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Division of Infectious Diseases

UNMC Clinical Microbiology Fellowship Program Welcomes Dr. Arryn Craney!

Content courtesy of Dr. Paul Fey and Dr. Arryn Craney.

UNMC’s Department of Pathology and Microbiology in collaboration with Nebraska Medicine sponsors a Clinical Microbiology Fellowship Program that is accredited by the Committee on Postgraduate Educational Programs (CPEP) of the American Academy of Microbiology.  This two year training program provides the trainee hands-on experience in the basic disciplines of clinical microbiology.  Upon successful completion of the Clinical Microbiology Fellowship Program, the Fellow will be eligible to sit for the examination as the next step to certification as a diplomate by the American Board of Medical Microbiology (D [ABMM]).  Our new fellow is Dr. Arryn Craney.  Dr. Craney received her PhD from McMaster University in Canada and most recently finished a post-doctoral fellowship at the Scripps Research Institute in San Diego where she studied the type I signal peptidase as a potential antibiotic target.

See more about the Clinical Microbiology Fellowship here.


 

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Welcoming our new ID fellows – Focus on Dr. Karnatak

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

Tell us about the position you are starting?
I am starting infectious diseases fellowship at UNMC. I plan to do two years of specialization in infectious diseases followed by one year in critical care medicine.
Tell us about your background? 
I  finished medical school from the Himalayan Institute of Medical Sciences in India and further training in cardiac critical care at the All India Institute of Medical Sciences in New Delhi. I did my Internal Medicine residency at the Brookdale University Hospital in Brooklyn, New York. Post residency I have been practicing academic internal medicine from last three and half years. 
Why UNMC?
Omaha is second home for my wife. She always wanted to come back to Omaha. I was well aware of great training environment at UNMC as my wife did part of her residency and fellowship training here at UNMC. During my fellowship interview I realized infectious disease fellowship program at UNMC is designed to create a great learning environment for fellows and help fellows to grow in their career irrespective of whatever they want to achieve.  
What about ID makes you excited?
Infectious diseases is very exciting due to its complexity. During my practice I often noticed when I needed an specialist experienced in complexity I would call ID!! Infectious disease in today’s era is incredibly important due to crisis of multi-drug resistance, growing number of immunosuppressed oncology and transplant population, international travel related infections, infection control and need for expertise in health care epidemiology. According to a recent CDC report health care infections costs around 26-33 billion annually. In 2013 “Infectious Diseases Specialty Intervention is Associated with Decreased Mortality and Lower Healthcare Costs”,  study by Steven K. Schmitt, MD and Daniel McQuillen, MD provided data when ID specialists were involved early  less patients died in the hospital and after discharge and when ID docs were involved patients had 5.1% shorter ICU stays and had fewer readmissions within 30 days discharge from the hospital. ID physicians reduced costs by estimated 6%. Infectious disease is consistently changing and unpredictable as seen by recent emergence of infections like Ebola to  MERS to bioterrorism. For me, choosing infectious disease after finishing internal medicine residency was simply right thing to do.
Tell us something about yourself UNRELATED to medicine?
Apart from medicine I enjoy spending time with my family. My wife and I both have our families back in India. We chat with our folks almost every day. We both love cooking and travel. We both grew up in northern India close to Himalayas and love mountains and lakes!!! In the future, I want own a boat and take it to lake every weekend to go fishing!! 
See more about the UNMC Infectious Diseases Fellowship here.


 

Advancing Healthcare and Antimicrobial Stewardship in Nebraska

Content courtesy of Phil Chung and the Nebraska ASAP. 

The Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) is funded by the Nebraska Department of Health and Human Services, Healthcare-Associated Infection Team through a CDC grant.  It is closely affiliated with the nationally recognized Antimicrobial Stewardship Program (ASP) at Nebraska Medicine and Division of Infectious Diseases at University of Nebraska Medical Center. The ASAP program employs a full-time ID trained pharmacist, ID trained medical directors as well as infection control and research nurses, all with extensive experience in establishing and running successful stewardship programs.

Nebraska ASAP has recently launched a completely revamped website.  The purpose of the website is to stimulate and support antimicrobial stewardship activities in a variety of healthcare settings.  The website offers a number of ASP tools, templates and guidance documents developed by Nebraska ASAP team in addition to providing links to other available resources. These resources will help hospital and long-term care facility administrators, healthcare providers, infection preventionists, pharmacists and other healthcare personnel working on promoting appropriate use of antibiotics in establishing or improving their own institutional antimicrobial stewardship program.

