Division of Infectious Diseases

Keeping Fourth of July full of Explosions in the Air (Not from Down There)

The following was written by Dr. Jasmine Marcelin and originally posted to the Physician’s Weekly Blog on July 3, 2018 in honor of the upcoming Independence Day holiday.

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Fourth of July. Independence Day. For most, a delightful holiday filled with fun, family, friends and most importantly, FOOD.

Independence Day is the most popular day to grill. Whether the plan for July 4th is grilling, picnics or checking out a hot dog eating contest, if you will be gathering around food, there’s a chance that food-borne illnesses will gather with you. You may not realize immediately that you have been exposed to a potential foodborne illness until days after your picnic. Here’s a list of potential offenders and how to keep them safe:

Potato/Egg Salad: Salmonella – causes vomiting, diarrhea, fever, cramps within 12-72hrs
Hot Dogs/Deli meat: Staphylococcus aureus – causes nausea, vomiting, diarrhea, cramps within 30 minutes-6 hours
Chicken: Campylobacter spp – causes bloody diarrhea/fever and stomach cramping within 2-5 days (Also Salmonella, as above for potato/egg salad)
Beef: Clostridium perfringens – causes acute diarrhea/stomach cramps within 6-24hrs
Burgers: Escherichia coli – causes diarrhea, stomach cramps, vomiting within 3-4 days
Shellfish: Vibrio – causes nausea, vomiting, watery diarrhea, fever within 1-4 days
Fresh Fruit/Vegetables: Cyclospora spp – causes watery diarrhea/cramps within a week
Cheeses: Listeria – causes fever, flu-like illness in pregnant women (can hurt the growing fetus too), and meningitis in elderly or immunocompromised persons

So how do you keep your 4th of July focused on fireworks instead of flatulence? The CDC encourages using the steps “Clean, Separate, Cook and Chill” to ensure proper food safety. Step 1 – Clean: Wash your hands, utensils and food handling surfaces often
Step 2 – Separate: Don’t cross-contaminate. Keep raw meat separate from other cooked or uncooked foods, separate your meats (i.e. keep your chicken separate from your pork and beef), and use separate cutting boards for each item
Step 3 – Cook: Always cook your food to the right internal temperature, and use a food thermometer. Consuming raw or partially uncooked meats increases your risk of foodborne illnesses. The CDC suggests these temperature recommendations for different types of foods:
• 145°F for whole cuts of beef, pork, veal, and lamb (then allow the meat to rest for 3 minutes before carving or eating)
• 160°F for ground meats, such as beef and pork
• 165°F for all poultry, including ground chicken and turkey
• 165°F for leftovers and casseroles
• 145°F for fresh ham (raw)
• 145°F for fin fish or cook until flesh is opaque

Step 4 – Chill: Refrigerate your food promptly, and at most within 2 hours (within 1 hour if outside temperature is above 90°F). After cooking, put the food back in the cool refrigerator and make sure it can keep temperatures below 40°F. Food left at room temperature for long periods invites bacteria to multiply rapidly, increasing likelihood of foodborne illnesses.

Remember, summer heat and humidity makes it difficult to keep food cold outdoors. If leaving your home to celebrate the Fourth, invest in a proper cooler and load it with ice to keep your meats cold before cooking. Use a separate cooler for drinks. Remember to fill up your grill gas tank or stack up on charcoal to ensure that food is grilled to the “Kill bacteria and keep them dead” temperature.

Most importantly, WASH YOUR HANDS before and after handling raw meat, before handling non-meat items, and before you sit down to enjoy the fruit of your grilling prowess. (Or at least use hand sanitizer!)

Check out these CDC websites for more food safety tips and information about symptoms and sources of foodborne illnesses.

We hope everyone enjoys their holiday, Happy Independence Day!

Ending the AIDS epidemic with 90-90-90…Have YOU been tested?

Today is National HIV Testing Day, and one of the most fulfilling conversations to have with persons living with HIV (PLWH) is to share that since the 1980’s, we have made significant progress in the management of the AIDS epidemic. FDA approval of 27 antiretrovirals and 20 fixed dose combination antiretrovirals, increased HIV testing campaigns and funding for HIV care through the Ryan White Comprehensive AIDS Resource Emergency (CARE) Act have made it possible for millions of persons with HIV to live fulfilling lives. Notwithstanding these amazing movements, eliminating HIV remains a moving target as stigma and socioeconomic, racial, age and gender disparities result in inequalities of diagnosis, linkage to and retention in care.

