This week is U.S. Antibiotic Awareness Week (USAAW), which serves to raise awareness of the importance of appropriate antibiotic and antifungal use and the threat antimicrobial resistance poses to people, animals, plants, and their shared environment.
This year, the week’s theme is ‘Fighting Antimicrobial Resistance Takes All of Us.’ The CDC explains:
“Antimicrobial resistance happens when germs, like bacteria and fungi, develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow. Antimicrobial resistance is an urgent global public health threat that is estimated to cause more than 1.27 million deaths around the world and nearly 35,000 deaths in the United States each year. When Clostridioides difficile (C. diff) is added to the annual U.S. death toll for all antimicrobial resistance threats, the number jumps to 48,000 deaths. Antimicrobial resistance can affect anyone, anywhere, and at any stage of life. Antimicrobial-resistant germs can spread rapidly across the globe in and between healthcare facilities, as well as in the community, environment, and our food supply.
Preventing infections in the first place is our first line of defense against antimicrobial resistance. Access to clean water and adequate sanitation, vaccination coverage, and access to quality health care can prevent infections and the spread of antimicrobial resistance worldwide. Improving appropriate antibiotic and antifungal use is also critical. Appropriate use of antibiotic and antifungal drugs helps improve patient outcomes by optimizing the treatment of infections, avoiding drug-related side effects, and slowing the development of antimicrobial resistance.”
In recognition of this week, we have a series of posts planned on antimicrobial stewardship and UNMC efforts to help combat resistance. This is an incredibly important topic, and as an ID Division, we are at the front line of this mounting threat. Keep an eye on the blog for the rest of the week for seminars, UNMC ID research, and write-ups to learn more about what can be done to slow the development of antimicrobial resistance.
Congratulations to Dr. Sara Bares, who received the UNMC New Investigator Award on November 14, 2024. Dr. Bares is an Associate Professor in the Division of Infectious Diseases. She joined the division in 2013 and her clinical and research interests include HIV treatment and prevention, HIV-related comorbidities and HIV in women.
Dr. Bares has been successful with significant federal grant funding and publication of impactful scholarship. In 2023 she was was awarded an RO1 from the National Institutes on Aging for a proposal entitled: “Hormone Therapy for Peri- and Postmenopausal Women with HIV (HoT).” This year Dr. Bares was awarded an R25 grant from the NIH entitled “EMPOWHer: Embracing Midlife and Menopause Positively-Offerings by Women with HIV.” Dr. Bares leads the research activities of the UNMC Specialty Care Clinic which conducts both NIH and industry-funded studies focused on advancing care for people with HIV.
In 2022, Dr Sara Bares received the HIV Medicine Association (HIVMA) Research Award. The Research Award recognizes outstanding contributions to HIV medicine in clinical or basic research. She was recognized “for her work as a prolific and collaborative researcher advancing studies to increase understanding of HIV-related sex differences, HIV and aging and the cardiometabolic complications of HIV“.
In addition to being an exceptional clinician and researcher, Dr. Bares is an inspiring team leader and collaborator. Her award acceptance remarks always include thanks to her collaborators, mentors, mentees, patients (at UNMC and in the AIDS Clinical Trial Group), and especially her outstanding research team at the UNMC Specialty Care Center. “I know R01s are for investigators but our whole SCC research team is so talented – I want to make sure they are included in the recognition and know how much they are appreciated!“, she said.
UNMC New Investigator Awards go to outstanding scientists who in the past two years have secured their first funding from the National Institutes of Health, the Department of Defense or other national sources.
New Investigators also had to demonstrate scholarly activity, such as publishing their research or presenting their findings at national conventions.
We are very proud of Dr. Bares for her impactful research and clinical care and look forward to celebrating her future accomplishments!
A huge congratulations to Nikki Regan, APRN (pictured left) at the Specialty Care Center, who recently presented a session at the National Ryan White Conference in Washington D.C. this past August entitled, “The Ryan White HIV/AIDS Program Best Practices Compilation: Co-Creation of an Ambassador Toolkit”, along with co-presenters Julie Hook (JSI Research), Devon Brown (JSI Research), and Jill York, DDS (Assistant Dean at Rutgers School of Dental Medicine).
At the Virtual National Ryan White Conference in 2022, Regan shared a poster abstract detailing the quick process mapping that occurred in the early days of COVID-19 to offer telehealth to patients with HIV at the SCC. Following that abstract, Regan was approached by the Target HIV Best Practices team to submit the story and protocols to the Best Practices Compilation, which is a collection of interventions and programs that have demonstrated effectiveness and may be replicable for other Ryan White programs.
