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Division of Infectious Diseases

Welcoming our New Infectious Diseases Fellows: Dr. Mackenzie Keintz

We are excited to welcome Dr. Mackenzie Keintz as a new fellow in our Infectious Diseases program! Read on to learn a little more about her…

Tell us about the position you are starting
I will be starting my Infectious Disease fellowship at University of Nebraska Medical Center. I will spend the next two (or three?!?) years learning about infectious diseases and antimicrobials. I plan to focus on antimicrobial stewardship and general infectious diseases but look forward to learning about all areas in the next few years!

Tell us about your background
I was born in a small town in northern Wisconsin. I did my undergraduate studies at University of Wisconsin-Madison in Madison, WI where I majored in Medical Microbiology and Immunology and Biology. This is where I first developed my love for infectious diseases! I then went to medical school at St. George’s University. I spent my first two years in Grenada where I got to see tropical infectious diseases first hand. I then moved to Atlanta, Georgia to finish medical school. I came to UNMC for my Internal Medicine residency and am very excited to be staying for my Infectious Diseases fellowship.

Why did you choose to come work at UNMC
I chose UNMC for Internal Medicine residency in part because of the strong Infectious Diseases fellowship program. During residency, I was able to form strong mentorship bonds that truly made leaving the program incredibly hard. Working with the incredible faculty throughout my three years made staying at UNMC the right decision for my career. My interest in ID is antimicrobial stewardship. Our stewardship team is one of the best in the country (maybe I’m biased?), and I look forward to training under them throughout my fellowship. Furthermore, having access to the biocontainment unit and leaders in the field of emerging pathogens is an experience I don’t know I would be able to get anywhere else. Our training here is well balanced between general ID, immunocompromised services, and antimicrobial stewardship so I know that when I come out of fellowship I will be prepared for whatever position I decide to take.

What makes you excited about working in ID
Initially what attracted me to ID was getting to play detective on the strange and interesting cases. The part of ID that I find most interesting (or maybe equally interesting) at this point in my career is antimicrobial stewardship. I really enjoy taking care of patients with very complex problems, determining when/and if antibiotics are required and if we can narrow our spectrum to fight antimicrobial resistance.

Tell us something about yourself that is unrelated to medicine
In addition to my interest in microbes, I also have an interest in other flora and fauna. Within my house you will find two rabbits, two cats, a planted aquarium full of fish and innumerable shrimp, as well as orchids, mushrooms, cacti, and many other plants. It is honestly a wonder that everyone manages to coexist.

Dr. Keintz’s rabbits, Reggie (L) and Fay (R)

Learn more about the UNMC Infectious Diseases Fellowship here.

Welcoming our New Infectious Diseases Fellows: Dr. Bryan Walker

We are excited to welcome Dr. Bryan Walker as a new fellow in our Infectious Diseases program! Read on to learn a little more about him…

Tell us about the position you are starting
I am beginning my first year in infectious diseases training at the University of Nebraska Medical Center (UNMC). Over the next two years I will be immersed in the sub-specialty of infectious diseases, both in the inpatient and outpatient settings. My hope is that my time here will help me become a clinician expertly prepared to assess and care for those affected by infectious diseases.     

Tell us about your background
I am from East Tennessee and went to college at the University of Tennessee in Knoxville.  My undergraduate degree was in microbiology, which is where I first became interested in infectious diseases.  After college, I moved to Maryland to work at the National Institute of Allergy and Infectious Diseases, where I studied and worked on fungal genomics.  My boss in Maryland was an infectious diseases doctor and he largely propelled me toward a career in medicine.  Subsequently, I attended medical school at the George Washington University School of Medicine and Health Sciences in Washington, DC. I came back down to Knoxville, Tennessee for internal medicine residency.  Throughout my clinical training, infectious diseases have remained a key interest.   

Why did you choose to come work at UNMC
I originally visited Omaha and UNMC when I was interviewing for internal medicine residency back in 2017.  After my interview, I knew that it was a special place in terms of internal medicine practice and training. It stayed on my mind throughout residency as a definite place of interest.  After researching the program for infectious diseases fellowship, I was especially struck at how both comprehensive and well-organized the training program appeared to be. Having dedicated clinical experiences in orthopedics, oncology, and transplant, for example, caught my eye.  After my interview day, I learned that the program’s strongpoints were largely the result of a dedicated program leadership and faculty.  There is a sincere interest at UNMC in helping me become the clinician I hope to be.   

