Division of Infectious Diseases

Unpacking the new IDSA Community-Acquired Pneumonia guidelines

We are always excited to have our ID fellows provide guest blog posts. Second year ID fellow Dr. Lindsey Rearigh (follow her on Twitter @LRearigh) was recently on her Antimicrobial Stewardship rotation and reviewed the latest published guidelines for Community-Acquired Pneumonia (CAP).  The American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) recently released updated community-acquired pneumonia (CAP) guidelines. The first immediate implication… Continue Reading

Journal Club – Stewardship in Community Hospitals: How should we spend our limited resources? 

Stewardship in Community Hospitals: How should we spend our limited resources?  The following is a review by our ID Fellowship Program Director Dr. Trevor Van Schooneveld from our last Infection Control/Antimicrobial Stewardship Journal Club. He discussed the article by Anderson et al: Feasibility of Core Antimicrobial Stewardship Interventions in Community Hospitals. JAMA Network Open.  2019;2(8):e199369.   Antimicrobial stewardship is important to improving patient care and outcomes and numerous entities… Continue Reading

Treatment of Osteomyelitis – What’s the Evidence for our Strategies?

New UNMC ID publication alert! #ReadUNMCID Recently, the newest member of our Division of Infectious Diseases at UNMC/Nebraska Medicine, Dr. Nicolas Cortes-Penfield published an invited review in Open Forum Infectious Diseases entitled: The History of Antibiotic Treatment of Osteomyelitis.  Dr. Cortes-Penfield wrote this summary describing the review article, which was commissioned after he published a comprehensive blog post (on his blog IDJournalClub.com) about the history… Continue Reading

How Clean is the Hub?

New UNMC ID publication alert! #ReadUNMCID Recently, several members of the Division of Infectious Diseases at UNMC/Nebraska Medicine published a study in American Journal of Infection Control (AJIC) entitled: Microbial colonization of intravascular catheter connectors in hospitalized patients. Drs. Richard Hankins (former ID fellow, class of 2019), and Kelly Cawcutt (Associate Medical Director of Infection Control) are the lead and senior authors on this study. … Continue Reading

Inpatient Diarrheal Illness…Don’t Flush your Money: Save it with Diagnostic Stewardship!

Recently, a multidisciplinary team at UNMC published a diagnostic stewardship study in Infection Control & Hospital Epidemiology (ICHE) entitled: Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing, that prompted a press release from The Society for Healthcare Epidemiology of America (SHEA), and a feature on an upcoming ICHE podcast episode. Drs. Jasmine Marcelin and Trevor Van Schooneveld are the lead and senior authors on this study…. Continue Reading

Do you really need to test the poo? Diagnostic stewardship for (outpatient) diarrheal illness

Rapid molecular testing has changed the landscape of diagnostic approaches to many infectious disease syndromes, including diarrheal illnesses. These panels typically have the capacity to diagnose multiple organisms in one test. The FilmArray gastrointestinal pathogen panel (BioFire) tests 22 stool pathogens. Despite the impact of improved clinical efficiency, these tests are often expensive, especially in the outpatient setting, but the convenience of a comprehensive testing… Continue Reading

The Antimicrobial Stewardship Program: Keeper of the S. aureus bacteremia Checklist Manifesto

Staphylococcus aureus bacteremia (SAB) is a serious and sometimes devastating infection. There are established guidelines for optimal management, and more recently, numerous studies have shown the benefits of Infectious Diseases consultation, including improving guideline-adherent management, and reducing hospital stays, 30-day readmissions, and in-hospital mortality. Pharmacist-driven initiatives embedded within the Antimicrobial Stewardship Program (ASP) have also been shown to improve quality of care for patients with… Continue Reading

When you see CRE: Add Equal Parts Antimicrobial Stewardship and Infection Control

The following was previously posted by Dr. Marcelin to SHEA Journal Club published online in April 2019. Dealing with carbapenem resistant organisms presents both an antimicrobial stewardship and infection control problem. Richter et al. aimed to predict risk factors for carbapenem resistance among Gram-negative rods (CR-GNR). The authors were particularly interested in whether differences exist in risk factors for development of ertapenem-resistance (ER-GNR), versus resistance… Continue Reading

Does de-escalation of anti-MRSA therapy for culture-negative pneumonia affect patient outcomes?

Nosocomial pneumonia is a common hospital-acquired infection and has a high mortality rate in the critically ill.  Because drug-resistant bacteria like Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) are commonly responsible for these infections, guidelines recommend broad-spectrum empirical therapy that includes anti-MRSA coverage.  Treatment is ideally de-escalated and refined based on culture results.  However, culture negative infections leave a conundrum for clinicians who want to protect their… Continue Reading

What to Expect in Antimicrobial Stewardship…Shorter is Better, Of Course!

The following was previously posted by Dr. Marcelin to SHEA Journal Club published online in February 2019. Electronic clinical decision support tools and rapid diagnostic testing have significantly impacted the way we practice Infectious Diseases. Despite these scientific gains, Antimicrobial Stewardship still requires an understanding of the behavioral science of prescribing. Prior studies have demonstrated that antibiotic prescribing may be influenced by specific behavioral interventions,… Continue Reading