2024 DIG Research Project | "Antimicrobial De-escalation and Outcomes in Sepsis"
Background
Tetsu Ohnuma, MD, PhD, MPH, is an assistant professor in Duke Anesthesiology. He serves as the method core director in the Critical Care and Perioperative Population Health Research (CAPER) program in which he conducts health services research in critical care medicine and anesthesia, using large administrative databases. He is an active member of several national and international societies, including the Society of Critical Care Medicine, the American Thoracic Society, and the Japanese Society of Intensive Care Medicine. He has authored numerous peer-reviewed publications.
Ohnuma grew up in Saitama, Japan. He earned his medical degree at Gunma University before completing an internal medicine residency and internal medicine and critical care medicine fellowships at Saitama Medical Center at Jichi Medical University. During his fellowship in critical care medicine, Ohnuma trained in the medical and surgical ICU where he had opportunities to care for a variety of critically ill patients. Also, he was involved in research projects investigating external validation of acute kidney injury severity scores using a multicenter data repository of ICU data in Japan. These experiences led him to pursue a career in research. He completed a master’s in public health in epidemiology at UNC at Chapel Hill in 2018. He completed a PhD in the Department of Health Policy and Informatics at Tokyo Medical and Dental University in 2020. During his PhD work, he analyzed data from the national inpatient database to investigate risk factors for re-hospitalization among ICU survivors. Ohnuma was awarded the Kosaka Best of Meeting Abstract Award in 2019 for his work investigating the association between perioperative gabapentinoids and postoperative pulmonary complications after total hip and knee arthroplasties.
Research
Recently, Ohnuma’s research has focused on clinical practices and outcomes associated with empirical antimicrobial therapy and antimicrobial de-escalation in patients with sepsis. Sepsis is a leading cause of mortality among critically ill patients. Appropriate antimicrobial therapy is a fundamental and life-saving pillar of sepsis management. In fact, with the support of his mentors (Drs. Miriam Treggiari and Vijay Krishnamoorthy), Ohnuma and his group investigated patients with bacteremia in the US, and found that the use of appropriate empirical antimicrobials was associated with lower in-hospital mortality. However, in addition to the initial choice of empiric antimicrobials, clinicians need to make decisions regarding appropriateness of antimicrobial therapy based on culture results for opportunities to de-escalate or potentially discontinue therapy. While antimicrobial de-escalation is a key factor to prevent development of resistant organisms and adverse events associated with antimicrobials, de-escalation is applied in only 40–50% in critically ill patients. Furthermore, de-escalation decisions are more challenging in patients with culture-negative sepsis due to lack of guidance to inform practice.
DREAM Innovation Grants (DIG) support innovative high-risk and potentially high-reward investigations to accelerate anesthesia and pain management research and are made possible through Duke Anesthesiology’s Duke DREAM Campaign. The DIG award provides Ohnuma’s research team with the opportunity to establish new research that will identify factors associated with antimicrobial de-escalation in patients with culture negative sepsis and determine whether de-escalation strategies are associated with improved outcomes. This contribution is significant because such a strategy could be implemented in the clinical workflow to promote broader and safer de-escalation or discontinuation practices.
The awarded DIG funds will provide preliminary data, which will enable Ohnuma to apply for NIH funding to conduct future pragmatic randomized controlled trials to examine the efficacy and safety of antimicrobial de-escalation in patients with culture-negative sepsis.