Natalie Mackow, MD, MSCR
Renaissance School of Medicine
at Stony Brook University
About my role
I was awarded an ARLG fellowship in 2023, which provides support for my salary to conduct mentored research in antibacterial resistance (AR), full tuition, and conference travel for 2 years. As an ARLG fellow, I also participate as a non-voting member of both the Steering Committee and the Gram-Negative Committee. These memberships allow me to learn by listening to experts in the field discuss clinical study development and by reviewing project proposals. I have been able to focus on the development of my research and data analysis skills and build my research portfolio and professional network.
I am grateful for mentorship through the ARLG. My primary mentor, Dr. David van Duin, has facilitated my participation in projects with the Multi-Drug Resistant Organism (MDRO) network and introduced me to many ARLG members.
About my research
We have poor definitions of what it means for antibacterials to be “anti-anaerobic,” yet multiple recent studies report an association between anaerobic antibiotic coverage with poor patient outcomes, including ventilator-associated pneumonia in critically ill patients and Clostridioides difficile colitis in patients treated for aspiration pneumonia. Through my primary ARLG research project, I am trying to redefine how we think about anaerobic antibiotic coverage in patient care and clinical research. Using retrospective data from my hospital, I am evaluating the relationship between exposure to antibiotics by anaerobic activity on subsequent infections with MDRO and other outcomes including hospital-acquired infections.
This work aims to inform antibacterial therapy practices in patients with severe burns to reduce prevalence of antibacterial resistance and may be applicable to prevention approaches in other critically ill patient populations. In terms of antibacterial activity against anaerobes, AR is a growing, global phenomenon and must be considered when defining which antibiotics have “good” anaerobic activity.
Why is this research important?
Patients with severe burns are a unique, immunocompromised population and are at risk for prolonged hospitalizations and frequent antibiotic exposures. Infection is a leading cause of death, and infections with MDRO are associated with worse clinical outcomes in this population including longer hospital length of stay and more days requiring mechanical ventilation. Systemic antibiotic therapy is an important, potentially modifiable, risk factor for antibacterial resistance in this vulnerable patient population. Additionally, a novel tool to improve our definition of the anti-anaerobic activity of antibacterials has the potential to be utilized broadly in clinical studies and clinical practice, once validated.
Impact of the ARLG mentoring and funding on my career
Through the ARLG, I have completely funded and protected research time. It is critical for me as a young investigator to have time to connect with collaborators, attend national meetings, establish myself in the field of antibacterials resistance, and generate preliminary data for future career development awards. I have also been able to work on multiple projects within the MDRO network, including a study comparing outcomes after hospital onset and community onset carbapenem-resistant Enterobacterales (CRE) bloodstream infections and a study on outcomes after infections with Escherichia coli bloodstream infections. Both projects have led to abstract presentations at IDWeek.
Finally, tuition support from the ARLG has allowed me to obtain biostatistics, data science, and epidemiology skills through a Master’s in Clinical Research and Epidemiology at the Gillings School of Global Public Health at UNC. These foundational skills are essential for my current project and overall career trajectory, and I would not have been able to develop them to such an extent without this support from the ARLG.
The ARLG is a highly collaborative and supportive network comprised of researchers in various stages of their careers, with a breadth of experience in the field of AR. The main mission of the ARLG is to both thoughtfully pursue and support practice-changing clinical research in the field of AR. In doing this, mentorship and promotion of trainees and young faculty is a central component, thereby fostering an extended family of successful, independent investigators in the field of AR.