In addition, a blog will regularly post news and study highlights related to antimicrobial stewardship and antimicrobial therapy.  Recorded ASAP antimicrobial stewardship educational webinars geared toward hospitals and long-term care facilities will also be posted on the website in the future.

Nebraska ASAP team is also maintaining an email distribution list for website users who would like to get an email alert for important new postings on the website. Healthcare personnel can join the distribution list by sending an email to Nebraska ASAP Community Network Pharmacy Coordinator Phil Chung, PharmD, MS, BCPS at pchung@nebraskamed.com.

To learn more about ASAP and the ASAP website, visit https//asap.nebraskamed.com.

 


 

Are contact isolation precautions (CP) necessary when caring for patients infected or colonized with endemic MRSA or VRE?

Researchers from the University of Nebraska Medical Center Division of Infectious Diseases and Nebraska Medicine Department of Infection Control and Epidemiology recently published results from a two-year observational study indicating that routine use of contact isolation precautions (CP) are not needed in caring for patients with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). (Rupp ME, et al.  Infection Control and Hospital Epidemiology 38:1005-1007, 2017).

The CDC has long recommended use of CP (i.e. private room, gowns and gloves, limitation of potential fomites) when caring for patients colonized or infected with multi-drug resistant pathogens (MRSA, VRE).  However, some studies have indicated that CP adversely influence provider behavior (fewer and shorter provider-patient interactions) and may result in delays in patient admissions and transfers, excess adverse events, and psychologic harm.

In the UNMC two-year quasi-experimental before-after study, it was noted that the rate of infection due to MRSA or VRE did not change in the yearlong period after CP were discontinued compared to the previous year.  However, it was also noted that the discontinuation of CP was conducted in an institution with excellent horizontal infection control interventions in place [hand hygiene (>90%), careful attention to environmental cleanliness (>90% clean rate on high-touch surfaces) and a practice of routine patient bathing with chlorohexidine].

This recently published paper adds additional support for re-examining the need for CP in the routine care of patients colonized/infected with endemic MRSA or VRE.

Read the article at:  https://www.cambridge.org/core/product/905595BFE67B3D41CF603C2D497EE517

Content courtesy of Dr. Mark Rupp. 

See more from the UNMC ID Division here.


 

Cephalexin with or without TMP-SMX Showed Similar Clinical Cure Rates for Uncomplicated Cellulitis

Content courtesy of Philip Chung, PharmD, MS, BCPS

The Infectious Diseases Society of America recommends use of antimicrobial agent active only against streptococci (e.g., cephalexin) for management of cellulitis in patients without systemic signs of infection, penetrating trauma, evidence of MRSA, and injection drug use.  Despite this recommendation, healthcare providers frequently prescribe additional antimicrobial agents with anti-MRSA activity (e.g., cephalexin plus trimethoprim-sulfamethoxazole).

A recent multicenter, double-blind, randomized, controlled trial evaluated the efficacy of cephalexin alone or in combination with trimethoprim-sulfamethoxazole (TMP-SMX) for treatment of acute uncomplicated cellulitis in the outpatient setting.  Clinical cure rates were similar between the combination therapy arm (83.5%) and the monotherapy arm (85.5%).  Adverse event rates and secondary outcomes (including overnight hospitalization, recurrent skin infections, and similar infection in household contacts) were not different between treatment arms.

For additional details, please read Moran GJ, et al. JAMA 2017;317(20):2088-96.


 

THINK FUNGUS – Fungal Disease Awareness Week!

Welcome to the first Fungal Disease Awareness Week sponsored by the CDC and partners! In Infectious Diseases, we truly to see lives saved by thinking about possible fungal diseases and we treat them often. Interested in learning more about Fungal Diseases? Check out the CDC video and the website here.

Share the post to help the CDC increase awareness of these important infections!

Site content and images from CDC link above. 


 

 

Antimicrobial Stewardship in Long-Term Care Facilities – The Time is Now!

Antibiotic use is common in long-term care facilities (LTCF) with 70% residents receiving at least one course of systemic antibiotic every year. A significant proportion of the antibiotic use (40% to 75%) in nursing homes has been found to be unnecessary or inappropriate. The prevalence of multi-drug resistant organisms and C. difficile infections are already a significant problem for the post-acute and long-term care facilities. As these facilities are now providing care to more medically complex individuals with increasing numbers of post-acute care (Medicare) admissions, these problems may continue to amplify unless new interventions are introduced to promote appropriate antibiotic use in this setting. Antibiotic stewardship programs have demonstrated effectiveness in reducing inappropriate antibiotic use in long-term care facilities. The Center for Medicare and Medicaid Services (CMS) revised the condition of participation for LTCF in October 2016 and mandated LTCF to develop antibiotic stewardship program as a part of their infection prevention and control program.

