Emergency Care for Infectious Diseases (EC-ID)

Primary Researcher

Dr. Michael Pulia

Goals

Dr. Michael Pulia leads a health services research program focused on improving infectious disease diagnosis, infection control, and antimicrobial stewardship in the emergency department and downstream care settings. The primary focus of his program is the inappropriate use of antibiotics in healthcare settings, a global public health threat due to an association with increasing rates of antibiotic-resistant bacterial infections. In the U.S. alone, greater than two people die every hour as a direct result of these infections. Additionally, antibiotic overuse poses a significant patient safety concern due to the risk of serious adverse drug events such as drug-drug interactions, anaphylaxis and Clostridiodes difficile colitis.

The emergency department increasingly functions as the de facto center of the healthcare system and antibiotics prescribed here have significant downstream effects in both inpatient and outpatient settings. The ED has also been identified as a clinical environment with high rates of inappropriate antibiotic use. Despite this, antibiotic stewardship research in the ED setting is lacking and has been identified as a priority area for federal funding.

Given his research focus on infectious diseases, Dr. Pulia has taken on several studies related to the ongoing COVID-19 pandemic. This includes work to elucidate the role of biomarkers to improve screening and antibiotic stewardship practices for patients with COVID-19 and utilize EHR-based surveillance to rapidly inform institutional response strategies.

Selected Ongoing Studies

Evaluating the Utility of Thermal Imaging in Diagnosing Cellulitis for Lower Extremity Complaints in the Emergency Department

This study aims to determine the temperature gradient between affected and unaffected legs in patients with cellulitis and compare the difference in temperature between cases of cellulitis and pseudocellulitis. This study will also assess the impact of thermal imaging data on diagnostic assessments of potential cellulitis cases when added to standard techniques.

This research study is funded by a pilot award from the BerbeeWalsh Department of Emergency Medicine.

Improving Antibiotic Stewardship During the Treatment of Skin and Soft Tissue Infections in the Emergency Department: A Human Factors and Systems Engineering Approach

Emergency department encounters for abscesses and cellulitis, the most commonly encountered skin and soft tissue infections, have more than tripled in the past two decades accounting for nearly 4 million visits annually. This increase coincides with the widespread emergence of infections caused by methicillin-resistant Staphylococcus aureus (MRSA), which are estimated to impose an annual economic burden of up to $13.8 billion in the U.S. Emergency department antibiotic use in the treatment of skin and soft tissue infections often fails to adhere to best practice clinical guidelines due to diagnostic errors (overuse) and incorrect selection (inappropriate use).

The overall objective of this project is to develop and test interventions that improves guideline adherent antibiotic use for ED patients with skin and soft tissue infections. This will be achieved using a mixed methods approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS), a human factors and systems engineering framework. Funding for this project is provided by a 5-year career development award from the Agency for Healthcare Research and Quality (AHRQ K08).

Improving Antibiotic Stewardship for Long Term Care Facility Residents Treated in the Emergency Department

Residents of long-term care facilities (LTCFs) (primarily those > 65 years old with several comorbidities) have been identified as a priority population by the Agency for Healthcare Research and Quality (AHRQ) in part because they are particularly vulnerable to harm related to suboptimal medical care. Each year, over 2.5 million LTCF residents receive care in the ED, often for serious bacterial infections such as pneumonia, urinary tract infections and sepsis. Estimates of inappropriate antibiotic use in this patient population are as high as 75%. Atypical presentations, lack of definitions for infections, and inadequate data exchange during transitions of care may explain the suboptimal antibiotic use observed in this vulnerable population.

The overall objective of this project is to develop an intervention that can improve public health in Wisconsin by reducing inappropriate antibiotic use for LTCF patients in the ED. Given the complex nature of this clinical dilemma, we propose using a mixed methods approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) framework to identify barriers and facilitators to appropriate antibiotic use for LTCF residents in the ED. This will effectively test our hypothesis that an evidence-based intervention can improve antibiotic for this vulnerable population. This project is funded by a new investigator grant from the Wisconsin Partnership Program.

The Role of Aspiration in Community Acquired Pneumonia

Pneumonia is the most common infectious cause of mortality in older adults. Standard practice for older adults with pneumonia involves hospitalization and antibiotics. However, recent studies suggest that a significant portion of suspected community-acquired bacterial pneumonia cases may actually be due to distinct, dysphagia-related aspiration syndromes (e.g. aspiration pneumonia, pneumonitis). This study will utilize diagnostic imaging to generate a prevalence estimate for aspiration in older adults diagnosed with pneumonia or with suspected pneumonia for dysphagia, as well as determine rates of recurrent pneumonia in this population.