In 2006, the Centers for Disease Control and Prevention (CDC) recommended universal HIV screening, which was endorsed by the United States Preventive Services Taskforce (USPSTF) in 2013. Despite these recommendations, 1 in 7 persons living with HIV (PLWH) in the United States are unaware of their diagnosis. When stratified by age, young people between the ages of 13-24 account for 22% of all new HIV diagnoses in the U.S., but 44% of PLWH in this age group are unaware of their diagnosis (the highest percentage among all age groups).

HIV testing is available at multiple locations. You can ask your primary care clinician to test you for HIV, but did you know that you can get tested for free or low cost at multiple locations near you? These can be local nonprofits like the Nebraska AIDS Project (NAP), your County Health Department like the (Douglas County STD Clinic). Getting tested for HIV can be quick, easy and confidential – go to bit.ly/NHTD2017 and enter your zip code to find an HIV testing location near you.

Our Specialty Care Clinic works closely with the Douglas County STD Clinic and NAP. We treat PLWH diagnosed with HIV at these locations and provide pre-exposure prophylaxis (PrEP) for patients who are at risk. Our nurse and case manager Precious Davis BSN, MSN has been very involved with reaching out to our community to spread the message of HIV testing. At an event in the Spring, Precious shared some of these statistics and information on treatment and stigma of HIV care in a poem (pictured here). At that event, 25 people were tested for HIV.

The HIV Care Continuum demonstrates our progress and areas for improvement towards our goal of eliminating HIV. While 85% of persons living with HIV (PLWH) are aware of their diagnosis, less than 50% of these people have achieved viral suppression. PLWH who are not virally suppressed are at risk of transmitting the virus to others, subsequently repeating the cycle of infection. Therefore successful campaigns to end HIV must not only focus on diagnosis and treatment, but also prevention. HIV treatment as prevention for PLWH and Pre-exposure prophylaxis (PrEP) for persons without HIV (but are at risk for becoming infected) are very powerful prevention tools that require retention in care. We need to test more people for HIV so that 15% of undiagnosed PLWH are brought into care, but a greater challenge beyond that lies in our ability to retain PLWH engagement in care.

How can YOU help to end the AIDS epidemic? Get tested. Encourage your friends and partners to get tested. If you test positive, get into care with an HIV clinician, and STAY in care. If you are a clinician, screen your patients for HIV, regardless of perceived risk; offer high risk patients PrEP, and commit to keep your patients engaged in care.

Jennifer O’Neill, RN, BSN on Why I Love ID

Why I Love ID:

” I love ID. In my role as a clinical research coordinator with the HIV team, I get the opportunity to provide very holistic, multidisciplinary care to our patients while working with the latest interventions and seeking to gain new information to advance the science of care. It is exciting to share those advances with patients, reflecting on how far we have come in a relatively short amount of time and knowing that we are helping to shape the management of the disease going forward. I truly feel privileged to work with such a gifted team focused on providing continuity of care in such a comprehensive way. “

-Jennifer O’Neill, RN, BSN

Learn more about ID at UNMC here.

When You Stop To Smell the Roses and Cannot Smell A Thing

The following was written by Dr. Kelly Cawcutt and originally posted to the Physician’s Weekly Blog on May 31, 2018. Dr. Cawcutt was inspired by a recent personal experience with an upper respiratory infection and its impact on her senses of smell and taste, and she shares how some infections can interfere with basic senses we often take for granted.

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It all started with allergies – or so I thought. We moved into a new house and there are all of these new plants, some more exotic, that were in full bloom when it started. The itchy watery eyes, the sneezes, the post-nasal drip..drip..drip. Too much? Nah, you hear (and see) worse over your Grand Rounds or Noon Lunch-and-Learn sessions.

But, I digress.

Then it got worse. Around 1 week later, the cough started. The body aches. The headaches. The sore throat. The “influenza-like illness,” or ILI, arrived with no apologies. I thought the virus had done its worst; then, as I made my morning coffee, Wacky Wednesday started. I could not smell it. It seemed strange, but I thought it was just congestion. I took a sip. Hot liquid, tasteless. I rummaged through my kitchen–smelling and tasting noxious things, testing my senses. Garlic? Nothing. Chili Lime seasoning? Nothing. Pepper, salt, ginger? All nothing.

I lost my sense of taste and smell.

The loss of smell (anosmia) and taste (ageusia) impact millions of adults in the United States, with distortions in smell being more common. The actual prevalence is likely underestimated, however, given that the primary method of diagnosis is self-reporting. The range of symptoms can go from impairment to total absence and to phantom sensory involvement—that’s right, smelling the roses when they are not there. Advanced age can be a cause for loss of both of these chemosensory agents, but there are many other potential causes, including sinus disease, ear diseases, trauma, neurologic diseases, and infections ranging from the sinuses to the oral cavity to upper respiratory infections and beyond. Interestingly, hepatitis C is also associated with altered perceptions of taste.

