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Manjari G. Joshi, MBBS

Academic Title:

Clinical Associate Professor

Primary Appointment:

Medicine

Additional Title:

Infectious Diseases Attending, R Adams Cowley Shock Trauma Center

Location:

R Adams Cowley Shock Trauma Center at the U. of Maryland Medical Center, 22 S. Greene Street, Baltimore, Maryland 21201

Phone (Primary):

(410) 328-3656

Fax:

(410) 328-6826

Education and Training

  • Dyal Singh College, New Delhi, India – Premedical - 1970
  • All India Institute of Medical Sciences, New Delhi, India – MBBS - 1975
  • All India Institute of Medical Sciences, New Delhi, India - Rotating Intership - 1975
  • All India Institute of Medicial Siences, New Delhi, India - Gastroenterology Residency
  • ECFMG/FLEX 1976/1979

  • Internal Medicine Residency Prince George's General Hospital and Medical Center, Cheverly, MD (1977 - 1980)
  • Attending, Internal Medicine at Prince George's General Hospital Medical Center Cheverly, MD  (1980 - 1981)
  • Fellow, Division of Infectious Diseases, University of Maryland, School of Medicine, Baltimore, MD (1981 - 1983)

Biosketch

I am an Associate Professor of Medicine at the University of Maryland, School of Medicine, Department of Medicine,  Division of Infectious Diseases.  As an attending physician at the R Adams Cowley Shock Trauma Center, Program of Traumatology, Department of Infectious Diseases I have been providing patient care at the trauma center for the last 34 years.  A separate passion of mine is that of teaching and research to include the following:

Infectious Diseases and Infection Control based clinical, educational and research activities:

  • Providing care to the critically ill patients
  • Establishing standards for antimicrobial stewardship and establish appropriate use of antibiotics
  • Decreasing Hospital acquired infections: CLABSI, UTI and VAP, CNS infections
  • Establishing incidence, diagnosis, prevention of infections related to Orthopedic trauma
  • I continue to teach all levels of medical care providers including nurses, nurse practitioners, medical students, pharmacists, residents and fellows (ID, critical care, surgery).

Instructor  1995 - present     RA Cowley Shock Trauma Center/Universityof Maryland Medical Systems

  • Orthopaedic Fellow Core Lectures
  • Anesthesia  Fellow Core Lectures
  • Critical Care Fellows Core Lectures
  • Infectious Disease Fellows Core lectures
  • Preceptor 2009 - present  U. of Maryland School of Nursing Acute Care Nurse Practitioners Students – Course Nurse 727 Overview
  • Preceptor /Elective in I.D.   InfectiousDisease Fellows/ Critical Care fellows/ Trauma Surgery Fellows/ Pharmacy residents/ NP students

Leader for the Global Initiative taken in 2006 as a responder team for India.  Working in collaboration with the only established trauma center in India, Ja Pakash Narayan Apex Trauma Center in New Delhi, India.  The goals of this program have been the following:

Education of physicians and nurses, mentorship of the trauma physician and the nursing groups.

Establish Infection Control / Infectious Disease based clinical research activity to include:

  • Establishing standards for antimicrobial stewardship and appropriate use of antibiotics
  • Decreasing hospital acquired infections: CLABSI, UTI, and VAP
  • Develop protocols for tracking antimicrobial resistance
  • Develop protocols for tracking antimicrobial use and associated cost                                              

Research/Clinical Keywords

Major Research Interests include: Prevention of infection in surgical settings; Establishing incidence, diagnosis and prevention of infections in orthopedic trauma

Highlighted Publications

Recent Publications:

  1. Duane TM, Capitano B, Puznaik L, Biswas P, Joshi, M.  The Impact of Linezolid versus Vancomycin on Surgical Interventions for Complicated Skin and Skin Structure Infections Caused by Methicllin-Resistant Staphylococcus aureus. Surgical Infections. August 2013, 14(4): 401-407. doi:10.1089/sur.2012.033.

  2. Tobert, JT, Joshi M, Moraff, A,  Matusewski PE, Holmes, A, Pollak AN, O’Toole RV: Current Bacterial Speciation and Antibiotic Resistance in Deep Infections After Operative Fixation of Fractures. Journal of Orthopaedic Trauma. 29 (1): 7-17, January 2015.

  3. Other authors, Joshi, M, et al.: Can Applied External Fixators Be Sterilized for Surgery? A Prospective Cohort Study of Orthopaedic Trauma Patients, Injury, 2016.

