The Antibiotic Management Program is a joint initiative of the Division of Infectious Disease and the Department of Pharmacy and Therapeutics. The program is staffed by Dr. M. Hong Nguyen and Brian Potoski PharmD. Fellows of the Division of Infectious Disease assist after hours. The Antibiotic Management Program is responsible for limiting the initial prescription of suboptimal antibiotic therapy. This is achieved by an aggressive telephone approval service. Additionally, the Antibiotic Management Program, in collaboration with the Department of Critical Care Medicine, has introduced a number of "order sets", in order to protocolize appropriate empiric antibiotic therapy for critically ill patients. The Antibiotic Management Program also aids in streamlining antibiotic therapy, and curtailing excessively prolonged therapy. Within 18 months of the introduction of this program, an improvement in antibiotic susceptibility of Pseudomonas aeruginosa and Acinetobacter spp. was observed, while at the same time decreasing cost of antibiotic expenditure.
The Infectious Diseases Epidemiology Unit is a bi-departmental entity within the School of Medicine and the Graduate School of Public Health of the University of Pittsburgh. The mission of the Unit is research, teaching and service in infectious diseases epidemiology. The main research focus of the Unit is the epidemiology and prevention of vaccine preventable and drug-resistant bacterial pathogens, the molecular epidemiology of community-acquired and nosocomial infections, and the epidemiology and prevention of HIV infection in Brazil and in Mozambique. The Public Health Infectious Diseases Laboratory supports the Unit's research. The Unit is led by Lee Harrison, M.D., Professor of Medicine.
The research interests of the Geriatric ID Unit emphasize the epidemiology, microbiology, treatment, and outcomes of infections affecting older adults. Specific areas of interest include infections acquired in long-term care facilities, nosocomial infections, and multiple antibiotic resistant organisms. A major site of patient care and clinical research is the H.J. Heinz Progressive Care Center (formerly known as the Aspinwall VAMC), part of the VA Pittsburgh Healthcare System. This 300 bed long-term care facility has full-time infection control personnel, and is supported by a modern clinical microbiology laboratory and microbiology research laboratory. The Unit is directed by Nina Singh, M.D., Professor of Medicine and Cornelius (Neil) Clancy, M.D., Associate Professor of Medicine.
This Unit provides patient care at the UPMC HIV-AIDS Center and conducts clinical trials of antiretrovirals for therapy and prevention of HIV-1 infection. The HIV-AIDS Center provides comprehensive HIV primary care to over 1100 HIV-infected adults following the latest DHHS Treatment Guidelines. Deborah McMahon, M.D., Professor of Medicine, is the Medical Director of the Center, which receives Ryan White Title II, III, and IV funding to enhance HIV primary care services from the Health Resources Services Administration (HRSA). These funds support a multidisciplinary team approach to care, which includes an on-site mental health nurse, HIV pharmacist, peer advocate, social support services, and adherence counselor. Women receive on-site gynecologic care at the Women’s Health Clinic. Patients with hepatitis B or C or with other underlying liver disease may be seen at the on-site co-infection clinic conducted by a hepatologist. Patients experiencing chronic pain or requiring palliative care expertise may be seen by the pain specialist. The Title IV-funded Family Nurse works with pregnant women, mothers and exposed infants/infected youth to keep them engaged and linked to care. The unit-wide quality management program conducts initiatives which address multiple facets of the program including retention in care, adherence with quarterly monitoring visits, and women’s health. The primary care unit serves as a clinical teaching site for University of Pittsburgh infectious disease fellows, medical residents, medical students, and HIV providers from the region and international sites as well.
An active AIDS clinical trials unit offers on-site access to the latest investigational agents through NIH-funded and industry-sponsored clinical research trials. The University of Pittsburgh became an independent unit of the AIDS Clinical Trials Group in 2000, and received a new cycle of funding in 2006 to continue as a site for the next 7 years. The site consistently remains among the top ten performing sites in the ACTG network. Currently the University of Pittsburgh Clinical Trials Unit (CTU) actively participates in two networks, the AIDS Clinical Trials Group (John Mellors, PI) and the Microbicide Trials Network (Sharon Hillier, PI). Working closely with an experienced research staff, University of Pittsburgh investigators conduct Phase I, II, and III studies of new antiretroviral agents, salvage therapies, and immune-based therapies, including dendritic cell vaccines in HIV-infected adults. The unit utilizes an on-site research recruiter to identify potential study participants. Over 90% of patients in care are part of a HIPPA-compliant research volunteer registry which facilitates recruitment efforts for all studies. The regulatory affairs staff assists investigators with Institutional Review Board (IRB) submissions, correspondence, and all reporting requirements. The IRB meets frequently and most protocols receive approval within 4-6 weeks. University of Pittsburgh investigators also utilize the Clinical Transitional Research Center for studies that require intensive sampling or in-patient stays.
