We are proud of our ID leaders for many reasons, one of which is their constant desire to improve and educate themselves and others for the betterment of patient care. One example of this is seeking out additional training at the national level and sharing that knowledge with those here at UNMC. Read on for a quick story of a successful training course and what it means for education and quality improvement at Nebraska Medicine.
“Nichole Regan is the Assistant Director for HIV Programs at the UNMC/Nebraska Medicine Specialty Care Center. She has been a great asset to the program in assisting with clinical directorship as well as directing the HIV Clinical Quality Management Program. She is leading the training of SCC staff on quality improvement. Her participation in this program is a great step towards improving understanding of the principles of QI amongst the staff and we hope to be able to spread this knowledge regionally as well.“
– Dr. Nada Fadul
Nichole Regan, APRN, Assistant Director of HIV Programs at UNMC/Nebraska Medicine Specialty Care Center, attended the national Training-of-Trainers (TOT) Program on March 22-24, 2023, in Dallas, TX. The three-day, in-person training was presented by the HRSA Ryan White HIV/AIDS Program Center for Quality Improvement & Innovation (CQII). CQII will celebrate its 20-year anniversary later in the year and close to 2,000 individuals have graduated from its advanced trainings across the country. The TOT is an advanced capacity-building training program for individuals with experience in clinical quality management, who wish to refine their skills in training others on quality improvement principles and practice.
This year’s TOT began in February 2023 with several Zoom meetings as well as preparatory self-paced studies in quality management and adult learning principles. While in Dallas, the cohort of approximately 50 leaders across the U.S. in HIV care and quality management met in person for an intensive session comprised of didactic as well as hands-on, experience-oriented learning activities. The program culminated with a capstone project where participants had the opportunity to train each other regarding components of clinical quality management. In the next 4 months, participants will complete the program requirements by utilizing their training skills and resources to lead three clinical quality management trainings for other Ryan White program stakeholders.
UNMC Giving Day is a virtual day of giving and engagement in support of UNMC students, researchers and clinical partners. To honor the year of UNMC’s founding, this philanthropic event will last for 1,869 minutes (about 31 hours) beginning at 10 a.m. on March 30 and concluding at 5 p.m. on March 31.
Join us in support of those who selflessly commit their lives to helping others; unite with other UNMC alumni, friends, and grateful patients to develop the next generation of healthcare professionals.
How can I help?
Consider a gift to the Diana Florescu Clinical Research and Education Excellence Endowed Fund. This fund was established to honor Dr. Florescu, creating a legacy to recognize her many accomplishments, and continuing the work to which she dedicated her life. Diana demonstrated strongly held beliefs in the power of education and the value of clinical research, those same ideals to which the fund is dedicated.
Diana Florescu, MD.
Please consider demonstrating your support for UNMC, the ID Division, and Dr. Diana Florescu by donating to this fund to sustain education and clinical research efforts of the ID Division for decades to come.
Vincent Van Gogh stated “Great things are done by a series of small things brought together”
Please consider making a donation, in any denomination, to continue the work of our friend and colleague who was taken from us all too soon.
Please contribute online directly to the Nebraska Foundation on this webpage.
Written donations in memory of Diana Florescu, M.D. may be sent to the University of Nebraska Foundation, P.O. Box 82555, Lincoln, NE 68501-2555. Please ensure to include on the memo line or enclosed note that the gift is in memory of Dr. Diana Florescu.
Thank you for your consideration and your generosity.
Research Digest is a periodic post summarizing the findings of a few recent articles published by our UNMC ID faculty surrounding a particular topic. These articles are linked below for full details on the work. This week, we discuss recent efforts by UNMC ID faculty to explore how we can make healthcare work better for patients, providers, and the community at large.
We spend a lot of time on this blog reviewing research about ID disease diagnosis, treatment, and outcomes- a critical aspect of healthcare progress. Equally important, however, is how we practice healthcare and what can be done to ensure that our practice evolves in pace with our knowledge. Today, we highlight a few recent articles authored by UNMC ID faculty which operationalize healthcare research tools to study healthcare itself. From COVID-19 responses to infection prevention and telehealth, read on to learn about how research can identify the best path forward in improving healthcare delivery.