 

 

Additional Publication Citations

Memoli D, Shepardson A, Joshi M, Heil E.  Reducing daptomycin expenditures by standardizing doses.  Am J. Health Syst Pharm 71 (1): 12-14, 2014.

Bulger EM, Maier RV, Sperry J, Joshi M, Henry S, Moore FA, Moldawer LL, Demetriades D, Talving P, Schreiber M, Ham B, Cohen M, Opal S, Segalovich I, Maislin G, Kaempfer R, Shirvan A.  A Novel Drug for Treatment of Necrotizing Soft-Tissue Infections: A Randomized Clinical Trial. JAMA Surgery, 149 (6): 528-536, 2014.

Torbert JF, Joshi M, Moraff A, Matuszewski PE, Holmes A, Pollak AN, O’Toole RV.  Current bacterial speciation and antibiotic resistance in deep infections after operative fixation of fractures.   J. Orthopaedic Trauma, 29 (1): 7-17, 2015.

Vranis N, Paryavi E, Christian M, Joshi M, Pensy RA.  Septic Arthritis and Osteomyelitis Caused by Pasteurella multocida.  Am J. Orthopaedics 44 (7): E239-241 2015.

Rock C, Thom KA, Harris AD, Li S, Morgan D, Milstone AM, Caffo B, Joshi M, Leekha S.  A Multi-center Longitudinal Study of Hospital-Onset Bacteremia: Time for a New Quality Outcome Measure?  Infect Control Hosp Epidemiol 37 92): 243, 2016.

Hardeski D, Gaski G, Joshi M, Venezia R, Nascone JW, Sciadini MJ, O’Toole RV.  Can applied external fixators be sterilized for surgery? A prospective cohort study of orthopaedics trauma patients.  Injury 47 (12): 279-2682, 2016.

Richert ME, Hosier H, Weltz AS, Wise EC, Joshi M, Diaz JJ.  Acute Transverse Myelitis Associated with Salmonella Bacteremia: A Case Report.  Am J Case Report 17: 929-933, 2016.

O’Toole RV, Joshi M, Carlini AR, Murray CK, Allen LE, Scharfstein DO, Gary JL, Bosse MJ, Castillo RC (METRC) Local Antibiotic Therapy to Reduce Infections After Operative Treatment of Fractures at High Risk of Infection: A Multicenter, Randomized, Controlled Trial (VANCO Study).  J Orthro Trauma, S1: S18-S24, 2017.

O’Toole RV, Joshi M, Carlini AR, Sikorski RA, Dagal A, Murray CK, Weaver MJ, Paryavi E, Stall AC, Scharfstein DO, Agel J, Zadnik M, Bosse MJ, Castillo RC, METRC.  Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High-Energy Fracdture Surgery (OXYGEN Study). J Orthop Truma S1: S25-S31, 2017.

Lauerman M, Kolesnik O, Sethuraman K, Rabinowitz R, Joshi M, Clark E, Stein D, Scalea T, Henry S. Less is More? Antibiotic duration and outcomes in fournier’s gangrene.  J Trauma Acute Care Surg, May, 2017.

Research Interests

Major Research Interests include:  

  1. Vanco study - Intrawound application of Vancomycin powder 
  2. Supplemental Oxygen study to reduce surgical site infectios after engery fracture surgery
  3. Novel diagnostic strategies for early detection of infections in orthopedic trauma

 

Grants and Contracts

Support for Dr. Joshi

Title: Novel Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection: A Multicenter Randomized Controlled Trial

Funded by: Department of Defense

Role: Co-InvestigatorI

Effort: 1.2 calendar months

Amount: $2,447,136 Period of Performance: 09/30/2010-03/29/2018

Brief Description: Research clinical trial evaluating a novel therapy to reduce infection after operative treatment of fractures at high risk of infection.

Title: Supplemental Perioperative Oxygen to Reduce Surgical Site Infection (Oxygen) Funded by: Department of Defense

Role: Co-Investigator           Effort: 1.2 calendar months Amount: $2,647,910

Period of Performance: 09/30/2012-09/29/2017

Brief Description: This study aims to evaluate supplemental perioperative oxygen as a means to reduce surgical site infection after high-energy fracture surgery.

TitlePragmatic Randomized trial Evaluating Pre-operative Antiseptic skin solutions in fRactured Extremities (PREPARE)

Funded by:  Department of Defense (DoD)

Role:  Co-Investigator          Effort:  1.2 Cal Months

Amount: 3,200,000               Period of Performance:  09/30/2017-08/31/2021

Brief Description:  The PREPARE trial will enroll 2,000 open fracture patients across 10 hospitals in the US to determine which pre-operative skin antiseptic solution is most effective at  reducing infections associated with open fractures. Specifically, we will compare the effectiveness of 2% chlorhexidine gluconate versus 10% povidone-iodine, to reduce infections within 90 days of surgical fixation for an open extremity fracture.

