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...
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...
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 ...
Do you add gentamicin when treating prosthetic valve endocarditis secondary to viridans group Streptococcus with a penicillin-intermediate isolate (MIC >0.125 - <0.5)?
No, we do not treat patients with such infections with a combination of penicillin and gentamicin. For these infections, we treat with ceftriaxone alone. Monotherapy with ceftriaxone is a more reasonable option than a combination of penicillin and gentamicin because we have every reason to consider ...
What is your approach when cryptococcus serum or CSF antigen titers do not change despite treatment in HIV-positive patients with cryptococcal meningitis or invasive disease, but there is clinical improvement and cultures remain negative?
While cryptococcal antigen is an excellent diagnostic marker for this infection, with excellent sensitivity and specificity, it is not reliable for tracking response to therapy. An initially high CSF antigen level has been identified as a sign of poor prognosis in patients with AIDS, but multiple st...
How long do you recommend that a patient wear a mask when resuming biologic infusions following a recent upper respiratory infection?
Patients who have acquired an upper respiratory tract infection in the COVID, RSV, influenza era should wear masks as long as they are deemed contagious. The CDC makes recommendations concerning the duration of masking and the type to use. For COVID the current suggestion is 10 days after the cessat...