Dr. Lawler, ID faculty, UNMC
The SARS-CoV-2 pandemic was an unprecedented time for the healthcare system. Crisis-level infection rates led many hospitals all across the nation to develop new strategies in real-time to try to optimize medical resource allocation and manage hospital capacity. This response was complicated by the lack of national or state-wide standards or crisis plans, leading to broadly divergent plans between hospital systems. The first article featured today, co-authored by Dr. Lawler and others from UNMC, explores the COVID-19 crisis responses of Nebraska and California to determine which aspects of their plans were effective and where each could have improved. With a focus on “ground truth”, or the actual experience of people on the frontlines, the paper argues that, among other aspects, stronger statewide coordination in future public health emergencies could benefit all states, no matter their demographics. Check out the complete comparison here.
Dr. Cortés-Penfield, ID faculty, UNMC
The second article, written by UNMC student Riley Ostdiek, Drs. Fadul and Cortés-Penfield, and other UNMC members, explore the best way to expand infection prevention training across the healthcare system. Traditionally, infection prevention training is offered to physicians and nurses, with few opportunities for this knowledge to reach other healthcare professionals. This study was designed to identify the best way to expand this training to reach a broader audience. Barriers to training as identified by surveyed nursing assistants and dental professionals included cost/lack of financial support as well as competing priorities and lack of time. Respondents also preferred self-paced learning modules as well as lecture-based delivery, both differing in preference by particular field of work. The authors conclude that a hybrid program including both shorter self-paced modules and prerecorded online lectures along with standard discussion with experts would be the most effective way to reach additional healthcare professionals and bypass the major barriers to participation. Click here for the full article.
Dr. Fadul, ID faculty, UNMC
Propelled by the SARS-CoV-2 pandemic, telehealth has become a major tool in the provider’s toolbelt to reach patients in a quicker, easier, and often safer way. The last article we feature today, co-authored by UNMC ID’s Nichole Regan and Precious Davis as well as Dr. Fadul, reviews the current state of telehealth utilization, particularly in HIV care. They conclude that, while powerful, disparity in the usefulness of this technology does exist. Racial minority groups, older adults, and individuals with low telehealth literacy report low preference, dissatisfaction, and experience poorer health outcomes than other groups. Lack of broadband access, compatible devices, standardization, and government regulations of telehealth in HIV care can contribute to poor patient-provider experience and utilization. Read their full report here.
Sepsis is a life-threatening condition caused by an extreme immune response to infection which has often invaded the blood. In severe cases, this can lead to mortality in up to 50% of patients. Luckily, the treatment for this condition is straightforward: antibiotics. But identifying sepsis early enough for effective treatment can be complex. Some of the same hallmarks of sepsis can also be caused by various other illnesses including low blood pressure, lactic acidosis, and kidney or liver failure. This often leads to overprescription of antibiotics which can have serious consequences on patients (GI upset, C. Diff, medication side effects) and the community at large (increased antimicrobial resistance). But the risks of missing a sepsis diagnosis are profound, often leading to the empiric use of antibiotics in patients suspected of sepsis anyways. So, how do we balance antibiotic stewardship with ensuring a serious case of sepsis doesn’t go untreated?
This is exactly the question explored in a recent article in Clinical Infectious Diseases. UNMC ID’s Dr. Erica Stohs (pictured left) recently outlined this article as a SHEA journal club article, which we repost below. Read on to learn about a new strategy for antibiotic de-escalation in potential sepsis patients.
Reviewed by Erica Stohs, MD, MPH, University of NebraskaMedical Center
This multicentered randomized controlled trial evaluated an opt-out protocol to decrease unnecessary antibiotic use prescribed for non-ICU hospitalized patients with suspected sepsis.
Stewarding antibiotics has been challenging in the era of SEP-1 (sepsis management bundle regulation required by CMS), which did not incorporate the balancing measure of antibiotic overuse and its consequences. This RCT studied an opt-out intervention in which clinicians had to actively engage to continue antibiotics for carefully selected patients in whom broad-spectrum agents were initiated due to suspected sepsis. Suspected sepsis was defined as having no positive blood cultures at 48-96 hours and active orders for broad-spectrum antibiotics.