This study is being conducted in collaboration with Nicole Rogus-Pulia, PhD, CCC-SLP, Director of the Swallowing and Salivary Bioscience Laboratory within the UW Department of Medicine Division of Geriatrics. This study is funded by the UW Office of the Vice Chancellor for Research and Graduate Education.

Trial of Early Therapies During Non-hospitalized Outpatient Window (TREAT NOW) for COVID-19

The purpose of this study is to evaluate the efficacy of Lopinavir/Rotinavir on the outcomes of ambulatory patients diagnosed with COVID-19. Emergency Department Research Coordinators (EDRCs) will call patients who recently tested positive for COVID-19 and offer them study participation over the phone. Patients agreeing to participate will be mailed the drug or a placebo and followed for 30 days. This study is in collaboration with Vanderbilt University, and no study activities will take place in the emergency department.

View more information about this study.

In The News

  • Dr. Pulia honored with the EM Faculty Award for Excellence in Scholarship 2020-21 from the BerbeeWalsh Department of Emergency Medicine.
  • Dr. Pulia awarded the 2021 Distinguished Service Award from the Wisconsin chapter of the American College of Emergency Physicians.
  • Dr. Pulia received the Best Overall Presentation Award at the 29th annual Wisconsin Emergency Medicine Research Forum for a study titled, "Comparison of Skin Surface Temperature Measurements between Patients with Cellulitis and Pseudocellulitis in the Emergency Department."
  • Dr. Pulia invited gave the opening plenary session at the Dysphagia Research Society's 29th Annual Meeting, an international meeting with over 700 participants attending from more than 30 countries. The session discussed COVID epidemiology, transmission, and infection control and was voted People’s Choice for Best Presentation by attendees selecting from more than 80 invited speakers. Pulia was also invited to give an oral research presentation on the second day of the conference regarding his work on dysphagia profiles and management patterns in emergency department patients with COVID-19.
  • Dr. Pulia served as an invited expert for the Delphi procedure on a recent paper that developed quality metrics for ED antibiotic stewardship. The Delphi procedure is a method of congregating expert opinion through a series of iterative questionnaires with the goal of coming to a group consensus.
  • Dr. Pulia was invited to serve on the European Society of Clinical Microbiology and Infectious Diseases ED Antibiotic Stewardship Guideline Committee.

View additional research program highlights...

Funding

The EC-ID research program is currently supported by the following grants and awards:

Wisconsin Real-time Emergency Department Surveillance and Responsive Training (WIRED-RT)

Title:  Wisconsin Real-time Emergency Department Surveillance and Responsive Training (WIRED-RT)
Funding Source:  Wisconsin Partnership Program
Faculty:  Michael Pulia, MD, MS; Manish Shah, MD, MPH; Brian Patterson, MD, MPH

Redefining Community-Acquired Pneumonia in Older Adults: The Role and Impact of Aspiration

Title:  Redefining Community-Acquired Pneumonia in Older Adults: The Role and Impact of Aspiration
Funding Source:  UW Office of the Vice Chancellor for Research and Graduate Education
Faculty:  Michael Pulia, MD, MS

The Multicenter REgistry of potential COVID-19 in emERgency care (Project RECOVER)

Title:  The Multicenter REgistry of potential COVID-19 in emERgency care (Project RECOVER)
Funding Source:  Indiana University
Faculty:  Michael Pulia, MD, MS

Utility of Thermal Imaging in Diagnosis of Cellulitis for Lower Extremity Complaints in the Emergency Department

Title:  Utility of Thermal Imaging in Diagnosis of Cellulitis for Lower Extremity Complaints in the Emergency Department
Funding Source:  BerbeeWalsh Department of Emergency Medicine Pilot Research Award
Faculty:  Michael Pulia, MD, MS

Engineering Safe Care Journeys for Vulnerable Populations

Title:  Engineering Safe Care Journeys for Vulnerable Populations
Funding Source:  AHRQ R18
Faculty:  Michael Pulia, MD, MS; Manish Shah, MD, MPH; Brian Patterson, MD, MPH; Azita Hamedani, MD, MPH, MBA

Improving Antibiotic Stewardship During the Treatment of Skin and Soft Tissue Infections in the Emergency Department: A Human Factors and Systems Engineering Approach

Title:  Improving Antibiotic Stewardship During the Treatment of Skin and Soft Tissue Infections in the Emergency Department: A Human Factors and Systems Engineering Approach
Funding Source:  AHRQ K08
Faculty:  Michael Pulia, MD, MS

Trial of Early Therapies During Non-hospitalized Outpatient Window (TREAT Now) for COVID-19

Title:  Trial of Early Therapies During Non-hospitalized Outpatient Window (TREAT Now) for COVID-19
Funding Source:  Vanderbilt University Medical Center
Faculty:  Michael Pulia, MD, MS

Publications

Visit Dr. Pulia’s Google Scholar profile