Division of Infectious Diseases

Research Digest is a periodic installment that recognizes the world-class clinical research performed right here at UNMC ID. Today, we review three articles covering new developments regarding COVID-19. As always, check out the linked full articles for more details.

In the first article, authored by graduating UNMC medical student Jonathan Freese, Dr. Nada Fadul, and others, the state of vaccine hesitancy and uptake was characterized among Sudanese Americans. Community-level inquiries on vaccine practices are crucial as the risk of infection is not constant across the population, and certain groups, including Sudanese Americans and other immigrant and refugee communities, have historically higher risk of COVID-19 exposure. With the help of community leaders, this study surveyed over 100 individuals. Vaccine hesitancy, when present, was found to be driven primarily by fears that it had not been studied enough. However, the authors found that the rate of COVID-19 vaccination exceeded the national average (93% vs 78% for the American public), a metric that covaried with educational attainment and belief in vaccine efficacy. Find the full article here.

The second article, co-authored by Dr. Andre Kalil, is an invited commentary that calls for a change in the way COVID-19 investigational drug trials are controlled. The authors point out that while some COVID-19 investigational compounds have been reported to cause cardiac complications, COVID-19 infection itself is known to cause many of these same complications. Without a sound control group and a carefully designed study, it is all too easy to falsely attribute adverse cardiac events to the drug being used to treat the infection when they may be the result of the infectious pathology itself. Randomized controlled trials have a long history of sound scientific and medical success in both ID and cardiology, but this hinges on meticulously designed studies. In short, an adverse event seen in those given the experimental treatment may be a sign of clinical efficacy if the rate that it is observed is actually higher in the untreated control group. However, if this factor is not examined in the control group, it would appear falsely to be caused by the treatment instead. Read the full commentary here.

In the last article, also co-authored by Dr. Kalil, the risk of immunomodulatory medications in COVID-19 was assessed, specifically in immunocompromised patients at higher risk of side effects from these treatments. Several immunomodulators have been shown to be beneficial in the treatment of COVID-19, as they can help restrict an overactive immune response and prevent collateral damage to the body during infection. However, by inhibiting certain aspects of the immune system, these drugs may also have the potential to increase the risk of secondary infections in those with an already compromised immune system. This study examined the existing literature, conducting a meta-analysis to determine whether evidence of outsized risk of these medications existed within immunocompromised populations, finding no statistically significant difference between patients randomized to immunomodulators vs control in terms of mortality or secondary infections. Read the full details of the analysis, including more detailed conclusions and considerations, here.

Research Digest is a periodic installment that recognizes the world-class clinical research performed right here at UNMC ID. Today, we review two articles covering novel antimicrobial efforts or discoveries that may help us better treat different infectious pathologies. As always, check out the linked full articles for more details.

In the first article, Dr. Nicholas Cortes-Penfield and co-authors review evidence for the timing and process of switching from i.v. to oral antibiotic treatments during bone or joint infection. The authors explain that, for the past 50+ years, the medical community has been divided on the best time to transition from the standard post-surgical i.v. antibiotic regimen to a more accessible oral strategy, with regional and global differences in accepted standard of care. The team reviewed 8 randomized control trials and multiple retrospective studies and concluded that no data exists to definitively set a minimum i.v. antibiotic duration post-surgery. That said, a growing body of research supports an early switch to oral antibiotics, in most cases, within a few days following surgery. The authors caution, however, that this approach should be tailored for case-specific factors. Read the full article here.

The second article, co-authored by Dr. Jonathan Ryder, Dr. Daniel Brailita, Dr. Mark Rupp, and Dr. Richard Hankins, along with others from the UNMC community, tests whether additional sterilization of catheter connectors is beneficial in reducing the risk of microbial colonization of catheter equipment. Antiseptic-containing port-protecting caps are routinely used to help limit this possibility. However, the team aimed to determine whether additional manual disinfection with an alcohol wipe was further preventative of microbial colonization (the current standard of care at UNMC). 356 catheter connectors were cultured in this study, 165 in each group, with an additional 26 that did not have an antiseptic cap as a control group. The team found that the vast majority of positive cultures were from the non-antiseptic cap group (15 positive cultures), while both antiseptic cap treatments (with and without manual disinfection) performed similarly, with 1 and 2 positive cultures, respectively. The team concluded that antiseptic caps are an extremely useful tool for preventing bacterial colonization, but additional disinfection strategies (i.e. manual alcohol-based disinfection) do not further decrease the chance of colonization. Read the full article here.