the primary outcome) was 169.8 per 10,000 person-years, which was similar to that of the overall population rate for people aged 65 years and older (161.0 per 10,000 person-years in 2007, according to a 2010 National Health Statistics Report).

In a multivariate analysis, modifiable risk factors were mean oral plaque score (hazard ratio, 1.43), incident mobility limitation (HR, 1.84), and active smoking (HR, 1.95).

Nonmodifiable risk factors included male sex (HR, 2.08), white race (HR, 1.67), and age older than 75 years (HR, 1.32).

Looking at the average attributable fraction for each of the risk factors, the investigators found that the plaque score accounted for 13.1% of pneumonias, mobility limitation accounted for 12.2%, and smoking for 1.1%.

The study was supported by grants from the National Institutes for Health. Dr. Juthani-Mehta reported that she had no relevant financial disclosures.

BOSTON – Community-dwelling seniors who brush their teeth, keep as active as their infirmities permit, and shun cigarettes may be able to significantly lower their risk for serious pneumonia, investigators reported at the annual meeting of the Infectious Diseases Society of America.

Among 1,575 adults aged 70 years and older who were followed in an ongoing prospective study, a higher oral plaque burden was associated with a 1.43-fold greater risk for pneumonia that required hospitalization; the development of a mobility limitation was linked to 1.84-fold increased risk, and an active smoking status effectively doubled the risk (1.95-fold), reported Dr. Manisha Juthani-Mehta of Yale University in New Haven, Conn.

"The novel and interesting thing from this study is that these findings are consistent with the emerging theme linking oral bacteria (and therefore, potentially, the oral microbiome) to pneumonia risk in many different clinical settings – not only hospital-acquired pneumonia and ventilator-associated pneumonia, but now potentially ... community-acquired pneumonia, where aspiration may be a predominant mechanism for risk pneumonia in community-dwelling older adults as well," she said.

Dental plaque has been identified as a reservoir for respiratory pathogens implicated in hospital-acquired and ventilator-associated pneumonia, and her group has identified inadequate oral care as a risk factor for nursing home–acquired pneumonia, Dr. Juthani-Mehta said.

Whether dental plaque or poor oral hygiene also puts presumably healthy, community-dwelling older adults at greater risk for developing serious pneumonia was unclear, however.

The investigators hypothesized that in addition to inadequate dental care, modifiable risk factors for pneumonia would include lack of influenza and Pneumovax vaccinations, poor nutrition (body mass index loss), and cigarette smoking.

The overall Health ABC study cohort included 3,075 community-dwelling adults in Pittsburgh and Memphis who were aged 70-79 years at baseline. Of that group, 1,575 had a study interview within 6 months of a dental exam and had an available plaque score.

The authors defined poor oral hygiene as a mean oral plaque score of 1 or greater on a scale of 0-3 (0 = no plaque; 1 = plaque identified by a probe; 2 = visible plaque; 3 = abundant plaque).

The rate of pneumonia cases requiring hospitalization (the primary outcome) was 169.8 per 10,000 person-years, which was similar to that of the overall population rate for people aged 65 years and older (161.0 per 10,000 person-years in 2007, according to a 2010 National Health Statistics Report).

In a multivariate analysis, modifiable risk factors were mean oral plaque score (hazard ratio, 1.43), incident mobility limitation (HR, 1.84), and active smoking (HR, 1.95).

Nonmodifiable risk factors included male sex (HR, 2.08), white race (HR, 1.67), and age older than 75 years (HR, 1.32).

Looking at the average attributable fraction for each of the risk factors, the investigators found that the plaque score accounted for 13.1% of pneumonias, mobility limitation accounted for 12.2%, and smoking for 1.1%.

The study was supported by grants from the National Institutes for Health. Dr. Juthani-Mehta reported that she had no relevant financial disclosures.

BOSTON – Community-dwelling seniors who brush their teeth, keep as active as their infirmities permit, and shun cigarettes may be able to significantly lower their risk for serious pneumonia, investigators reported at the annual meeting of the Infectious Diseases Society of America.

Among 1,575 adults aged 70 years and older who were followed in an ongoing prospective study, a higher oral plaque burden was associated with a 1.43-fold greater risk for pneumonia that required hospitalization; the development of a mobility limitation was linked to 1.84-fold increased risk, and an active smoking status effectively doubled the risk (1.95-fold), reported Dr. Manisha Juthani-Mehta of Yale University in New Haven, Conn.

"The novel and interesting thing from this study is that these findings are consistent with the emerging theme linking oral bacteria (and therefore, potentially, the oral microbiome) to pneumonia risk in many different clinical settings – not only hospital-acquired pneumonia and ventilator-associated pneumonia, but now potentially ... community-acquired pneumonia, where aspiration may be a predominant mechanism for risk pneumonia in community-dwelling older adults as well," she said.

Dental plaque has been identified as a reservoir for respiratory pathogens implicated in hospital-acquired and ventilator-associated pneumonia, and her group has identified inadequate oral care as a risk factor for nursing home–acquired pneumonia, Dr. Juthani-Mehta said.

Whether dental plaque or poor oral hygiene also puts presumably healthy, community-dwelling older adults at greater risk for developing serious pneumonia was unclear, however.

The investigators hypothesized that in addition to inadequate dental care, modifiable risk factors for pneumonia would include lack of influenza and Pneumovax vaccinations, poor nutrition (body mass index loss), and cigarette smoking.

The overall Health ABC study cohort included 3,075 community-dwelling adults in Pittsburgh and Memphis who were aged 70-79 years at baseline. Of that group, 1,575 had a study interview within 6 months of a dental exam and had an available plaque score.

The authors defined poor oral hygiene as a mean oral plaque score of 1 or greater on a scale of 0-3 (0 = no plaque; 1 = plaque identified by a probe; 2 = visible plaque; 3 = abundant plaque).

The rate of pneumonia cases requiring hospitalization (the primary outcome) was 169.8 per 10,000 person-years, which was similar to that of the overall population rate for people aged 65 years and older (161.0 per 10,000 person-years in 2007, according to a 2010 National Health Statistics Report).

In a multivariate analysis, modifiable risk factors were mean oral plaque score (hazard ratio, 1.43), incident mobility limitation (HR, 1.84), and active smoking (HR, 1.95).

