Dr. Farmakiotis' research interests focus on infectious complications of chemotherapy and transplantation, common and opportunistic infections in non-HIV immunocompromised patients, and more specifically invasive fungal infections in non-HIV immunocompromised patients, mechanisms and clinical significance of resistance to antifungals in Candida species, multi-drug resistance in Candida glabrata, antifungal stewardship, CMV, particularly the use of cellular immunity assays, and hepatitis-C in oncology and solid organ transplantation. 

The study of viral, bacterial and fungal infections in immunocompromised individuals, such as those with cancer, hematologic malignancies or solid organ transplant recipients, is challenging. Unfortunately, the relatively new subspecialty of transplant - oncology ID has been historically hampered by empiricism and poorly-supported data from retrospective studies and small case-series. The stakes for the community are high, because of (i) the substantial investments in cancer care, solid organ, or hematopoetic stem cell transplantation and (ii) the significance of appropriate organ allocation and favorable outcomes in  transplantation, given the increasing demand with relatively small and stable donor pools.

In these patient populations, we and others have shown that early initiation of  antifungal treatment can be life-saving, causing a marked increase in the use of antifungals over the last few years, and, consequently, the development of resistance among Candida species. The molecular basis of resistance to multiple antifungal drugs and its effect on the virulence of Candida clinical isolates are largely unknown. Such information could enable rational and precise antifungal stewardship, help in the development of novel antifungal agents and optimise management of invasive fungal infections. To this end, I aim to provide critical insight into mechanisms of antifungal resistance, help develop and study new antifungal drugs, and accelerate my career as a leader in the structured study of life-threatening infections in immunocompromised hosts.

Ongoing Research Support:

ENDEAVOR, Astellas Pharma Global Development 

Observational disease registry of patients treated with systemic mold-active triazoles
The goal of this multi-institutional registry is to capture the baseline characteristics and clinical course of patients treated with the new triazoles voriconazole, posaconazole and isavuconazole.
Role: Site PI 

Using a commercially available assay measuring cytomegalovirus (CMV)-specific CD4+ and CD8+ T-cell immunity by intracellular cytokine staining to monitor cellular immunity and predict protection against CMV. Funded by Viracor-Eurofins.

The goal of this investigator-initiated, prospective, blinded study is to assess the performance of a novel, commercially available assay measuring CMV-specific cellular immunity in predicting clinically significant CMV events.

Role: PI

 

Completed Research Support:

MYCA 12E-01, Astellas Pharma USA Kontoyiannis (PI)  

Outcomes of Candida fungemia in adult cancer patients treated with micafungin
The goal of this project was to study the efficacy and tolerability of monotherapy with micafungin for the treatment of candidemia and deep-seated candidiasis and identify factors associated with clinical failure and death, among patients with cancer, including those with hematologic malignancies and severe neutropenia, an understudied patient population.
Role: Co-PI

Rhode Island Foundation Medical Research Award  

Caenorhabditis elegans as a host model to study multi-drug resistance in Candida glabrata
The goal of this pilot project is to establish the nematode C. elegans as a high throughput, inexpensive model to study MDR in C. glabrata and the efficacy of different antifungal regimens against drug-resistant C. glabrata strains.
Role: PI 

INQUIRE, Astellas Pharma Global Development 

Non-interventional registry study of systemic antifungal therapy in adult subjects with invasive mucormycosis or invasive aspergillosis caused by a non-fumigatus species
The goal of this multi-institutional registry is to the clinical course of patients infected with rare molds, specifically Aspergillus non-fumigatus species and the mucorales, with a focus on efficacy and tolerability of isavuconazole.
Role: Site PI 

2010, 2011  AECOM Leo M. Davidoff Award for Excellence in the Teaching of Medical Students

2011            2nd place, best clinical research &

                    1st place, best case presentation at the Jacobi Medical Center annual poster competition

2013            BCM ID Chief Fellow  

2014            Permanent US residency as “Scientist of Extraordinary Ability” (EB1)

                    2nd place, best clinical research at the BCM Annual Medicine Research Symposium

                    First-author manuscript selected for CDC press coverage

2015            First co-author manuscript selected for CME activity

2016            MMSA Thomas J. Walsh Young Investigator Award  

                    Co-author in manuscript ranked #1 paper in medical mycology at ASM Microbe 2016

                    Invited speaker for ID Week 2016

                    Fellow, American College of Physicians (FACP)

                    Second author manuscript featured in Uptodate

                    IDSA Mentorship Program

                    ID Week presentation selected for CME activity

2017            Invited panelist for ID Week 2017 

                    IDSA Mentorship Program

                    Brown Internal Medicine Residents’ Consultant Teaching Award

                    First author manuscript fetured in Uptodate

2018            1st place award for best clinical research at the Allegheny annual medicine research retreat

                    2nd place award in clinical/basic science at the Pennsylvania Chapter of ACC annual conference

Rhode Island Hospital

Rhode Island Hospital Cancer Center

Rhode Island Hospital Cardiovascular Institute

The Miriam Hospital

During bedside rounds and through designated 1-hour talks, Dr. Farmakiotis teaches medical students, internal medicine and surgery residents, as well as infectious diseases and nephrology fellows about (a) fungal infections, (b) infections in non-HIV immunocompromised hosts, such as solid organ or hematopoietic transplant recipients and patients with hematologic maligancies or solid tumors receiving toxic chemotherapy, and (c) pre-transplant ID evaluation of the potential kidney donor and recipient. Dr. Farmakiotis often serves as invited speaker or panelist at Grand Rounds and Morbidity-Mortality lectures across different speciaties. Dr. Farmakiotis' main goal in medical education is to teach by example and train the next generation of medicine and infectious disease specialists. Based on real-world educational cases, he always tries to put emphasis on thought process and principles of decision-making, as opposed to listing isolated knowledge that is available through multiple educational sources, such as textbooks, journals and the internet. So far, Dr. Farmakiotis has presented over one-hundred didactic sessions to medical students, residents, fellows and faculty at Albert Einstein College of Medicine, Baylor College of Medicine, the University of Texas at Houston, Harvard Medical School and the Alpert Medical School of Brown University.