Division of Infectious Diseases

Dr. Sandkovsky on “Why I Love ID”

Dr. Sandkovsky on “Why I Love ID”: I love ID because we tend to deal with the unknown, and even when we think we might know there is this intriguing relationship between clinical medicine, basic science and pathophysiology, combined with the social aspects provided by our patients, who make this such a personalized and unique specialty.

See more about Dr. Sandkovsky and the rest of the UNMC ID Division here.

“After Ebola: Nebraska and the Next Pandemic”

Nebraska is a midwest state with those innate values that, in my limited experience thus far, tends to be against boasting and toward humility. Characteristics often to be proud of, but at times, humbleness verges on being a fault.

The Ebola experience highlights the experience here – UNMC and NMC were ready for Ebola – for a LONG time. Preparedness, drills and money spent “just in case” we ever needed those skills. Guess what? We did. And we were ready.

These experiences have prompted an amazing documentary that you should both watch and share. Infectious diseases are among the most terrifying and deadly diseases known to man. Help us, and the world, be prepared.

The link below connects to the full-length version of the documentary created by NET called “After Ebola: Nebraska and the Next Pandemic”, which chronicles the Nebraska Biocontainment Unit and Nebraska preparedness.  It will also air on NET at the following times:

Wednesday, April 19 at 9pm on NET
Friday, April 21 at 7pm on NET World
Saturday, April 22 at 12am on NET
Saturday, April 22 at 7pm on NET
Sunday, April 23 at 8am on NET World
Sunday, April 23 at 12pm on NET
Monday, April 24 at 7pm on NET World
Wednesday, April 26 at 8am on NET World
Friday, April 28 at 11:30 1pm on NET World
Saturday, April 29 at 12am on NET World
Saturday, April 29 at 7pm on NET World
Wednesday, May 24 at 8pm on NET

http://netnebraska.org/interactive-multimedia/news/net-news-after-ebola-nebraska-and-next-pandemic

This post represents personal opinion and was written by Kelly Cawcutt, MD, MS. It does not necessarily represent the opinions of the entire Division of Infections Diseases, UNMC, NMC or NET as a whole. 

Credit given to: Angela Hewlett, MD and Phil Smith, MD along with the entire Nebraska Biocontainment Unit for their amazing leadership and efforts throughout this ongoing experience.

Improving Patient Care Through Research

Our Division is committed to improving the care of our patient through scholarly activities including clinical research. Here is one of our teams out on the patient floors collecting data related to improve the technology we use for intravenous (IV) lines in our patients. We presented our first phase of this project at IDWeek last year (see poster below) and have just finished collecting data on phase 2 using our updated technology. One part of this team to highlight is that research is not just for our faculty! We have Richard Hankins (internal medicine resident), Jen Cavalieri (research coordinator extraordinaire), Denisa Majorant, MD (ID fellow) and Dr. Kelly Cawcutt (Faculty).  Not pictured are Dr. Paul Fey (Microbiology), Elizabeth Lyden(Biostatistician) and Dr. Mark Rupp (Faculty).

Read the published abstract here.

   

 

 

Dr. Florescu on “Why I Love ID”

Dr. Florescu on “Why I Love ID”:  In infectious diseases, the process of diagnosis is like detective work, a real challenge of the clinical ability. I also feel that I have a significant impact on the life of my patients – infections can make people incredibly sick very fast, and I can get them back to where they were.

See more about Dr. Florescu and the UNMC ID Division here.

ID Interest Group Continues to Expand Around Careers in Infectious Diseases

Last week, our Infectious Diseases Interest Group held a multidisciplinary panel surrounding careers in Infectious Diseases. Students from medicine, pharmacy, nursing, graduate studies and public health were all in attendance!

There are broad career opportunities within Infectious Diseases and this area always evolving. Teams are multidisciplinary and truly collaborate together regarding patient care, education and scholarly activities. To highlight the different avenues of career paths, the panelists discussed their role on the ID team and the path that led each one of them to a career within Infectious Diseases along with their current carrier and what each panelist finds rewarding about ID.

The student panel included:

Nursing: Ryan Ross from Nebraska Medicine; Kallie Hannam and Marilyn Van Gestel from Children’s

Nurse Practitioner: Whitney Knuth from Nebraska Medicine

Physician Assistants: Maggie Krejci from Children’s; Kim Meyer from Nebraska Medicine

Pharmacy: Dr. Philip Chung from Nebraska Medicine

MD: Dr. Andrea Green

Infectious Diseases Journal Club – Why Antibiotics Are Not Always The Answer

Asymptomatic bacteriuria (presence of bacteria in the urine with no clinical symptoms) is a common finding, especially in the elderly and people with diabetes, and current guidelines recommend against treating patients who harbor bacteria in the urine.

There are a few exceptions, for example treating pregnant women, in order to prevent complications.

This scenario however, has not been extensively studied or addressed in patients who are immunosuppressed or who have a transplanted organ, especially those who underwent kidney transplantation. It would be prudent to believe a priori, that if bacteria is present in the urine of a patient who has a kidney transplant, it may lead to complications such as infection in the transplanted kidney, sepsis or even loss of the organ.

To address this question, researchers from Hospital 12 de Octubre in Spain studied 112 kidney transplant patients who developed one or more episodes of asymptomatic bacteriuria after the second month post-kidney transplantation. 53 patients were selected to undergo treatment of every episode of bacteriuria (treatment group)  and 59 patients were followed without treatment (control group). Every patient had several urine cultures performed to document clearance or persistence of bacteria, and episodes of pyelonephritis (kidney infection) or graft rejection were documented.

The investigators found that both groups had an average of 4 episodes of asymptomatic bacteriuria per patient. Treating bacteriuria did not prevent subsequent bacteriuria in the treatment group. Interestingly, while all episodes of bacteriuria should have been followed by antibiotic prescription in the treatment group, this only occurred in 64% of the episodes. Moreover, 5% of the bacteriuria episodes in the control group were also treated. Another important finding was that culturing one kind of bacteria in the urine of a given patient, did not predict subsequent development of urinary infections with the same bacteria.

The authors were able to address their two most relevant questions:  there was no difference between groups for development of pyelonephritis or organ rejection.

Urine cultures are expensive, antibiotic prescriptions can also amount for a large sum of money and may predispose patients to drug resistant organisms or development of Clostridium difficile. We should also note how difficult it is to strictly adhere to study protocols, as exemplified by the failure to prescribe antibiotics for every episode in the treatment group.

This was not a large study but it sought to address a very relevant question, and the authors should be commended for their efforts in carrying it out.  The findings of this paper underscore a significant learning point:  antibiotics are not always the answer.

 

Read the article here.

 

– Perspective from Dr. Sandkovsky based on our ID Journal Club Discussion. This represents personal opinions and does not necessarily represent the views of UNMC or the entire Infectious Diseases Division as a whole. 

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