Nonmodifiable risk factors included male sex (HR, 2.08), white race (HR, 1.67), and age older than 75 years (HR, 1.32).

Looking at the average attributable fraction for each of the risk factors, the investigators found that the plaque score accounted for 13.1% of pneumonias, mobility limitation accounted for 12.2%, and smoking for 1.1%.

The study was supported by grants from the National Institutes for Health. Dr. Juthani-Mehta reported that she had no relevant financial disclosures.

BOSTON – In addition to causing cavities, oral microbes may be linked to the risk for health care–associated pneumonia, a small study has shown.

In the study, intubated patients in an ICU were found to have oral microbial profiles that were significantly different from those of similar patients who did not develop pneumonia, reported Dr. Samit Joshi of the section of infectious diseases at Yale University in New Haven, Conn.

The study investigators also found that mouth-dwelling microbe profiles of community-dwelling healthy adults differed markedly from those of adults at higher risk for pneumonia, including nursing home residents and patients on mechanical ventilation.

"We showed that as the risk for pneumonia increased among these three groups of adults, that certain types of bacteria living in their mouths decreased. Interestingly, in the adults who actually developed pneumonia, other disease-causing bacteria in their mouths actually increased days before those adults developed pneumonia," Dr. Joshi said in a briefing.

The findings suggest that genetic sequencing of oral microbial communities in patients’ mouths may provide novel methods for targeted prevention of pneumonia, he added.

The investigators took swab samples from the mouths of 19 healthy, community-dwelling adults (mean age, 60.1 years); 10 nursing home residents (86.2 years); and 8 patients in an ICU (51.6 years). The nursing home residents had been living in the facility for a mean of 33.2 months; the ICU patients had been in the unit for a mean of 3.6 days.

Samples of bacteria collected from the palate, buccal mucosa, tongue, and gingival crevice were then analyzed with165 ribosomal RNA pyrosequencing, a sophisticated technology suitable for complex microbiome analyses, but not available for bedside or point of care assays.

"We showed that as the risk for pneumonia increased among these three groups of adults, that certain types of bacteria living in their mouths decreased."

The authors found that bugs in the family Streptococcaceae were the dominant oral residents, but in proportions that differed significantly among the three patient groups: 65% among community dwellers, 43% among nursing home residents, and 33% among the ICU patients, all of whom were on mechanical ventilation.

Three of the patients went on to develop pneumonia at around 1 week of their ICU stay, and these patients had significantly smaller average proportions of oral Steptococcaceae species than did ICU patients who did not develop pneumonia (0.07% vs. 49%).

The authors then looked at the mean weighted UniFrac distance, which allows for phylogenetic comparisons of microbial communities, and found a significant difference between ICU residents who developed pneumonia and those who were spared from it.

"This discovery has implications for how we prevent pneumonia in the future," Dr. Joshi said at the annual meeting of the Infectious Diseases Society of America. "It may lead to new and improved ways that we can prevent pneumonia by maintaining the composition of bacteria which live inside our mouths, or by maintaining our local immune defense mechanisms."

The idea that microbial communities may be markers of disease is "exciting," said Dr. David Relman, professor of medicine at Stanford (Calif.) University. "What we don’t know right now is whether the two are linked causally – these changes in the microbial composition and the onset of disease – but regardless, I think there is value in understanding these novel kinds of markers of pneumococcal disease," he commented. Dr. Relman was not involved in the study, but moderated a briefing where the data were presented.

The study was funded by the National Institute on Aging and the Howard Hughes Medical Institute. Dr. Joshi and Dr. Relman each reported that they had no relevant financial disclosures.

BOSTON – In addition to causing cavities, oral microbes may be linked to the risk for health care–associated pneumonia, a small study has shown.

In the study, intubated patients in an ICU were found to have oral microbial profiles that were significantly different from those of similar patients who did not develop pneumonia, reported Dr. Samit Joshi of the section of infectious diseases at Yale University in New Haven, Conn.

The study investigators also found that mouth-dwelling microbe profiles of community-dwelling healthy adults differed markedly from those of adults at higher risk for pneumonia, including nursing home residents and patients on mechanical ventilation.

"We showed that as the risk for pneumonia increased among these three groups of adults, that certain types of bacteria living in their mouths decreased. Interestingly, in the adults who actually developed pneumonia, other disease-causing bacteria in their mouths actually increased days before those adults developed pneumonia," Dr. Joshi said in a briefing.

The findings suggest that genetic sequencing of oral microbial communities in patients’ mouths may provide novel methods for targeted prevention of pneumonia, he added.

The investigators took swab samples from the mouths of 19 healthy, community-dwelling adults (mean age, 60.1 years); 10 nursing home residents (86.2 years); and 8 patients in an ICU (51.6 years). The nursing home residents had been living in the facility for a mean of 33.2 months; the ICU patients had been in the unit for a mean of 3.6 days.

Samples of bacteria collected from the palate, buccal mucosa, tongue, and gingival crevice were then analyzed with165 ribosomal RNA pyrosequencing, a sophisticated technology suitable for complex microbiome analyses, but not available for bedside or point of care assays.

"We showed that as the risk for pneumonia increased among these three groups of adults, that certain types of bacteria living in their mouths decreased."

The authors found that bugs in the family Streptococcaceae were the dominant oral residents, but in proportions that differed significantly among the three patient groups: 65% among community dwellers, 43% among nursing home residents, and 33% among the ICU patients, all of whom were on mechanical ventilation.

Three of the patients went on to develop pneumonia at around 1 week of their ICU stay, and these patients had significantly smaller average proportions of oral Steptococcaceae species than did ICU patients who did not develop pneumonia (0.07% vs. 49%).

The authors then looked at the mean weighted UniFrac distance, which allows for phylogenetic comparisons of microbial communities, and found a significant difference between ICU residents who developed pneumonia and those who were spared from it.

"This discovery has implications for how we prevent pneumonia in the future," Dr. Joshi said at the annual meeting of the Infectious Diseases Society of America. "It may lead to new and improved ways that we can prevent pneumonia by maintaining the composition of bacteria which live inside our mouths, or by maintaining our local immune defense mechanisms."