The study was directed at non-critically ill adults on broad-spectrum agents with negative blood cultures in ten hospitals between September 2018 to May 2020. Through detailed expert panel review and rigorous protocol development, investigators developed a 23-item safety checklist to determine if patients were eligible for the de-escalation opt-out protocol. For example, patients with ongoing signs and symptoms of infection (fever, leukocytosis, pneumonia, or related complications), concerning or incomplete microbiologic data, antibiotic pre-treatment, and immunocompromised status were excluded. If clinicians opted out (i.e., continued antibiotics), they discussed their rationale and future plan to de-escalate. In essence, this involved thorough audit and feedback. The primary outcome was post-enrollment days of therapy (DOT) up to 30 days. Secondary outcomes: 30-day safety events, including C diff infection, readmission, ICU admission, death, and relapse of suspected sepsis.
Of the nearly 10 thousand patients screened, only 767 (8%) were enrolled. Intervened patients had 32% lower odds of antibiotic continuation and were exposed to fewer days of extended-spectrum antibiotics (36% vs 44%). For patients in whom antibiotics were continued, DOT was similar. No safety issues were noted. Interestingly, despite a quite conservative safety checklist limiting eligibility, safety concerns were commonly cited by clinicians as reason to continue antibiotics. Addressing diagnostic uncertainty remains a challenge to expansion of an opt-out approach to antibiotic de-escalation in suspected sepsis.
March 12th-18th marks patient safety awareness week, an initiative intended to encourage everyone to learn more about healthcare safety. Protecting patient safety is one of the most important responsibilities of the healthcare system and all its members. This week serves to recognize those who further patient safety and spark conversation on how we can continue to improve.
As part of Patient Safety Week, we want to recognize all of the incredible efforts from our Infectious Diseases colleagues focused on improving the safety and care of our patients here at UNMC/NMC. Earlier this week, we recognized the Nebraska Biocontainment Unit (NBU) personnel for their continued commitment to patient safety at all times of day and night. Two other key areas in which there is a significant commitment to patient safety, and often less recognition, are our Infection Control & Epidemiology (ICE) team and our Antibiotic Stewardship (ASP) team.
Just like our NBU team, our hospital ICE team, comprised of physician medical directors and a group of infection preventionists) has also been critical in our COVID and Mpox responses, along with past collaboration on many of the highly infectious pathogen preparations. The ICE team monitors and engages in quality improvement as it relates to hospital-acquired infections such as surgical site infections and central-line associated bloodstream infections (CLABSI), amongst many others. Some less well-known efforts also include investigation of infection outbreaks, ensuring the safety of hospital water to minimize any risk of water-borne infections, ensuring appropriate sanitation of all patient areas and equipment to minimize transmission risk, monitoring construction areas for risk to patient health, and much more. The ICE medical directors (Drs. Rupp, Cawcutt, Hankins, Ashraf and Van Schooneveld) also contribute to the overall expertise and leadership in this area via active research, publications, participation in guideline creation, and engagement regionally and nationally through various venues. Thank you ICE personnel for all you do to keep patients safe and prevent transmission of infectious diseases!
Second, our ASP team continues to demonstrate commitment to safety by ensuring patient safety related to exposure to antibiotics. This includes focused efforts of helping our medical teams get the ‘right antibiotic at the right dose for the right amount of time’ for our patients. All antibiotics have risks of side effects and adverse events, such as developing more drug-resistant bacteria or getting a C. diff infection; this team works to actively prevent such things from happening. This also extends to assessing safety for home-going IV antibiotics (via the OPAT program), which provides monitoring for side effects and dosing adherence for the duration of treatment. Here again, this team with medical directors Drs. Van Schooneveld, Marcelin, Stohs, Rupp, and Hankins, among a host of other stewardship professionals, continue to expand and share expertise as a Center for Excellence for ASP care via research, publications and regional and national engagement. Thank you to all members and contributors to the ASP program for keeping our patient population safe from antimicrobial resistance!
