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PharmtoExamTable (Part 1): Why should sulfamethoxazole/trimethoprim (Bactrim) be used with caution in patients with renal impairment or those on dialysis?

This #PharmToExamTable post was authored by Eric Hiatt, PharmD Candidate (2025) at the UNMC College of Pharmacy, and explores Bactrim’s use in those with impaired renal function.

(Content reviewed by Jenna Preusker, PharmD, BCPS, BCIDP)

In the world of antimicrobial stewardship, finding the right antibiotic for definite therapy against a bacterial infection can be the difference between life and death. Bacterial resistance has emerged with the use and misuse of antibiotics. The result leads to dwindling options and reliance on less-than-ideal antibiotics for specific populations. An example is sulfamethoxazole/trimethoprim in populations with renal impairment or those on dialysis. 

A meta-analysis explored the adverse renal effects of sulfamethoxazole/trimethoprim and included patients who initially received their first dose in the hospital. The study included 573 patients, of which 64 (11%) developed an AKI. Out of the 64 with AKI, the authors noted a significantly higher percentage of patients had pre-existing chronic kidney disease. The inclusion criteria itself has a limitation; with or without sulfamethoxazole/trimethoprim, many hospitalized patients are likely to develop an AKI. To control this limitation, the authors included a comparator group with similar characteristics but who were administered clindamycin instead due to no known AKI-associated events with clindamycin. The clindamycin group consisted of 84 patients, of which none developed an AKI, with only 3 having an increase in serum creatinine and no increase in BUN. The study concluded that since there were patients who developed AKI even with no other known risk factors for renal impairment, sulfamethoxazole/trimethoprim was suggested to be an independent risk factor for AKI.1

Image 1: Example of the crystalline structure form in the urine by NASM

In 2024, a case series of 14 patients investigated whether sulfamethoxazole-induced crystalline structures result in AKI. The crystalline structure results from sulfamethoxazole’s metabolite N-acetyl-sulfamethoxazole (NASM). NASM has been observed to form a crystalline structure in acidic urine, potentially causing renal damage resulting in an AKI. The authors concluded that patients with sulfamethoxazole-induced crystalline nephropathy developed an AKI. They also noted that individuals at risk for crystalline structures forming from NASM include patients who have hypovolemia, hypoalbuminemia, acidic urine, high concentrations of sulfamethoxazole/trimethoprim and NASM in urine, and chronic kidney disease.2

In hospitalized patients, providers can avoid crystallization by giving intravenous normal saline for hydration and promoting diuresis with an agent like a loop diuretic. Another way would be to ensure the pH of the urine is basic (pH > 7.15), as it would increase sulfamethoxazole solubility in the urine, preventing further crystallization. If needed, sodium bicarbonate can be administered to increase urine pH. Additionally, clinicians should monitor the estimated glomerular filtration rate and monitor urine for crystalluria. In acute renal failure resulting from sulfamethoxazole/trimethoprim, the first step is to discontinue it and administer fluids to ensure the patient is euvolemic, followed by diuresis to clear any obstructing crystals within the kidney. If needed, sulfamethoxazole/trimethoprim can also be removed through dialysis.3

To be continued in Part 2 soon!

References:

1. Fraser TN, Avellaneda AA, Graviss EA, et al. Acute kidney injury associated with trimethoprim/sulfamethoxazole. Journal of Antimicrobial Chemotherapy, 2012; 67(5), 1271–1277. https://doi.org/10.1093/jac/dks030

2. Azencot R, Saint-Jacques C, Haymann JP, et al. Sulfamethoxazole-induced crystal nephropathy: Characterization and prognosis in a case series. Scientific Reports, 2024; 14, 6078. https://doi.org/10.1038/s41598-024-56322-9

3. Perazella MA. Crystal-induced acute renal failure. The American Journal of Medicine, 1999; 106(4), 459–465. https://doi.org/10.1016/S0002-9343(99)00041-8

UNMC ID Wins Internal Medicine Residency’s Best Teaching Division Award!

