Track Director: Judith O’Donnell, MD
This track is designed for second year infectious diseases fellows to become an expert in the clinical management of patients in the critical care setting. There are high rates of infection, antibiotic use and antibiotic resistance in intensive care units (ICUs), which underscores the need to train infectious diseases specialists to work with critically ill and complex patients in order to drive antimicrobial stewardship and infection control in this setting. This practical training in critical care infectious diseases also may be combined with an advanced degree research training program such as the Master of Science in Clinical Epidemiology (MSCE) or the Master of Science in Health Policy Research (MSHP), if desired.
Clinical Training
Inpatient
The fellow will spend a minimum of 12 weeks during his/her second year of fellowship on inpatient rotations, with majority of the clinical experience at PPMC. Ideally, two to three week blocks should be spent in each of the following units: Medical Intensive Care Unit (MICU), Heart Vascular Intensive Care Unit (HVICU), Trauma Surgical Intensive Care Unit (TSICU), and Neurology Intensive Care Unit (NICU). The second-year fellow will be responsible for antimicrobial stewardship and infection control related issues as well as consultative services with the support of an attending physician.
Antimicrobial Stewardship
Antibiotic use in the critical care setting is prevalent. Many times antibiotics prescribed in the ICUs are unnecessary, inappropriate or suboptimal. The fellow will have the opportunity to work along with the ICU pharmacists and the antibiotic stewardship team to learn how to perform effective stewardship in the ICU setting. Working closely with the pharmacists, the fellow will also become more comfortable with the pharmacokinetic and pharmacodynamics of antimicrobial therapies in critically ill patients, particularly adjusting for patients with septic shock and renal injury requiring continuous veno-venous hemodialysis. The fellow will also participate in monthly hospital-based meetings to discuss antimicrobial related issues such as drug shortages, microbiology reports, antibiotic guidelines, and formulary changes. It is an expectation that the fellow will be an active participant in developing some of these guidelines and reports as they pertain to the critical care track.
Infection Control
ICUs carry a high risk of nosocomial infections leading to increase morbidity and mortality. Catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonias (VAP) and central line associated blood stream infections (CLABSI) are just a few of the hospital-associated infections that are commonly seen in critical care units. Multidrug-resistant organisms and Clostridium difficile are also major issues in this setting. Fellow participation in reducing the risk of transmission of these infections, implementing treatment and prevention protocols, and educating house staff will be an essential part of this track.
In this rotation the fellow will learn the basics of how an Infection Control (IC) department works: what National Healthcare Safety Network (NHSN) definitions are, round in units with infection preventionists (IPs), assess unit Hospital-Acquired Infection (HAI) data and hand hygiene data. He/she will also round as part of Environment of Care Rounds and attend several ICU-related meeting including (but not limited to) the Critical Care Committee, Infection Control Committee, and patient safety.
Transplant/Oncology
The fellow will have one to two week rotations in at least two of the above mentioned consult services to increase exposure to the immunocompromised patients and the unique issues related to the management of the critically ill transplant and oncology patients. This includes complications of opportunistic infections, device related infections (e.g. ventricular assist devices and extracorporeal membrane oxygenation), and both community and health care related infections in these populations. The inpatient consult service will be divided between the solid organ transplant ID service and the hematological malignancy/stem cell transplant service. During these rotations, the fellow will work closely with non-ID transplant providers in the other transplant programs.
Long-Term Acute Care Facility
The fellow will have the option to spend one to two weeks at the Long-Term Acute Care Facility (Good Shepherd, Penn Partners) to learn more about the infectious diseases complications associated with long term ventilator management/ventilator wean programs.
Research Experience
The fellow will design and conduct an independent clinical research project with support from their primary mentor and other collaborators on an ICU-related topic. For fellows who do not intend to pursue training in a degree granting program (e.g., MSCE, MSHP), but would like to learn the fundamentals of research methodology, there is the opportunity to obtain a certificate in clinical research. Fellows may work with members of the ID division or other faculty at the University of Pennsylvania in other specialties as appropriate for their interests. In addition, there are a number of ongoing clinical trials of particular interest for critical care infectious diseases and fellows may choose to participate in those as well.
Mentorship
The fellow will be assigned a primary mentor to help develop career goals and design research project(s), and identify potential additional mentors.
Core Faculty Mentors
- Judith O’Donnell, MD, Critical Care Fellowship Track Director
- Jerry Jacob, MD
- Brendan Kelly, MD, MSCE
- Ebbing Lautenbach, MD, MPH, MSCE
- Naasha Talati, MD, MS