The idea that microbial communities may be markers of disease is "exciting," said Dr. David Relman, professor of medicine at Stanford (Calif.) University. "What we don’t know right now is whether the two are linked causally – these changes in the microbial composition and the onset of disease – but regardless, I think there is value in understanding these novel kinds of markers of pneumococcal disease," he commented. Dr. Relman was not involved in the study, but moderated a briefing where the data were presented.

The study was funded by the National Institute on Aging and the Howard Hughes Medical Institute. Dr. Joshi and Dr. Relman each reported that they had no relevant financial disclosures.

BOSTON – In addition to causing cavities, oral microbes may be linked to the risk for health care–associated pneumonia, a small study has shown.

In the study, intubated patients in an ICU were found to have oral microbial profiles that were significantly different from those of similar patients who did not develop pneumonia, reported Dr. Samit Joshi of the section of infectious diseases at Yale University in New Haven, Conn.

The study investigators also found that mouth-dwelling microbe profiles of community-dwelling healthy adults differed markedly from those of adults at higher risk for pneumonia, including nursing home residents and patients on mechanical ventilation.

"We showed that as the risk for pneumonia increased among these three groups of adults, that certain types of bacteria living in their mouths decreased. Interestingly, in the adults who actually developed pneumonia, other disease-causing bacteria in their mouths actually increased days before those adults developed pneumonia," Dr. Joshi said in a briefing.

The findings suggest that genetic sequencing of oral microbial communities in patients’ mouths may provide novel methods for targeted prevention of pneumonia, he added.

The investigators took swab samples from the mouths of 19 healthy, community-dwelling adults (mean age, 60.1 years); 10 nursing home residents (86.2 years); and 8 patients in an ICU (51.6 years). The nursing home residents had been living in the facility for a mean of 33.2 months; the ICU patients had been in the unit for a mean of 3.6 days.

Samples of bacteria collected from the palate, buccal mucosa, tongue, and gingival crevice were then analyzed with165 ribosomal RNA pyrosequencing, a sophisticated technology suitable for complex microbiome analyses, but not available for bedside or point of care assays.

"We showed that as the risk for pneumonia increased among these three groups of adults, that certain types of bacteria living in their mouths decreased."

The authors found that bugs in the family Streptococcaceae were the dominant oral residents, but in proportions that differed significantly among the three patient groups: 65% among community dwellers, 43% among nursing home residents, and 33% among the ICU patients, all of whom were on mechanical ventilation.

Three of the patients went on to develop pneumonia at around 1 week of their ICU stay, and these patients had significantly smaller average proportions of oral Steptococcaceae species than did ICU patients who did not develop pneumonia (0.07% vs. 49%).

The authors then looked at the mean weighted UniFrac distance, which allows for phylogenetic comparisons of microbial communities, and found a significant difference between ICU residents who developed pneumonia and those who were spared from it.

"This discovery has implications for how we prevent pneumonia in the future," Dr. Joshi said at the annual meeting of the Infectious Diseases Society of America. "It may lead to new and improved ways that we can prevent pneumonia by maintaining the composition of bacteria which live inside our mouths, or by maintaining our local immune defense mechanisms."

The idea that microbial communities may be markers of disease is "exciting," said Dr. David Relman, professor of medicine at Stanford (Calif.) University. "What we don’t know right now is whether the two are linked causally – these changes in the microbial composition and the onset of disease – but regardless, I think there is value in understanding these novel kinds of markers of pneumococcal disease," he commented. Dr. Relman was not involved in the study, but moderated a briefing where the data were presented.

The study was funded by the National Institute on Aging and the Howard Hughes Medical Institute. Dr. Joshi and Dr. Relman each reported that they had no relevant financial disclosures.

BOSTON – Some antimicrobial agents are in such short supply that a majority of physicians surveyed reported having to switch to a more toxic or expensive alternative, and more than half said that the shortage adversely affected patient care, reported investigators at the annual meeting of the Infectious Diseases Society of America.

Among 634 members of the IDSA's Emerging Infections Network, 78% said they had had to modify their antimicrobial choice because of a shortage of the preferred agent within the past 2 years, and 52% reported that the shortage had adversely affected patient care or outcomes, said Dr. Philip M. Polgreen of the University of Iowa in Iowa City.

Fully 70% learned of the shortage from the pharmacy only after they had prescribed the drug, and only 24% said they found out about the shortage from an official source such at the Food and Drug Administration's Drug Shortages website.

"Some of the adverse effects that were reported were exposing a patient to a more toxic drug, exposing them to a much more expensive drug, exposing them to a drug with a much broader spectrum than was needed, and in some cases the physician reported that a patient had to stay longer in the hospital or had a failure of therapy," Dr. Polgreen said at a briefing on Oct. 20.

In a subgroup of 250 respondents, 28% said that patients incurred long-term morbidity from inadequate treatment.

The drugs that are reported to be in short supply tend to be those recommended for less common infections, and their availability may be subject to supply chain issues or local shortages. Although the study was not designed to examine reasons for shortages, several of the agents come from a single supplier, and the shortage of one agent may lead to overuse and subsequent shortage of another, Dr. Polgreen suggested.

The drugs reported most frequently to be unavailable or in short supply include the intravenous formulation of trimethoprim/sulfamethoxazole (Bactrim), amikacin (Amikin), aztreonam (Azactam), foscarnet (Foscavir), and penicillin G.

Other agents in short supply include oseltamivir (Tamiflu) oral suspension, and acyclovir (Zovirax) tablets, as well as injectable biologic agents and vaccines, including intravenous immune globulin, live zoster vaccine, yellow fever vaccine, and inactivated influenza vaccine.

The investigators sent a web-based survey with nine questions to all 1,350 members of the IDSA-EIN, a sentinel network of physicians. They received a total of 634 responses (47% response rate).

Dr. Polgreen acknowledged that that study was limited by self-reporting with no verification and by possible response bias, with members who had encountered a drug shortage being more likely to respond.

He said that physicians need more effective ways of learning about impending or current shortages and about acceptable alternatives to first-line agents. Such efforts are particularly important in light of the fact that there are very few antimicrobial agents in the drug development pipeline, he said.

In a separate presentation, Dr. Helen Boucher, of Tufts Medical Center, Boston, and her colleagues reported that drug companies aren't exactly scrambling to solve the problem of antimicrobial resistance to existing agents.

