Publications

For a detailed list of the Garey Lab’s publications and citations, please visit PubMed and Google Scholar

Additionally, we have highlighted some key areas of interest and relevant publications within three disciplines (epidemiology, clinical trials and stewardship, and drug discovery) below:

Epidemiology

1. C. difficile pharmacoeconomic studies

A part of our clinical focus is an ongoing interest to evaluate the potential healthcare economic costs associated with certain disease states and how potential stewardship interventions may decrease these costs. We’ve put considerable attention into the costs of C. difficile with a particular interest in costs of recurrent CDI.¹⁻² To better estimate direct and indirect costs, we also have developed a validated quality of life measure that is able to determine quality of life differences between patients with primary vs. recurrent C diff³⁻⁴ and partnered with our colleague Dr. Kelly Reveles to demonstrate patients have a higher likelihood of death or discharge from the hospital following CDI.⁵

2. C. difficile epidemiology

In 2015, we partnered with our frequent collaborator Dr. Seth Walk, to validate the PCR-fluorescent ribotyping method previously developed by Dr. Walk.¹ We have used this method along with whole genome sequencing to trace an outbreak of ribotype 027 at a nursing home² and track the evolution of C. difficile over time. Specifically, Dr. Anne Gonzales-Luna’s expertise in epidemiology and clinical research has allowed us to expand our reach across Texas³ and globally.⁴ We have expanded our translational studies combing strain typing with clinical data to demonstrate that certain ribotypes are more virulent than others.⁵

3. CDI immunology and genetics

For decades we have run an observational, multicenter study of hospitalized patients with C. difficile infection in the Texas Medical Center with one of our most important collaborators, Dr. Herbert DuPont. A number of important studies have arisen from this effort, including identification of a human gene polymorphism that increases patients’ risk for recurrent CDI.¹ In studies that included outpatient follow-up, we demonstrated that >10% of CDI patients experienced symptoms consistent with IBS months after the initial infection.² Our lab has since continued studying the interaction between the immune system and CDI and demonstrated that either the presence of eosinopenia or infection with a binary toxin strain increase the likelihood of mortality.³

4. C. difficile environmental microbiology/One Health

Dr. M. Jahangir Alam brought with him a wealth of environmental microbiology and a network of worldwide research collaborators when he joined The Garey Lab. Based on techniques he developed, we have been able to demonstrate environmental C. difficile colonization both in Houston¹ and around the world.²⁻⁴ In one of these, we evaluated zoo animals receiving antibiotics and demonstrated C. difficile colonization increased during antibiotic therapy and returned to baseline at follow-up evaluation, similar to what is seen in humans.⁵

Clinical trials and stewardship

1. Candida infection

Our lab has put considerable effort into clinical and translational studies associated with invasive candidiasis. In 2006, we published a sentinal study that demonstrated a time to delay in the initiation of antifungals increased the likelihood of toxicity¹ which resulted in a guideline recommendation to initiate antifungal treatment as soon as possible. This likely improved clinical outcomes but also increased antifungal resistance selection pressure. Several years later, a faculty colleague published one of the first reports on emergence of echinocandin resistance.² These experiences lead us to partner with T2 Biosystems to help develop their T2Candida panel to be able to better optimize antifungal therapy in patients with suspected invasive candidiasis.³⁻⁴

2. C. difficile infection

Our lab has decades of experience conducting clinical trials related to CDI. In conjunction with our clinical fellows, we studied the use of rifaximin for recurrent CDI¹⁻² and have also offered microbiologic and microbiome support on phase I-III trials.³⁻⁴

3. Diagnostic Stewardship

A part of our clinical focus is an ongoing interest to evaluate the potential healthcare economic costs associated with certain disease states and how potential stewardship interventions may decrease these costs. We frequently evaluate the potential stewardship interventions possible with new diagnostics¹ and have several cost effective papers that evaluate potential costs and cost savings associated with implementation of new diagnostics.²

Drug discovery

Our lab has always been interested in extending new drug discovery and development. Dr. Khurshida Begum’s experience with molecular biology has allowed us to expand the tools we have for drug discovery. This includes in vitro MIC determinations using our large biobank of well-characterized C. difficile strains.¹⁻² We have a number of important in vitro assays including time kill curves, toxin production, host immune response, and spore characterization.³⁻⁴ We also have a sub-specialty interest in microscopy using either electron or confocal microscopy to help characterize the killing effects of antibiotics on C. difficile.⁵⁻⁷

Publications

For a detailed list of the Garey Lab’s publications and citations, please visit PubMed and Google Scholar

Epidemiology

Relevant Papers

Relevant Papers

Relevant Papers

Relevant Papers

Clinical trials and stewardship

Relevant Papers

Relevant Papers

Relevant Papers

Drug discovery

Relevant Papers