March 12th-18th marks patient safety awareness week, an initiative intended to encourage everyone to learn more about healthcare safety. Protecting patient safety is one of the most important responsibilities of the healthcare system and all its members. This week serves to recognize those who further patient safety and spark conversation on how we can continue to improve.
Specifically, within ID, we have many people who take part in diverse roles that are integral to patient safety. Often times that work is not as well recognized or understood. In this post, we would like to highlight these roles and the wonderful people behind them who safeguard patient safety every day.
NBU Training with Dr. Sullivan and ICU nurse Rika Tully.
One prime example of this concerns the Nebraska Biocontainment Unit (NBU), which recently played a critical role in the response to the recent Mpox outbreak. The NBU leadership team responded swiftly when Mpox cases were on the rise across the US. The nursing team assembled an on-call schedule that provided 24/7 coverage to support local response which involved many of our nurses responding immediately and at all hours to be onsite and help with collecting specimens and managing waste so that our staff and other patients could be kept safe.
This support was available to Nebraska Medicine clinics, ED and inpatient areas as well as other healthcare systems in the Omaha metropolitan area. The focus of this clinical team was to provide guidance on patient care questions, review of spaces/workflows identified to provide isolation care, provide patient education, and collect specimens for laboratory testing. While responding to on-site requests, the team educated all staff involved in the care process to include patient communication and home care education, utilization of personal protective equipment, specimen collection, and cleaning and disinfection. In addition, the team answered emails and phone calls related to caring for patients suspected or confirmed to have Mpox. These activities greatly enhanced the safety for the staff, community, and patients seeking care during this outbreak.
NBU healthcare professionals in action.
The focus of the NBU on training others to adequately and responsibly respond to infectious outbreaks is not an isolated event, but instead a core component of their mission. The NBU routinely collaborates emergency medical services to provide training and education on transportation and management of patients suspected or confirmed to have high consequence infectious disease. They provide quarterly trainings covering PPE utilization, ambulance preparation, and clinical skills. This level of collaborative preparedness increases special pathogen response capabilities and improves safety for the EMS providers and the patient in their care.
The NBU is just one great example of how patient safety is prioritized at UNMC ID. Thank you to all our contributing healthcare professionals who keep this crucial unit functioning for the safety of the community!
This #PharmToExamTable post exploring the evidence for a reduced duration of treatment for certain bloodstream infections was authored by Shawna Stricker, PharmD (left) and Austin Dockins, PharmD (right). Shawna is a PGY1 pharmacy resident at Nebraska Medicine who will be continuing her training here next year as a PGY2 oncology pharmacy resident. Austin is also a current PGY1 pharmacy resident at Nebraska Medicine who will be continuing his training here next year as a PGY2 critical care pharmacy resident.
Dr. Austin Dockins
In an era of growing antimicrobial resistance, prolonged antibiotic courses have been reconsidered to determine if shorter treatment durations are just as clinically effective. Shorter treatment durations can lead to fewer drug-related adverse events, shorter hospital length of stay (LOS), and lower risk of antimicrobial resistance. In the case of uncomplicated gram-negative bacteremia, 14 days of therapy has been historically recommended due to lack of data, as until recently, patients with bacteremia had been excluded from many studies on duration of therapy. Over the past few years, more research has been conducted to determine if a shorter course of antibiotics leads to non-inferior outcomes when treating bloodstream infections (BSIs) caused by gram-negative bacteria.1
What is the evidence supporting shorter durations of therapy?