The researchers identified nine drugs in clinical development for parenteral use against gram-negative bacilli. Of these agents, only two have novel mechanism of action, and none is being studied for efficacy against community-acquired bacterial pneumonia, or hospital- or ventilator-associated pneumonia.

The number of new antibiotics approved for marketing in the United States annually continues to decline, and major pharmaceutical companies – many of which pioneered antimicrobial drug development – are continually slackening both the pace and the quantity of antimicrobial agent development.

"We all know that with antibiotics, attrition happens, so that even in the later stages of development, we can’t count on getting all or even a majority of these compounds to market. Further, and very importantly, none of these drugs is available today, and our patients need new drugs now," Boucher added.

Dr. Polgreen's study was supported by the Centers for Disease Control and Prevention. He reported having no conflicts of interest. Dr. Boucher's study was funded by the participating institutions. She disclosed serving on an adjudication committee for Merck and as a consultant to Merck, Wyeth/Pfizer, Durata, and PolyMedix.

BOSTON – Some antimicrobial agents are in such short supply that a majority of physicians surveyed reported having to switch to a more toxic or expensive alternative, and more than half said that the shortage adversely affected patient care, reported investigators at the annual meeting of the Infectious Diseases Society of America.

Among 634 members of the IDSA's Emerging Infections Network, 78% said they had had to modify their antimicrobial choice because of a shortage of the preferred agent within the past 2 years, and 52% reported that the shortage had adversely affected patient care or outcomes, said Dr. Philip M. Polgreen of the University of Iowa in Iowa City.

Fully 70% learned of the shortage from the pharmacy only after they had prescribed the drug, and only 24% said they found out about the shortage from an official source such at the Food and Drug Administration's Drug Shortages website.

"Some of the adverse effects that were reported were exposing a patient to a more toxic drug, exposing them to a much more expensive drug, exposing them to a drug with a much broader spectrum than was needed, and in some cases the physician reported that a patient had to stay longer in the hospital or had a failure of therapy," Dr. Polgreen said at a briefing on Oct. 20.

In a subgroup of 250 respondents, 28% said that patients incurred long-term morbidity from inadequate treatment.

The drugs that are reported to be in short supply tend to be those recommended for less common infections, and their availability may be subject to supply chain issues or local shortages. Although the study was not designed to examine reasons for shortages, several of the agents come from a single supplier, and the shortage of one agent may lead to overuse and subsequent shortage of another, Dr. Polgreen suggested.

The drugs reported most frequently to be unavailable or in short supply include the intravenous formulation of trimethoprim/sulfamethoxazole (Bactrim), amikacin (Amikin), aztreonam (Azactam), foscarnet (Foscavir), and penicillin G.

Other agents in short supply include oseltamivir (Tamiflu) oral suspension, and acyclovir (Zovirax) tablets, as well as injectable biologic agents and vaccines, including intravenous immune globulin, live zoster vaccine, yellow fever vaccine, and inactivated influenza vaccine.

The investigators sent a web-based survey with nine questions to all 1,350 members of the IDSA-EIN, a sentinel network of physicians. They received a total of 634 responses (47% response rate).

Dr. Polgreen acknowledged that that study was limited by self-reporting with no verification and by possible response bias, with members who had encountered a drug shortage being more likely to respond.

He said that physicians need more effective ways of learning about impending or current shortages and about acceptable alternatives to first-line agents. Such efforts are particularly important in light of the fact that there are very few antimicrobial agents in the drug development pipeline, he said.

In a separate presentation, Dr. Helen Boucher, of Tufts Medical Center, Boston, and her colleagues reported that drug companies aren't exactly scrambling to solve the problem of antimicrobial resistance to existing agents.

The researchers identified nine drugs in clinical development for parenteral use against gram-negative bacilli. Of these agents, only two have novel mechanism of action, and none is being studied for efficacy against community-acquired bacterial pneumonia, or hospital- or ventilator-associated pneumonia.

The number of new antibiotics approved for marketing in the United States annually continues to decline, and major pharmaceutical companies – many of which pioneered antimicrobial drug development – are continually slackening both the pace and the quantity of antimicrobial agent development.

"We all know that with antibiotics, attrition happens, so that even in the later stages of development, we can’t count on getting all or even a majority of these compounds to market. Further, and very importantly, none of these drugs is available today, and our patients need new drugs now," Boucher added.

Dr. Polgreen's study was supported by the Centers for Disease Control and Prevention. He reported having no conflicts of interest. Dr. Boucher's study was funded by the participating institutions. She disclosed serving on an adjudication committee for Merck and as a consultant to Merck, Wyeth/Pfizer, Durata, and PolyMedix.

BOSTON – Some antimicrobial agents are in such short supply that a majority of physicians surveyed reported having to switch to a more toxic or expensive alternative, and more than half said that the shortage adversely affected patient care, reported investigators at the annual meeting of the Infectious Diseases Society of America.

Among 634 members of the IDSA's Emerging Infections Network, 78% said they had had to modify their antimicrobial choice because of a shortage of the preferred agent within the past 2 years, and 52% reported that the shortage had adversely affected patient care or outcomes, said Dr. Philip M. Polgreen of the University of Iowa in Iowa City.

Fully 70% learned of the shortage from the pharmacy only after they had prescribed the drug, and only 24% said they found out about the shortage from an official source such at the Food and Drug Administration's Drug Shortages website.

"Some of the adverse effects that were reported were exposing a patient to a more toxic drug, exposing them to a much more expensive drug, exposing them to a drug with a much broader spectrum than was needed, and in some cases the physician reported that a patient had to stay longer in the hospital or had a failure of therapy," Dr. Polgreen said at a briefing on Oct. 20.

In a subgroup of 250 respondents, 28% said that patients incurred long-term morbidity from inadequate treatment.

The drugs that are reported to be in short supply tend to be those recommended for less common infections, and their availability may be subject to supply chain issues or local shortages. Although the study was not designed to examine reasons for shortages, several of the agents come from a single supplier, and the shortage of one agent may lead to overuse and subsequent shortage of another, Dr. Polgreen suggested.

The drugs reported most frequently to be unavailable or in short supply include the intravenous formulation of trimethoprim/sulfamethoxazole (Bactrim), amikacin (Amikin), aztreonam (Azactam), foscarnet (Foscavir), and penicillin G.

