Anti-MRSA De-escalation and Antimicrobial Stewardship Updates | September 18, 2025

Date of Presentation: September 18, 2025

Type: Past Presentation

Audience: Clinical

Keywords: #antimicrobial resistance #avian #covid #infectious diseases #influenza #measles #mrsa #stewardship #syphilis

In this series of presentations, Dr. Jorge Mera, provides an overall infectious disease clinical update focusing on COVID-19, avian influenza, measles, and syphilis. Then, Dr. Lena Wong, reviews current literature on de-escalating anti-MRSA (Methicillin-Resistant Staphylococcus aureus) therapy guided by nasal MRSA swabs, highlights local population-specific pitfalls and cautions, examines quality and performance improvement initiatives to optimize antimicrobial use, and explores opportunities for additional stewardship projects. This overview aims to provide practical strategies for enhancing antimicrobial stewardship while minimizing unnecessary therapy.

Presented by:

Lena Wong

MD, MPH

Dr. Lena Wong, MD, MPH, is an Infectious Disease Physician in Internal Medicine and a Pediatrician serving at the Tuba City Regional Healthcare Corporation

Dr. Jon Iralu

Faculty

Dr. Iralu, MD, MACP, FISDA, is the Indian Health Service Chief Clinical Consultant for Infectious Diseases. He has a special interest in HIV, tuberculosis, and sexually transmitted disease care in rural communities. His research has focused on undifferentiated febrile illness in the American Southwest and on rural HIV care delivery. He has worked at Gallup Indian Medical Center since 1994 and is an instructor at Harvard Medical School and Senior Physician at Brigham and Women’s Hospital Division of Global Health Equity in Boston, Massachusetts.

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Dr. Jorge Mera

Faculty

Dr. Jorge Mera is the director of the Infectious Disease Department at the Cherokee Nation Health Services, the largest tribally operated health care system in the United States. In 2014, in response the HCV national epidemic he launched the first ProjectECHO hub in the state of Oklahoma. This hub was focused on Hepatitis C treatment and elimination and has provided treatment recommendations to over 1400 American Indian/Alaska Native patients with HCV. In addition, Dr. Mera has been instrumental in the implementation of other ECHO hubs across Indian Country. These hubs have focused on COVID-19, HIV, HIV PrEP, infectious diseases, substance use disorders and eliminating the HIV/HCV/SUD/Syphilis syndemic. Dr. Mera completed his fellowship in Infectious Diseases and Clinical Microbiology at Baylor College of Medicine in Houston, Texas and is Board Certified by the American Board of Internal Medicine in Infectious Diseases. He is an Associate Professor in the Infectious Diseases Division at the University of New Mexico, Health Science Center, Strategic Advisor for Project ECHO in Latin America, as well as the ECHO Medical Director for the Northwest Portland Area Indian Health Board. Dr. Mera is a Fellow of the American College of Physicians.

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Resources Provided:

Activity Evaluation and Claiming CE

Date added: September 18, 2025

Resources

Past Presentation

Anti-MRSA De-escalation and Antimicrobial Stewardship Updates | September 18, 2025

Presented by:

Lena Wong

MD, MPH

Dr. Jon Iralu

Faculty

Dr. Jorge Mera

Faculty

Resources Provided:

Great Lakes Inter-Tribal Epidemiology Center

Kauffman & Associates
Graphic Designer

CDC Foundation
Tribal Public Health Educator

Rocky Mountain Tribal Leaders Council
Epidemiology Center Director

Lummi
Northwest Portland Area Indian Health Board
Maternal Child Health Programs Director
Native BOOST Project Director

Oglala Sioux
Great Plains Tribal Epidemiology Center
Epidemiology and Disease Prevention Program Manager

Diné (Navajo)
Northwest Portland Area Indian Health Board
Native BOOST Provider Expert

Tigua Indian from Ysleta del Sur Pueblo
Good Medicine Tribal Public Health Consulting
Lead Consultant

Stockbridge-Munsee Band of Mohican Indians
Good Medicine Tribal Public Health Consulting
CEO and Founder

Alaska Native Tribal Health Consortium
Communication Lead

Great Lakes Inter-Tribal Epidemiology Center
Communication Lead

Southern Plains Tribal Health Board
Epidemiologist

Seminole/Muscogee
Southern Plains Tribal Health Board
Tribal Epidemiology Center Core Program Manager

Crow Nation
Rocky Mountain Tribal Leaders Council
Project Coordinator

Northwest Portland Area Indian Health Board
Native BOOST Project Manager

Diné (Navajo)
Northwest Portland Area Indian Health Board
TEC-IVAC Program Manager

Rosebud Sioux
Great Plains Epidemiology Center
Senior Director

Oglala Lakota
Great Plains Epidemiology Center
EDP Program Director

Cochita Pueblo
Albuquerque Area Tribal Epidemiology Center
Program Director for the Good Health and Wellness in Indian Country Program

