Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
In drawing blood cultures from a central line to evaluate for CLABSI, do you advise drawing separate blood cultures from each port in case of dual or triple lumen line?
You don't need to use the central line to draw those cultures. Using the line to draw blood can in it by itself pose risk of introducing a microorganisms. NHSN CLABSi definition does not call for blood culture to be done from a line.
What is your approach to management of CIED in a patient with community-acquired Staph aureus bacteremia who clears blood cultures quickly with negative follow up blood cultures within 72 hours of antimicrobial therapy and negative TEE?
The recent 2023 guidelines on AHS CIEDI defined definite CIED infection as 2 or more sets of blood cultures positive for staph aureus or CoNS + (positive TEE and/Or positive PET/CT). The guidelines stated that the organism isolated from blood cultures determines the likelihood of CIEDI, and coagulas...
What is your approach to duration of systemic antibiotics for treatment of isolated bacterial endophthalmitis in the absence of bacteremia or other deep-seated metastatic foci of infection?
Post-surgical (exogenous) endophthalmitis is an uncommon complication. The incidence ranges from 0.04%-0.3%, 0.019%- 0.54%, and 0.11% - 0.03% following cataract surgery, intravitreal injection, and vitrectomy, respectively (Soliman et al., PMID 32467482). Initial management of exogenous endophthalmi...
What factors should guide the choice between fosfomycin and nitrofurantoin for uncomplicated cystitis, given the reduced efficacy of fosfomycin?
I agree with the authors you reference that, though fosfomycin is listed as a first-line option in the 2011 IDSA UTI guidelines for uncomplicated cystitis, our assessment of its efficacy has changed somewhat since then.We now have two larger randomized controlled trials that demonstrate that women r...
Would you recommend treating asymptomatic bacteriuria in a kidney transplant patient who has a ureteral stent in place?
An exercise in futility. You can eradicate for a short period - long enough to safely perform a urologic procedure. But longer term? Fugetaboutit.
Do you recommend to continue acyclovir to prevent HSV infection in an HIV patient with CD4 count more than 200 and with high viral load?
The intent of this question isn't clear. Are you considering treatment of a person to prevent acquisition of HSV? Or to prevent transmission by an infected patient? The wording sort of implies the latter, so that scenario first. There are no data that document efficacy of antiherpetic therapy (acycl...
When do you discontinue contact precautions in patients known to be colonized with ESBL-producing Enterobacterales?
There is no widely accepted guideline regarding the timing of discontinuation of isolation for ESBL-producing organisms. However, according to the article “Duration of Contact Precautions for Acute-Care Settings” published by ICHE in 2018, Maintaining contact precautions for ESBL-E and CRE for the d...
Do you ever stop tobramycin prophylaxis in a patient with chronic bronchiectasis previously colonized with pseudomonas?
Yes, I will often stop tobramycin if there are issues with tolerance, antibiotic resistance, or treatment fatigue. Further, in more mild bronchiectasis (cylindrical vs. varicoid or cystic morphologies), sputum bacterial cultures will negatively convert on chronic cycled inhaled tobramycin, and this ...
Can non-16/18 HPV types cause ASCUS and squamous cervical metaplasia on biopsy within 3 months of acquisition, or would it take longer?
It isn't clear that HPV causes ASCUS. I'm not sure how to interpret "squamous metaplasia" as opposed to dysplasia, but certainly many HPV types other than 16 and 18 cause cervical dysplasia, and probably can do so within 3 months of acquisition. However, I would be cautious in telling a patient that...
Would you consider antifungal prophylaxis for immunocompromised patients with COVID-19 requiring mechanical ventilation, considering the high risk of invasive pulmonary aspergillosis in patients with severe COVID-19?
I don't universally add anti-mold prophylaxis in all immunocompromised patients with severe COVID-19 requiring intubation, but I am always considering it. Factors that might push me to add would be: positive fungal markers (Beta-D-Glucan or galactomannan) on BAL or blood at time of intubation, use o...