We are proud to announce that, earlier this month, UNMC ID was awarded the Best Teaching Division among all 12 Divisions of UNMC’s Department of Internal Medicine for this academic year! This is a huge honor for UNMC ID, which is voted on by current IM residents and awarded at the annual IM residency graduation celebration.

Dr. Jasmine Marcelin (pictured left) accepted the award on the Division’s behalf, commenting, “Thanks to all our faculty and fellows for your exceptional teaching of our residents!”

Dr. Trevor VanSchooneveld, Director of the ID Fellowship Program and Core Faculty for the Internal Medicine Residency, echoed that sentiment, saying, “The ID Division is exceedingly pleased to receive this award, and the ID faculty deserve the credit for their above and beyond effort to educate and mentor trainees.”

Dr. Andre Kalil also praised the achievement, stating, “Truly an amazing Division accomplishment that will certainly translate into more interest in following an infectious disease career.”

Lastly, Dr. Mark Rupp, Chief of the Division of Infectious Diseases, also commended the award and the work of the UNMC ID community towards training our great IM residents in ID- “What a great recognition of the effort that so many make to contribute to the positive educational environment in the Division.  Great job, team!”

Great job team, indeed! A huge thanks to all our faculty, fellows, APPs, staff, and all others who assist in making resident education a great experience for all!

UNMC Specialty Care Clinic Presents Work at National HIV Conference

Lance (middle) and the two other co-presenters of work on HIV Telehealth Care


Back in March, we ran this Sneak Peak post announcing that Lance L. Burwell, LIMHP, PC, behavioral therapist at the UNMC SCC, was invited to co-present an ongoing project titled “Bridging HIV Care Gaps through Telehealth: An Evidence-Informed Intervention to Support Engagement in Care” at the 2024 National Conference on Social Work and HIV/AIDS. This is a huge honor, and we congratulate Lance on a fantastic presentation and commitment to a project that has improved care for many SCC patients. Read below for Lance’s recap of the presentation and the impact of this important work.

I attended the 2024 National Conference on Social Work and HIV/AIDS and co-presented with the lead presenter Masil Miranda, MSW, a Program Manager from AIDS United, along with Clover C. Cambell-Woods, MA, PsyD, from Georgia Harm Reduction Coalition.  We presented the intervention we have been implementing- “Bridging HIV Care Gaps through Telehealth: An Evidence-Informed Intervention to Support Engagement in Care.” 

The goal of Intervention to Telehealth and Text to Improve Engagement in Care (i2TEC) is to increase engagement in HIV care and viral suppression for people with HIV by raising understanding of the intersection between mental health, substance use, and HIV care.  The hope is that this intervention will reduce or eliminate barriers to care, such as transportation, stigma, and insecurities related to food, income/finances, and housing, not only by connecting people with resources but also by providing an alternative that allows patients to improve their own engagement in their healthcare.  The telehealth option allows patients to participate remotely, thereby minimizing attendance concerns related to transportation and stigma while also increasing patient awareness of how their mental health, substance use, and/or HIV knowledge impacts their treatment, the outcomes, and their overall health, wellness, and life satisfaction.

My portion of the presentation provided information on how our site implemented the intervention, the staff involved, the challenges we faced, and the successes we experienced to date.  Our site demonstrated that, in spite of typical challenges of patient outreach & enrollment, technology, and sustainability concerns, the implementation was hugely successful. Not only were we able to meet patient enrollment goals and integrate them into the clinic using existing staff and technology, but we also provided resources & referrals to patients who utilized these to further reduce barriers and improve health, wellness, and life satisfaction.  More importantly, however, the intervention decreased the stigma associated with mental health counseling as many of those previously hesitant to pursue therapy transitioned into ongoing therapy upon completion of their 12 sessions.  Our site experience demonstrates the ease of implementing an intervention in an existing clinic while providing a valuable option for patients that reduces barriers to care.  This translates to improved treatment consistency and adherence while also providing needed resources to patients, thereby furthering goals of minimizing transmission and improving patient quality of life. 

–Lance L. Burwell, LIMHP, PC

Research Digest: The Practice of ID

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 advancements in how ID professionals practice. As always, check out the linked full articles for more details.