Of course, as an ID specialist, the infections are what catch my eye.
What infections can cause this? How does it happen?

Loss of smell from infection, or any kind of sinusitis, usually is due to the acute inflammation of the nose and sinuses impeding the olfactory nerves and system to respond appropriately.

For most infections, think the common cold or upper respiratory infections, it seems that the post-infection loss of smell is generally temporary due to the phenomenal plasticity of the olfactory system. In fact, after URI’s, 32-66% of patients will recover their sense of smell spontaneously. For those struggling, training your sniffer can carry significant advantages toward recovering with intentionally smelling various types of odors a few times per day to “retrain” the olfactory system. It’s physical therapy for the nose!

Taste carries similar risk factors, with URIs, oral infections, sinus infection,s and the unusual association of hepatitis with ageusia. Dysgeusia is more common that ageusia, and many of those who have alternations in taste will also report changes in their sense of smell. Pathophysiology is very similar—acute inflammation of the immediate nerves enroute back to the brain limit the sensation. Except with hepatitis C—there are several potential hypotheses out there on this one, but it is thought that the virus directly impacts the nervous system, resulting in symptoms.

All this being said, smell and taste can be a secondary impact of many common viral and bacterial infections of the head and neck. Treatment should be specific toward the underlying infection to start. Any infections that can cause mass or invasive lesions (aspergillus, mucormycosis, actinomyces) could also result in damage. Many patients will have full recovery, but for those who do not, referral to a specialist is in order for further evaluation and management.

As for me, my taste and smell started to recover slowly after about 48 hours. But, it did raise some awareness—without smell, I may miss the smell of my roses, but I would also not smell the smoke from a fire spreading outside or a gas leak from my stove. These are tangible risks that we should consider in patients with reported losses.

Tomorrow, I will try again to stop and smell the roses.

References

https://academic.oup.com/chemse/article/41/1/69/2365821

https://academic.oup.com/chemse/article/42/7/513/3844730

https://www.ncbi.nlm.nih.gov/books/NBK482152/

https://www.amjmed.com/article/S0002-9343(16)30177-2/fulltext

UNMC ID In The Trenches – Perspective From A Current ID Fellow

Dr. Karnatak, who is finishing his 1st year of ID fellowship, shares what ID fellowship is like here at UNMC:

UNMC ID fellowship is uniquely designed to create an individualized training path for fellows. During my fellowship interview, I believed this fellowship would support fellows to achieve their personal career aspirations, and now after completing my first year of fellowship, I know this is true. The UNMC ID faculty are both the reason for this support and are also the best part of the fellowship! Everyone in the division is very approachable and ready to help in every feasible way. The faculty take pride in teaching the fellows.

The, first year of fellowship provides excellent experience in general ID and introductory rotations to solid organ transplant infections and oncology infectious disease. Overall, two years of ID fellowship at UNMC also provides 6+ months of research experience and at least 4-6 months experience of immunocompromised infections (solid organ transplant and oncology ID). When I started my fellowship, I had very little research experience. At UNMC I was able get the opportunity to work with national leaders in ID. Research training is very well designed to train fellows in writing research proposals, IRB applications and independently doing your research projects. During my first year, I was able to co-author a manuscript and submit an abstract for a national ID meeting. I am close to finishing my first research project, and I have already started discussing about more research projects I will be doing during my second year of fellowship.

The Multidisciplinary HIV ambulatory continuity clinic provides excellent exposure to HIV care, which is critical for gaining confidence in managing patients with HIV. I started my fellowship with very little experience in HIV management. At the HIV continuity clinic, once you demonstrate understanding of basic HIV knowledge, you will be exposed to more complex issues in HIV care such as HIV resistance, therapy switch challenges, drug-drug interactions and more. The bimonthly HIV round-table discussion is an excellent place to discuss challenges in HIV care with the experts.

Omaha is a city is known for its pioneer history and cultural centers. People are welcoming and you will feel the authentic Midwestern hospitality. No matter where you come from there is always something for everyone to enjoy here in Omaha. I lived in New York city during my residency and I was amazed see the cultural diversity in Omaha. It’s a perfect balance of amenities of big city with less hassle. In Omaha, people are nice and will greet you, even if they don’t know you.