Prevention of HIV infection has become an increasingly important aspect of the HIV/AIDS Program. Through an on-site risk reduction counselor, HIV-infected patients exhibiting risky behaviors receive focused interventions, referrals and counseling regarding strategies to reduce the transmission of HIV. Through the Microbicide Trials Network, investigators are focused on the development of microbicides, particularly for women in resource-limited settings, as well as the potential role antiretrovirals may have as chemoprevention in high-risk populations. The Unit is directed by John Mellors, M.D., Division Chief.
The goal of the Infection Prevention Department is to identify and reduce the risks of acquiring and transmitting infectious pathogens among patients, healthcare personnel, contract service workers, volunteers, students, and visitors. This plan applies to all UPMC-Presbyterian programs located at the hospitals, which include but are not limited to, Presbyterian University Hospital, Western Psychiatric Institute and Clinic, and the Transitional Care Unit, as well as hospital-based off-site facilities.
Surveillance, Prevention and Control Programs:
Infection surveillance is performed to determine the frequency and types of nosocomial (hospital acquired) infections seen at UPMC, to identify clusters of infections or single infections of epidemiological significance, and to identify community-acquired communicable diseases that are required to be reported to the Allegheny County Health Department, or which merit special attention regarding isolation or precaution procedures and/or notification of hospital staff.
Prevention and control programs are in place to minimize the risk of acquisition of infections such as device-related infections, surgical-site infections, aspergillus, legionella, CDJ, tuberculosis, and drug-resistant organisms. The Infection Control Department works closely with Employee Health to minimize the risk of transmission of infection between patients and healthcare workers. The department is also an active advocate of patient and healthcare worker safety and programs are in place to assess and evaluate safety devices for use by staff. The Unit is directed by Carlene Muto, M.D., Associate Professor of Medicine.
The surgical infectious diseases unit was designed to provide expertise in complicated surgical infections and continuity of care for patients requiring long-term follow-up. The focus is on patients with neurosurgical, orthopedic, and ENT infections. The Unit is directed by Karin Byers, MD, MS, Assistant Professor of Medicine.
The Transplantation Infectious Diseases Unit is involved in the study of infectious complications in recipients of organ transplants. The Unit provides Infectious Diseases consultations to the transplant surgeons in the various solid organ disciplines at UPMC-Presbyterian.
UPMC Health System provides both cardiothoracic and abdominal transplantation. These include heart, lung, liver, kidney, pancreas, small bowel, and multi-visceral transplant operations. The Unit provides advice not only for transplant recipients but also to transplant candidates before their operation. Although, in general, the transplant recipients have common infectious disease complications, each transplant population also has unique infectious disease problems. Therefore, physicians seeing these patients have a unique opportunity to obtain experience in various aspects of this fascinating branch of Infectious Diseases.
The Infectious Disease Division in collaboration with the Thomas E. Starzl Transplantation Institute is offering training to Infectious Disease specialists interested in experience in this field. The Unit is directed by Dr. M. Hong Nguyen.
The UPMC Anal Dysplasia Clinic was founded in 2007 to provide preventative care to individuals at risk of developing anal cancer. Similar to cervical cancer, anal cancer develops due to infection with sexually transmitted human papillomavirus (HPV/wart virus) in combination with co-factors such as cigarette smoking. Prior to the development of anal cancer, anal canal cells become increasingly abnormal and these changes may be detected and treatment offered to stop the progression to cancer. Individuals at increased risk for anal cancer include anyone with HIV infection or other forms of immunosuppression such as taking long-term steroids, or following an organ transplant. Women with dysplasia of the cervix, vulva or vagina are also at increased risk of developing anal cancer.
Dr. Ross D. Cranston MD FRCP, an Assistant Professor in the Division of Infectious Diseases, is the Director of the Anal Dysplasia Clinic and Research Program.