Dr. Cawcutt, author of a recent paper of HIAs

In the first article, authored by Dr. Kelly Cawcutt and others, the authors address how surveillance for healthcare-associated infections (HIAs) is performed in the medical system. Great strides have been made toward efficient and timely monitoring of invasive device-associated infections that arise from things like central lines, ventilators, and catheters. This has enabled the medical community to recognize spikes in infection rates and adjust recommended practices to keep patients safe and devices sterile. However, these devices are not the only nidus that can cause infection in a healthcare environment. Alternative devices, as well as non-ventilator hospital-acquired pneumonia and infectious complications from other conditions, can all increase the risk of HAI. Therefore, the authors discuss alternative performance metrics that can provide a more comprehensive picture of the HAI landscape and identify a wider range of infections that may require systematic intervention. Read the full details here.

Dr. Lawler, co-author on this paper addressing PPI

The second article, written by many from the UNMC community including Sara Donovan and Dr. James Lawler, identifies a core need in the ID community as we face increasing rates of high-consequence infectious disease events; safe and effective donning and doffing protocols for personal protective equipment (PPI). Utilizing knowledge from an exhaustive literature review as well as their own expertise as experts in ID and PPI use, the authors identified a set of cardinal rules to keep in mind when dealing with PPI. While they note that these rules are not all-encompassing, these rules serve as a great starting point and refresher for any who would need it. Read the full text here.

Dr. Van Schooneveld, co-author on a recent paper exploring ID fellowship training

In the final article, authored by Dr. Trevor Van Schooneveld and others, considerations for ID fellowship training are explored. Training ID fellows unavoidably involves a balance between delivering great patient care and managing a high caseload while also protecting the educational environment for trainees. Recently, consult volume has been identified as an area of concern, which has a large effect on the educational environment. To characterize this concern, the authors performed a survey of ID fellowship programs in the United States to assess consult volume trends and any mitigation strategies implemented. This effort was able to quantitatively describe ID program daily new consult and total census rates, which rose as high as 12 and 30, respectively. It also identified shared strategies used to protect trainees and other ID professionals from burnout. The authors conclude that “as we navigate the challenges posed by the consultation surge, it is crucial to strike a balance between ensuring quality patient care, preserving educational opportunities, and safeguarding the well-being of both faculty and fellows.” Read the full article here.

Specialty Care Clinic HIV Team to Share Work at National Conferences

A huge congratulations to our Specialty Care Clinic (SCC) HIV team, who have been hard at work implementing quality improvement programs and clinic implementation efforts and will be sharing updates on their accomplishments with the national ID community throughout the summer. The team will be represented at no less than 6 conferences this summer, with 12 abstracts currently accepted for presentation. We are proud of our SCC team for many reasons, among them their tireless effort to improve the quality and implementation of care for their patients. See below for the details of those who will be sharing their work this summer, and keep an eye on this blog throughout the summer for updates and summaries from presenters. Congratulations, SCC team!

Professional Association of Social Workers in HIV/AIDS Conference in Orlando, FL, May 2024:

Bridging HIV Care Gaps through Telehealth: An Evidence-Informed Intervention to Support Engagement in Care (Miranda, M; Burwell, L; et al)

SYNC2024 in Alexandria, VA, in May 2024:

RWHAP Best Practices Compilation: Sharing Successes in Telehealth and Addressing STIs (Hook, J; Flaherty Dore, K; Regan, N; Nelson, J.)