She commented, “The compilation is really the epitome of ‘no need to reinvent the wheel’ in the world of Ryan White care. Anyone can access the page. If you are looking for ideas on how to incorporate a new practice, like telehealth for example, you can search and see what other teams have already had success with.”
In 2023, Regan was approached by JSI Research to help develop a toolkit for Ryan White programs to more efficiently SEARCH, SHARE, and NOMINATE programs and teams with best practices in the care of people with HIV, which resulted in a presentation at the National Ryan White Conference in Washington D.C. this Summer.
Through this, Jill, Nikki, and several other representatives demonstrated to the audience how they worked through three stages of project development- Inspiration, Ideation, and Implementation- to create what is now known as the Ambassador Toolkit.
When asked for further comment, Nikki shared, “Prior to being approached in 2022, I was not aware the Best Practices Compilation even existed! Now that our intervention is included, I wanted to do my part to advocate for the compilation and help other teams access and utilize it. This process allowed me to give feedback on my own experience using the compilation, and make it a more dynamic and intuitive tool for myself, our SCC team, and other HIV care teams.”
Congrats, Nikki and the SCC team! This is a huge accomplishment that will go a long way toward helping accelerate the care of patients with HIV around the world.
This post is the final part of a multi-part installment exploring the career and life of Dr. Mark Rupp, outgoing Chief of Infectious Disease at UNMC. If you missed our first post introducing Dr. Rupp and this series, part 2 exploring Dr. Rupp’s career, or part 3 exploring his life outside of medicine, see the linked posts to catch up. Otherwise, read on to learn more about Dr. Rupp’s outlook on the future of ID and advice for the next generation of ID professionals.
How do you avoid burnout?
I think a little introspection and self-reflection really helps. In our line of work, it is not hard to find very worthy people who, through no fault of their own, are dealing with truly daunting challenges. Many of us have so much for which to be grateful. Many people in the world would jump at the chance to switch places with us. Keeping these things in mind goes a long way to avoiding a doom and gloom/burnout cycle. Also, I think that the 24-hour news feed, social media, and the pace of communication – constantly texting, checking posts, and emails, lends itself to a frantic, chaotic mindset. Setting aside the phone for a while, turning off the TV and radio, and getting outside in nature is a great way to recalibrate.
What advice do you have for those considering ID?
Infectious Diseases is a wonderful field. In many instances, ID docs are able to cure their patients fully and restore them to health. There is rarely a dull moment – a new bug, outbreak, or resistance trait is always just around the corner. Also, the people who chose ID as their field of specialization are some of the smartest, most interesting, and most pleasant folks in the world – you’ll have great colleagues and coworkers!
Where do you see the field of ID going in the next 10 years?
I only see the need for ID specialists growing in the coming years. We’ll continue to see a quick pace in the development of better ways to diagnose infections and AI/ML assisting us in the clinics. The interface between public health, funding, politics, and social media will continue to be challenging. ID specialists who have additional skills in IT, data analysis, population health, patient safety/quality improvement, and mass media/communication will be in high demand. The way in which our country funds health insurance and healthcare will continue to be problematic, as will healthcare access issues – these issues are global but will impact the practice of infectious diseases in the coming years. Antimicrobial resistance will only increase and ID specialists will be needed to steer how to best treat these complex patients. The big wild card is when we will see the next pandemic.
What keeps you excited about ID to this day?
As I mentioned earlier “you‘ve got to love them bugs” – new pathogens, new virulence determinants, new resistance traits. In addition, interacting with students and trainees keeps you on your toes.
Next week begins IDWeek 2024, and UNMC will have a very strong showing at the conference! Below, we have gathered info on all oral presentations, panel participation, and other involvement from UNMC ID personnel, so read on to see where you can find us in Los Angeles this week!
This post is part of a multi-part installment exploring the career and life of Dr. Mark Rupp, outgoing Chief of Infectious Disease at UNMC. If you missed our first post introducing Dr. Rupp and this series or part 2 exploring Dr. Rupp’s career, see the linked posts to catch up. Otherwise, read on to learn more about Dr. Rupp’s life, interests, and hobbies.
A recent hiking trip to Escalante in Utah (the little pink person in the corner is Elizabeth – Dr. Rupp’s wife)
What are your favorite pastimes/hobbies?
