Division of Infectious Diseases

New Faculty Spotlight – Dr. Marcelin

Tell us about the position you are starting? My current roles are Assistant Professor of Medicine and Associate Medical Director of Antimicrobial Stewardship.  In my clinical practice I will be seeing patients on the General Infectious Disease hospital service. This means patients admitted to the hospital (who do not have transplants or malignancies) who have infections. Common conditions include skin/soft tissue infections, respiratory tract infections, and patients who are very ill from an overwhelming infection requiring ICU admission.  In the outpatient clinic, I will be seeing primarily HIV-infected patients at the Specialty Care Center. Finally, in my role as the Associate Medical Director of the Antimicrobial Stewardship Program, I will be part of the team that reviews antimicrobials and their use for infections, educating patients and healthcare professionals on the importance of appropriate antimicrobial use, and from a big-picture viewpoint, helping to try to reduce the number of resistant microorganisms present in our institution, country and the world by preserve the antibiotics we do have for responsible use when needed.

Background: I was born in the Caribbean on the Nature Island of Dominica and spent my teenage years and early adulthood on another island, Antigua.  I completed my undergraduate education at St. Mary’s University in Halifax, Nova Scotia and returned to Antigua for medical school at American University of Antigua College of Medicine. I completed my Internal Medicine Residency and Infectious Diseases Fellowship at Mayo Clinic in Rochester, Minnesota before joining the faculty in the Division of Infectious Diseases at University of Nebraska Medical Center.

Why UNMC? Having done all of my postgraduate training at an academic medical center, I knew I wanted to stay in academics for my career. One of the things that drew me to this institution was the immensely collegial environment. I felt welcomed on every visit, and everyone I spoke to was happy here. I love that the faculty is strongly supported by the division in academic, educational and clinical pursuits, and that there are opportunities for junior faculty to be very involved in any of these ventures if they desire.

What about ID makes you excited? I have always been interested in mysteries and detective work. In medical school I realized that I enjoyed taking care of patients with diagnostic dilemmas rather than focusing on one organ system, so Internal medicine made sense as an initial choice. During residency I further realized that I was most excited about patients with potential infectious causes of their diagnostic dilemmas and Infectious diseases was the one rotation that never felt like “work” to me. I love that infectious diseases is both consistent and ever-changing; both old-fashioned and new-fangled, and while we have made so many life-changing advances in diagnosis and therapy like the microscope and penicillin, there is still so much discovery and change in the horizon, like HIV cure or finding ways to prevent multi-drug resistant organisms. Finally, in infectious disease, I can be both a consultant that manages specific conditions, as well develop long-term relationships with my HIV-infected patients. One of the most rewarding things about Infectious diseases is the ability to cure disease; even if disease cannot be cured such as with HIV, it is humbling to be able to care for a person who is extremely ill at diagnosis and journey with them to a place where they can live a near-normal life such that visits become less about the HIV infection itself, and more about non-infectious issues such as heart disease, cholesterol and diabetes.

Something interesting about me not related to medicine: I speak conversational (but not quite medical) French creole. I was on the track team in college. I have travelled to almost every island in the Eastern Caribbean

See more about the UNMC ID Division here.


 

Physician Assistant’s Week – Celebrating Our Colleagues!

As Physician Assistant’s Week draws to a close, the ID Division wants to recognize and extend our appreciation to our Physician Assistant’s that provide extraordinary care to our patients at Nebraska Medicine.

Kim Meyer

 

A graduate of the University of Nebraska Medical Center Physician Assistant Program, Kim has been a Physician Assistant for 15 years. Kim has served patients in both the inpatient and ambulatory environments. During her training, Kim had a deep interest in Microbiology. Had it not been for the influences of Drs. Pete Iwen, Mark Rupp, and Phil Smith during PA school, we would not have been lucky to have her a part of her our team. Whether she starts her day with a dog bite or with a potential exposure to Zika, Kim enjoys the challenges that provide care as part of the Infectious Diseases Team presents.

 

Erin Van Surksum

A graduate of Union College Physician Assistant program in Lincoln, NE, Erin has been a Physician Assistant for two years. Erin provides care for patients as part of the Transplant Infectious Diseases team in both the inpatient and ambulatory environment. Erin always knew she wanted to contribute in the healthcare field and was introduced to the Physician Assistant role by a family member. After shadowing a Physician Assistant, she knew this is how she wanted to contribute in the healthcare field. Erin enjoys the challenges that the unique patient population she serves presents, often researching unfamiliar infections, reviewing cultures, and adjusting antibiotic dosing to ensure the most appropriate plan of care is utilized. For Erin, one of the most rewarding aspects of being a Physician Assistant is the collaborative culture between the care teams she experiences while caring for our patients.