IAPAC Continuum Conference in Puerto Rico in June 2024:

Determining Capacity and Desire for Age-Friendly Healthcare at a Midwest HIV Clinic (Regan, Essam Nkodo, Fadul, along with colleagues from geriatrics: Jenkins and Porter)

Medicaid insurance expansion and its association with HIV outcomes in Nebraska, USA: An observational prospective cohort study (Essam Nkodo, Arroyo, Fadul, Furl, Lyden)

Data-driven Strategies Towards Case Management Utilizing Tableau Dashboard Reporting and Automation (Glassman, Arroyo, Jones, Fadul)

Leveraging Implementation Science to Address HIV Disparities (Fadul, Essam Nkodo, Furl, Regan)

25th AIDS 2024 Conference in Munich, Germany, in July 2024:

Medicaid insurance expansion and its association with HIV outcomes in Nebraska, USA: An observational prospective cohort study (Essam Nkodo, Arroyo, Fadul, Furl, Lyden)

Ryan White National Conference in D.C. in August 2024:

Bridging the Gap: Multi-Specialty Collaboration to Bring Age-Friendly Care to a HIV Clinic (Regan, Essam Nkodo, Fadul, along with colleagues from geriatrics: Jenkins and Porter)

Telehealth 2.0: Revitalizing a Previously Successful Telehealth Program with Updated Process Mapping (Regan, Cramer, along with colleague from Ohia Advisors: Wetherhold)

Screening is Believing: Increasing Depression Screening in a HIV Primary Care Clinic (Regan, Arroyo, Burwell, Furl)

Data-driven Strategies Towards Case Management Utilizing Tableau Dashboard Reporting and Automation (Glassman, Arroyo, Jones, Fadul)

GLMA as WORKSHOP in Sept/Oct 2024 in Charlotte, NC:

Meeting them where they’re at: Implementing telehealth services in a HIV clinic to increase LGBTQ+ patient engagement (Cramer, Carr, Burwell, Regan)

Updated Antibiotic Guidance for Skin and Soft Tissue Infections and Diabetes-Related Foot Infections

This post was researched and written by Dr. Jonathan Ryder, Assistant Professor and previous UNMC ID Fellow. Dr. Ryder is also Associate Medical Director of the Nebraska Medicine Antimicrobial Stewardship Program and Associate Hospital Epidemiologist. Here, Dr. Ryder shares key changes the Antimicrobial Stewardship Program has recently made in guidance on the treatment of SSTIs.

The Nebraska Medicine Antimicrobial Stewardship Program has published updated local guidance on the management of patients with skin and soft tissue infections (SSTI) and diabetes-related foot infections (DFI). This includes conditions such as non-purulent cellulitis, abscesses, necrotizing skin soft tissue infections, and bite wounds. These changes are due to new 2023 IDSA guidelines on the management of diabetes-related foot infections as well as updates in the microbiology for these infections since the 2014 IDSA guidelines for SSTI.

In this post, we highlight the key changes we have made to our guidance and the rationale behind these changes.

So Long to Clindamycin

Two of the most common pathogens for SSTI and DFI are beta-hemolytic Streptococci (including group A Streptococci [GAS] and group B Streptococci [GBS]) and Staphylococcus aureus. Unfortunately, resistance to clindamycin is rising significantly in these pathogens. Per surveillance data from the Centers for Disease Control, resistance to clindamycin was found in 34.4% of invasive GAS and 51.4% of invasive GBS.1 For Staphylococcus aureus, our 2024 antibiogram shows over 25% resistance to clindamycin.2 Given these high rates of resistance to clindamycin, clindamycin is no longer recommended for empiric treatment of SSTIs or DFI. 

However, there are other reasons why clindamycin has fallen out of favor. Clindamycin is associated with high rates of adverse effects, in particular gastrointestinal side effects in over 20%.3 Specifically, antibiotic-associated diarrhea is found in over 13% of patients.3 Clindamycin is also associated with the highest risk of Clostridioides difficile infection (CDI) compared to other antibiotics, with one study demonstrating 25 times higher odds of CDI when receiving clindamycin.4,5 Clindamycin is also dosed 3-4 times per day, which can make adherence challenging for patients. In a systematic review assessing adherence to therapy, 3-times-daily dosing was associated with only 65% adherence, while 4-times-daily was 51%.6 Thus, clindamycin is also a poor choice for SSTI and DFI given its high rate of adverse events and poor adherence to therapy. 

But What about Patients with Penicillin Allergies?

