This is a review of a recently published article.
Andrew Kozlov, Lorenzo Bean, Emilie V Hill, Lisa Zhao, Eric Li, Gary P Wang; Molecular Identification of Bacteria in Intra-abdominal Abscesses Using Deep Sequencing, Open Forum Infectious Diseases, Volume 5, Issue 2, 1 February 2018
Most intra-abdominal abscesses are polymicrobial. Sometimes aerobic organisms are identified from culture, but often anaerobic organisms do not grow on conventional culture media, especially when patients have received prior antibiotics. This knowledge often leads to broad-spectrum antibiotic therapy including anaerobic coverage.
The authors proposed that culture-independent 16S rRNA sequencing can be used to identify bacteria within intra-abdominal abscesses independent of culture data. They used de-identified clinical specimens from intraabdominal abscesses. They obtained gram stain and culture of all specimens, and used 16s rRNA Illumina Sequencing to amplify a particular hypervariable bacterial region.
They included 26 samples with amplification products and deep sequenced them. 8 of these samples were gram stain and culture negative, and while these had lower microbial diversity, bacterial sequences revealed a predominance of streptococci, B. fragilis and gram positive anaerobic cocci.
In 5 of the samples, culture growth was monomicrobial. The deep sequencing found that even the samples with monomicrobial culture growth were in fact polymicrobial, with the dominant bacteria being the one identified on culture (in 3 of those 5), and recovery of anaerobic organisms was abundant.
An interesting clinical relevance of this: a perihepatic culture had monomicrobial growth of Coagulase-negative staphylococcus, but the sequencing revealed the dominant organism to in fact be Enterococcus faecium. This discrepancy would have significant clinical implications for choice of therapy, especially in the context of a potential vancomycin-resistant enterococcus. The polymicrobial culture samples on the other hand, were a mish-mash of organisms on sequencing; anaerobic cultures predominated, with minority aerobic organisms growing on culture.
The biggest limitation is that with the samples being de-identified, there is no patient-level antimicrobial history data to correlate and account for culture growth. We also don’t have treatment and outcomes data after the cultures were obtained, so it is not clear whether or not the targeted therapy for a monomicrobial abscess culture resulted in clinical cure; in which case, what difference does it make to know about these other organisms?
Knowledge of the complete biodiversity of organisms within an abscess may result in narrowed therapy, however it could also result in prolonged broad spectrum therapy, as prescribers try to chase all of the organisms identified on PCR. Ultimately, proposing this as a culture-independent modality may be risky given the inability to perform antibiotic susceptibility testing on the result; but there may be some utility for this in situations where cultures are negative.
The following is a review by one of our fellows 
accumulating slowly.
Based on the beta-lactam allergy history 50% of the patients received preferred beta-lactam agents during the baseline period. This number was increased to 60% during intervention period by careful evaluation by ASP team by history alone (P = .02). During the intervention period after implementation of BLAST, use of preferred beta lactam therapy further increased to 81% (P < .001). The authors concluded there were 4.5-folds higher odds of receiving preferred beta lactam therapy after implementation of BLAST without increase in side effects (95% CI, 2.4–8.2; P < .0001). During the intervention period use of agents with higher risk for C difficile infection such as fluoroquinolones and carbapenems decreased more than half (28% vs 13%; P < .0002) and penicillin use tripled (11% vs 32%; P < .0002).
Given the improvement in use of beta-lactams with just more intensive allergy history-taking, is the cost-effective solution simply just 
Olivia: During my studies at UNL, I became interested in underserved communities after volunteering at the People’s City Mission (PCM) free health clinic. While at PCM, I interacted with patients who fell through the cracks in our healthcare system, a system that I have always been able to access. Soon after, I began to recognize disparity in my hometown of Columbus, NE in patients living in rural areas who struggle to meet with urban specialists to manage their health problems. Furthermore, my major of Global Studies took me to Mumbai, India where I met patients diagnosed with epilepsy who faced a great deal of social stigma surrounding their disease.
Rohan: My interest in health disparities largely stems from the time I spent as an undergraduate in St. Louis. Following the shooting of Michael Brown in Ferguson, a neighborhood 10-15 minutes from where I lived at the time, I became acutely aware that St. Louis, like Omaha, is a city with historically ingrained divisions that create disparities in the social determinants of its citizens’ health. I was inspired by the widespread activism I saw around St. Louis and involved myself in a narrative-based music outreach program to help uplift the stories of young community members. I was also motivated to leverage my own leadership positions on campus to advocate for the mental health of students of color and LGBTQ+ students.
Laura: Through volunteering at community organizations growing up, I became aware of differences in wealth, educational opportunities, and neighborhood resources between Omaha communities. During a college course in Ecuador which focused on social and political transformations, I gained a broader understanding of the global pervasiveness of inequalities, especially in health. In Minnesota where I attended college, I volunteered at a community health clinic teaching an exercise and nutrition class for Hispanic and Somali women struggling with obesity and diabetes. The hard work, persistence, and camaraderie of these women left me inspired and grateful for their friendship and the privilege to take part in their path to better health, and I felt drawn to a vocation in health care.
Independence Day is the 
Hot Dogs/Deli meat: Staphylococcus aureus – causes nausea, vomiting, diarrhea, cramps within 30 minutes-6 hours
Burgers: Escherichia coli – causes diarrhea, stomach cramps, vomiting within 3-4 days
Step 1 – Clean: Wash your hands, utensils and food handling surfaces often
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.
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!)
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 
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 
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.
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!
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