Overall UNMC ID fellowship provides opportunity to build a career in multitude of areas including clinical infectious diseases, infection control, antibimicrobial stewardship, ID-critical care, Transplant infectious diseases, Oncology infectious diseases and biopreparedness training. If this kind of diverse exposure excites you, UNMC ID fellowship would be a good fit. Join us!!

What happened at the first Nebraska Antimicrobial Stewardship Summit?

After almost a year of planning, the First Annual Nebraska Antimicrobial Stewardship Summit convened on Friday, June 1^st, 2018 in La Vista, NE. This conference is the first of its kind in Nebraska in which information on antimicrobial stewardship in various healthcare settings is the focus of the meeting. The conference center was abuzz with excitement as close to 270 healthcare professionals attended the Summit that included over 130 nurses, 80 pharmacists, and 30 providers. While the majority of the attendees were from Nebraska, healthcare professionals from neighboring states such as Iowa, Kansas, Missouri and South Dakota also attended the Summit.

Following a warm welcome from Dr. Maureen Tierney (Director of the HAI/AR Program, Nebraska DHHS), Dr. Srinivasan (Associate Director for Healthcare-Associated Infection Prevention Programs, CDC) gave an Update on National Antimicrobial Stewardship Activities in acute, long-term and ambulatory care settings. His concluding message was that the question now is not IF we need antimicrobial stewardship but WHAT is the most efficient and effective way to accomplish it because stewardship is more than just antibiotic resistance, it is a matter of patient safety.

The morning session continued with presentations from Dr. Diekema (Professor, University of Iowa Carver College of Medicine, pictured to the left) on the Role of the Laboratory in Antimicrobial Stewardship; Drs. Vivekanandan (Associate Professor of Medicine, Creighton University) and Horne (Assistant Professor of Medicine, Creighton University) on “Is Antibiotic Stewardship the Answer to C. difficile”; and Kate Tyner, RN, CIC (Nurse Coordinator, Nebraska ASAP and ICAP) on the “Role of the Infection Preventionist in Antimicrobial Stewardship”. The morning session concluded with a presentation from Drs. Tierney and Pedati (Medical Epidemiologist, Nebraska DHHS) on “Public Health Support for Antimicrobial Stewardship” in which they discussed the state MDRO outbreak detection and management protocols as well as the state antimicrobial susceptibility registry and antibiogram.

During lunch, Summit attendees had the opportunity for roundtable discussions with Summit speakers, Planning Committee members, and HAI Antimicrobial Stewardship Advisory Committee members during the Meet-the-Expert session. The goal of this activity was to promote networking and stimulate discussion on solutions to overcome antimicrobial stewardship challenges. Lively discussions ensued between antimicrobial stewardship experts and attendees over hoagies and subs! (Dr. Marcelin pictured with her table above)

Education in antimicrobial stewardship continues in the afternoon with breakout sessions in the Acute and Ambulatory Track and the Post-Acute and Long-Term Care Track at the Summit. Dr. Bergman (Pharmacy Coordinator, Antimicrobial Stewardship Program, Nebraska Medicine, pictured to the left) started the acute and ambulatory session with his presentation on “Regulatory Requirements for Hospitals and Outpatient Antimicrobial Stewardship”. This was followed by presentations from Dr. Van Schooneveld (Medical Director, Antimicrobial Stewardship Program, Nebraska Medicine) on “Antimicrobial Stewardship Interventions in Acute Care Hospitals”; Dr. Kuper (Senior Clinical Manager, Infectious Diseases, Vizient) on “Antibiotic Stewardship Metrics: How Do You Measure Up?”; and Drs. Marcelin (Associate Medical Director, Antimicrobial Stewardship Program, Nebraska Medicine) and Green Hines (Medical Director, Antimicrobial Stewardship Program, Children’s Hospital & Medical Center) on “Antimicrobial Stewardship in the Outpatient Setting (#OutptASP)”. The session was well attended and appreciated by Summit attendees.

Equally well attended is the post-acute and long-term care session that was opened with a presentation from Dr. Crnich (Chief of Medicine and Hospital Epidemiologist, Williams S. Middleton VA Hospital, pictured to the left) on “Regulatory Requirements for Post-Acute and Long-Term Care Antimicrobial Stewardship Programs”. This afternoon session continued with Dr. Ashraf (Co-Medical Director, Nebraska ASAP and Medical Director, Nebraska ICAP) speaking on “Antimicrobial Stewardship Implementation in Post-Acute and Long-Term Care Facilities”; Dr. Crnich on “Management of Common Infections in Long-Term Care Facilities”. The session concluded with a presentation from Tammi Schaffart, RN (Infection Control Nurse and QAPI Coordinator, Douglas County Health Center) and Dr. Ortmeier (Consultant Pharmacist Team Lead, Community Pharmacy Services) on the “Role of Nurses and Consultant Pharmacists in Antibiotic Stewardship in Post-Acute and Long-Term Care Facilities”.