In a non-inferiority randomized controlled trial by Yahav and colleagues, 604 patients were randomized to 7 or 14 days of antibiotic therapy for uncomplicated, monomicrobial gram-negative BSI. Adult patients were enrolled if hemodynamically stable and afebrile for ≥48 hours. Patients with urinary, intra-abdominal, respiratory, catheter-associated, skin/soft tissue, and unknown sources of infection were included, and source control was required for enrollment. Patients who were neutropenic at the time of randomization, had HIV or a recent stem cell transplant (within 30 days) were excluded from the study. The most common pathogens isolated were Enterobacterales species, though Pseudomonas was the causative pathogen in about 8% of cases. The primary outcome was a composite of 90-day mortality and numerous outcomes associated with clinical failure, including relapse, readmissions, extended LOS, and suppurative complications. There was no difference between the groups for this outcome. The 7-day treatment duration was associated with a reduction in antibiotic days within 90 days and reduced time to functional recovery.2
The SHORTEN trial, another randomized control trial, evaluated the outcomes of 248 patients with Enterobacterales BSI with appropriate source control randomized to receive 7-day or 14-day antibiotic treatment courses.3 Adult patients were enrolled if they had negative follow-up blood cultures and were afebrile for at least 72 hours. Patients receiving chemotherapy with neutropenia expected to last >7days were excluded. The most common organisms isolated were E. coli (62.5%), K. pneumoniae (15.7%), and Enterobacter species (10.5%), and sources of infection included urinary, intra-abdominal, vascular, respiratory, and unknown. There were no significant differences in relapse, mortality, or adverse events between groups, and a desirability of outcome ranking and response adjusted for duration of antibiotic risk (DOOR/RADAR) analysis showed an approximately 78% chance that a 7-day course of therapy would lead to better outcomes compared to a 14-day course.3
How common is adoption of shorter durations in practice?
In 2020, a survey was conducted across 28 countries to determine the adoption of shorter durations of antibiotic therapy for gram-negative BSI. The survey discussed five primary scenarios with pneumonia, vascular catheter infection, urinary tract infection (UTI), intra-abdominal infection and skin/soft tissue infection sources of gram-negative BSI. The survey was completed by 277 participants with 64% of respondents being ID physicians and 31% being ID pharmacists. Overall, the median preferred duration of therapy was 7 days (IQR, 7-10 days); however, the percentage of providers that reported treating gram-negative BSI for ≤7 days was different for different sources of infection. For example, 52% reported treating ≤7 days for intraabdominal sources versus 65% for bacteremic UTIs. This survey found that only approximately half of practitioners report completely adopting the practice of using 7-day durations for gram-negative BSI despite clinical trials suggesting shorter durations are non-inferior to longer therapy durations, though acceptance of shorter durations of therapy is growing.4
Discussion on immunocompromised patients
There are still limited data regarding treatment duration of bacteremia in immunocompromised individuals, as often these patients are excluded from research studies or only included in small numbers. An individual participant data meta-analysis performed by Turjeman et al. included 181 immunocompromised patients from the 2 randomized controlled trials discussed above. Patients treated with immunosuppressive drugs, on active chemotherapy, and having a history of solid organ transplantation and stem cell transplantation were included, though patients with HIV infection with CD4 count ≤500 and patients with neutropenia were excluded. Any administration of antibiotics whether it was oral or IV was included in the analysis. The results of this meta-analysis demonstrated non-inferiority of 7 versus 14 days of antibiotic therapy for hemodynamically stable patients, regardless of immune status, and there was no significant difference shown in terms of 90-day mortality, 30-day mortality, hospital readmission rates and relapse of bacteremia in the immunocompromised patients that received 7 days of therapy versus 14 total days of therapy.5Hopefully, with ongoing research, even more evidence for short-course antimicrobial therapy in immunocompromised patients will be available through randomized controlled trials.6
Discussion on critically ill patients
Critically ill patients are another population that may require special attention when selecting antibiotic duration. Patel et al. conducted a retrospective cohort study evaluating short duration (≤7 days, median 5.5 days) versus extended duration (>7 days, median 15 days) of antibiotic therapy for BSI from intra-abdominal source with appropriate source control in 42 surgical intensive care patients.7 Though only a small number of patients had gram-negative BSI (13/42, 31%), there were overall similar rates of recurrence between the short treatment group and the extended treatment group (1/12 (8.3%) vs 4/30 (13.3%), p=0.5), and a numerical increase in risk of secondary fungal infections in the extended therapy group was noted (0% vs 4%, p=0.3).7 While this study is retrospective and includes only a small sample size, the results can be used as guidance to suggest shortening antibiotic duration in critically ill patients pending further clinical data. The Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) study, which is expected to conclude later this year, is anticipated to include >3600 patients and will evaluate the non-inferiority of a 7-day treatment regimen versus a 14-day regimen for bacteremia in hospitalized patients, including critically ill patients.8 This international, multicenter randomized trial could potentially provide the largest amount of evidence in support of a 7-day treatment course for bacteremia to date.
