UNMC/Nebraska Medicine was an important contributor to a study, published Sept. 26 in the Journal of the American Medical Association (JAMA), that documents the utility of a staphylococcal bacteremia treatment algorithm.
Mark Rupp, M.D., professor and chief of the UNMC Division of Infectious Diseases and medical director of the Infection Control & Epidemiology Program at Nebraska Medicine, is co-author of the study that examined how the use of an algorithm can provide a roadmap for clinicians treating patients with staphylococcal bloodstream infection.
“We do not have good evidence-based information on the best way of treating these patients,” Dr. Rupp said.
UNMC was one of 16 sites participating in the study, which enrolled a total of 509 patients over five years. Dr. Rupp was the principal investigator for the UNMC site, which enrolled a total of 32 patients and was the sixth most active recruitment site in the study. Thomas Holland, M.D., of Duke University, was the lead author of the study.
The algorithm, built in decision points for clinicians, guided by patient data, to help determine the amount and duration of antimicrobial use for patients with staphylococcal bacteremia, which is generally caused by infections at other sites such as abscesses, pneumonia, skin and soft tissue infections or infections associated with IV catheters or surgical procedures.
“It will be most useful in places where you don’t have an infectious disease specialist’s input,” Dr. Rupp said, pointing out that Nebraska’s small community hospitals and rural medical practices could fall into that category.
“The algorithm can really help these clinicians make well-informed decisions to enable best care for their patients,” he said.
The impact of the study will be twofold, according to Dr. Rupp.
First, the algorithm provides a framework to help clinicians decide if their patient is fighting a simple bacteremia or requires a longer course of therapy for a more complicated infection.
Also, the study hopefully will help curtail excessive antimicrobial use, as it will help clinicians determine the correct course of antimicrobials to use.
“We need these collaborative projects to answer these really complicated questions,” Dr. Rupp said, pointing to the large number of collaborating institutions and study subjects who participated. Interestingly, UNMC enrolled both the first and the last subjects who took part in the study.
Dr. Rupp was quick to thank and praise the patients and families who participated in the trial.
“It is only through our altruistic patients volunteering to participate in these types of trials that we are able to expand our knowledge and improve clinical care for all patients – everywhere.” Similarly, he related that this was a team effort that involved numerous study personnel, lab workers, nurses, pharmacists, and clinicians.
In an editorial comment on the study, JAMA — while noting several limitations — called it “an elegant addition to the evidence base of how to best manage staphylococcal bacteremia, and these results will likely influence the next iteration of treatment guidelines.”