Other agents in short supply include oseltamivir (Tamiflu) oral suspension, and acyclovir (Zovirax) tablets, as well as injectable biologic agents and vaccines, including intravenous immune globulin, live zoster vaccine, yellow fever vaccine, and inactivated influenza vaccine.

The investigators sent a web-based survey with nine questions to all 1,350 members of the IDSA-EIN, a sentinel network of physicians. They received a total of 634 responses (47% response rate).

Dr. Polgreen acknowledged that that study was limited by self-reporting with no verification and by possible response bias, with members who had encountered a drug shortage being more likely to respond.

He said that physicians need more effective ways of learning about impending or current shortages and about acceptable alternatives to first-line agents. Such efforts are particularly important in light of the fact that there are very few antimicrobial agents in the drug development pipeline, he said.

In a separate presentation, Dr. Helen Boucher, of Tufts Medical Center, Boston, and her colleagues reported that drug companies aren't exactly scrambling to solve the problem of antimicrobial resistance to existing agents.

The researchers identified nine drugs in clinical development for parenteral use against gram-negative bacilli. Of these agents, only two have novel mechanism of action, and none is being studied for efficacy against community-acquired bacterial pneumonia, or hospital- or ventilator-associated pneumonia.

The number of new antibiotics approved for marketing in the United States annually continues to decline, and major pharmaceutical companies – many of which pioneered antimicrobial drug development – are continually slackening both the pace and the quantity of antimicrobial agent development.

"We all know that with antibiotics, attrition happens, so that even in the later stages of development, we can’t count on getting all or even a majority of these compounds to market. Further, and very importantly, none of these drugs is available today, and our patients need new drugs now," Boucher added.

Dr. Polgreen's study was supported by the Centers for Disease Control and Prevention. He reported having no conflicts of interest. Dr. Boucher's study was funded by the participating institutions. She disclosed serving on an adjudication committee for Merck and as a consultant to Merck, Wyeth/Pfizer, Durata, and PolyMedix.

BOSTON – Some antimicrobial agents are in such short supply that a majority of infectious disease specialists surveyed reported having to switch to a more toxic or expensive alternative, and more than half said that the shortage adversely affected patient care, reported investigators at the annual meeting of the Infectious Diseases Society of America.

Among 634 members of the IDSA’s Emerging Infections Network, 78% said they had had to modify their antimicrobial choice because of a shortage of the preferred agent within the past 2 years, and 52% reported that the shortage had adversely affected patient care or outcomes, said Dr. Philip M. Polgreen of the University of Iowa in Iowa City.

Fully 70% of the ID specialists learned of the shortage from the pharmacy only after they had prescribed the drug, and only 24% said they found out about the shortage from an official source such at the Food and Drug Administration’s Drug Shortages website.

"Some of the adverse effects that were reported were exposing a patient to a more toxic drug, exposing them to a much more expensive drug, exposing them to a drug with a much broader spectrum than was needed, and in some cases the physician reported that a patient had to stay longer in the hospital or had a failure of therapy," Dr. Polgreen said at a briefing on Oct. 20.

In a subgroup of 250 respondents, 28% said that patients incurred long-term morbidity from inadequate treatment.

The drugs that are reported to be in short supply tend to be those recommended for less common infections, and their availability may be subject to supply chain issues or local shortages. Although the study was not designed to examine reasons for shortages, several of the agents come from a single supplier, and the shortage of one agent may lead to overuse and subsequent shortage of another, Dr. Polgreen suggested.

The drugs reported most frequently to be unavailable or in short supply include the intravenous formulation of trimethoprim/sulfamethoxazole (Bactrim), amikacin (Amikin), aztreonam (Azactam), foscarnet (Foscavir), and penicillin G.

Other agents in short supply include oseltamivir (Tamiflu) oral suspension, and acyclovir (Zovirax) tablets, as well as injectable biologic agents and vaccines, including intravenous immune globulin, live zoster vaccine, yellow fever vaccine, and inactivated influenza vaccine.

The investigators sent a web-based survey with nine questions to all 1,350 members of the IDSA-EIN, a sentinel network of physicians. They received a total of 634 responses (47% response rate).

Dr. Polgreen acknowledged that that study was limited by self-reporting with no verification and by possible response bias, with members who had encountered a drug shortage being more likely to respond.

He said that physicians need more effective ways of learning about impending or current shortages and about acceptable alternatives to first-line agents. Such efforts are particularly important in light of the fact that there are very few antimicrobial agents in the drug development pipeline, he said.

In a separate presentation, Dr. Helen Boucher, of Tufts Medical Center, Boston, and her colleagues reported that drug companies aren’t exactly scrambling to solve the problem of antimicrobial resistance to existing agents.

The researchers identified nine drugs in clinical development for parenteral use against gram-negative bacilli. Of these agents, only two have novel mechanism of action, and none is being studied for efficacy against community-acquired bacterial pneumonia, or hospital- or ventilator-associated pneumonia.

The number of new antibiotics approved for marketing in the United States annually continues to decline, and major pharmaceutical companies – many of which pioneered antimicrobial drug development – are continually slackening both the pace and the quantity of antimicrobial agent development.

"We all know that with antibiotics, attrition happens, so that even in the later stages of development, we can’t count on getting all or even a majority of these compounds to market. Further, and very importantly, none of these drugs is available today, and our patients need new drugs now," Boucher added.

Dr. Polgreen’s study was supported by the Centers for Disease Control and Prevention. He reported having no conflicts of interest. Dr. Boucher’s study was funded by the participating institutions. She disclosed serving on an adjudication committee for Merck and as a consultant to Merck, Wyeth/Pfizer, Durata, and PolyMedix.

BOSTON – Some antimicrobial agents are in such short supply that a majority of infectious disease specialists surveyed reported having to switch to a more toxic or expensive alternative, and more than half said that the shortage adversely affected patient care, reported investigators at the annual meeting of the Infectious Diseases Society of America.

Among 634 members of the IDSA’s Emerging Infections Network, 78% said they had had to modify their antimicrobial choice because of a shortage of the preferred agent within the past 2 years, and 52% reported that the shortage had adversely affected patient care or outcomes, said Dr. Philip M. Polgreen of the University of Iowa in Iowa City.

Fully 70% of the ID specialists learned of the shortage from the pharmacy only after they had prescribed the drug, and only 24% said they found out about the shortage from an official source such at the Food and Drug Administration’s Drug Shortages website.