When asked about take-home points on establishing antimicrobial stewardship programs in long-term care facilities, speakers from the Post-Acute/Long-Term Care Track shared their thoughts. Dr. Crnich said it takes a team to establish a stewardship program while Dr. Ashraf (pictured to the left) echoed a similar sentiment that no one is alone in this journey. Tammi emphasized to the many nurses in the audience the importance of documentation to show their efforts for the numerous clinical activities they performed in nursing facilities, including antimicrobial stewardship. Dr. Ortmeier stressed the importance of persistence and the need to continue to ‘keep at it’ for eventual success.

We genuinely appreciate the support Summit attendees expressed. It is our hope that this type of Summit will continue annually in the future and that new topics and updated contents in antimicrobial stewardship will be presented. Additionally, we hope to make many more connections with healthcare professionals in Nebraska and neighboring states to improve the care and safety of our patients and residents by improving prescribing of this precious resource, antimicrobials, through antimicrobial stewardship.

Even beyond our almost 300 live participants, our hashtag #NebStewardSummit2018 was active on twitter as members of our team live-tweeted and shared the conference all over the globe, leading to a potential reach of over 340,000 impressions. Continue to follow us on our websites here and here, and follow us on twitter @UNMC_ID for more updates on what we are doing in Antimicrobial Stewardship here in Nebraska.

Content provided courtesy Phil Chung, PharmD

Pharm To Exam Table: Dual Antiretroviral Therapy with Dolutegravir + Lamivudine

Pharm To Exam Table: Dual Antiretroviral Therapy with Dolutegravir + Lamivudine

Currently, triple therapy regimens constituted with a two nucleoside reverse transcriptase inhibitor backbone and anchored by an integrase inhibitor has been the standard treatment for HIV infection. However, these conventional therapies are being challenged due to their long-term side effects. Dual therapy regimens were recently introduced with the first comprising of dolutegravir (DTG)/rilpivirine (RPV). The combination was approved under the trade name JULUCA® in the setting of antiretroviral therapy (ART) switch cases for maintenance of viral suppression. Current trials are ongoing to support dual therapy for patients who are treatment naïve or experienced. DTG 50mg paired with lamivudine (3TC) 300mg has been introduced as a potential option for dual therapy. The agents of interest offer an array of advantages when compared to the conventional triple therapy. DTG is a potent agent exhibiting a high genetic barrier to drug resistance and 3TC offers a complimentary agent with low toxicity. In addition, the potential for drug-drug interactions is minimal with DTG/3TC.

A number of studies have released data in which they assess the practicality of dual antiretroviral therapy with DTG/3TC. Below, is a summary of such studies:

PADDLE Trial⁴: A pilot, non-blinded, non-randomized, non-parallel, 48 week trial in Argentina. This trial enrolled 20 patients that were naïve to ART, viral loads ranging from 5,000 to 100,000 copies/mL and CD4+ greater 200cells/mm3. The participants in this trial were primarily assessed to see the rate of success at achieving HIV levels of 50 copies/mL or less at 48 weeks. At 48 weeks, 18/20 (90%) patients reached the viral levels desired, including 4 patients with viral loads greater than 100,000 (albeit to protocol). Additionally, safety and efficacy of this dual therapy was analyzed in this trial. Only one protocol failure developed; however, participants achieved levels less than 50 copies/mL from Week 4-24 and developed no resistance to any of the agents.

ASPIRE Trial³: A pilot, open-label, randomized, parallel, multicenter, 48-week clinical trial that enrolled 90 treatment experienced patients. The HIV RNA viral loads ranged from undetectable to less than 50 copies/mL and CD4+ greater than 200/mm3. The primary objective of this study was to assess the possibility of using DTG/3TC as maintenance therapy, compare the rate of failure in both arms, and establish non-inferiority to conventional ART. The rate of failure was similar in both arms with 3/44 (6.8%) patients in DTG/3TC and 3/45 (6.7%) in the triple ART arm developing protocol defined failure. Participants with treatment failure were further examined and found to have no drug mutations that would confer resistance to treatment.

LAMIDOL⁵: A pilot, open-label, single-arm (non-parallel), multicenter, 48 week trial primarily set in France. This study enrolled 110 patients who needed to have plasma HIV RNA less than 50 copies/mL for more than 2 years and CD4 count greater than 200/mm3. The study was designed so that participants would have an 8 week lead-in with triple therapy then switch to dual therapy. At Week 48, analysis was performed to see the proportion of participants who achieved therapeutic success (HIV RNA less than 50 copies/mL). At Week 48 the study results showed 101/104 (97%) participants had achieved therapeutic success.