Dr. Ashraf and other national speakers spoke on the topic of antimicrobial stewardship in long-term care facilities at 2017 Illinois Summit on Antimicrobial Stewardship. They discussed the strategies for implementation of such a program and introduced the participants to the free resources, which they can use to develop a program at their facilities.

If you would like to learn more about the talk and the available resources, the slides of the presentation are available at the following link:

http://www.dph.illinois.gov/sites/default/files/publications/antimicrobial-stewardship-long-term-care-ashraf-frentzel-mahajan-072617.pdf

 

Content courtesy of Dr. Ashraf. 

Pharmacist-Driven Intervention Improves Care of Patients with Staphylococcus aureus Bacteremia

Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality.  Previous studies have shown Infectious Diseases (ID) consultation for patients with SAB optimizes care and reduces mortality.  A recent study highlights outcomes of a pharmacist-driven intervention to encourage adherence to SAB quality-of-care measures and ID consultation in an Ohio medical center.  The study investigators found that these interventions significantly increased compliance to SAB quality-of-care measures from 69% to 92% and ID consultation from 76% to 95%.  Although not statistically significant, all-cause mortality reduced by 6-fold, from 15.6% to 2.6%, after implementation of these interventions.  For additional details, please read Wenzler E, et al. Clin Infect Dis 2017;65(2):194-200.

Content courtesy of Philip Chung, PharmD, MS, BCPS

 

Microbiology and Infectious Diseases – The Ghostbusters of Medicine

 

Medicine is a team sport, there is no denying that, but together the Microbiologist and Infectious Diseases(ID) specialists create a powerhouse of for diagnosis and treatment. Detect, Identify and Destroy.

Infectious Disease physicians are called in to start the investigation – does the patient have an infection? What do we think is the most likely infection? What tests do we need to determine what it is and how to treat it? Do we need to isolate the patient for risk of spreading infection?

Then the tag-team starts and we order tests to look for different germs (bacteria, viruses, fungi) to figure out what infection the patient may have. Our amazing microbiology colleagues run the tests, try to identify and if possible, grow the germ, and sometimes can even tell us which medicines are the best for treating it. They can tell us if it is one of the “superbugs” that some antibiotics no longer work against. Sometimes, the work is more dangerous and requires special precautions if it could be contagious! They really are the scientists with all the technology and expertise we rely on for this critical information.

Tag! Back to the ID team to review those results and help decide if the patient needs treatment, and if so, what it may be.

ID relies on everyone in microbiology to do our job well EVERY DAY.

We ain’t afraid of no bugs. Who you gonna call?????

 

Content courtesy of Dr. Paul Fey and Dr. Kelly Cawcutt. 


 

 

Dr. Sue Swindells on “Why I Love ID”

Dr. Sue Swindells on “Why I Love ID”: 

“So, I found myself in a fancy maternity hospital in San Francisco not too long ago, while my daughter was having a baby.  The nurses there were very excited to have an Infectious Diseases doctor in the room.  I had thought they might be a bit nervous about my presence, but they were very happy to have me because they had lots of questions.  More than one of them said that they thought Infectious Diseases doctors were amongst the smartest, and that we are really good at solving difficult patient problems.  Mostly they had personal questions like whether going to Brazil on honeymoon was a good idea or not, in light of the ongoing Zika epidemic.  That one was pretty easy to answer.

It was very rewarding to be thought of as a “smart” doctor, and I do believe that many Infectious Diseases doctors that I know are very wise and thoughtful people.  This is important in a discipline where we are mostly paid to think, rather than to do procedures or operate on people.  I have now been an HIV doctor for more than 30 years, and can say that this disease has entirely shaped my career.  It was unheard of when I was in medical school, and only discovered when I was a very junior doctor.  The disease still fascinates me and I learn new things every week.  Every year I also get Christmas cards from patients who credit me with saving their lives – there are very few professions where you actually get to save lives.  At the risk of sounding sappy, I can honestly say I view this as a privilege.”

 

See more about Dr. Swindells and the UNMC HIV team here.


 

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