Why Kids Need Bug Squashers: An Infectious Disease Q&A

Pediatric infectious disease specialists, the doctors who specialize in wiping out microbial and other infections in children, are a dedicated bunch. These physicians work at the front lines of diseases new and old, as well as protecting against complications from other medical interventions.

Last month, members of this profession honored Theoklis E. Zaoutis, MD, MSCE, chief of the Division of Infectious Diseases at The Children’s Hospital of Philadelphia, as an exemplary leader in their midst with the Distinguished Service Award from the Pediatric Infectious Diseases Society (PIDS). This award, presented at the Society’s annual IDWeek meeting, recognizes a member who has made an outstanding contribution to the specialty of pediatric infectious diseases.

On the occasion of this recognition, Cornerstone sat down with Dr. Zaoutis, who is also director ofClinical Futures a CHOP Research Institute Center of Emphasis, and Thomas Frederick McNair Scott Professor of pediatrics and professor of epidemiology at the Perelman School of Medicine at the University of Pennsylvania. We wanted to know what is hot in the field of pediatric infectious disease research and what lies ahead. Read on for the edited conversation.

What is exciting and important in the world of infectious diseases today?

Everything. Infectious diseases are at the forefront of public health issues right now. If we look back at what’s happened in this past year alone, Ebola comes to mind. The world was taken aback by Ebola, by the magnitude of the outbreak, by the magnitude of the mortality associated with the outbreak, and by all the preparedness we had to do to build capacity to tackle it.

I would put Ebola under the larger umbrella of emerging infectious threats to the world. Ebola may be today, but there may be other ones that are out there. I think what’s exciting in the field now is thinking about ways to prepare for these diseases. That includes surveillance — how do we catch it before it gets out of control? How do we stop it? That means rapid capability to respond with treatments, development of vaccines, and infection control methodology. What do we need to wear when we take care of these patients? Emerging infectious diseases are a huge area right now.

What else is really hot right now in infectious diseases is antibiotic resistance. The World Health Organization (WHO) has listed antibiotic resistance — germs that are resistant to antibiotics — as one of the three greatest threats to human health. Antibiotic resistance is clearly an infectious-disease-related issue. For the first time in United States history, a U.S. president used the words “antibiotic resistance” in the State of the Union address. That’s how important infectious disease is right now. The Obama administration has a national strategic plan to combat antibiotic resistance called CARB, Combatting Antibiotic Resistant Bacteria. Again, this is the first time the United States government administration has declared war on infectious disease like this. It’s not a specific infectious disease like Ebola, but it’s more broadly a threat of having germs we can’t treat with antibiotics. Those are two big areas in infectious diseases that are at the forefront right now.

What are some of the biggest concerns or challenges in the pediatric infectious disease realm?

I think a lot of the concerns are very similar in pediatrics as in the general population. Kids were affected by Ebola. Kids will be affected by emerging infectious diseases. Kids are affected by antibiotic resistance. I think, in many ways, infectious disease does not necessarily know bounds in terms of adult versus pediatric patients. I can’t think of one infectious disease that affects just adults and doesn’t affect children. The magnitude of effect may be different depending on which infectious disease we’re talking about, but they’re very similar concerns in pediatrics.

One of the challenges for the field of pediatric infectious disease is it’s very hard in this healthcare climate to show value in what we do. Those of us in cognitive specialties in general in pediatrics — the ones who bring the know-how in aid of other specialties — don’t make a lot of money because we aren’t doing a procedure that we can list as a billable item for insurance companies. For example, we had three people on our faculty working on Ebola. They didn’t get paid for that. The current way the system is structured there is no way to pay for that.

This challenge has led to a significant decline in pediatric residents going into pediatric infectious diseases in the last two years. There was a report put out several years ago showing it was the pediatric subspecialty with the lowest return on investment if you just looked at it in terms of dollars. Infectious diseases are at the forefront, and yet we have people not going into the specialty because the return on investment is not there, and there’s no way to quantify the financial impact of the specialty.

What can be done about this decline in pediatric infectious disease specialists?

I have been working on an initiative that I think is one of the reasons for the PIDS Distinguished Service recognition. The initiative is an effort to both qualitatively and quantitatively assess the value of the subspecialty of pediatric infectious disease specialists.

We’re partnering with a medical sociologist, Julia Szymcak, who’s been involved in other studies here in the institution, to talk to all the stakeholders, from administrators to our customers, who are the other physicians who consult with infectious disease specialists, to say: Where’s the value added with the infectious disease folks?

There’s a lot of value added. It’s just hard to measure it. That’s the upshot of the study, that it’s hard to measure. Bean counters can’t value it. They know it’s there, they know it’s valuable, but when they get to their line items in the budget they can’t quantify it. People talked about improving antibiotic use in the hospital, that infectious disease is involved in quality. The results of this qualitative study so far have been presented at a national meeting.

Also as part of this initiative, we’re in the process of looking at data that’s more quantitative, trying to see other differences in patient outcomes when an infectious disease physician is consulted versus not consulted for similar kinds of patients and conditions. Both of these assessments are ongoing.

Were there other factors that you think contributed to your recognition by PIDS for distinguished service?

A few years ago the Pediatric Infectious Disease Society decided to launch its own journal, the Journal of the Pediatric Infectious Disease Society (JPIDS). I was fortunate enough to be named the inaugural editor-in-chief of that journal. I was given the task of taking a journal from zero to success. One of the milestones for a journal is to be listed in the National Library of Medicine and be searchable. We just made that milestone in June. The journal has been very successful, the quality of the papers has been very good, and it has increased revenue for the Society, and now it’s listed in PubMed. I think that part of the award was acknowledging that success.

Tell us about your current projects here at CHOP.

A lot of my current research work is focusing on addressing the problem of antibiotic resistance and improving antibiotic use. I’m involved in several national, NIH-funded studies now to determine what is the least amount of antibiotics we can use to effectively treat infections. The less antibiotics you use, the less likely you are to develop a resistant bug or bacteria. A lot of my research work is focused on using antibiotics more appropriately so that we do not develop antibiotic resistance.