"Some of the adverse effects that were reported were exposing a patient to a more toxic drug, exposing them to a much more expensive drug, exposing them to a drug with a much broader spectrum than was needed, and in some cases the physician reported that a patient had to stay longer in the hospital or had a failure of therapy," Dr. Polgreen said at a briefing on Oct. 20.

In a subgroup of 250 respondents, 28% said that patients incurred long-term morbidity from inadequate treatment.

The drugs that are reported to be in short supply tend to be those recommended for less common infections, and their availability may be subject to supply chain issues or local shortages. Although the study was not designed to examine reasons for shortages, several of the agents come from a single supplier, and the shortage of one agent may lead to overuse and subsequent shortage of another, Dr. Polgreen suggested.

The drugs reported most frequently to be unavailable or in short supply include the intravenous formulation of trimethoprim/sulfamethoxazole (Bactrim), amikacin (Amikin), aztreonam (Azactam), foscarnet (Foscavir), and penicillin G.

Other agents in short supply include oseltamivir (Tamiflu) oral suspension, and acyclovir (Zovirax) tablets, as well as injectable biologic agents and vaccines, including intravenous immune globulin, live zoster vaccine, yellow fever vaccine, and inactivated influenza vaccine.

The investigators sent a web-based survey with nine questions to all 1,350 members of the IDSA-EIN, a sentinel network of physicians. They received a total of 634 responses (47% response rate).

Dr. Polgreen acknowledged that that study was limited by self-reporting with no verification and by possible response bias, with members who had encountered a drug shortage being more likely to respond.

He said that physicians need more effective ways of learning about impending or current shortages and about acceptable alternatives to first-line agents. Such efforts are particularly important in light of the fact that there are very few antimicrobial agents in the drug development pipeline, he said.

In a separate presentation, Dr. Helen Boucher, of Tufts Medical Center, Boston, and her colleagues reported that drug companies aren’t exactly scrambling to solve the problem of antimicrobial resistance to existing agents.

The researchers identified nine drugs in clinical development for parenteral use against gram-negative bacilli. Of these agents, only two have novel mechanism of action, and none is being studied for efficacy against community-acquired bacterial pneumonia, or hospital- or ventilator-associated pneumonia.

The number of new antibiotics approved for marketing in the United States annually continues to decline, and major pharmaceutical companies – many of which pioneered antimicrobial drug development – are continually slackening both the pace and the quantity of antimicrobial agent development.

"We all know that with antibiotics, attrition happens, so that even in the later stages of development, we can’t count on getting all or even a majority of these compounds to market. Further, and very importantly, none of these drugs is available today, and our patients need new drugs now," Boucher added.

Dr. Polgreen’s study was supported by the Centers for Disease Control and Prevention. He reported having no conflicts of interest. Dr. Boucher’s study was funded by the participating institutions. She disclosed serving on an adjudication committee for Merck and as a consultant to Merck, Wyeth/Pfizer, Durata, and PolyMedix.

BOSTON – Some antimicrobial agents are in such short supply that a majority of infectious disease specialists surveyed reported having to switch to a more toxic or expensive alternative, and more than half said that the shortage adversely affected patient care, reported investigators at the annual meeting of the Infectious Diseases Society of America.

Among 634 members of the IDSA’s Emerging Infections Network, 78% said they had had to modify their antimicrobial choice because of a shortage of the preferred agent within the past 2 years, and 52% reported that the shortage had adversely affected patient care or outcomes, said Dr. Philip M. Polgreen of the University of Iowa in Iowa City.

Fully 70% of the ID specialists learned of the shortage from the pharmacy only after they had prescribed the drug, and only 24% said they found out about the shortage from an official source such at the Food and Drug Administration’s Drug Shortages website.

"Some of the adverse effects that were reported were exposing a patient to a more toxic drug, exposing them to a much more expensive drug, exposing them to a drug with a much broader spectrum than was needed, and in some cases the physician reported that a patient had to stay longer in the hospital or had a failure of therapy," Dr. Polgreen said at a briefing on Oct. 20.

In a subgroup of 250 respondents, 28% said that patients incurred long-term morbidity from inadequate treatment.

The drugs that are reported to be in short supply tend to be those recommended for less common infections, and their availability may be subject to supply chain issues or local shortages. Although the study was not designed to examine reasons for shortages, several of the agents come from a single supplier, and the shortage of one agent may lead to overuse and subsequent shortage of another, Dr. Polgreen suggested.

The drugs reported most frequently to be unavailable or in short supply include the intravenous formulation of trimethoprim/sulfamethoxazole (Bactrim), amikacin (Amikin), aztreonam (Azactam), foscarnet (Foscavir), and penicillin G.

Other agents in short supply include oseltamivir (Tamiflu) oral suspension, and acyclovir (Zovirax) tablets, as well as injectable biologic agents and vaccines, including intravenous immune globulin, live zoster vaccine, yellow fever vaccine, and inactivated influenza vaccine.

The investigators sent a web-based survey with nine questions to all 1,350 members of the IDSA-EIN, a sentinel network of physicians. They received a total of 634 responses (47% response rate).

Dr. Polgreen acknowledged that that study was limited by self-reporting with no verification and by possible response bias, with members who had encountered a drug shortage being more likely to respond.

He said that physicians need more effective ways of learning about impending or current shortages and about acceptable alternatives to first-line agents. Such efforts are particularly important in light of the fact that there are very few antimicrobial agents in the drug development pipeline, he said.

In a separate presentation, Dr. Helen Boucher, of Tufts Medical Center, Boston, and her colleagues reported that drug companies aren’t exactly scrambling to solve the problem of antimicrobial resistance to existing agents.

The researchers identified nine drugs in clinical development for parenteral use against gram-negative bacilli. Of these agents, only two have novel mechanism of action, and none is being studied for efficacy against community-acquired bacterial pneumonia, or hospital- or ventilator-associated pneumonia.

The number of new antibiotics approved for marketing in the United States annually continues to decline, and major pharmaceutical companies – many of which pioneered antimicrobial drug development – are continually slackening both the pace and the quantity of antimicrobial agent development.