Conclusion
New studies consistently demonstrate the non-inferiority of 7-day treatment courses compared to traditional 14-day courses in patients with gram-negative BSI with effective source control and early clinical improvement. This reduction in the duration of therapy has been shown to produce similar clinical outcomes and can lead to a reduction in medication-related adverse events, hospital LOS, superinfections, and antibiotic resistance. With this continual growth of evidence, 7-day antibiotic treatment courses for gram-negative bacteremia should be considered whenever possible.
References:
Le Fevre L, Timsit JF. Duration of antimicrobial therapy for Gram-negative infections. Curr Opin Infect Dis. 2020;33(6):511-516. doi:10.1097/QCO.0000000000000689
Yahav D, Franceschini E, Koppel F, et al. Seven Versus 14 Days of Antibiotic Therapy for Uncomplicated Gram-negative Bacteremia: A Noninferiority Randomized Controlled Trial. Clin Infect Dis. 2019;69(7):1091-1098. doi:10.1093/cid/ciy1054
Molina J, Montero-Mateos E, Praena-Segovia J, et al. Seven-versus 14-day course of antibiotics for the treatment of bloodstream infections by Enterobacterales: a randomized, controlled trial. Clin Microbiol Infect. 2022;28(4):550-557. doi:10.1016/j.cmi.2021.09.001
Thaden JT, Tamma PD, Pan Q, Doi Y, Daneman N. Survey of infectious diseases providers reveals variability in duration of antibiotic therapy for the treatment of Gram-negative bloodstream infections. JAC Antimicrob Resist. 2022;4(1):dlac005. Published 2022 Feb 9. doi:10.1093/jacamr/dlac005
Turjeman A, von Dach E, Molina J, et al. Duration of antibiotic treatment for Gram-negative bacteremia – Systematic review and individual participant data (IPD) meta-analysis. EClinicalMedicine. 2022;55:101750. Published 2022 Dec 1. doi:10.1016/j.eclinm.2022.101750
Imlay H, Laundy NC, Forrest GN, Slavin MA. Shorter antibiotic courses in the immunocompromised: the impossible dream? [published online ahead of print, 2022 Aug 19]. Clin Microbiol Infect. 2022;S1198-743X(22)00423-2. doi:10.1016/j.cmi.2022.08.007
Daneman N, Rishu AH, Pinto RL, et al. Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) randomised clinical trial: study protocol. BMJ Open. 2020;10(5):e038300. Published 2020 May 11. doi:10.1136/bmjopen-2020-038300
Nebraska Medicine, UNMC and The Gold Humanism Honor Society are excited to celebrate all Residents and Fellows today on Thank a Resident/Fellow Day. Thank a Resident Day offers faculty and students the chance to show their gratitude to the unsung teachers of their medical school clerkship, the house-staff.
UNMC ID Directors, Fellows, and Family
While Residency and Fellowship is an important stage in medical training, it is also a period of peak burn out. Physician burnout affects more than half of U.S. doctors. Burnout is characterized by three symptoms; exhaustion, cynicism or dehumanization, and sense of ineffectiveness and lack of accomplishment. Thank a Resident Day is meant to celebrate our rising medical professionals and explore their resiliency.
A simple, but heart-felt, thank you may carry a larger impact than any of us realize. Please take a moment today to personally thank a resident or fellow for their crucial work.
Here in the ID world, we would like to extend a particular thanks to our residents here in ALL specialties at UNMC, as well as specifically our ID fellows (pictured below). Thank you for EVERYTHING you do to help prevent and treat infections in the community and here in the hospital. We need your help every day in preventing the spread of disease, in antimicrobial stewardship and in providing the best possible care for our patients.
