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.

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.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Mentored Patient-Oriented Research Career Development Award (K23)
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Microbiology and Infectious Diseases B Subcommittee (MID)
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Huntley, Clayton C
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Denver Health and Hospital Authority
United States
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Jenkins, Timothy C; Haukoos, Jason S; Cotton, Eleanor et al. (2018) Time Course of C-Reactive Protein and Procalcitonin Levels During the Treatment of Acute Bacterial Skin Infections. Open Forum Infect Dis 5:ofy029
Young, Heather; Miller, Whitney; Burnham, Randy et al. (2017) How Do Preoperative Antibiotics Affect Culture Yield in Diabetic Foot Infections? Open Forum Infect Dis 4:ofx016
Yogo, Norihiro; Shihadeh, Katherine; Young, Heather et al. (2017) Intervention to Reduce Broad-Spectrum Antibiotics and Treatment Durations Prescribed at the Time of Hospital Discharge: A Novel Stewardship Approach. Infect Control Hosp Epidemiol 38:534-541
Pedela, Rebecca L; Shihadeh, Katherine C; Knepper, Bryan C et al. (2017) Preferential Use of Nitrofurantoin Over Fluoroquinolones for Acute Uncomplicated Cystitis and Outpatient Escherichia coli Resistance in an Integrated Healthcare System. Infect Control Hosp Epidemiol 38:461-468
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
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
Jenkins, Timothy C; Knepper, Bryan C; McCollister, Bruce D et al. (2016) Failure of outpatient antibiotics among patients hospitalized for acute bacterial skin infections: What is the clinical relevance? Am J Emerg Med 34:957-62
Yogo, Norihiro; Gahm, Gregory; Knepper, Bryan C et al. (2016) Clinical Characteristics, Diagnostic Evaluation, and Antibiotic Prescribing Patterns for Skin Infections in Nursing Homes. Front Med (Lausanne) 3:30
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

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