Title:  Phase III, Randomized, Double-blind, Placeo-controlled, Paralle-group, Study of AB103 as compared to placebo in patients with (NSTI) necrotizing soft tissue infections.

Funded by: ATOX - Effort - 3%             Period of Peformance - 2015 - 2019

Role- Co-Investigator - (Dr.  Sharon Henry - P.I.)

Brief Desription: The purpose of this study is to determine whether AB103 is safe and effective in the treatment of patiets with necrotizing soft tissue infections received

_________________________________________________________________________________________________________

09/30/2010*    (Co-Investigator)                                          

PI: Robert O’Toole, M.D.

“Novel Therapy to Reduce Infection after Operative Treatment of Fractures at High Risk of Infection: A Multicenter Randomized, Controlled Trial”

PROPR DOD OR090221 (W81XWH-10-2-0134)

Annual Direct Cost:                         $273,567

Total Direct Cost:                             $2,447,136

Status: **Delays in FDA IND have led to study re-design, multicenter randomized treatment trial began enrollment in early 2015, 38 sites participating.

09/30/2012-09/30/2015     (Co-Investigator)                                          

PI: Robert O’Toole, M.D.

“Supplemental Perioperative Oxygen to Reduce Surgical Site Infection after High-Energy Fracture Surgery”

PROPR DOD OR110123

Annual Direct Cost:           $416,257

Total Direct Cost:              $2,647,991

Status: First patient set to enroll in multicenter randomized controlled treatment trial in late 2013, currently over 300 patients enrolled at 15 sites.

PI: Robert O'Toole, M.D.

Vanco (Metrc study) - Assessment of Severe Extremity Wound Bioburden at the Time of Definitive Wound Closure or Coverage: Correlation with Subsequent Post-Closure Deep Wound Infection (Bioburden Study).

Community Service

Global Initiative – R Adams Cowley Shock Trauma Center – Teaching and Development of a Trauma Program  and First Responder Team for India  2006 – present

Visits to India with Trauma Team – (under the direction of  John Spearman and Dr. Tom Scalea)

September, 2006,   February, 2007, December, 2007,  February, 2009,  November, 2009  

Global Trauma Program: 2007 - present

Leading the India trauma group for the past 10 years. Working in collaboration with the only established trauma center in India, Jai Prakash Narayan Apex trauma center in New Delhi, India. The goals of this collaborative program have been the following:

1. Education of Physicians and nurses

Mentorship of the Trauma physician and the nursing groups

2. Infectious Diseases and Infection Control based clinical and research activities:

-       Establishing standards for antimicrobial stewardship and establish appropriate use of antibiotics

-       Decreasing Hospital acquired infections: CLABSI, UTI and VAP

-       Develop protocols for tracking antimicrobial resistance

-       Protocols to track antimicrobial use and associated cost

Global Initiative Team Member – R Adams Cowley Shock Trauma Center

–      China, Hong Kong – 2008

Outside Activities

 1992 - 2002                 Board of Trustees, Bryn Mawr School

 1995 - 1999                 Chairman, Financial Aid/Admissions, Bryn Mawr School

 1995 - 1999                 Samuel Ready Board of Trustees, Bryn Mawr School

 1996 - 1997                 Chairman, Upper School Parents Association, Bryn Mawr School             

                       Head - Admissions Committee, Bryn Mawr School

1999 – 2002                Teacher and Head of Language Proficiency, Greater Baltimore Temple

2007 - present            Global Representative from Shock Trauma to the Fundraising Brain Trauma Foundation (for India), March, New York City

2007 – present            Board of Trustees, India Head Injury Foundation

2008 –present             Treasurer, All India Institute of Medical Sciences Alumni Group

Professional Activity

Committee participation:

1995 - 2004                            Credentialing Committee, University of Maryland Medical Systems

1997 - present                         ADHOC Admission Committee, University of Maryland School of Medicine

1998 - present                         RA Cowley Shock Trauma Research Committee

1995 - present                         RA Cowley Shock Trauma Infection Control Committee

2000 - 2008                            Shock Trauma Board of Directors

2002 - 2016                            University of Maryland, Institutional Review Board

2005 – present                       Shock Trauma Center Leadership Group

2007 – present                       Patient Advocacy Group (patient family education group)

2014- present                        Hospital Acquired Infection Prevention Commitee

2011 - present                       Antimocrobial Stewardship Committee