Dr. Jenkins is an Infectious Diseases specialist three years out of fellowship and director of the Antibiotic Stewardship Program at Denver Health. His clinical and research interests have focused on improving antibiotic use for the treatment of bloodstream and skin and soft tissue infections (SSTIs). His long-term career goal is to become a leader in the design and implementation of federally-funded clinical trials that define optimal treatment strategies for invasive bacterial infections, thus promoting more judicious antibiotic use. The dual threat of progressive antimicrobial resistance and the declining rate of new antibiotic development has highlighted the need for strategies to conserve current antibacterial agents. SSTIs are among the most common infections leading to hospitalization and result in a substantial amount of unnecessary antibiotic use. The objective of the proposed research is to provide data essential to direct antibiotic stewardship efforts, design federally-funded clinical trials of interventions to decrease antibiotic exposure for SSTIs, and strengthen clinical trial design for new antibiotic development. A generalizable knowledge of antibiotic prescribing practices is of fundamental importance to develop antibiotic stewardship initiatives and frame clinical trials to improve treatment of SSTIs. In order to gain a better understanding of antibioti use for SSTIs in the hospital setting, a multi-institutional retrospective cohort study will be performed to describe antibiotic prescribing practices across diverse institutions and evaluate factors associated with use of excessively broad-spectrum and prolonged treatment courses. There is controversy regarding the design of clinical trials for SSTIs because of a lack of contemporary data regarding their natural history. A prospective observational cohort study will be performed to characterize the time course of resolution of signs and symptoms of infection, identify clinical factors associated with adverse outcomes, and evaluate endpoint definitions in patients hospitalized with cellulitis/erysipelas, major cutaneous abscess, and wound infection The assessment of clinical response and decision of treatment duration for patients hospitalized with SSTI is frequently challenging on clinical grounds alone. Biomarker-guided treatment strategies have promise to improve antibiotic prescribing but have not been studied in SSTIs. The proposed studies will characterize serum biomarkers, including C-reactive protein, procalcitonin, and selected cytokines during the treatment of patients hospitalized with SSTI and assess their utility as markers of treatment response. In summary, the proposed research will provide essential data to move the field of SSTI research forward while facilitating Dr. Jenkins'development into an independently funded investigator. Project Narrative Antibiotic resistance in bacteria is becoming more widespread while the development of new antibiotics has dramatically slowed. It is imperative that antibiotics are used judiciously to conserve the effectiveness of current drugs for as long as possible. Skin infections such as cellulitis, abscesses, and wound infections are among the most common infections treated in hospitals and result in a substantial amount of unnecessary antibiotic use. The proposed research will generate a broader understanding of antibiotic prescribing practices across hospitals, the response to treatment and predictors of poor outcomes, and the role of serum proteins as markers of treatment response for skin infections. The information obtained will inform the design of antibiotic conservation efforts and future clinical trials to identify treatment strategis that promote more judicious use of antibiotics.

Public Health Relevance

Antibiotic resistance in bacteria is becoming more widespread while the development of new antibiotics has dramatically slowed. It is imperative that antibiotics are used judiciously to conserve the effectiveness of current drugs for as long as possible. Skin infections such as cellulitis, abscesses, and wound infections are among the most common infections treated in hospitals and result in a substantial amount of unnecessary antibiotic use. The proposed research will generate a broader understanding of antibiotic prescribing practices across hospitals, the response to treatment and predictors of poor outcomes, and the role of serum proteins as markers of treatment response for skin infections. The information obtained will inform the design of antibiotic conservation efforts and future clinical trials to identify treatment strategis that promote more judicious use of antibiotics.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
1K23AI099082-01A1
Application #
8383402
Study Section
Microbiology and Infectious Diseases B Subcommittee (MID)
Program Officer
Huntley, Clayton C
Project Start
2012-06-15
Project End
2017-05-31
Budget Start
2012-06-15
Budget End
2013-05-31
Support Year
1
Fiscal Year
2012
Total Cost
$131,003
Indirect Cost
$9,704
Name
Denver Health and Hospital Authority
Department
Type
DUNS #
093564180
City
Denver
State
CO
Country
United States
Zip Code
80204
Young, Heather; Knepper, Bryan C; Price, Connie S et al. (2016) Clinical Reasoning of Infectious Diseases Physicians Behind the Use or Nonuse of Transesophageal Echocardiography in Staphylococcus aureus Bacteremia. Open Forum Infect Dis 3:ofw204
Haas, Michelle K; Dalton, Kristen; Knepper, Bryan C et al. (2016) Effects of a Syndrome-Specific Antibiotic Stewardship Intervention for Inpatient Community-Acquired Pneumonia. Open Forum Infect Dis 3:ofw186
Yogo, Norihiro; Haas, Michelle K; Knepper, Bryan C et al. (2015) Antibiotic prescribing at the transition from hospitalization to discharge: a target for antibiotic stewardship. Infect Control Hosp Epidemiol 36:474-8
Jenkins, Timothy C; Knepper, Bryan C; Shihadeh, Katherine et al. (2015) Long-term outcomes of an antimicrobial stewardship program implemented in a hospital with low baseline antibiotic use. Infect Control Hosp Epidemiol 36:664-72
Jenkins, Timothy C; Knepper, Bryan C; Jason Moore, S et al. (2015) Microbiology and initial antibiotic therapy for injection drug users and non-injection drug users with cutaneous abscesses in the era of community-associated methicillin-resistant Staphylococcus aureus. Acad Emerg Med 22:993-7
Jenkins, Timothy C; Haas, Michelle K; Shihadeh, Katherine C et al. (2014) Trimethoprim-sulfamethoxazole for skin and soft tissue infections--let us not forget the risks. Ann Emerg Med 63:783-4
Jenkins, Timothy C; Knepper, Bryan C; Jason Moore, S et al. (2014) Comparison of the microbiology and antibiotic treatment among diabetic and nondiabetic patients hospitalized for cellulitis or cutaneous abscess. J Hosp Med 9:788-94
Moore, S Jason; O'Leary, Sean T; Caldwell, Brooke et al. (2014) Clinical characteristics and antibiotic utilization in pediatric patients hospitalized with acute bacterial skin and skin structure infection. Pediatr Infect Dis J 33:825-8
Jenkins, Timothy C; Irwin, Amy; Coombs, Letoynia et al. (2013) Effects of clinical pathways for common outpatient infections on antibiotic prescribing. Am J Med 126:327-335.e12
Hurley, Hermione J; Knepper, Bryan C; Price, Connie S et al. (2013) Avoidable antibiotic exposure for uncomplicated skin and soft tissue infections in the ambulatory care setting. Am J Med 126:1099-106

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