Content courtesy of Jonathan Nguyen.


 

Norovirus in Intestinal Transplant Recipients – A Different Presentation of Enteritis

Dr. Diana Florescu performed a large retrospective study, evaluating clinical presentation and outcomes of Norovirus infections in intestinal allograft compared to the native intestine. The study was done in collaboration with Dr. Pearlie Chong and included patients transplanted at UNMC and the University of North Carolina at Chapel Hill.

The study showed that intestinal transplant recipients tend to have more severe norovirus enteritis reflected in more frequent hospital admissions and requirement of prolonged intravenous hydration, but less likely to have nausea and vomiting at presentation compared with other allograft recipients. Understanding the differences in clinical course of norovirus enteritis between different allografts would help to understand who might require more aggressive intervention or might benefit from novel therapeutic agents. The findings suggest that the intestinal allograft might be infected earlier after transplantation than the native intestine.

This research collaboration led to the invitation to present our findings at the prestigious 26th International Congress of the Transplantation Society in Hong Kong. Our findings have been fully detailed in papers published Transplant Infectious Diseases in 2017.

https://www.ncbi.nlm.nih.gov/pubmed/28273399

Content courtesy of Dr. Florescu. 


 

IDWeek Continues with Great Sessions – Including One On Tele-Antimicrobial Stewardship

Whether ID physicians should help smaller hospitals develop their own program or should run the program for them was debated during discussions. Most likely the right approach will depend on the facility characteristics and their resources. During Question and Answer Session, Dr. Ashraf informed the speakers and the audience that Nebraska ASAP do work with small hospitals and long-term care facilities to help them develop their own program. The approach has its challenges but overall facilities learn over time and so do we. Nebraska ASAP has developed various tools for them to make their job easy and the best part is those tools are then available free of charge on Nebraska ASAP website (asap.nebraskamed.com) which can be used by facilities who are not directly involved in the educational intervention.

Resistant CMV – Research Aimed at the Cure

Image courtesy of CDC/ Rosalie B. Haraszti, M.D

 

Infections due to Cytomegalovirus(CMV) remain a significant problem for patients undergoing various types of transplants, including both hematopoietic stem cell transplants and solid organ transplant, particularly since these groups both require the use of potent immunosuppressive chemotherapy. Although the currently available systemic anti-cytomegalovirus agents are usually effective, their use is limited by their toxicities, especially in transplant recipients, who receive ongoing immunosuppressive medications to prevent organ rejection or graft-versus-host disease, and who receive other potential nephrotoxic therapies. The population of hematopoietic stem cell transplant and solid organ transplant recipients, whose CMV infections are increasingly refractory to available antiviral treatment, is an area of high unmet medical need as currently there are no approved treatment for resistant cytomegalovirus infections.

To help discover ways to meet this need, here at UNMC, Dr. Florescu and her research team are leading a study in transplant recipients of a drug for the treatment of CMV infections, including those resistant or refractory to standard of care.

Learn more about ID research at UNMC here.

Content courtesy of Dr. Diana Florescu. 


 

Dr. Rupp Setting the Record Straight on Transmission of Organisms via the Floor

Dr. Mark Rupp debated Curtis Donskey today regarding the role of the hospital floor in transmission of resistant pathogens. According to several in attendance, this was a great discussion! Key Point  Dr. Ashraf took away from this debate : Even though it is important to thoroughly clean floors, we need to remember that transmission of pathogens is more likely to happen due to lack of hand hygiene or not paying attention to high touch surfaces.

Content courtesy of the ID Division attendees at IDWeek. 

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IDWeek Pre-Meeting – Seminar on Best Practices in Antimicrobial Stewardship

Excellent pre-meeting Seminar on Best Practices in Antimicrobial Stewardship where numerous national experts presented.  The picture shows Dr.  Arjun Srinivasan from the CDC presenting on national compliance with Stewardship Core Measures. Dr. Trevor Van Schooneveld fromUNMC also presented during this session on Syndromic Stewardship: Combining Interventions to Improve Care.

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Content courtesy of Dr. Van Schooneveld.