Clinical Associate Professor; Medical Director of Antimicrobial Stewardship Program, Oishei Children's Hospital; Director of Medical Student Education, Pediatrics Department
Jacobs School of Medicine & Biomedical Sciences
Pediatric Infectious Diseases; Pediatrics
My scholastic interests are varied, and include clinical reasoning and medical education, international infectious diseases and public health, diagnostic marker performance, and antimicrobial stewardship. The below elaborates on these, including my recent and current academic involvement in some of these areas:
1. Pediatric Antimicrobial Stewardship: Antibiotics are amongst the most frequently prescribed medicines in children, but up to 50% of their use may be unnecessary. Indiscriminate antibiotic use contributes to medical costs, the development of multi-drug resistant pathogens, and can lead to adverse events. In collaboration with various specialists at our Children’s Hospital, I’ve led several active projects studying the antibiotic utilization patterns and clinical outcomes of common pediatric infectious conditions, including osteo-articular infections, necrotizing enterocolitis (NEC) in neonates, and sepsis in the PICU. My most recent foci with collaborators has been in various outpatient setting, including Urinary tract infections (UTIs) and Upper respiratory Infections in community based private clinics and urgent care centers.
2. Global Antimicrobial Resistance: Sources, Drivers, and Dissemination: Antimicrobial-resistance (AMR) is a pressing international public health problem that disproportionately affects lower income countries, whose sources, reasons for dissemination, and overall epidemiology, continue to be poorly characterized. My scholastic focus in this area has been on intestinal colonization of multi-drug resistance bacteria, and the role of international travel and environmental factors in AMR emergence and spread. As part of multi-disciplinary AMR research team at UB, we aim to more comprehensively explore environmental contributors to AMR dissemination and as source of acquisition for humans. We held a symposium/workshop with several prominent scholars at UB in May, 2018, and have received a UB ‘Big Ideas’ seed grant to examine AMR in the environment in Bangladesh. We have also prepared grants for the NIH and CDC awards, with UB and various national collaborators.
3. Medical Education: The landscape of medical education is constantly changing, creating both extraordinary opportunities but also novel challenges. My growing interest and involvement in the field are focused on the science of learning, clinical reasoning skills, and the incorporation of humanities throughout the continuum of medical education and training.
4. Interferon-gamma-release assays (IGRAs) in the evaluation of Pediatric Latent Tuberculosis Infection (LTBI) and Tuberculosis (TB) Disease: The newer, blood based IGRAs promise diagnostic specificity and potentially sensitivity advantages over the traditional tuberculin-skin test (TST), but data and experience in children is relatively limited. In collaboration with colleagues at the California Dept. of Public Health, we are examining the performance of IGRAs in the pediatric population, including studies that compare the IGRAs to the TST, and which assess negative predictive value through longitudinal follow-up.