Up until fairly recently (pandemic casualty) I played indoor soccer with an “old timers” club. With the arrival of grandchildren, I enjoy spending time with them and watching them grow up so very quickly. Gardening is a favorite pastime, as is spending evenings on the backyard deck with friends and neighbors. The high point of my year is an annual backpacking trip with my adult children in a remote wilderness area – truly off the grid.
What are your favorite genres of book/movie/music?
I’ve always thought that life is a bit better when you are reading a good book and I usually have a book or two that I am engaged with. I favor American history, but also enjoy science, current events, economics, politics, etc. Once in a while, my wife will steer me to great fiction. For example, I just finished Eric Larson‘s “The Demon of Unrest’ about the days just before the Lincoln inauguration and the initiation of the Civil War (some interesting parallels to the modern day) and I’ve started Hampton Sides’ “The Wide Wide Sea” about Captain James Cook’s 3rd and final voyage. I definitely recommend Abraham Verghese and the Covenant of Water. A few other recent worthy reads include Wasteland – by Oliver Franklin Wallis, Caste – by Isabel Wilkerson, and The Deadly Rise of Anti-Science – by Peter Hotez.
Where have you lived? Which was your favorite?
My father was a geologist who worked for an oil company, and we moved around the western US oil fields as I was growing up – born in Kansas, lived in Oklahoma, Colorado, and moved to Houston, Texas, in high school. I went to UT Austin and Baylor College of Medicine and then went out to Virginia for 7 years of post-doctoral training. UNMC was my first “real job” – my dad kidded me about finishing 27th grade as I joined faculty at UNMC. I’ve lived in Nebraska longer than any other place. I truly believe that “you should bloom where you are planted” and every place I’ve lived has been full of wonderful people, places, and opportunities.
This post is part of a multi-part installment exploring the career and life of Dr. Mark Rupp, outgoing Chief of Infectious Disease at UNMC. If you missed our first post introducing Dr. Rupp and this series, catch up here. Otherwise, read on to learn more about Dr. Rupp’s career in medicine and his impact on UNMC.
I’ve been fortunate to enjoy a long career at UNMC and I have many persons to thank. After completing residency in Internal Medicine, I spent 4 years as an ID Fellow at Virginia Commonwealth University and trained in Dr. Gordon Archer’s lab studying staphylococcal pathogenesis. I came to UNMC in 1992 to join the new UNMC/Creighton University combined ID Division led by Laurel Preheim. Prior to 1992, UNMC ID was an ID “one-man show” with J Calvin Davis. The UNMC component of the combined ID Division consisted of Drs. Swindells, Dominguez, Rupp, and Preheim, with Cal Davis leading the University Hospital infection control program.
Dr. Rupp and the Staphylococcal Research Lab
I opened a lab at UNMC primarily directed toward understanding adherence and biofilm formation in coagulase-negative staphylococci. One of the smartest professional decisions I made was the recruitment of Dr. Paul Fey to UNMC ID and the Staphylococcal lab. Dr. Fey has been tremendously successful and was a cornerstone in the development of the UNMC Center for Staphylococcal Research.
In about 1994, I assumed leadership of the infection control program, and most of my career has been dedicated to better understanding and preventing healthcare-associated infections. In 1998, with the merger between Clarkson Hospital and University Hospital, Dr. Phillip Smith transitioned to the UNMC ID Division Chief position. Phil moved the Division forward and had the foresight to establish the Nebraska Biocontainment Unit.
A few of my career highlights include my service on the Society for Healthcare Epidemiology of America (SHEA) Board of Directors and being the President of SHEA in 2009 (the year of the H1N1 flu pandemic – just a warmup act for the 2019 COVID-19 pandemic). I founded the Antimicrobial Stewardship Program at UNMC in 2004 and turned over the directorship to Dr. Van Schooneveld in 2009, who has helped to build the stewardship program into the nationally recognized program it is today. I was fortunate to assume leadership of the ID Division in 2011.
Dr. Rupp receiving the UNMC Distinguished Scientist Award (2013)
In 2014, the ID Division was tested during the West Africa Ebola outbreak, and the Biocontainment Unit, established by Drs. Smith and Angela Hewlett, rose to the occasion with great success and notoriety. The care of patients with Ebola hemorrhagic fever was the start of the next phase of the UNMC Biosecurity Program and led to the development of the Global Center for Health Security. The UNMC ID Fellowship kicked off in 2012 and, despite stiff headwinds from national ID training trends, under the leadership of Dr. VanSchooneveld, has been terrifically successful. In part because of our performance during the Ebola outbreak, the CDC supported our development of the Nebraska ICAP and ASAP programs in 2015 (a unique model of cooperation between the CDC, NEHHS, and UNMC to improve infection prevention and antimicrobial stewardship throughout the state of Nebraska) which came under the capable leadership of Dr. Salman Ashraf in 2017 and now Dr. Juan Teran. I served as the Chief of Staff for Nebraska Medicine in 2018 and 2019 and remember thinking as 2019 was winding down that I would enjoy not having quite as many 6:30 or 7:00 AM or 5 PM meetings. Unfortunately, SARS-CoV-2 and the COVID-19 pandemic had different plans. Again, the UNMC ID Division stood up and served in an exemplary fashion.
