Division of Infectious Diseases

Research Digest is a periodic installment that recognizes the world-class clinical research performed right here at UNMC ID. Today, we review two articles covering novel antimicrobial efforts or discoveries that may help us better treat different infectious pathologies. As always, check out the linked full articles for more details.

In the first article, Dr. Nicholas Cortes-Penfield and co-authors review evidence for the timing and process of switching from i.v. to oral antibiotic treatments during bone or joint infection. The authors explain that, for the past 50+ years, the medical community has been divided on the best time to transition from the standard post-surgical i.v. antibiotic regimen to a more accessible oral strategy, with regional and global differences in accepted standard of care. The team reviewed 8 randomized control trials and multiple retrospective studies and concluded that no data exists to definitively set a minimum i.v. antibiotic duration post-surgery. That said, a growing body of research supports an early switch to oral antibiotics, in most cases, within a few days following surgery. The authors caution, however, that this approach should be tailored for case-specific factors. Read the full article here.

The second article, co-authored by Dr. Jonathan Ryder, Dr. Daniel Brailita, Dr. Mark Rupp, and Dr. Richard Hankins, along with others from the UNMC community, tests whether additional sterilization of catheter connectors is beneficial in reducing the risk of microbial colonization of catheter equipment. Antiseptic-containing port-protecting caps are routinely used to help limit this possibility. However, the team aimed to determine whether additional manual disinfection with an alcohol wipe was further preventative of microbial colonization (the current standard of care at UNMC). 356 catheter connectors were cultured in this study, 165 in each group, with an additional 26 that did not have an antiseptic cap as a control group. The team found that the vast majority of positive cultures were from the non-antiseptic cap group (15 positive cultures), while both antiseptic cap treatments (with and without manual disinfection) performed similarly, with 1 and 2 positive cultures, respectively. The team concluded that antiseptic caps are an extremely useful tool for preventing bacterial colonization, but additional disinfection strategies (i.e. manual alcohol-based disinfection) do not further decrease the chance of colonization. Read the full article here.

This just in! A new article published last month by Dr. Andre Kalil outlines an effective measure to treat COVID-19 in immunocompromised individuals at elevated risk of serious disease from this infection. See below for a quick digest of the article, and read the full story here.

Why is it essential to research COVID-19 treatment specifically in the immunocompromised population?

This population is at elevated risk of severe disease and death resulting from infection. This is due to an increased susceptibility to the virus and the reduced efficacy of preventative measures, such as vaccines. Therefore, these patients have been largely excluded from clinical trials centered around COVID-19 for ethical and logistical reasons. This means there are comparatively few evidence-backed medical standards for treating COVID-19 infection in this population, leaving medical professionals with insufficient standardized guidance on which regimens are safe and effective.

How does the study address this gap in evidence-based medicine?

This study focused specifically on immunocompromised COVID-19 patients and retrospectively assessed whether or not they were administered remdesivir, a common COVID-19 treatment, during their hospital stay, calculating all-cause mortality rates for each population. More than 50,000 patients from 48 US states were assessed in this study.

What is remdesivir?

Remdesivir is an anti-viral medication that has been shown to be very effective in reducing death, disease severity (including the need for assisted ventilation), and hospitalization rates among infected individuals. It works by interfering with the ability of the virus to replicate itself and infect other cells.

What did they find?

The authors found that patients who were administered remdesivir had a much lower mortality rate than those who did not receive the medication. This trend was consistent across multiple different SARS-CoV-2 variants, including pre-Delta, Delta, and Omicron viruses. The authors concluded, “Remdesivir, with its established efficacy and safety profile and widespread availability, is an important therapeutic option for treatment of COVID-19 in immunocompromised patients“.

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 the efforts to utilize research to improve the way we practice medicine, from optimizing the work environment to making it easier to find the most up-to-date recommendations. As always, check out the linked full articles for more details.

The first article, co-authored by our own Dr. Angela Hewitt and Dr. James Lawler of the UNMC Global Center for Health Security, discussed the impact of heat strain and dehydration on healthcare workers who must wear personal protective equipment (PPE) as they care for patients with high-consequence infectious diseases. The authors conducted a literature review of 30 articles that analyzed the effect of PPE on providers and concluded that there is much benefit to be gained from the development of cooler and more comfortable PPE materials. Such developments could slow the rate of dehydration and reduce heat strain on front-line workers caring for those with serious infectious diseases. Read the full details here.

The next article, authored by many UNMC faculty members, including Dr. Jana Broadhurst and Dr. David Brett-Major, explored the use of a new generation of cost-effective biocontainment units called ISTARI (Isolation System for Treatment and Agile Response for High-Risk Infections). Designed to provide negative-pressure rooms in low-resource areas and decrease PPE use in the setting of highly infectious diseases, each unit is designed to perform ~20 air exchanges/hour with HEPA filters and multiple access points for providers to perform patient care without entering the unit, decreasing overall PPE usage. While some limitations were noted, providers rated their ability to perform their job roughly equivalent to the standard care scenario. 100% of teams met critical actions for patient management, including intubation, cardioversion, and CPR! This establishes the ISTARI unit as a cost-effective isolation unit, maximizing provider safety in managing patients with highly infectious diseases, particularly in low-resource settings. Read the full story here.

The last article, co-authored by Dr. Kelly Cawcutt, outlines ways to improve the dissemination of new medical information, such as that which changes rapidly (i.e., COVID-19 best practices). The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative is a 6-month project that trains volunteer interprofessional teams on the Checklist for Early Recognition and Treatment of Acute Illness and Injury approach, a structured and systematic method for delivering evidence-based critical care. The included weekly 1-hour videoconference sessions on high-impact topics, monthly quality improvement coaching sessions, and extensive additional resources for asynchronous learning. The program was well-received by participants and led to the initiation of several quality improvement projects. Read the paper here.