Our UNMC ID Fellows (from top left to bottom right): Dr. Nabil Al-Kourainy, Dr. Catherine Cichon, Dr. Timothy Jang, Dr. Mackenzie Keintz, Dr. Timothy McElroy, and Dr. Bryan Walker. Thank you for all you do!
Since 1976, each February has been host to a series of events recognizing the achievements and contributions of African Americans throughout U.S. history. It is as much a celebration as it is a time of education and reflection. Accordingly, UNMC has planned multiple events to share and commemorate African American culture. Check out the UNMC Newsroom’s post for full details and see below for an abbreviated summary of next week’s events.
Speakers and Panels
February 20th, 3pm Panel discussion about Black and Black diaspora culture and how it is represented in Omaha. Panelists include Eric Ewing, executive director of the Great Plains Black History Museum; Jade Rodgers, historian and adjunct professor at Metropolitan Community College; and Charles Ahovissi, founder of African Culture Connection. Available via YouTube.
February 21st, 10am Justin Payne, award-winning composer, playwright, international vocalist and professor of Black studies at the University of Nebraska at Omaha, speaks on the relationship between African Americans and their influence on all musical genres. Presentation via Zoom.
February 22nd, 3pm Brave Space conversation focusing on the social and ethical impacts that social determinants of health have on the community. Attendees will engage on topics such as defining health equity, health disparities and health inequities; understanding impact of social determinants of health; exploring health status, behaviors and needs of residents of Omaha through a systemic and data-drive approach; and reflect on how health care providers can promote health equity in their practices. Presentation via Zoom.
Other Events
February 6th-24th Donate to a campuswide diaper and supply drive. Donations will go to A Mother’s Love and the Nebraska Diaper Bank. A list of donations and drop-off locations can be found here.
Heads up for later next week
February 25th A two-hour guided tour of North Omaha. On this tour, attendees will learn about the rich legacy of the area, the African American community and why North Omaha is a beacon of the past and important for the future. Pre-registration is required.
Microbe Monday is a monthly installment featuring a microbe of clinical or scientific importance. This month, we discuss Halteria sp. which, while not pathogenic to humans, sheds new light on the competition dynamics between microbes. See here for our previous Microbe Monday posts.
Dr. John DeLong of UNL, who recently discovered a new trick from an old microbe. Credit
In infectious diseases, we tend to focus on the one-directional interaction from microbe to host. This is certainly an important point of view and frames how clinicians treat infections. But it is just a chapter in the lifecycle of most microbes. Many pathogens normally exist outside of humans, whether that be in soil, lakes/rivers, other animal hosts, or elsewhere in the environment. It turns out that, in this environment, microbes can compete fiercely with each other for food and resources. Certain larger microbes even have the ability to eat bacteria. Viruses, on the other hand, have been thought to be too small and contain too little nutrients to fit into the microbe food-chain. Or so we thought…
A micrograph of Halteria, the first identified virus-eating microbe.
A new paper authored by Dr. John DeLong and colleagues at the University of Nebraska-Lincoln has identified the first microbe which acts as a ‘virivore’ or virus-eating organism. Meet Halteria sp. (pictured right), a ciliate which lives in freshwater aquatic environments. This is by no means a new microbe to science; it may have been first identified as far back as 1675 and certain species are found around the world. It is not a picky eater, having been known to consume algae and bacteria for nutrients for some time. But evidence of Halteria consuming viruses is brand new, and was recently published in PNAS earlier this year.
Halteria after consuming fluorescently labeled virus (white/light areas).
In his paper, Dr. DeLong showed that when you put chloroviruses and Halteria in the same flask with no other food sources, viral titers are decreased ~10x while Halteria begin to divide. Furthermore, viral particles were detected inside the ciliate cell. Together, this indicates that the ciliate was consuming virus and using that energy to grow and reproduce. While this is the first evidence of an organism consuming virus, it is not likely the only example in nature. As more scientists start looking for this behavior, we will probably start to see many other microbes exhibiting this trick.
Halteria is not known to cause disease in humans, and it is not a pathogen we encounter in clinical infectious disease. However, this discovery does begin to rewrite the dogma surrounding how we view the microscopic world, and begs the question: what other tricks may microbes be hiding?
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