Dr. Rupp and the Clinical Trials Office (CTO) he directed for over a decade
It has been incredibly gratifying to help the UNMC ID Division grow from the 3 UNMC faculty in 1992 to the over 30 faculty, over one dozen specialized APPs, 6 Fellows, and dozens of support staff and clinical researchers that make up the Division today and to witness UNMC ID blossom into a nationally well-recognized Division with excellent training programs, state of the art clinical care, and vibrant clinical research. UNMC ID is known for expertise in immunocompromised host ID that has been developed over the years by Drs. Kalil, Florescu (who tragically died in 2023), Freifeld, and Zimmer; HIV care capably led by Dr. Swindells for many years and more recently by Drs. Fadul and Bares; Orthopedic ID led by Drs. Hewlett and Cortes-Penfield; and Community Practice led by Dr. Starlin. Many other faculty are involved in our programs in infection prevention, antimicrobial stewardship, OPAT, biocontainment, telehealth, DEI/Advocacy, and other areas. We are truly fortunate to have so many smart, talented, and hardworking people call UNMC ID their professional home. UNMC ID is a wonderful mix of persons of different ages, genders, ethnic backgrounds, and religious/cultural beliefs – it is a place where people are comfortable and can achieve their full potential.
As I wind down my career in UNMC ID, there are so many to thank for the great opportunities and support I’ve been afforded. I would also be remiss to not note that any career success I’ve enjoyed has only been possible with the unwavering support of my wife and family.
We are thrilled to announce a new blog post series on the UNMC ID blog: microBio. microBio is a biographical exploration of the lives and careers of ID physicians and scientists at UNMC segmented into multiple periodic installations. In this series, we will gain a deeper understanding of the professionals and leaders who have worked tirelessly to make UNMC ID better.
Who better to be our inaugural featured physician than Dr. Mark Rupp, outgoing Chief of Infectious Disease here at UNMC. Dr. Rupp has been an incredibly impactful force for good during his tenure at UNMC ID. We recently recognized his continued service in educating the public on ID topics on Rural Health Matters, a television show that features experts discussing various health topics and their impact on farmers, ranchers, and rural Americans. In the same vein, he was also recently awarded the prestigious Bartee Advocacy of Science Award in recognition of his exceptional community engagement as a scientist. Dr. Rupp has also garnered national recognition as well, having previously served as president of the Society for Hospital Epidemiology of America (SHEA) and as a consultant for the FDA, CDC, NIH, and the VA. He has also published well over 100 peer-reviewed scientific articles. As you will see during the series of upcoming microBio posts, these achievements only scratch the surface of the positive changes he oversaw in the Division and University at large. Dr. Rupp plans to stay on as faculty for several more years, and we thank him for his leadership through pandemics, outbreaks, and impressive growth in the Division.
Please tune in to the upcoming 3 microBio posts exploring Dr. Rupp’s career, life, and advice/outlook for the next generation of ID professionals. For now, though, enjoy a sneak peek below, where Dr. Rupp offers how he got interested in medicine and how that interest matured into a passion for ID?
I have had a life-long interest in biology/life science. My mother related that she thought I would be a doctor when I showed an interest during elementary school in microbiologists and “Microbe Hunters” a book published back in 1926 by the famous bacteriologist Paul De Kruifl (and no, despite common belief, I was not around to work with Dr. De Kruif or read the initial release). I earned a degree in Chemical Engineering because I’ve always been a “belt and suspenders” kind of person and wanted to have a profession to fall back on if I was not able to get into med school. While in medical school at Baylor College of Medicine (a few years before Dr. Cortes-Penfield – also a Baylor grad), I thought I wanted to be a surgeon. I ended up going into Internal Medicine due to the very broad career choices available and eventually came around to ID because “you just got to love them bugs!”