Clindamycin has frequently been used as an alternative choice in patients with penicillin allergies; however, a better understanding of antibiotic allergies provides more alternatives. New guidelines for management of antibiotic allergies were released in 2022.7 In collaboration with our allergy experts, local guidance for management of penicillin allergy and other beta-lactam allergy were developed. Within the new SSTI and DFI guidance, penicillin allergy guidance is provided for each scenario. Reference to these documents is helpful for finding alternative regimens. Generally speaking, even in the presence of a severe IgE-mediated penicillin allergy (e.g., anaphylaxis), first-line regimens for cellulitis, such as intravenous cefazolin, can still be used.

Alternative Options Exist with Increased Accessibility

Other options for patients with beta-lactam allergy include trimethoprim-sulfamethoxazole (TMP-SMX) and linezolid. Historically, TMP-SMX has been avoided in non-purulent SSTI due to concerns about high rates of resistance to TMP-SMX in GAS. However, this concern about resistance has been found to be a myth .8 Older studies found high rates of resistance to TMP-SMX in vitro as a result of methodologic problems. After these problems were corrected, TMP-SMX susceptibility rates were very high for GAS. In clinical studies, TMP-SMX has performed well in the treatment of SSTI.9 TMP-SMX has been a preferred alternative when allergy precludes first-line regimens.

Linezolid has excellent Staphylococcal and Streptococcal activity, but concerns have existed regarding cost and serotonin syndrome. Fortunately, the price of linezolid has decreased substantially, although there can be variation between outpatient pharmacies on price (ensuring patients can access the drug at a lower price is key for prescribing linezolid outpatient).10 Regarding serotonin syndrome, the risk for this adverse event in patients receiving linezolid is exceedingly low, even in patients on selective serotonin reuptake inhibitors.8 In patients with serious infections, a careful weighing of risks/benefits is warranted. Regardless, linezolid remains a much safer and more effective option compared to clindamycin, especially as an alternative agent in patients with severe penicillin allergies.

Changes in Management of Necrotizing Soft Tissue Infection

Another common indication for clindamycin has been adjunctive antitoxin therapy for necrotizing soft tissue infections due to GAS or Clostridium species. However, there has been debate about whether clindamycin should be replaced by linezolid, which has similar in vitro antitoxin activity.11 The crux of this debate involves the increasing GAS resistance to clindamycin, a lower risk of CDI with linezolid, and replacing empiric vancomycin (and its associated risk of acute kidney injury) with linezolid. Since publishing this debate, two small retrospective studies have demonstrated linezolid and clindamycin have similar efficacy, but replacing clindamycin (and vancomycin) with linezolid reduced a composite risk of death, CDI, and acute kidney injury in one of these studies.12,13 Another study found a lower risk of acute kidney injury with this switch as well.14

Shorter is Better

The new guidance documents include updated antibiotic durations. For non-purulent cellulitis, antibiotic durations of 5-6 days are now the standard.15 For necrotizing soft tissue infections without concurrent bacteremia or cellulitis, antibiotic therapy can likely be stopped within 48 hours of the final debridement.16 Several changes in duration for DFI have also been incorporated from the 2023 IDSA guidance.

Conclusion

The management of patients with SSTI and DFI is changing due to increasing resistance, myth busting, and improved understanding of antibiotic allergies. Our updated guidance accounts for these changes by moving away from clindamycin, recommending more linezolid and TMP-SMX use, and shortening antibiotic durations.