ACTG A5353⁶: A phase 2, single-arm, open-label study in United States that enrolled 120 ART naïve participants to be assessed at Week 52. The study required participants to have viral loads (VL) between 1,000-500,000 copies/mL and there were no restrictions in regards to CD4+ cells. The study’s primary end-point was to assess virological success (<50copies/mL) at Week 24 with safety and tolerability being secondary. At Week 24, 108/120 (90%) achieved virological success. As part of the secondary results, 10/120 (8.3%) experienced adverse effect although no participants discontinued the study due to adverse effects. This study was the first one to provide unique information about the feasibility of viral suppression. Additionally, DTG/3TC was efficacious at suppressing virus despite large zenith viral loads and it was the first study that showed the development of viral resistance (M184V, 106I, 263K).

GEMINI I¹ and GEMINI II²: Two, nearly identical large phase III, randomized, double-blinded, multinational, multicenter, parallel studies that enrolled 719 and 722 ART naïve participants. The primary purposes of these studies were to assess the percentage of subjects with viral loads between 1,000-100,000 copies/mL and CD4>200/mm3 who achieved viral suppression (HIV VL<50 copies/mL) at Week 48. Preliminary results for these trials are expected to be released in the summer of 2018 and study completion is scheduled for March 2020.

In conclusion, dual ART comprising of DTG/3TC is a potent, safe, and to some extent cost-effective therapy when compared to conventional triple ART therapy. Based on the current data available, dual therapy with DTG/3TC provides an intriguing option for those patients with exclusionary reasons to not use a regimen containing either abacavir or tenofovir and already exhibit a high level of medication adherence in either naïve or treatment experienced patients. While the highlighted studies have shown optimistic results for ART naïve and experienced patients, results from trials with a larger sample size is needed. Additionally, use of DTG/3TC in patients with archived drug resistance has yet to be explored.

References:

An Efficacy, Safety, and Tolerability Study Comparing Dolutegravir Plus Lamivudine With Dolutegravir Plus Tenofovir/Emtricitabine in Treatment naïve HIV Infected Subjects (Gemini 1). April 17, 2018. [NCT02831673]May 17, 2018
An Efficacy, Safety, and Tolerability Study Comparing Dolutegravir (DTG) Plus Lamivudine (3TC) With Dolutegravir Plus Tenofovir/Emtricitabine in Treatment naïve HIV Infected Subjects (Gemini 2). April 13, 2018, [NCT02831764] May 17, 2018
Babafemi O Taiwo, Vincent C Marconi:Dolutegravir plus lamivudine maintains HIV-1 suppression through week 48 in a pilot randomized trial (ASPIRE), Clinical Infectious Diseases, Volume 66, Issue 11, 17 May 2018, Pages 1794–1797, [PubMed 29293895] May 17, 2018.
Cahn P, Rolón MJ: Dolutegravir-lamivudine as initial therapy in HIV-1 infected, ARV-naive patients, 48-week results of the PADDLE(Pilot Antiretroviral Design with Dolutegravir Lamivudine) study. Journal of AIDS international society. May 9, 2017, [PubMed 28537061] May 17, 2018.
Taiwo BO, Zheng L: ACTG A5353: A Pilot Study of Dolutegravir Plus Lamivudine for Initial Treatment of Human Immunodeficiency Virus-1 (HIV-1)-infected Participants With HIV-1 RNA <500000 Copies/mL. Clinical Infectious Diseases, Volume 66, Issue 11, 17 May 2018, Pages 1689–1697 [PubMed 29253097] May 17, 2018.
Veronique Joly, Charles Burdet: A Trial Evaluating Maintenance Therapy With Lamivudine (Epivir®) and Dolutegravir (Tivicay®) in Human Immunodeficiency Virus 1 (HIV-1) Infected Patients Virologically Suppressed With Triple Highly Active Antiretroviral Therapy (HAART) (ANRS 167 Lamidol), French National Institute for Health and Medical Research-French, August 22,2017, [NTC 02527096] May 17, 2018.

Content provided by Freddy Orellana, UNMC PharmD Candidate ’18, and Joshua Havens PharmD

Men’s Health Month at UNMC ID

June is Men’s Health Month, a time to highlight the unique men’s health issues and advocate for awareness of preventive services for men and boys. We have some amazing men in our division who have served as clinicians, educators, leaders, and mentors.