The UNMC/Nebraska Medicine Antimicrobial Stewardship team has developed a new clinical guidance regarding use of infectious disease next generation sequencing diagnostic tests. There is currently no national consensus regarding the use of ID-NGS tests, nor have they been systematically compared to a diagnostic gold standard. The UNMC Antimicrobial Stewardship team reviewed the literature and evaluated UNMC’s most common uses of ID-NGS tests to develop this set of practical guidelines. The guidelines project and this blog post were led by one of our recent graduates, Dr. Cathy Cichon, MD, MPH, during her fellowship.
What is NGS?
Next-generation sequencing (NGS) is a culture-free method of analyzing the microbes within a sample. These tests sequence all or part of the microbial DNA or RNA in a patient specimen (such as serum, tissue, or cerebrospinal fluid [CSF]).
What NGS tests are currently available?
All NGS tests are send-out studies. The most common NGS tests that Nebraska Medicine clinicians order are the Karius Test, University of Washington Broad-Range PCR, and Delve Bio (previously UCSF Center for Next-Gen precision diagnostics) CSF cell-free DNA.
What are the advantages of NGS testing verses conventional microbiology?
The benefits of NGS testing include the potential detection of obscure or rare pathogens, detection of pathogens that are difficult to grow using conventional methods, or detection of pathogens in patients previously treated with antimicrobials.
What are the drawbacks of NGS testing verses conventional microbiology?
The limitations of NGS testing include high cost (>$1000), long turnaround times due to shipping requirements, the detection of commensal/non-pathogenic organisms, and lack of antimicrobial susceptibility testing. Additionally, they have not been compared to a diagnostic gold standard and their performance (sensitivity, specificity, etc.) is unknown.
When are NGS tests useful?
NGS tests have been proposed as a diagnostic tool for a variety of clinical syndromes. While studies are still ongoing, to date the Karius Test has been most useful for culture-negative endovascular infections (i.e. endocarditis or mycotic aneurysm) and the University of Washington Broad-Range PCR has been most useful for biopsies of focal infections (i.e. culture-negative osteomyelitis) where traditional cultures have been negative. They can be considered in other limited circumstances when traditional testing is unrevealing, as detailed in the new guidance document. They are not useful for undifferentiated clinical syndromes (i.e. febrile neutropenia, polyarthritis, etc.). They should only be considered where the result will change care such as if the patient is expected to need >14 days of antibiotics or there is concern that empiric antibiotics will be inadequate.
Who can order NGS tests?
Due to the complexity of interpretation and cost, these tests can only be ordered by infectious diseases (ID) clinicians. If you think your patient would benefit from an NGS test, please consult the appropriate ID team.
Are you an exceptional infectious diseases physician specialized in the care of immunocompromised patients and dedicated to teaching and making a significant impact within a diverse and collaborative environment? If yes, we invite you to consider joining our world-class team as a Solid Organ Transplant (SOT)/Oncology ID (OncID) faculty member in the Infectious Diseases (ID) Division at the University of Nebraska Medical Center (UNMC).
UNMC’s robust solid organ transplant programs perform lung, heart, liver, kidney, pancreas, intestinal and multi-visceral organ transplants and attract patients from across the region and nation. UNMC’s Fred and Pamela Buffett Cancer Center is NCI-designated and provides specialty care to patients with solid tumors and hematologic malignancies, including autologous and allogeneic hematopoietic cell transplants and CAR T cell therapies. As a SOT/OncID faculty member, you will work in collaboration with faculty from the Transplant and Cancer Centers to provide excellent clinical care, foster a stimulating learning environment, and engage in impactful research initiatives. You will also play a crucial role in educating and mentoring future medical professionals while contributing to the advancement and success of UNMC.
Responsibilities:
Deliver exceptional care for solid organ transplant and oncology patients to optimize clinical outcomes.
Provide high-quality instruction and mentorship to medical students, residents, and fellows in a positive, inclusive, and dynamic learning environment.
Collaborate with faculty colleagues, specialty APPs, and multidisciplinary staff.
Conduct and contribute to clinical and translational research.
Desired Characteristics:
Advanced degree in a relevant field (MD, DO, MBBS, or equivalent).
Board certified or board eligible in Infectious Diseases.
Proven ability to teach and mentor medical students, residents, or fellows.
Strong communication skills, with proficiency in conveying complex information effectively.
Demonstrated research experience and a track record of scholarly publications.
Capability to work collaboratively in a team-oriented setting.
We look forward to your application and the opportunity to explore how your expertise and excellence can contribute to our vibrant academic community. If you are interested in this opportunity, please apply at https://unmc.peopleadmin.com/postings/86084.
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