References

  1. US Centers for Disease Control and Prevention. ABCs Bact Facts Interactive Data Dashboard. Accessed May 3, 2024, 2024. https://www.cdc.gov/abcs/bact-facts-interactive-dashboard.html
  2. Nebraska Medicine Antimicrobial Stewardship Program. Antibiograms. Accessed May 3, 2024, 2024. https://www.unmc.edu/intmed/divisions/id/asp/antibiograms.html
  3. Neu HC, Prince A, Neu CO, Garvey GJ. Incidence of diarrhea and colitis associated with clindamycin therapy. J Infect Dis. Mar 1977;135 Suppl:S120-5. doi:10.1093/infdis/135.supplement.s120
  4. Miller AC, Arakkal AT, Sewell DK, Segre AM, Tholany J, Polgreen PM. Comparison of Different Antibiotics and the Risk for Community-Associated Clostridioides difficile Infection: A Case-Control Study. Open Forum Infect Dis. Aug 2023;10(8):ofad413. doi:10.1093/ofid/ofad413
  5. Brown KA, Khanafer N, Daneman N, Fisman DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother. May 2013;57(5):2326-32. doi:10.1128/aac.02176-12
  6. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. Aug 2001;23(8):1296-310. doi:10.1016/s0149-2918(01)80109-0
  7. Khan DA, Banerji A, Blumenthal KG, et al. Drug allergy: A 2022 practice parameter update. J Allergy Clin Immunol. Dec 2022;150(6):1333-1393. doi:10.1016/j.jaci.2022.08.028
  8. McCreary EK, Johnson MD, Jones TM, et al. Antibiotic Myths for the Infectious Diseases Clinician. Clin Infect Dis. Oct 13 2023;77(8):1120-1125. doi:10.1093/cid/ciad357
  9. Bowen AC, Carapetis JR, Currie BJ, Fowler V, Jr., Chambers HF, Tong SYC. Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess. Open Forum Infect Dis. Fall 2017;4(4):ofx232. doi:10.1093/ofid/ofx232
  10. Cheap Generic Drugs. NEJM Journal Watch. Accessed May 3, 2024, 2024. https://blogs.jwatch.org/hiv-id-observations/index.php/hey-insurance-companies-and-pharmacies-stop-messing-around-with-cheap-generic-drugs/2024/04/26/
  11. Cortés-Penfield N, Ryder JH. Should Linezolid Replace Clindamycin as the Adjunctive Antimicrobial of Choice in Group A Streptococcal Necrotizing Soft Tissue Infection and Toxic Shock Syndrome? A Focused Debate. Clin Infect Dis. Sep 3 2022;doi:10.1093/cid/ciac720
  12. Heil EL, Kaur H, Atalla A, et al. Comparison of Adjuvant Clindamycin vs Linezolid for Severe Invasive Group A Streptococcus Skin and Soft Tissue Infections. Open Forum Infect Dis. Dec 2023;10(12):ofad588. doi:10.1093/ofid/ofad588
  13. Dorazio J, Chiappelli AL, Shields RK, et al. Clindamycin Plus Vancomycin Versus Linezolid for Treatment of Necrotizing Soft Tissue Infection. Open Forum Infect Dis. Jun 2023;10(6):ofad258. doi:10.1093/ofid/ofad258
  14. Lehman A, Santevecchi BA, Maguigan KL, et al. Impact of Empiric Linezolid for Necrotizing Soft Tissue Infections on Duration of Methicillin-Resistant Staphylococcus aureus-Active Therapy. Surg Infect (Larchmt). Apr 2022;23(3):313-317. doi:10.1089/sur.2021.329
  15. Lee RA, Centor RM, Humphrey LL, et al. Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians. Ann Intern Med. Jun 2021;174(6):822-827. doi:10.7326/m20-7355
  16. Lyons NB, Cohen BL, O’Neil CF, Jr., et al. Short Versus Long Antibiotic Duration for Necrotizing Soft Tissue Infection: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt). Jun 2023;24(5):425-432. doi:10.1089/sur.2023.037

Dr. Rupp Comments on COVID-19 and Avian Flu on Rural Heath Matters

A few weeks ago, we proudly shared that our Chief of Infectious Diseases, Dr. Mark Rupp, was honored with the 2024 Bartee Advocacy of Science Award, which is given to a UNMC scientist who exemplifies and lives out a commitment to community engagement. Illustrating this commitment to public science and medicine outreach, Dr. Rupp recently appeared on Rural Health Matters with the University of Nebraska President Dr. Jeffrey Gold to discuss the current state of COVID-19, avian influenza, and Lyme disease.

Rural Health Matters is a television show that features experts from UNMC discussing various health topics and their impact on farmers, ranchers, and rural Americans. The show is hosted on RFD-TV and features a live call-in segment where viewers can pose questions on a wide range of health-related topics that impact rural America.