Meet the Men of UNMC ID:

Dr. M. Salman Ashraf, MBBS is an Associate Professor of Medicine and Medical Director of the Nebraska Infection Control Assessment and Promotion Program (ICAP). He also Co-Directs the Nebraska Antimicrobial Stewardship Assessment and Promotion (ASAP) Program with Dr. Trevor Van Schooneveld, and is Associate Medical Director Infection Control and Epidemiology at Nebraska Medicine. Dr. Ashraf’s clinical and research interests in antimicrobial stewardship and infection control in long-term care facilities (LCTF) have led to countless national speaker invitations and significant research funding granted to study antimicrobial stewardship and infection control in LCTF.

Dr. Scott Bergman, PharmD is an Infectious Diseases Trained Pharmacist, Clinical Associate Professor in the College of Pharmacy and Pharmacy Coordinator for the Nebraska Medicine Antimicrobial Stewardship Program. He also serves as the co Pharmacy Coordinator for the Nebraska ASAP program and has a special interest in appropriate antibiotic use and rapid diagnostic testing as an adjunct to antimicrobial stewardship. In 2016 and 2017 he was recognized as a Fellow in the Infectious Diseases Society of America (FIDSA) and American College of Clinical Pharmacy (FCCP), respectively. He works closely with our Infectious Diseases fellows and gives regular “antibiotic basics” lectures to the fellows and Internal Medicine residents.

Dr. Bradley Britigan, MD is the Dean of the University of Nebraska Medical Center College of Medicine, and Department of Internal Medicine Stokes-Shackleford Professor. Despite his busy administrative duties, Dr. Britigan still finds time to practice clinically at the VA hospital, attends on our General ID teaching service, and contributes to our Division research meetings. His research interests include the pathogenesis of Pseudomonas spp. and Mycobacteria spp. Lung Infections, and Microbial Iron Metabolism as a target for Novel Antimicrobial Therapies.

Dr. Paul Fey, PhD is a Professor in the Department of Pathology and Microbiology, Medical Director of the Clinical Microbiology Laboratory and Research Vice Chair of the Department of Pathology and Microbiology. Our Division collaborates closely with Dr. Fey and the microbiology lab on implementation and improvement of diagnostic testing to improve clinical care. His research interests include the Metabolism and Pathogenesis of staphylococcal infections. Just recently, Dr. Fey was honored with the 2017-2018 Outstanding Graduate Student Educator award in the department of Pathology & Microbiology at UNMC.

Dr. Josh Havens, PharmD is an Infectious Diseases-Trained Pharmacist with primary focus in the Specialty Care Clinic (SCC) which serves persons living with HIV (PLWH) in our Omaha and neighboring communities. He is leads the management team for the Ryan Wite AIDS Drug Assistance Program (ADAP) for the state of Nebraska. In his clinical role at the SCC, Dr. Havens not only facilitates discussions with clinicians and PLWH about complex medication issues, but runs a clinic for HIV pre-exposure prophylaxis (PrEP). This has fueled his primary research focus on the prevention of HIV as well as developing novel adherence strategies to keep PLWH healthy. He collaborates in these projects with Drs. Sara Bares and Susan Swindells.

Dr. Andre Kalil, MD is a Professor of Internal Medicine, and Director of the Transplant Infectious Diseases practice group at UNMC ID. He also holds board certification in Critical Care Medicine and has a special interest in infections occurring in the intensive care unit. Dr. Kalil is nationally and internationally recognized for his work in the field of severe sepsis, hospital acquired and ventilator acquired pneumonia, and was the first author and writing group leader of the recent IDSA/American Thoracic Society Guidelines on Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia. Dr. Kalil has acquired numerous grants with funding to study cytomegalovirus and other infections associated with solid organ transplantation.

Dr. James Lawler, MD, MPH is an Associate Professor of Medicine and Fellow in the Infectious Diseases Society of America (FIDSA). He is the Director of International Programs and Innovation, at the Global Center for Health Security and has led several teams to countries in West Africa focusing on Public Health Emergency Preparedness. Dr. Lawler, a former White House Homeland Security Council biodefense policy director, has national expertise on Biosecurity and viral hemorrhagic fevers, and is the current Director of Clinical and Biodefense Research at the National Strategic Research Institute.

Dr. Mark Rupp, MD our fearless leader is a Professor of Medicine and Chief of the Division of Infectious Diseases. He is a Fellow in the Infectious Diseases Society of America (FIDSA), Society for Healthcare Epidemiology of America (FSHEA), American College of Physicians (FACP) and past president of SHEA. He is also Medical Director of Infection Control & Epidemiology at Nebraska Medicine and Associate Director of Nebraska ASAP and ICAP. Dr. Rupp is also Chief of Medical Staff at Nebraska Medicine and has received the Top Teacher award in the Department of Medicine for almost a decade. He has published over 400 peer-reviewed articles and is nationally and internationally known for his expertise in healthcare associated infections, antimicrobial stewardship and staphylococcal infections.

