Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
What is your approach to dental prophylaxis for patients on biologics?
My approach has been to not recommend antibiotics prior to routine dental care for patients on biologic therapy. I'm not aware of any compelling evidence or guidelines supporting preventive antibiotic treatment for such patients. Of course, there may be exceptions to this. Antibiotic prophylaxis mig...
What is your approach to anal pap screening among MSM with HIV, and if routinely recommend, starting at what age (assuming access to HRA)?
We taught our nurses and patients how to do self-collection, which cut down on the amount of time it takes. Multiple guidelines for HPV have been revised in the past few months based on more recent studies (although the emotional reaction to having multiple of my patients diagnosed with anal cancer ...
What factors do you consider when deciding between monotherapy with an antipseudomonal cephalosporin and combination therapy in ICU patients with Pseudomonas aeruginosa bloodstream infection who are not in septic shock?
In a patient who is critically ill, combination therapy can be used if there is concern that there may be a drug-resistant organism. In that case, a combination regimen can be used while awaiting the susceptibility test results. The combination choice should be based on the resistance patterns of th...
Do you switch to an alternative agent for C difficile colitis for a patient with suspected infection and positive testing who continues to have >3 watery bowel movements daily despite multiple days of oral vancomycin treatment?
I don't know if all nucleic acid-based tests for C. difficile are quantitative, but the most commonly used tested is cobas C. diff by Roche. The test results are reported qualitatively for some reason. Y'all have gotten used to cycle thresholds, but I, in a former life, ran thousands of RT-Q-PCR ass...
What agent and for how long would you treat a patient with asymptomatic azole-resistant C auris candiduria who is planning to undergo a urological procedure?
I would be cautious here. If there are reasonable MICs to fluconazole (SDD but achievable), this would be preferred. Intravesical amphotericin is a good option. But, if this were impossible to achieve, I would be reluctant to use IV amphotericin in any formulation, since there's a risk of harm, and ...
What is your preferred agent for fungal prophylaxis in a patient post lung transplant with abnormal LFTs?
Isavuconazonium tends to cause less elevations in LFTs.
How do you manage resistant infections that persist after stopping antibiotic therapy in patients with non-CF bronchiectasis?
Ultimately depends on the why and where WHY has the organism acquired resistance genomes? (Too much) Prior Abx exposures? Resident in a unit (NH, Chronic Care, ICU) with high ambient MDR’s? Warranted or inadvertent elimination of protective normal flora? Usually, a combination of several. WHERE is t...
For a patient on appropriate treatment for invasive aspergillosis, how do you determine if and when it is acceptable to reintroduce a TNF inhibitor that likely contributed to their acquisition of the infection but is considered essential for control of their inflammatory condition?
There is no established answer to this question. The reintroduction of a TNF inhibitor must be individualized based on the clinical situation of the patient under consideration. There are two critical questions. First, how much does the patient need the inhibitor”? The more the patient is dependent ...
Do you adhere to the standard 5-day minimum treatment duration for community-acquired pneumonia, or have you used shorter courses for certain low-risk patients?
This is a question addressing a shorter duration of antibiotic therapy than the current IDSA guidelines for community-acquired pneumonia (CAP) recommend. It has been the topic of several studies, for example, 3-day treatment (Richard T. Ellison III, MD, reviewing Dinh et al., PMID 33773631; Niederma...
How do you integrate next-generation sequencing with traditional culture methods to improve the identification of fungal pathogens, especially in cases where routine cultures are negative when evaluating suspected prosthetic joint infections?
To my knowledge, there is no evidence that molecular studies improve the detection of fungal pathogens in periprosthetic joint infections. The vast majority of fungal PJIs are caused by Candida species, while mold infections are rare and typically diagnosed through fungal cultures. If a PJI remains ...