Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
For patients with MSSA bacteremia and planned oxacillin at home via OPAT due to start the day after discharge, would you consider discharging after a one-time dose of ceftriaxone or daptomycin?
In a patient with MSSA bacteremia, I would not be comfortable sending a patient home after one dose of ceftriaxone or daptomycin to continue outpatient anti-staph IV antibiotics. Staphylococcus aureus bacteremia causes distant seeding in more than 1/3 of cases and has a mortality rate ranging betwee...
In light of recent measles outbreaks in the US, would you recommend an MMR booster for immunocompetent patients born before 1957?
I would not recommend a measles vaccine for a person born before 1957. This year has been chosen because people before born before 1957 have a very very high likelihood of having had measles because virtually all children got this highly contagious disease. On the other hand, there is no harm to get...
Do you use MRSA nares PCR to influence antibiotic selection for non-respiratory infections?
BLUF: Yes, I use a MRSA nares PCR for early de-escalation in the stable patient with a non-purulent, non-respiratory infection. Mergenhagen et al., PMID 31573026 retrospectively examined nearly half a million clinical cultures and compared them to MRSA nares results. Among all infections, the NPVs w...
Should asymptomatic esophageal candidiasis identified incidentally on endoscopy be treated?
Yes, in our practice, we do treat asymptomatic esophageal candidiasis when found incidentally on endoscopy. A few things to consider: 1) While patients may be asymptomatic at the time of the endoscopy, untreated disease can lead to the future development of complications/symptoms, such as odynophagi...
Would you recommend anti-fungal treatment for aspergillus infection for a patient with an incidental finding of worsening ground glass opacities and enlarging nodules on CT chest with positive BAL galactomannan, elevated aspergillus IgE and IgG in an otherwise immunocompetent host with no respiratory symptoms?
No, I would not recommend antifungal treatment in this case. The patient, as described, does not seem to have invasive aspergillosis, chronic necrotizing aspergillosis, or allergic bronchopulmonary aspergillosis, so I don't believe antifungal treatment is indicated. There may be other details of the...
Under what circumstances would you choose the 1-month 1HP treatment over a 3-4 month regimen for latent TB?
I tend to favor the 1-month daily isoniazid–rifapentine regimen (1HP) in very specific clinical and programmatic contexts, rather than as a default option. Its main advantage is speed i.e. when there is a narrow window to complete latent TB treatment such as prior to imminent immunosuppression (e.g....
What has been your experience with tecovirimat for monkeypox?
I thought it worked well in 2 patients of mine with rectal Mpox. However, the clinical trial did not confirm this, and it was a lot of trouble to get TPOXX going with consent, investigational drug, etc so we have abandoned use here.
Under what circumstances do you recommend use of antibiotics during end-of-life care?
I use antibiotics at the end of life for palliation of pain and suffering after discussion with the hospitalist, family, and patient, if possible.
What is the best alternative oral therapy for treatment of non-severe pulmonary nocardiosis in an immunocompetent patient with sulfa allergy?
We have been using linezolid for this indication, based on a paper from ARUP Labs.Schlaberg et al., PMID 24247124
Do you recommend the use of ampicillin/ceftriaxone for prosthetic valve endocarditis due to ampicillin-susceptible Enterococcus faecium?
The prognosis for Enterococcus faecalis endocarditis is generally better than that for Enterococcus faecium, primarily due to antibiotic susceptibility patterns. It is fortunate to have an ampicillin-susceptible strain of E. faecium in this case of prosthetic valve infective endocarditis. In general...