What makes you excited about working in ID
I am excited to work in ID for so many reasons! For one, I love how pervasive the field is. Perhaps more so than any other specialty, it is fundamentally shaped by humankind, our interactions with one another, and our role in nature. As a result, there is not a single patient, culture, or community unaffected by it. There will always be a new problem to solve and challenge to overcome.  Secondly, I identify with the culture (no pun intended!) of infectious diseases medicine.  Patient advocacy, scholarship, and a general conscientiousness toward patient care are characteristics exemplified by my own clinical role models. It seems more than just a coincidence that most all of them are infectious diseases practitioners.   

Tell us something about yourself that is unrelated to medicine
Outside of medicine, I have been fortunately married to the smartest and coolest person I know for six years now and we are expecting our first child this summer! We like to cook, eat, watch movies, read, and work-out together.  I’ve also played guitar since I was a kid and still enjoy trying to play when I have a chance to. I just picked up rollerblading again after an 18-year hiatus and have not broken any bones yet. Overall, my wife and I are excited about living here in Omaha, seeing what the area has to offer and seeing in what ways we can help!  

Learn more about the UNMC Infectious Diseases Fellowship here.

UNMC ID is growing and we want you to join us!

Due to unprecedented growth and success, the Division of Infectious Diseases at the University of Nebraska Medical Center in Omaha, NE is recruiting for three (3) faculty members to join our team. 

Oncology & Solid Organ Transplant (SOT) ID

  • Provide care for immunocompromised patients in inpatient and outpatient settings with experienced advanced practice providers
  • Collaborate with highly accomplished colleagues in SOT/Oncology ID
  • Abundant clinical and translational research opportunities
  • State-of-the-art Fred & Pamela Buffet Cancer Center
  • Teach medical students, residents, and ID fellows on the Oncology-ID and SOT-ID consult service

Apply here: https://unmc.peopleadmin.com/postings/58781

General ID

  • Join the team including ID Physicians, advanced practice providers, and clinical and research support personnel.
  • Provide care for both inpatients and outpatients at Nebraska Medicine and through our collaborative relationships
  • Explore abundant clinical and research opportunities.
  • Teach medical students, residents, and ID fellows on the General ID consult service
  • Opportunity to participate in collaborative work with the federally-funded Infection Control and Antimicrobial Stewardship programs (ICAP/ASAP) to offer guidance to healthcare facilities throughout the state and region

Apply here:  https://unmc.peopleadmin.com/postings/59815

Community ID

  • Provide inpatient and outpatient care with skilled advanced practice providers
  • Provide ambulatory telehealth ID consultation services in several communities across Nebraska 
  • Collaborative activities with the ICAP/ASAP Program to offer infection control and antimicrobial stewardship guidance to healthcare facilities across Nebraska 
  • Abundant clinical and/or research opportunities

Apply here:  https://unmc.peopleadmin.com/postings/59954

About UNMC:

The Division is a robust group comprised of 27 ID physicians, advanced practice providers, and clinical and research support staff. We provide full spectrum infectious disease care at our clinical partner, Nebraska Medicine.   Members of the division pursue specialty interests in all areas of infectious diseases including Biopreparedness, Critical Care, Orthopedic ID, HIV, Infection Control, Antimicrobial Stewardship, Occupational Health, Clinical Microbiology, Oncology ID, Solid Organ Transplantation ID, etc. We enjoy productive collaborative relationships with clinicians and scientists in numerous departments. We have a full portfolio of funded research and a robust educational mission including a thriving ID fellowship training program.    

The successful candidate must be an MD/DO (or equivalent degree) who is board certified/eligible in Infectious Diseases with excellent clinical skills and enthusiasm for patient care, teaching, and clinical research. Our compensation package is extremely competitive.  In addition, comprehensive benefits and relocation assistance are offered. Academic rank is dependent on qualifications. Individuals from diverse backgrounds are encouraged to apply.

Learn more at:

Publication Alert: De-Isolation of COVID19 Patients

UNMC ID Fellowship graduate (’21), Clayton Mowrer, D.O., MBA.

Content by Dr. Clayton Mowrer, 2021 UNMC ID graduate.

Early in the pandemic, it became clear that patients with COVID-19 can demonstrate prolonged detection of viral RNA (as along as weeks to months), which can lead to prolonged hospitalizations, especially for those patients with more severe disease. One of the difficulties often encountered in managing these patients was in determining how long they were required to be in isolation. Initially, the policy for removal of isolation at UNMC involved two sequential negative molecular testing 24 hours apart. However, after studies surfaced demonstrating the probability of isolating replication-competent SARS-CoV-2 virus was rare after 14 days of illness and at cycle-threshold (Ct) values greater than 30, UNMC revised our policy to reflect a conservative approach based on these findings. In June 2020, the revised policy stated that, in a patient who continues to test positive, isolation precautions could be removed 21 days after 1st positive test after review by the COVID ID team.  

