AOA honors Medical College of Georgia student with Kuckein Fellowship

A student at the Medical College of Georgia at Georgia Health Sciences University is among 47 recipients of the 2012 Carolyn L. Kuckein Student Research Fellowship from the national medical honor society Alpha Omega Alpha.

The $5,000 award is enabling Puja Chebrolu to spend her summer pouring over a huge federal database in an effort to help predict kidney dialysis patients' risk of bacteremia, a potentially lethal infection. It's also helping her better prepare for her likely future in public health.

While looking for ways to optimize her summer, Chebrolu learned of Dr. N. Stanley Nahman's desire to mine the U.S. Renal Data System's extensive data set of about 600,000 patients with more than 13 million hospitalizations to find what puts dialysis patients at risk for bacteremia. Chebrolu figured it was a good way to marry her interest in data and infectious diseases.

Years before, Nahman, an MCG nephrologist, had looked at a much smaller sample of 100 patients and found that hemodialysis patients with bacteremia most often also were infected with the blood-borne infection, hepatitis C. Nearly 25 percent of the patients in the U.S. Renal Data System have bacteremia, which tends to result from infection by multiple organisms normally found on skin. Inside the body, they can cause flu-like symptoms or worse. Intensive-care patients are another easy target for bacteremia, Nahman noted.

Conceding that even with excellent preventive measures, needles likely are a common cause of bacteremia in dialysis patients, Nahman and Chebrolu along with MCG Epidemiologist Dr. Kristina Kintziger want to objectively assess risks.

"When you start sticking needs into people you may introduce bacteria," Nahman said. "There is no question that the risk of blood-borne infection is higher in patients on hemodialysis," he said since, barring a kidney transplant, these patients spend the rest of their lives having blood removed from their bodies, filtered and returned. While Nahman was at the University of Florida, Jacksonville, he observed that dialysis patients who happened to also be infected with hepatitis C, tended to be at highest risk of bacteremia. Whether the infection dampened immunity, putting an already vulnerable population at additional risk, was among the questions raised. Hepatitis C, best known for the toll it takes on the liver, is actually very common in patients in kidney failure.

The current study is further probing the bacteremia/hepatitis C link in this large patient population, but is looking far broader, at some 150,000 diagnoses, in the quest for associations that could serve as red flags for physicians.

"Puja is looking for risk factors, whether it's diabetes, the dialysis catheter, their race, age or the average white count in their bloodstream," Nahman said. "Are they infected with HIV or do they have other infections, because we have about 150,000 diagnoses that we can choose to query and see if they associate with patients who have bacteremia. It may turn out hepatitis C is the main risk factor."

They are focusing on the most recent three years of data, said Kintziger who is putting the raw data into a usable format. She's familiar with the data set she is using to mentor several other medical students, including a similar study looking for risk factors for candidemia, a fungal infection more common in patients with compromised immunity, as well as risk factors for bacteremia in HIV-positive dialysis patients.

"I spend a lot of time in her office," Chebrolu said of Kintziger, adding that she is glad to learn data dissection directly from a professional rather than gleaning what she can on her own. "Every scientist collects data. Learning how to make it useful, presentable and understandable is a really good skill."

Nahman's enthusiasm for the research is infectious as well, Chebrolu noted. "It's been a great decision," to spend the long, hot Augusta summer looking for answers that may help patients, said the native of Columbus, Ga., who majored in microbiology at the University of Georgia. While admitting that her goal to do research and treat patients in distant lands is slightly idealistic, she believes it will enable her to one day make the biggest impact for the least amount of cost.