Episode #23 – Febrile Faves from IDWeek 2021

Our last miscellaneous section!

Big & Little Beasts & the Infectious Diseases They Cause (Session 107; Moderators Belinda Ostrowsky, Teresa Zembower)

• Andrew Janowski –  All Bark & Some Bite–Animal Bites
  • • Dogs are the most common source of bite injury in the US: 4.5 of 5 million bites per year! Predominantly in younger children, more often in boys, frequently in head/neck area in younger children but then moves to arms/legs in older children, usually by a family dog or known dog. Even seen an increase in dog bites during the pandemic
    • Cat bites have the highest risk of infection though, ~50%
    • Most bite infections polymicrobial, average of 7 organisms per bite, Pasteurella, Staph & Strep (skin & mouth flora) most common in cats/dogs, humans with Staph & Strep, also Eikenella, anaerobes prevalent as well
    • Treatment: amox-clav, alternative TMP-SMX + metronidazole
    • Obviously worry about rabies if rabid, but also tetanus from dogs/cats. Human bites with case reports of HIV, hepatitis & syphilis transmission (but overall low risk, but have to risk assess for PPx)
    • Lastly, he provides a great link to a Clinical Microbiology Reviews article on the microbiology of various animal bite wound infections, including bears, sharks, Tasmanian devils, alligators, and komodo dragons….in case you ever need that information
      • Abrahamian FM, Goldstein EJ. Microbiology of animal bite wound infections. Clin Microbiol Rev. 2011;24(2):231-246. doi:10.1128/CMR.00041-10
• Stephen Cole, a veterinary microbiologist —  MDR organisms in companion animals
  • • 2 Staph species associated with dogs/cats: 
      • • Staphylococcus pseudintermedius, a coagulase positive Staph species with numerous virulence factors including urease, predisposing it to cause urinary stones in dogs, similar to Staph saprophyticus, frequently misidentified as Staph aureus, although improved in MALDI-TOF era, additionally, it carries MecA and often has limited antibiotic options
        • Staph schleiferi is another, causes otitis externa in dogs
        • Both pathogens reported in humans, usually methicillin resistant
        • MRSA uncommon in cats/dogs, but more common in horses, has been reportedly transmitted between people & animals
    • CRE in companion animals: rare, but reported, possible transmission amongst humans & pets
• Camille Cotton — Animal-related infections in ICH
  • • Importance of pre- & post-transplant education to our patients on risk of infections from animals, proper risk mitigation & avoidance techniques, also importance of exposure history when presenting with infectious symptoms but also pre-transplant to mitigate risks
    • Presented a case of cryptococcosis related to birds nesting in a house
      • Infections associated with birds: avian flu, campylobacter, salmonella, E. coli, Histo, Crypto & Psittacosis

Clinical Pearls in Outpatient ID: Field Notes from the Frontlines (Session 118; Moderator Adarsh Bhimraj; Speakers Ole Vielemeyer, Kristin Englund)

• • • Common outpatient situations: positive HSV or EBV serologies, chronic pain syndromes, +syphilis serology in setting of dementia, delusional parasitosis
    • Pearls: important to empathize with patient, listen to them, prepare well in advance to know these cases & testing well, difficult with medically unexplained or poorly defined diagnoses, need to set limits

Controversies in Antimicrobial Stewardship (Session 35; Moderators Daniel Morgan, Jacqueline Bork)

• Erin McCreary: Importance of diagnostic stewardship
  • • Right test, right time, right patient, right action
    • Options to intervene during the ordering/collection phase (order sets, restrictions on tests such as UCx or CDiff indications, etc), processing phase (e.g., multistep algorithms…CDiff GDH antigen–>toxin–>PCR or HIV Ab–>confirmatory test), reporting phase (comments for interpretation the so-called “nudge,”, suppressing extraneous results e.g., susceptibilities)
• Meghan Jeffres: how best to utilize time for ASP, is de-escalation of spectrum worth the effort?
  • • Presents a nuanced argument using available data, showing that no definitive evidence demonstrates de-escalation of antibiotic spectrum improves patient outcomes or prevents the development of resistance. This is SO controversial (hence the session name), but in a lot of ways, ANY antibiotic therapy increases risks of CDiff, resistance, etc in the studies, plus many limitations of the evidence. Ultimately, we need better quality evidence on the subject, but her argument is perhaps ASP should spend their limited times on more evidence based interventions (IV to PO conversions, decrease total duration of antibiotics, etc)
• Alison Tribble: great overview of handshake stewardship, evidence overview, compared to prospective audit/feedback & preauthorization, in-person vs remote, because handshake is time-intensive, perhaps implementing in select units or teams

Medical Education Sessions:

• Developing and maintaining expertise: deliberate practice for ID learners of all ages (Session 23)
  • • Moderators Michael Angarone, Ryan Maves
    • Speakers Diane Wayne, Emily Abdoler, Dana Blyth
• Language Matters: Integrating inclusive language in ID education and patient care (Session 06)
  • • Moderators Brian Schwartz, Jennifer Cuellar-Rodriguez
    • Speakers Mary Catherine Beach, Orlando Harris
• Strategies for optimizing ID case conference: an educator’s toolkit (Session 33)
  • • Moderators Christopher Ohl, Vera Luther
    • Speakers Varun Phadke, Jennifer Spicer
• Re-envisioning your ID curricula through a non-oppressive/anti-racist lens (Session 57)
  • • Moderator Christopher Ohl
    • Speakers Alexandre White, Erica Johnson, Yvonne Maldonado