In this study recently published in Infection Control & Hospital Epidemiology, we set out to: 

  • Evaluate UNMC de-isolation policy 
  • Describe the clinical characteristics of these patients 
  • Describe the Ct values 

We performed a retrospective study of adult hospitalized patients with persistently positive SARS-CoV-2 molecular testing who were removed from isolation after 21 days from their first positive test. Of the 23 patients we evaluated, we found that 4 (17%) of patients were considered to be immunocompromised. 19 (83%) of patients were considered to have severe disease (per NIH criteria), with 7 (30%) still mechanically ventilated.  

With regards to the Ct values, we compiled and evaluated 94 total tests these 23 patients. We found that, as demonstrated in the below table and figure, Ct values showed a general upwards trend over time and that there was a statistically significant difference in the mean Ct values between time interval. All Ct values after 21 days from first positive test were shown to be >30.  

Chart, scatter chart

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These findings, combined with the fact that no cases of transmission within our healthcare system have been linked to patients who have been removed from isolation at day 21, suggest that our 21-day de-isolation policy – which utilizes clinical criteria in conjunction with ID expert consultation – is a reasonable and safe approach. Furthermore, the Ct value, indeed, may be a useful addition in the overall assessment.   

Read the full article here.

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Faculty Spotlight – Dr. Anum Abbas

Tell us about your background:

I was born and raised in Cleveland, Ohio. I did my internal medicine residency and infectious disease fellowship at Creighton University and a third year fellowship at Cleveland Clinic for transplant infectious disease. I am married and have two sons, ages 6 years and 18 months. 

Why UNMC?

UNMC has a robust transplant program in both solid organ transplant and bone marrow transplant. My interest in immunocompromised patients makes UNMC a great place to practice infectious diseases and the collegial work environment here makes this place especially unique!

What about ID makes you excited?

With the detective work involved, treating rare and unusual pathogens, and the different/unusual patient exposures and risks there is never a dull moment in ID.

Tell us something interesting about yourself UNRELATED to medicine:

I love basketball and LeBron James is my favorite player! I also enjoy cooking, playing cards and traveling with my family. 

Biopreparedness Training in ID Fellowship

Photo of Drs. Mark Ridder and Clayton Mowrer, UNMC ID 2nd year fellows.

Content provided by Drs. Hewlett, Ridder and Mowrer.

Beginning in 2019, the UNMC ID Fellows have participated in Biopreparedness Training during their 2nd year of fellowship.  The ID Fellows learn about emerging infectious diseases and biopreparedness through didactic teaching sessions with internationally-recognized experts in the field, and also participate in specialized PPE training in the Davis Global Center and National Quarantine Unit alongside the Nebraska Biocontainment Unit team. Course directors include Drs. Angela Hewlett, James Lawler & David Brett-Major. Shradar Morgan, RN was a key educator for our fellows this year also.

“We are so fortunate to have the opportunity to learn from folk at the Davis Global Center and the National Quarantine Unit. With so few institutions that have programs such as these, it is truly an incredibly unique experience that allows (and encourages) us to work with and learn from international experts in the field of biopreparedness. It has been one of the highlights of my training here at UNMC.”

– Dr. Clayton Mowrer, 2nd year UNMC ID fellow.

“I appreciated the opportunity to see hands on the process for receiving individuals with exposures to pathogens. To experience directly what we are able to do to maximize patient and provider safety and our preparedness for significant outbreaks was truly eye opening and an enriching experience. I’m happy to have had the chance to take part and learn from world experts.”

– Dr. Mark Ridder, 2nd year UNMC ID fellow.

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Ambulatory Stewardship: A Little Bit of Everything Goes a Long Way

Inappropriate outpatient antibiotic use remains a problem needing to be addressed as part of the strategy to reduce antimicrobial resistance. Nebraska (NE) ranks among the highest states for per capita antibiotic (AB) use in outpatient (OP) settings. Nebraska Medicine (NM) partnered with NE Antimicrobial Stewardship Assessment and Promotion Program (ASAP), a program funded by NE DHHS via a CDC grant, to reduce AB prescribing for acute bronchitis in OP settings.

Jasmine Marcelin, MD and Phil Chung, PharmD led a multifaceted approach to reducing antibiotic use in ambulatory clinics within our Nebraska Medicine hospital system.  This approach included use of both clinician and patient-focused education with active and passive components.

