Nicholas A. Turner, MD MHSc
Assistant Professor, Duke University Health System
Hospital Epidemiologist, Duke Infection Control Outreach Network (DICON)
Associate State TB Controller, North Carolina
About my role in the ARLG
I began as an ARLG fellow and am now a clinical trialist in training. ARLG-supported opportunities have given me the chance to contribute to research in epidemiology and the prevention of drug-resistant infections. I’ve also gained experience in therapeutics by serving on clinical adjudications committees, drug safety monitoring boards, and as a sub-investigator on clinical trials.
My research spans two broad areas: the epidemiology and prevention of drug-resistant infections (mainly C. difficile) and treatment of drug-resistant infections. I’m presently serving as a trialist in training with the Dalbavancin as an Option for the Treatment of Staphylococcus aureus bacteremia (DOTS) trial.
During my ARLG fellowship, I completed a master’s degree in clinical research. For my thesis, I used mixed effects modeling methods to examine the shift in C. difficile from hospital-associated infection to community-onset infection. Using the same epidemiologic methods learned during my fellowship, I have continued to play an active role in analyzing epidemiologic trends both within the hospital (including time series regression to assess prevention efforts targeting C. difficile and catheter-associated UTIs) and community (including modeling geospatial inequities in COVID-19 infections and tuberculosis screening).
On the trials and therapeutics side, I conducted the microbiologic analysis for a unique trial assessing the effect of C. difficile treatment choice on contamination of the hospital environment. I am currently the site primary investigator for a multi-national trial assessing expedited methods for clearing penicillin allergies.
Why is this research important?
Addressing a complex problem like antimicrobial resistance requires a multifaceted approach. Certainly one solution is to help develop and test novel antimicrobials which is the reason for the DOTS trial. At the same time, striving to improve infection prevention, epidemiology, and stewardship can help to preserve the efficacy of existing antibiotics as long as possible. This is the unifying theme of most of my observational study work. My research projects straddle both of these broad goals.
The C. difficile research is important because it remains a leading cause of infectious diarrhea, but its epidemiology has changed significantly over the past decade. It was once strongly associated with hospitals, but our work and that of others has shown that C. difficile increasingly originates in the community. This means we need to rethink our prevention strategies. We currently have other projects underway to help track sources of C. difficile both within and beyond the healthcare environment.
The DOTS trial is significant because we are working to address the challenges with prolonged IV antibiotic courses that clinicians and patients are all too familiar with. Venous access associated complications, adverse effects, and lapses from care all hinder successful treatment. Because of its long half-life, dalbavancin offers a promising treatment option for S. aureus including MRSA. If a two-dose regimen can prove successful, many of the issues that usually complicate prolonged outpatient antibiotics can be avoided.
Impact of the ARLG mentoring and funding on my career
It goes without saying that the ARLG mentors are among the most experienced clinicians and researchers in their fields. They serve as a group of honest and committed advocates who care about trainees’ development and can often be the independent source of wisdom one needs when making important decisions about career and research work.
ARLG supported my pursuit of a master’s degree in clinical research, where I learned a variety of research methods that have helped me to become an active contributor on an array of exciting projects fighting drug resistance in the prevention and treatment stages. Most of my current research developed because of the training, mentorship, and collaboration provided through ARLG programs.
When I became an ARLG fellow, it dawned on me that many of the most influential researchers and clinicians are connected to the ARLG. It has been amazing to meet and interact with the people behind the names I’ve cited so many times in papers. Very few groups have such a high a concentration of influential thinkers and experts in their fields. I am thankful for the opportunities I’ve had to work with them and be a part of the ARLG.