Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
How do you or your practice manage young, average-risk patients without structural lung disease referred to you or self-referred for concern of environmental mold exposure?
These individuals are generally managed by pulmonology and allergy/immunology clinics because the clinical presentation is generally more aligned with allergy-type symptoms like a chronic cough, congestion, or other symptoms associated with airway irritation. In individuals who are receiving chronic...
Would you still consider adding clindamycin for streptococcal toxic shock syndrome in situations where the isolate is considered to be resistant?
I would not use clindamycin as clindamycin works by decreasing protein production specifically by binding to 50 S ribosomal subunit and disrupting the translation process. If I'm dealing with a toxin mediated pathology such as toxic shock, I prefer using linezolid.
What patient factors influence your decision between prescribing oral pre-exposure prophylaxis and long-acting injectable PrEP for HIV prevention?
First of all, is the patient generally compliant? Most of the time we use oral, once-daily agents for PrEP, but we do have some individuals on every-2-month injectable Cabenuva now. We do not have anyone on every-6-month lenacapavir, since the VA does not offer it. Have a discussion with the patient...
How have you incorporated sulopenem etzadroxil into your antibiotic stewardship protocols, particularly for managing uncomplicated UTIs with resistant Enterobacterales organisms?
We have not incorporated sulopenem rtzadroxil into our stewardship protocols. In fact, when I contacted our pharmacy leadership about this, they did not think the drug was available.
Would you avoid using cephalosporins in a patient with a history of cephalosporin neurotoxicity in the setting of CKD?
In elderly patients with underlying CNS disease, renal dysfunction and prior history of cephalosporin neurotoxicity, I would avoid the use of Cephalosporin therapy if possible. If there are not other alternatives, I would strive to give the lowest possible therapeutic dose of the antibiotic to dimin...
Would you treat Scedosporium growth in expectorated sputum in a patient with COPD, pulmonary hypertension, and bronchiectasis, who has chronic dyspnea with exertion, thick sputum production, negative bacterial cultures, and no signs of mold infection on a high resolution CT scan, with no other clinical symptoms of infection?
In persons with bronchiectasis, almost anything that grows can be a pathogen, but it is tough to know. If the patient has COPD and no other immunocompromising conditions, I would not expect typical invasive fungal infection findings. Having said that, scedosporium is not the first common pathogen th...
Given recent data from the REPRIEVE trial, how will you adapt your practice with regards to prescribing statins to patients living with HIV?
This randomized controlled trial (Randomized Trial to Prevent Vascular Events) found that, for people living with HIV between the ages of 40 and 75 years who were taking pitavastatin calcium, the risk of major adverse cardiovascular events was lowered by 35% and the risk of cardiovascular death was ...
When do you recommend limited or targeted respiratory pathogen testing versus a full respiratory pathogen panel in a patient presenting with URI symptoms?
I think we’re asking the wrong group of people. How infectious disease physicians use respiratory pathogen panels is not the same as how emergency medicine or urgent care clinicians use them. For stewards of diagnostics, especially ID providers, the test often doesn’t change management. In many sett...
What approximate portion of men develop infertility following a mumps infection?
In reviewing the literature, 25% is the number that comes up for males post puberty. The mechanism is one of antibodies being produced against germ cells, impacting spermatogenesis.
How do you approach a positive Quantiferon/PPD test result in a patient for whom testing is sent without a clinical indication and who does not have a risk factor for TB exposure nor TB reactivation?
If a test for TB infection such as a Quantiferon or PPD is done without TB exposure risk factor or clincial indication and is positive, a chest X-ray and good history for symptom assessment and exam should be done. I will assess to see if there is an increased risk of developing TB such as an immuno...