The antimicrobial stewardship (AS) pilot program targeted Nebraska Medicine ambulatory clinics in three groups during winter 2018. Antibiotic prescribing rates for acute bronchitis were recorded between January-April 2017 and January-April 2018 among the 3 groups.
Antibiotic prescribing rates for acute bronchitis for the 15 sites decreased from 53. 7% to 43. 6% (p = 0. 02). There was a sustained reduction in antibiotic prescription in the intervention groups compared with baseline.

The materials used in this quality initiative are available freely on the Nebraska Medicine Antimicrobial Stewardship Program/Nebraska Antimicrobial Stewardship Assessment and Promotion Program website, and this manuscript provides a blueprint for other institutions to implement using these materials. We presented this work as an Oral Abstract at IDWeek2019, Washington DC, and the full results were published in Infection Control and Hospital Epidemiology in May 2021.

Article citation: Chung, P., Nailon, R., Ashraf, M., Bergman, S., Micheels, T., Rupp, M., . . . Marcelin, J. (2021). Improving antibiotic prescribing for acute bronchitis in the ambulatory setting using a multifaceted approach. Infection Control & Hospital Epidemiology, 1-3. doi:10.1017/ice.2021.164

ID Fellowship Recruiting is virtual again in 2021, and we are ready to meet you!

Fellowship application season is open and as the leaders of our ID fellowship, we wanted to highlight some of the exciting aspects of our program.  Our program and our division are growing.  We began in 2011 with 2 fellows, grew to 4 in 2017, 5 in 2020, and now our full complement is six fellows.  Our faculty also continues to grow, as we now have 23 physician faculty and 4 full time ID pharmacists with diverse expertise.  Dr. Trevor Van Schooneveld is the Program Director and Director of the Antimicrobial Stewardship program.  Dr. Andrea Zimmer is Associate Program Director and also the director of the Oncology ID program. COVID-19 has provided opportunities for us to be flexible and nimble with our recruiting process; we were excited with the amazing fellows we matched last year through virtual interviews, and this year we are looking forward to meeting you on our remote interviews via zoom!

ID Fellows L-R: Drs. Mark Ridder (’21), Jonathan Ryder (’22), Casey Zelus (’22), Clayton Mowrer (’21), Laura Selby (’22)

Fellows at UNMC enjoy a robust clinical experience that includes not only the typically complex patients seen at a tertiary referral center, but also includes extensive experience caring for immunosuppressed patients.  In addition to our General ID service, where our fellows gain experience in teaching medical students and Internal Medicine residents, we have two separate immunocompromised services that care for oncology and solid organ transplant patients.  We also have an orthopedic infectious diseases rotation where fellows gain experience managing these complex patients and work with faculty who have extensive experience in this area.  Fellows have the opportunity to spend time in the non-tuberculous mycobacteria (NTM) clinic, the microbiology laboratory, as well as learn infection control and antimicrobial stewardship. The faculty at UNMC are nationally recognized experts in their field, and are also very approachable and devoted to the education and success of trainees. They have created extensive educational opportunities, covering topics from opportunistic infections in solid organ and hematopoietic stem recipients to emerging global pathogens and biopreparedness. Fellows gain knowledge in HIV/AIDS management working in our multidisciplinary HIV clinic which cares for over 1200 people with HIV. In addition to having access to world class ID expert antimicrobial stewardship, OPAT, and HIV pharmacists, our division also includes an ID pharmacy residency program and opportunities for research collaboration and rounding with pharmacy students, residents and faculty.

Recent graduate Dr. Clayton Mowrer (’21) leading General ID rounds; IM residents and ID Fellow Dr. Jonathan Ryder listen

As new career opportunities develop for ID physicians, we have worked to provide our fellows with the skills to engage in these fields.  UNMC ID fellows receive extensive experience in the area of infection control and antimicrobial stewardship.  UNMC also offers the opportunity to stay for an option third year to further develop a research portfolio or pursue additional clinical expertise in subspecialty areas.

An important part of fellowship is developing skills in interpreting and performing research, and we provide our fellows with six months of mentored research experience centered on their career goals.  A research committee assists fellows in mentor identification and project development.  Fellows also participate in a week-long UNMC sponsored research training program, and typically present their work at national conferences like IDWeek and SHEA. Fellows interested in medical education have the opportunity to participate in the UNMC Internal Medicine Health Educator and Academic Leaders (HEAL) Track.