Dr. Gold and Dr. Rupp are common features on the show, especially with increased infectious outbreaks in recent years. In this episode, Dr. Gold and Dr. Rupp were able to give actionable advice on how to avoid Lyme disease as we approach the summer months and commented on the current and future risks of avian influenza- which are especially important topics for rural Americans and all who work in agriculture or with animals which may contract or spread disease.

Both Dr. Rupp and Dr. Gold also received multiple comments from callers thanking them for their support on this show throughout the pandemic and continuing to today; a sentiment we would like to echo. Thank you, Dr. Rupp, for your outreach and commitment to ID education and awareness!

Watch the full episode on UNMC’s YouTube page here, and spread the word about Rural Health Matters on RFD-TV to all who may be interested.

Research Digest: New Findings on COVID-19

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.

Dr. Fadul, senior author on a publication exploring the COVID-19 vaccination status and opinions of Sudanese Americans.

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.

Dr. Andre Kalil, co-author on two recent publications examining COVID-19 treatments and their risks.

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.

UNMC ID Recognizes STI Awareness Week

This week is Sexually Transmitted Infection (STI) Awareness Week, a week set aside to educate and raise awareness about sexually transmitted infections, or STIs, and how they impact our lives. It is also a time to work towards reducing STI-related stigma, fear, and discrimination and a time to ensure people have the tools and knowledge for prevention, testing, and treatment.

The CDC estimates that about 20 percent of the U.S. population – one in five people – had an STI on any given day in 2018. Left undiagnosed or untreated, many STIs can lead to serious health problems and permanent damage, both in the short and long term. ID and primary care providers are on the frontlines of this crisis, and we would like to take this opportunity to recognize their work in identifying, diagnosing, and treating STIs- as early diagnosis and treatment is key to preventing associated complications.

For more information and resources about STIs, see the CDC’s page on general resources for STI Awareness Week 2024 here, including resources designed for clinicians to help improve communication about and treatment of STIs.

Dr. Rupp to Receive Bartee Advocacy of Science Award

Dr. Mark Rupp, chief of the UNMC Division of Infectious Diseases, is set to be awarded the Bartee Advocacy of Science Award in recognition of his exceptional community engagement as a scientist.

Support Dr. Rupp and UNMC ID by attending the awards ceremony at 12pm on March 26th (Yanney Conference Room, Fred & Pamela Buffett Cancer Center)

We are proud to share that our division’s chief, Dr. Rupp, will be awarded the Bartee Advocacy of Science Award tomorrow at noon! The Bartee Advocacy of Science Award is given to a UNMC scientist who exemplifies and lives out a commitment to community engagement. Dr. Rupp was chosen for the inaugural honor by a process led by Chris Kratochvil, Bob Bartee’s successor as vice chancellor of external relations for UNMC.

First published in a UNMC Newsroom post, Dr. Rupp commented on the award earlier this month:

“I am very pleased and incredibly honored to receive the inaugural Bartee Family Award for promotion of science literacy and advocacy. I have long respected and admired Bob for his incredible contributions to UNMC over the course of his career – which makes this award even more meaningful to me. I believe the amplification of scientific misinformation and disinformation via social media is a pressing challenge and the promotion of scientific literacy may be one of our best strategies to preserve public health. I am honored to share the stage with Mary Woolley, the president of Research America, and I look forward to her presentation.”

Bartee, the award’s namesake, has commented in return:

“During the COVID-19 pandemic, many medical center professionals distinguished themselves in providing accurate and timely scientific information to the public. Dr. Rupp stood out among an impressive group for his willingness to engage the media, elected officials and members of the public, at times almost daily, to provide a calm and reasoned voice among a cacophony of misinformation. I am pleased and honored that he is the first recipient of the Bartee Award.”

Please join us in celebrating Dr. Rupp’s huge (and well-deserved) achievement by attending the inaugural Bob and Helen Bartee and Family Advocacy of Science Lectureship; info below:

When: March 26th, 2024 @ 12pm

Where: Fred & Pamela Buffett Cancer Center (BCC), Yanney Conference Room

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