Inter-Tribal Council of Arizona
Vaccine Epidemiologist

Great Lakes Inter-Tribal Epidemiology Center
Epidemiologist

	Jason Arion Butler is an enrolled member of the Ute Tribe of Fort Duchesne, Utah and is also part Mojave and Cherokee. He resides in Gibson, Idaho with his wife of 22 years, children, and grandchild who are all enrolled members of the Shoshone-Bannock Tribes. He graduated from Idaho State University with a Bachelor of Arts in Psychology and earned his Master of Science in Family and Human Development from Arizona State University. He has spent the past 5+ years employed by the Shoshone-Bannock Tribes, Tribal Health and Human Services Department, where he spent time serving as the Recovery Service Coordinator for the Four Directions Treatment Center, the manager for the Community Health Representative program, and recently accepted the position of Behavioral Health Manager. He strives to incorporate Native culture, traditions, morals, and values into the healthcare services provided to Native communities, implementing these practices into his work with the Shoshone-Bannock Tribes and advocating for the reconstruction of healthcare practices nationally. Today he says, “I am loving life and am extremely thankful to have found a career path I love.

	Carrie Sampson-Samuels is an enrolled member of the Confederated Tribes of the Umatilla Indian Reservation located in Eastern Oregon. Carrie has an early background in nursing providing patient care in long term and clinical care settings. Carrie then furthered her education in community health and health studies at Portland State University, later advancing her education in healthcare management at Oregon Health and Sciences University while serving in leadership and executive management for a Tribal health organization as the Community Health Director. Carrie has served Tribes from Oregon to Montana and the Treaty 7 Blackfoot Confederacy in Southern Alberta. As the Community Health Aide Project Director for the Northwest Portland Area Indian Health Board, Carrie has provided leadership, advocacy and project management for expansion for the Behavioral Health Aide and Community Health Aide Program under the umbrella and direction of the Tribal Community Health Provider Project. This work has led to the expansion of Tribal Community Health Providers in Washington, Oregon, and Idaho. Carrie is responsible for leading partnerships with the education institutions, key Tribal partner sites, contract experts and advisory workgroups. This includes development of education infrastructure, education curriculum, recruitment strategies, tools for integration of providers into tribal health organizations, and working with state partners to develop policy and infrastructure for provider reimbursement. Carrie manages and writes multiple grants that support all aspects of this work and provides technical assistance support to the Portland Area CHAP Certification Board. Carrie is the proud mother of 4 daughters and resides on a small ranch on her Tribal homelands.

	Dr. Liu is a generalist OB/GYN at Gallup Indian Medical Center. In addition to her medical degree, she holds a PhD in Health Policy. Among other publications, she served as the chief editor for the 2019 Oxford University Press book: “50 Studies Every Obstetrician and Gynecologist Should Know.” She has formal training in Quality Improvement processes through the Partners Clinical Process Improvement Leadership Program (CPIP), which she utilized to implement emergency contraception at Massachusetts General Hospital. During her six years at Gallup Indian Medical Center she has primary responsibility for preparing and reporting of metrics related to the delivery of obstetric care, and serves on the Continuing Medical Education committee.

	Dr. Hoover is from Chicago, where he grew up and went to medical school, at Rush University, on Chicago’s diverse West Side. He was trained in Urology at Boston Medical Center in Boston’s beautiful South End neighborhood. Dr. Hoover went on to pursue fellowship training in voiding dysfunction and laser prostate surgery at Beth Israel Deaconess Medical Center. Dr. Hoover is a Board-Certified Urologist, by the American Board of Urology, having achieved this honor in 2018. Dr. Hoover has several peer-reviewed publications, including research studies and medical illustrations. His family is happy to call Gallup home since the end of 2017. In their free time they like to explore New Mexico’s wilderness and go camping. Now that their two girls are growing up, it’s also imperative that we catch Pokemon wherever we go.Dr. Hoover is the only Urologist in McKinley County, New Mexico, and in any of the surrounding counties– it’s just him between Albuquerque and Flagstaff. He’s happy to continue seeing established patients, and is accepting new patients from the entire region. Dr. Hoover believes in communication, candor, and compassion as essential tenets of patient care. Dr. Hoover is an expert in general Urology, male and female voiding dysfunction, kidney stones and kidney stone surgery, BPH and laser prostate surgery, erectile dysfunction, vasectomy, prostate cancer, bladder cancer, kidney cancer, testicular cancer. Many of the procedures he do as a Urologist are done in the office including: cystoscopy, vasectomy, urodynamics, treatment foroveractive bladder, and many others. Please call/text or email and let him and his staff know how they can help you.

	Eric Wortmann, MD is the former Director of Emergency Medicine at Chinle Comprehensive Health Care Facility. Besides patient care, Eric has a deep passion for mentoring aspiring physicians and health care providers. He was the Education Director of Emergency Medicine at Chinle as well as Adjunct Faculty for the US Army teaching Special Forces Medics. He has been a visiting professor of Emergency Medicine in Haiti and has worked in the Dominican Republic since 1989. Eric has a long-time passion as a mid and long-distance running coach. He has lived on Kauai for 30 years. Currently he divides his time between Northern Italy and Hawaii. Recently he was accepted into Doctors without Borders USA and is awaiting his first assignment.

	Corey Detlefs, MD, FACS, is the Trauma Outreach Director and an Associate Professor of Surgery at the University of Arizona College of Medicine – Phoenix