Our goal as program directors is to provide fellows with an educational experience that provides them with skills and knowledge to make them successful in whatever career path they choose.  The opportunities available to ID physicians continue to expand and we hope you will consider UNMC ID.  If you are interested in more information, please feel free to visit our website where you can check out a video to learn more about us. You can also contact us at the following:

Dr. Trevor Van Schooneveld
Program Director, Infectious Diseases Fellowship
Medical Director, Antimicrobial Stewardship Program
University of Nebraska Medical Center
985400 Nebraska Medical Center
Omaha, NE 68198-9400
Email: tvanscho@unmc.edu

Dr. Andrea J. Zimmer
Associate Program Director, Infectious Diseases Fellowship
Director, Oncology Infectious Diseases
University of Nebraska Medical Center
985400 Nebraska Medical Center
Omaha, NE 68198-9400
Email: andreaj.zimmer@unmc.edu

Farewell (but not Goodbye) to our Graduating Fellows

On Wednesday, June 3, 2021, the Infectious Diseases Division gathered to celebrate two outstanding fellows, Drs. Mark Ridder and Clayton Mowrer. Both are graduating and moving on to amazing (and different) next steps. These fellows joined our division in July 2019, a mere 6 months before our world would change as a result of the COVID-19 pandemic. They adapted to zoom lectures and conferences, and underwent tremendous growth over the last two years. Thanks to vaccines, we were able to gather to celebrate their graduation in person together.

(best viewed in full screen mode!)

Dr. Ridder and Dr. Mowrer joined our fellowship as we had just gotten used to having 2 fellows per year, and the year after they joined, we expanded to 3 fellows per year. We were honored to help them both grow and develop their infectious diseases knowledge, leadership and team management skills, the art of medical education, and most importantly, to expand their skills in delivering compassionate patient care. We also enjoyed getting to know them as amazing people, share laughs with them, and celebrate milestones with them.

(left photo, Dr. Mark Ridder and Dr. Marcelin with GenID team on rounds; right photo, Dr. Clayton Mowrer and GenID team on rounds)

Dr. Mark Ridder (back 2nd from left) with Specialty Care Center clinic staff: (L-R back Jeremy Johnson, Precious Davis RN, Dan Cramer APRN; L-R front Sara Bares MD, Sheila Daniel Cobos RN, Genie Shumaker)
Dr. Clayton Mowrer (middle, back) with clinic staff (L-R) Precious Davis RN, Rachelle Carr, Daniel Cobos RN

During his fellowship, Dr. Mark Ridder published an important manuscript describing UV germicidal irradiation as a practical approach to decontaminating and reusing facepiece respirators. Dr. Ridder is moving on to practice General Infectious Diseases at Marshfield Clinic in Eau Claire, WI. We will miss him dearly but wish him all the best on this new journey.

During fellowship, Dr. Clayton Mowrer published a manuscript describing an approach to using cycle threshold values for COVID-19 de-isolation. Dr. Mowrer is moving to our division of Pediatric Infectious Diseases, where he will complete his Pediatric ID fellowship at Children’s Hospital. We look forward to still having him around for conferences and collaboration!

Dr. Mark Ridder (Left) and Dr. Clayton Mowrer (Right) in the throes of the annual Specialty Care Center Annual Graduating Fellows’ Farewell Dance Day (this is a legitimate tradition started by our Nurse Case Manager Precious Davis RN, who always encourages our fellows to let loose and enjoy ‘shenanigans’ every once in a while. Every graduating fellow has to do a dance before they leave clinic for the last time)

We will certainly miss them both dearly, but wish them all the best in their journeys, and hope to keep sharing their news along the way!

COVID-19 In Vaccinated Health Care Workers – The Nebraska Medicine Experience

Content provided by Dr. Rick Starlin.

Household contacts to active SARS-Cov2 to infectious cases has been identified as a significant risk factor for acquisition of infection since early in the pandemic. We identified this as one of our biggest risk factors for colleague acquisition of SARS-CoV2 to infection at Nebraska Medicine as well. This brief report written by a team from Nebraska Medicine/UNMC, shows our experience of our colleagues with household contacts post vaccination. This suggests several important points of the pandemic and fully healthcare providers. The vaccines are very effective (we are ready knew that) however breakthrough cases have been reported. Household contact remains a significant risk factor in these breakthrough cases. As the United States and other locations open up society, we need to keep in mind that all contacts to infections are not equal and consideration for household contacts and needing close monitoring and testing is still warranted. The single biggest thing healthcare providers can continue to do to protect themselves, their families, their colleagues and their patients is to not only get themselves immunized but to get their families immunized, especially their domestic partners. We have continued this program and more data will soon be available.

Read the full article here.

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