Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
How would you manage a patient with necrotizing pneumonia due to a susceptible Pseudomonas aeruginosa strain who continues to have significant purulent secretions and worsening imaging while receiving cefepime?
I agree, not enough information here to make a firm recommendation, but often times these necrotic pneumonias will undergo significant liquefactive necrosis, and all of that dead lung and purulence has to come out through the mouth. I tell patients that they may have a worse cough for a while, and t...
How do you approach prophylactic antibiotics in patients who continue to have recurrent neutropenic fever following chemotherapy for solid tumors despite chemotherapy dose reduction and growth factor support?
This has to be individualized to the patient. It depends on the length of neutropenia, previous infections, and local antibiotic resistance. If the patient develops neutropenic fever after every cycle of chemotherapy and no obvious nidus of infection has been identified, a trial of a fluoroquinolone...
How long do you treat Staphylococcus aureus pyomyositis with antibiotics?
I agree, and certainly evaluating for bacteremia that can be associated with these types of infections, which would alter the duration of therapy.
Do you generally recommend device exchange/removal in patients with gram positive bacteremia in the setting of intra-aortic balloon bump or other mechanical circulatory devices?
I am assuming in this case that the patient has a mechanical circulatory support device such as an LVAD, IABP, or another implantable device, and has developed gram-positive bacteremia. No further details about the device type or clinical scenario are provided. In such cases, device removal is recom...
How would you approach the management of posterior uveitis caused by Toxoplasma gondii in immunocompromised patients, considering the potential for atypical presentations and treatment resistance?
There are no established studies to confirm the best medications and duration for the treatment of toxoplasmosis retinitis. The recommendations are based on experience and consensus. Further, I am not sure how you established resistance since one rarely has the organism to test, and there is no rout...
Have the growing reports about doxycycline resistance in gonorrhea isolates from patients prescribed doxy PEP for prevention of bacterial STIs influenced your use of doxycycline for this indication?
No, they have not. For 2-3 decades, the prevalence of tetracycline resistance in N. gonorrhoeae worldwide, including the US and Western Europe, has been too high to rely on doxycycline or other tetracyclines in treating gonorrhea. The rise in prevalence of tetracycline resistance in MSM, the main po...
How do you decide on supportive care vs empiric antibiotics in a patient with suspected aspiration pneumonitis (i.e., witnessed macroaspiration event within the past 24 hours) but with features that could suggest pneumonia (e.g., acute respiratory distress, fever, leukocytosis, pulmonary infiltrates, etc.)?
Great question and one that comes up all the time for me. As the patient has more signs of true infection, such as those you mention with fever, leukocytosis, and respiratory distress, I am much more likely to start antibiotics. If the patient just has chest radiograph findings of opacities and some...
How do you typically manage a patient with a single positive blood culture from two sets growing Candida species in a stable patient without prosthetic devices or material?
Candidemia is defined as the presence of Candida species in the blood, and even a single positive blood culture specimen is considered significant and warrants treatment as candidemia. Initial management should include: Initiating antifungal therapy with an echinochandin (micafungin, capsofungin, o...
How long do you typically treat mixed infections involving Actinomyces such as empyema or abdominal abscesses when adequate source control has been achieved?
In cases like this, shorter course of treatment can be given. In a case where there is no concern for residual mass, invasive disease or fistulous disease, treatment can be anywhere from 2 to 6 weeks. I would generally recommend at least 3 weeks for an empyema with Actinomyces as the cause provided ...
What is your preferred first-line treatment for chronic fatigue in patients with long COVID-19?
Assuming that a thorough workup for other causes of fatigue (anemia, thyroid dysfunction, sleep apnea, etc.) has been performed and is negative, no single medication has been proven by a randomized placebo-controlled trial to help chronic fatigue in PASC. Anecdotally, my colleagues who treat PASC ha...