Dr. Uriel Sandkovsky, MD is an Associate Professor of Medicine and Medical Director of Employee Health at UNMC. He attends on the Transplant Infectious Diseases service. His research interests include cardiac device infections and viral infections in transplantation.

Dr. Trevor Van Schooneveld, MD is an Associate Professor of Medicine and UNMC Infectious Diseases Fellowship Director. He is also Medical Director of our nationally recognized Nebraska Medicine Antimicrobial Stewardship program and Co-Director of the Nebraska ASAP with Dr. Ashraf. Dr. Van Schooneveld is a Fellow in the American College of Physicians (FACP) and actively involved in SHEA as an Associate Editor of the society flagship journal, Infection Control & Hospital Epidemiology (ICHE). Dr. Van Schooneveld’s areas of interest within the field of Antimicrobial Stewardship include reduction of C. difficile infections and use of infection biomarkers in clinical practice.

UNMC ID is looking for our next fantastic fellows! Could that be you?

Fellowship application season is nearing and as the Program Director for our ID fellowship, I wanted to highlight a few of the great things about our program. Our fellows have 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, we have two separate immunocompromised services that care for oncology and solid organ transplant patients. New this year we are adding an orthopedic infectious diseases rotation where fellows will gain dedicated experience managing these complex patients. The faculty at UNMC are nationally recognized experts in their field, but are also very approachable and devoted to the education and success of trainees. In addition to our inpatient experiences, fellows gain knowledge in HIV/AIDS management working in our multidisciplinary HIV clinic which cares for over 1200 persons with HIV.

An important part of fellowship is developing skills in interpreting and performing research and we provide our fellows with a 6 month mentored research experience centered on their career goals. A research committee assists fellows in mentor identification and project development. Fellows also participate in a two-week research training program provided by UNMC. Fellows have the opportunity to be mentored by well-known experts in a variety of areas including HIV/AIDS, immunocompromised hosts, orthopedic infections, hospital epidemiology, antimicrobial stewardship, critical care infectious diseases, and biopreparedness.

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 to add a critical care medicine fellowship. My goal as a program director 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 I hope you will consider UNMC ID. If you are interested in more information, please feel free to visit our website and/or contact me.

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

Interested in upcoming Transplant ID conferences? UNMC ID will be representing!

We are proud of our Transplant ID faculty who have demonstrated their academic productivity with invitations to present posters, oral lectures and moderate at upcoming Transplant ID conferences. If you are planning on attending any of these conferences, check out our faculty and staff presentations and tag us on twitter @UNMC_ID!

2018 American Transplant congress, Seattle, WA 2-6 June 2018

Dr. Andre C Kalil – moderator for “Frontiers in Cytomegalovirus – Bench to Bedside” Sunday June 3rd

Chambers HC, Kalil AC, Florescu DF. Timing of infections after TAH implantation. What did we learn? Jun 2-6, 2018 ATC, Seattle, WA. Poster

Florescu DF, Grimley M, Papanicolaou G, Prasad V, Vainorius E, Chittick G, Brundage T, Nichols T. Brincidofovir was Used to Successfully Treat Adenovirus Infections in Solid Organ Transplant Recipients and Other Immunocompromised Patients.. Abstract 294. Oral presentation. Jun 2-6, 2018 ATC, Seattle, WA

Henry M; Vacha M; Florescu DF; Keck M; Evaluation of the Use of Oral Valganciclovir for the Treatment of Cytomegalovirus (CMV) Infections in Pediatric Intestinal Transplant Recipients: A Single Center Experience. Jun 2-6, 2018 ATC, Seattle, WA Poster

27th International Congress of the Transplantation Society, Madrid, Spain, June 30- July 5, 2018

Dr. Diana F Florescu – oral presentation: Addressing the Threat of Infections Post-Transplant – Diarrhea in Transplantation, July 1, 2018

Dr. Diana F Florescu – oral presentation: Early Morning Symposium – Challenging Cases in Transplant Infectious Diseases: Pushing the Boundaries of Donor and Recipient Outcomes – Polyoma Viruses. July 4, 2018

Chambers HC, Kalil AC, Florescu DF. Hospital Course after TAH Implantation, Nebraska Experience. Poster session 2, P.398. TTS 2018, Madrid Spain