Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Would you recommend avoiding intravesical (bladder) tobramycin administration in a patient with advanced chronic kidney disease?
Guess fear is absorption, build up, and toxicity. A single loading dose of an aminoglycoside is not to toxic level. Maintaining the level of risks ototoxicity, build up also nephrotoxicity. Would depend on absorption and residual GFR. Try a single loading dose, check levels after 12 or 24 hours to g...
Would you use immunotherapy in patients with HIV and a positive viral load?
Current guidelines do not recommend universal HIV screening before starting immune checkpoint inhibitors (ICIs). However, if HIV is known or suspected, patients should ideally be on antiretroviral therapy (ART) before initiating immunotherapy.Safety:Retrospective data from the CATCH-IT Consortium (E...
What is your approach to treatment of macrolide-sensitive localized bone/joint MAC disease?
Agree with the above answers. Obviously, no strong clinical studies on duration and outcomes. At NJH, we typically recommend: Aggressive debridement/resection, Treat with appropriate antimicrobial therapy (in macrolide-S MAC, then AZM/EMB/Rifamycin +/- IV AMK) for a minimum of 6 months total, but a...
Do you recommend treatment of male partners for patients with recurrent bacterial vaginosis?
I would personally recommend treatment of male partners in females with recurrent bacterial vaginosis (BV). Recent data are pretty compelling that this is effective. See here:Vodstrcil et al., PMID 40043236In the group that had their male partners treated, BV recurrence occurred in 35% compared to 6...
Do you give chronic antibiotic prophylaxis for recurrent UTIs, including Pseudomonas aeruginosa, in a patient with retained ureteral stents?
If the "recurrent UTIs" are symptomatic (fever is what I would be mostly concerned about), then the stents should be changed as feasible, (I assume this has been done) and the UTIs treated as appropriate. If the UTIs continue after the change, I would just try to treat the symptomatic events as best...
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?
In our system, we have IM cabotegravir. Lenacapavir is covered by Medi-Cal, but is not on our formulary yet. In our publicly funded, managed care system, we are more cost-conscious than most, and we tend to prefer oral, generic FTC/TDF. However, when patients ask for IM HIV PrEP, we do our best to a...
How have you incorporated sulopenem etzadroxil into your antibiotic stewardship protocols, particularly for managing uncomplicated UTIs with resistant Enterobacterales organisms?
For starters, I’ve never prescribed sulopenem etzadroxil and have no affiliation with the company in any way. I benefit in no way from this post. ORLYNVAH (usually written in all caps) is the trade name of sulopenem etzadroxil plus probenecid. Yes, ORLYNVAH is available in the U.S., but it doesn't a...
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...