"We all know that with antibiotics, attrition happens, so that even in the later stages of development, we can’t count on getting all or even a majority of these compounds to market. Further, and very importantly, none of these drugs is available today, and our patients need new drugs now," Boucher added.

Dr. Polgreen’s study was supported by the Centers for Disease Control and Prevention. He reported having no conflicts of interest. Dr. Boucher’s study was funded by the participating institutions. She disclosed serving on an adjudication committee for Merck and as a consultant to Merck, Wyeth/Pfizer, Durata, and PolyMedix.

BOSTON – Born in an era when vaccine-preventable diseases are rare, newly minted physicians appear to have less faith in the efficacy and safety of vaccinations than do their older colleagues – and this skepticism may rub off on patients, with potentially harmful consequences, said investigators at the annual meeting of the Infectious Diseases Society of America.

Recent medical school graduates were about 15% less likely to say that vaccines are efficacious than were their more mature counterparts. The younger providers also were less likely to say they believe that live attenuated or inactivated vaccines against poliomyelitis, measles, mumps, rubella, and varicella were safe, and more likely to say that vaccines do more harm than good, said Dr. Saad B. Omer of the Rollins School of Public Health at Emory University, Atlanta, at a briefing and in a poster to be presented Oct. 21.

Overall support for vaccinations among physicians of all ages is generally strong, Omer said. But the data reveal trends that seem to mirror those seen among parents. Younger physicians, like younger parents, rarely encounter once-commonplace childhood ailments, and therefore may be less sanguine about the benefits of immunization than more seasoned providers, Dr. Omer noted.

"If you are a health care provider, and you have seen a case of whooping cough and have heard a child whoop, or if you have treated Haemophilus influenzae B meningitis, that experience is a little more visceral; and that possibly could have an impact not only on the individual level, but also at the institutional level in terms of training," he said.

In terms of parent and physician attitudes, vaccinations have been victims of their own success, suggested Dr. Bruce Gellin of the National Vaccine Program Office at the U.S. Department of Health and Human Services.

"I think it reflects the power that vaccines have had to make these diseases go away, which now [calls into question] their ‘value’ to the people who are receiving them, because they don’t understand how society has changed because of them," Dr. Gellin said.

"As the familiarity with the disease goes away, then [providers] are only hearing about vaccines and don’t link up with what the vaccines are designed to do," noted Dr. Gellin while moderated a briefing at which the data were presented.

To gauge physician attitudes, Dr. Omer and his colleague Michelle J. Mergler of the National Vaccine Program Office at the U.S. Department of Health and Human Services surveyed physicians who had been identified by parents participating in a vaccine attitudes survey. The children were either fully vaccinated or had parents who were vaccine refuseniks, choosing to opt out of their schools’ immunization requirements.

A total of 551 providers (84.3% response rate) returned completed surveys. The responses were stratified by physicians caring for vaccine-exempt and nonexempt patients, and by year of graduate clinical training in 5-year intervals, from 1954 through 2002.

The researchers found that every 5-year increase in the graduation date was associated with a 20% increase in the odds ratio (OR) that physicians would agree with the statement that "children get more immunizations than are good for them."

In addition, for every 5-year-later graduation date, there was a 20% decrease in the OR that providers would agree with the statement that "immunizations are getting better and safer all the time as the result of medical research."

Parental Attitudes

In a second study, Dr. Thomas Tryon and his colleagues from Children’s Mercy Hospitals and Clinics in Kansas City, Mo., surveyed 909 pediatricians in nine Midwestern states about patients’ reasons for refusing or questioning vaccinations.

They found that parents most frequently refuse or ask the pediatrician to defer administration of the measles, mumps, and rubella (MMR) vaccine, human papillomavirus (HPV) vaccine, and influenza vaccine. The most frequent reasons given were fear of causing autism, too many shots, and serious side effects.

Nearly all of the respondents (95%) said they engaged the family in discussion of or presentation of options, 66% referred families to evidence-based Web sites, and 63% handed out or referred patients to evidence-based literature as a means of intervention.

Overall, 21% of practitioners said they discharged vaccine-refusing families from their practices. Minnesota-based practitioners were least likely (0.9%) to report kicking out a family that had consistently refused vaccinations. In contrast, 38% of pediatricians in Iowa said they had given vaccine-refusing families the boot.

Dr. Omer’s study was internally funded. He reported having no relevant disclosures. Ms. Mergler reported having no relevant disclosures. Dr. Tryon’s study was supported by a research grant from GlaxoSmithKline to coauthor Dr. Christopher Harrison. Dr. Tryon reported no relevant disclosures.

BOSTON – Born in an era when vaccine-preventable diseases are rare, newly minted physicians appear to have less faith in the efficacy and safety of vaccinations than do their older colleagues – and this skepticism may rub off on patients, with potentially harmful consequences, said investigators at the annual meeting of the Infectious Diseases Society of America.

Recent medical school graduates were about 15% less likely to say that vaccines are efficacious than were their more mature counterparts. The younger providers also were less likely to say they believe that live attenuated or inactivated vaccines against poliomyelitis, measles, mumps, rubella, and varicella were safe, and more likely to say that vaccines do more harm than good, said Dr. Saad B. Omer of the Rollins School of Public Health at Emory University, Atlanta, at a briefing and in a poster to be presented Oct. 21.

Overall support for vaccinations among physicians of all ages is generally strong, Omer said. But the data reveal trends that seem to mirror those seen among parents. Younger physicians, like younger parents, rarely encounter once-commonplace childhood ailments, and therefore may be less sanguine about the benefits of immunization than more seasoned providers, Dr. Omer noted.

"If you are a health care provider, and you have seen a case of whooping cough and have heard a child whoop, or if you have treated Haemophilus influenzae B meningitis, that experience is a little more visceral; and that possibly could have an impact not only on the individual level, but also at the institutional level in terms of training," he said.

In terms of parent and physician attitudes, vaccinations have been victims of their own success, suggested Dr. Bruce Gellin of the National Vaccine Program Office at the U.S. Department of Health and Human Services.

"I think it reflects the power that vaccines have had to make these diseases go away, which now [calls into question] their ‘value’ to the people who are receiving them, because they don’t understand how society has changed because of them," Dr. Gellin said.

"As the familiarity with the disease goes away, then [providers] are only hearing about vaccines and don’t link up with what the vaccines are designed to do," noted Dr. Gellin while moderated a briefing at which the data were presented.

