Globally, some 71 million people are chronically infected with hepatitis C virus (HCV). Marginalized populations, particularly people who inject drugs (PWID), have low testing, linkage to care and treatment rates for HCV. Several models of care (MoCs) and service delivery interventions have the potential to improve outcomes across the HCV cascade of care, but much of the relevant research was carried out when interferon-based treatment was the standard of care. Often it was not practical to scale-up these earlier models and interventions because the clinical care needs of patients taking interferon-based regimens imposed too much of a financial and human resource burden on health systems. Despite the adoption of highly effective, all-oral direct-acting antiviral (DAA) therapies in recent years, approaches to HCV testing and treatment have evolved slowly and often remain rooted in earlier paradigms. The effectiveness of DAAs allows for simpler approaches and has encouraged countries where the drugs are widely available to set their sights on the ambitious World Health Organization (WHO) HCV elimination targets. Since a large proportion of chronically HCV-infected people are not currently accessing treatment, there is an urgent need to identify and implement existing simplified MoCs that speak to specific populations' needs. This article aims to: (i) review the evidence on MoCs for HCV; and (ii) distil the findings into recommendations for how stakeholders can simplify the path taken by chronically HCV-infected individuals from testing to cure and subsequent care and monitoring.

/pdf/we-know-daas-work-so-now-what-simplifying-models-of-care-to-rxxx76js85.pdf

We know DAAs work, so now what? Simplifying models of care to enhance the hepatitis C cascade.

The Role of Probiotics, Prebiotics and Synbiotics in Combating Multidrug-Resistant Organisms

White paper on antimicrobial stewardship in solid organ transplant recipients

Abstract The clinical impact of infections due to extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacterales ( Ent ) has reached dramatic levels worldwide. Infections due to these multidrug-resistant (MDR) pathogens—especially Escherichia coli and Klebsiella pneumoniae —may originate from a prior asymptomatic intestinal colonization that could also favor transmission to other subjects. It is therefore desirable that gut carriers are rapidly identified to try preventing both the occurrence of serious endogenous infections and potential transmission. Together with the infection prevention and control countermeasures, any strategy capable of effectively eradicating the MDR- Ent from the intestinal tract would be desirable. In this narrative review, we present a summary of the different aspects linked to the intestinal colonization due to MDR- Ent . In particular, culture- and molecular-based screening techniques to identify carriers, data on prevalence and risk factors in different populations, clinical impact, length of colonization, and contribution to transmission in various settings will be overviewed. We will also discuss the standard strategies (selective digestive decontamination, fecal microbiota transplant) and those still in development (bacteriophages, probiotics, microcins, and CRISPR-Cas-based) that might be used to decolonize MDR- Ent carriers. 

/pdf/intestinal-colonization-with-multidrug-resistant-2xkw90er.pdf

Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers

An increasing number of specialists and non-specialists are developing clinical programs to treat and cure hepatitis C virus (HCV). The goal of this paper is to evaluate and describe optimal strategies to improve outcomes related to HCV care delivery. Screening and diagnosis of HCV should be guided by established recommendations. Given the recognized disparity in HCV diagnosis and linkage to care, a multi-modal approach involving care coordination and technology resources should be used to improve patient engagement. Access to HCV treatment may be optimized through systematic documentation, prior authorization, and appeal processes. Treatment monitoring should emphasize medication adherence, side effect and drug interaction management, as well as elimination of practical barriers. Finally, post-treatment engagement to promote liver health and reduce the risk of complications or reinfection maximizes the benefit of HCV treatment. The landscape of HCV treatment has evolved from a specialist-driven model with few patients qualifying for treatment to an opportunity for non-specialists and other providers to provide curative therapies in most patients. Innovative practice models that employ a multidisciplinary approach will likely improve screening, diagnosis, engagement, and treatment outcomes.

/pdf/building-a-hepatitis-c-clinical-program-strategies-to-58bd7xd1bb.pdf

Building a Hepatitis C Clinical Program: Strategies to Optimize Outcomes

Preventing avoidable central line-associated bloodstream infections: Implications for probiotic administration and surveillance.

Implementation of a multidisciplinary, team-based model to treat chronic hepatitis C in the primary care setting: Lessons learned.

Antimicrobial Stewardship Centers of Excellence: Plea for Equal Opportunity.

Prosthetic joint infection (PJI) is a challenging complication after joint arthroplasty. Our institution performed preoperative screening and treatment of asymptomatic bacteriuria (ASB) prior to joint replacements. This is a common practice despite a lack of evidence showing benefit or a decrease in postoperative PJI. This practice can lead to increased rates of Clostridioides (Clostridium) difficile infection, multidrug-resistant organisms, higher costs, and adverse reactions. Furthermore, in patients who have both ASB and PJI, studies show that the causative organisms are usually discordant. In April 2016, the antimicrobial stewardship team (AST) met with the orthopedic surgery department to provide education and recommended removing routine urine culture from preoperative order sets for joint arthroplasty. The purpose of this project was to evaluate the impact of education alone followed by the removal of urine culture from the preoperative order set on screening and treatment of ASB prior to elective hip and knee joint arthroplasty.

Impact of tiered interventions to decrease routine urine cultures in asymptomatic patients undergoing arthroplasty

Abstract Clinicians, researchers, and the public frequently turn to digital channels and social media for up-to-the-minute information on novel therapeutics and vaccines. The value of credible infectious diseases drug information is more apparent in the setting of the coronavirus disease 2019 (COVID-19) pandemic. This viewpoint by the Society of Infectious Diseases Pharmacists (SIDP) provides guidance on utilizing social media platforms to optimize infectious diseases pharmacotherapy. It includes tips for all levels of users but primarily serves a guide for the infectious diseases clinician who has not yet joined social media. It compares various social media platforms and suggests which to begin with based on user needs, recommends efficient curation of social media content, and outlines a stepwise approach (shown below) to increasing engagement over time. This summary will hopefully spur further quality content and engagement regarding drug information from the infectious diseases social media network.

/pdf/how-to-harness-the-power-of-social-media-for-quality-drug-1nasxlat.pdf

How to Harness the Power of Social Media for Quality Drug Information in Infectious Diseases: Perspectives on Behalf of the Society of Infectious Diseases Pharmacists

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