To gauge physician attitudes, Dr. Omer and his colleague Michelle J. Mergler of the National Vaccine Program Office at the U.S. Department of Health and Human Services surveyed physicians who had been identified by parents participating in a vaccine attitudes survey. The children were either fully vaccinated or had parents who were vaccine refuseniks, choosing to opt out of their schools’ immunization requirements.

A total of 551 providers (84.3% response rate) returned completed surveys. The responses were stratified by physicians caring for vaccine-exempt and nonexempt patients, and by year of graduate clinical training in 5-year intervals, from 1954 through 2002.

The researchers found that every 5-year increase in the graduation date was associated with a 20% increase in the odds ratio (OR) that physicians would agree with the statement that "children get more immunizations than are good for them."

In addition, for every 5-year-later graduation date, there was a 20% decrease in the OR that providers would agree with the statement that "immunizations are getting better and safer all the time as the result of medical research."

Parental Attitudes

In a second study, Dr. Thomas Tryon and his colleagues from Children’s Mercy Hospitals and Clinics in Kansas City, Mo., surveyed 909 pediatricians in nine Midwestern states about patients’ reasons for refusing or questioning vaccinations.

They found that parents most frequently refuse or ask the pediatrician to defer administration of the measles, mumps, and rubella (MMR) vaccine, human papillomavirus (HPV) vaccine, and influenza vaccine. The most frequent reasons given were fear of causing autism, too many shots, and serious side effects.

Nearly all of the respondents (95%) said they engaged the family in discussion of or presentation of options, 66% referred families to evidence-based Web sites, and 63% handed out or referred patients to evidence-based literature as a means of intervention.

Overall, 21% of practitioners said they discharged vaccine-refusing families from their practices. Minnesota-based practitioners were least likely (0.9%) to report kicking out a family that had consistently refused vaccinations. In contrast, 38% of pediatricians in Iowa said they had given vaccine-refusing families the boot.

Dr. Omer’s study was internally funded. He reported having no relevant disclosures. Ms. Mergler reported having no relevant disclosures. Dr. Tryon’s study was supported by a research grant from GlaxoSmithKline to coauthor Dr. Christopher Harrison. Dr. Tryon reported no relevant disclosures.

BOSTON – Born in an era when vaccine-preventable diseases are rare, newly minted physicians appear to have less faith in the efficacy and safety of vaccinations than do their older colleagues – and this skepticism may rub off on patients, with potentially harmful consequences, said investigators at the annual meeting of the Infectious Diseases Society of America.

Recent medical school graduates were about 15% less likely to say that vaccines are efficacious than were their more mature counterparts. The younger providers also were less likely to say they believe that live attenuated or inactivated vaccines against poliomyelitis, measles, mumps, rubella, and varicella were safe, and more likely to say that vaccines do more harm than good, said Dr. Saad B. Omer of the Rollins School of Public Health at Emory University, Atlanta, at a briefing and in a poster to be presented Oct. 21.

Overall support for vaccinations among physicians of all ages is generally strong, Omer said. But the data reveal trends that seem to mirror those seen among parents. Younger physicians, like younger parents, rarely encounter once-commonplace childhood ailments, and therefore may be less sanguine about the benefits of immunization than more seasoned providers, Dr. Omer noted.

"If you are a health care provider, and you have seen a case of whooping cough and have heard a child whoop, or if you have treated Haemophilus influenzae B meningitis, that experience is a little more visceral; and that possibly could have an impact not only on the individual level, but also at the institutional level in terms of training," he said.

In terms of parent and physician attitudes, vaccinations have been victims of their own success, suggested Dr. Bruce Gellin of the National Vaccine Program Office at the U.S. Department of Health and Human Services.

"I think it reflects the power that vaccines have had to make these diseases go away, which now [calls into question] their ‘value’ to the people who are receiving them, because they don’t understand how society has changed because of them," Dr. Gellin said.

"As the familiarity with the disease goes away, then [providers] are only hearing about vaccines and don’t link up with what the vaccines are designed to do," noted Dr. Gellin while moderated a briefing at which the data were presented.

To gauge physician attitudes, Dr. Omer and his colleague Michelle J. Mergler of the National Vaccine Program Office at the U.S. Department of Health and Human Services surveyed physicians who had been identified by parents participating in a vaccine attitudes survey. The children were either fully vaccinated or had parents who were vaccine refuseniks, choosing to opt out of their schools’ immunization requirements.

A total of 551 providers (84.3% response rate) returned completed surveys. The responses were stratified by physicians caring for vaccine-exempt and nonexempt patients, and by year of graduate clinical training in 5-year intervals, from 1954 through 2002.

The researchers found that every 5-year increase in the graduation date was associated with a 20% increase in the odds ratio (OR) that physicians would agree with the statement that "children get more immunizations than are good for them."

In addition, for every 5-year-later graduation date, there was a 20% decrease in the OR that providers would agree with the statement that "immunizations are getting better and safer all the time as the result of medical research."

Parental Attitudes

In a second study, Dr. Thomas Tryon and his colleagues from Children’s Mercy Hospitals and Clinics in Kansas City, Mo., surveyed 909 pediatricians in nine Midwestern states about patients’ reasons for refusing or questioning vaccinations.

They found that parents most frequently refuse or ask the pediatrician to defer administration of the measles, mumps, and rubella (MMR) vaccine, human papillomavirus (HPV) vaccine, and influenza vaccine. The most frequent reasons given were fear of causing autism, too many shots, and serious side effects.

Nearly all of the respondents (95%) said they engaged the family in discussion of or presentation of options, 66% referred families to evidence-based Web sites, and 63% handed out or referred patients to evidence-based literature as a means of intervention.

Overall, 21% of practitioners said they discharged vaccine-refusing families from their practices. Minnesota-based practitioners were least likely (0.9%) to report kicking out a family that had consistently refused vaccinations. In contrast, 38% of pediatricians in Iowa said they had given vaccine-refusing families the boot.

Dr. Omer’s study was internally funded. He reported having no relevant disclosures. Ms. Mergler reported having no relevant disclosures. Dr. Tryon’s study was supported by a research grant from GlaxoSmithKline to coauthor Dr. Christopher Harrison. Dr. Tryon reported no relevant disclosures.