Infectious Disease&nbsp;&nbsp;&nbsp;

For how long do you recommend treatment for latent tuberculosis prior to initiation of anti-TNF therapy?

5 Answers available

What is your approach to recurrent asymptomatic bacteriuria in pregnancy for patients without personal history of recurrent UTIs or pyelonephritis?

Assuming patient already received an initial course of antibiotic treatment in response to a positive urine culture during routine screening early in ...

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?

What is your approach to counseling patients regarding re-initiation of anti-TNF therapy after completion of treatment for non-disseminated pulmonary histoplasmosis?

Would it be safe to resume and if so, when?

What is your approach to a patient with undetectable MMR titers checked prior to or during immunosuppression and a history of MMR vaccination in childhood?

Is there a role for booster vaccination and if so, how do you approach the timing when a patient is already on a biologic for immunosuppression?

Do you prescribe linezolid to patients who are concomitantly on an SSRI?

6 Answers available

When do you discontinue contact precautions in patients known to be colonized with ESBL producing Enterobacterales?

How long do you continue PJP prophylaxis in a patient with GPA who is able to wean steroids and remains only on rituximab for maintenance therapy?

How do you treat a patient with a gram-negative infection with resistance to imipenem but sensitivity to meropenem and negative for Carbapenem resistant organism by xpert Carba-R-assay?

Do you add gentamicin when treating prosthetic valve endocarditis secondary to viridans group Streptococcus with a penicillin-intermediate isolate (MIC >0.125 - <0.5)?

Have you incorporated the use of steroids for patients with severe community-acquired pneumonia?

In light of published data from the CAPE COD trial...

Is there a role for repeat surveillance blood cultures in patients with prosthetic valve endocarditis without associated cardiac abscess after a 6 week course of antibiotic treatment without surgical intervention?

Is there a role for chronic suppressive oral or inhaled therapy for recurrent Burkholderia cepacia pneumonia causing frequent hospitalizations in a patient with severe bronchiectasis with or without underlying cystic fibrosis?

How do you approach a patient who has anterior uveitis and is referred for evaluation of ocular TB with a positive Quantiferon gold (as part of their workup) in countries with low TB incidence?

What is your approach to treatment of macrolide-sensitive localized bone/joint MAC disease?

Does a low serofast RPR titer (such as 1:1 or 1:2) in the setting of a remote history of appropriately treated latent syphilis in a patient with now uveitis of yet unknown etiology referred from ophthalmology for possible ocular syphilis make a diagnosis of ocular syphilis less likely?

What is your approach to guiding ophthalmologists regarding our clinical suspicion for ocular syphilis and does the quantification of the titer help i...

How long do you treat an isolated bacterial liver abscess which has either undergone percutaneous drainage or for which an indwelling drain is placed?

In addition to ampicillin, is there any benefit to the addition of either gentamicin or bactrim when treating a patient with listeria meningitis?

How do you approach a positive Quantiferon/PPD test result in a patient for whom testing is sent without a clinical indication and who does not have a risk factor for TB exposure nor TB reactivation?

Do you routinely offer latent TB treatment in these cases?

Do you transition to oral antibiotics to treat uncomplicated Staphylococcus aureus bacteremia after patients have improved with intravenous antibiotic therapy?

Are contact precautions effective at preventing MRSA transmission in healthcare settings?

What is your approach to anal pap screening among MSM with HIV, and if routinely recommend, starting at what age (assuming access to HRA)?

Have you applied the POET trial to clinical practice?

Does your institution have formal policies or work flows to reduce unnecessary IGRAs ordered for patients on biologics?

What is current best practice with regards to antibacterial prophylaxis in patients with hematologic malignancy and resolved neutropenic fever (>72 hours)?

How long do you continue antibiotics after cholecystostomy tube placement for acute cholecystitis?

Since the COVID-19 pandemic, increasingly we see management of acute cholecystitis with cholecystostomy tubes as opposed to surgery, even amongst pati...

What approaches can we take to initiate therapy and improve survival rates in patients with HLH?

What isolation policies are Rheumatology offices employing for both staff and patients diagnosed with COVID-19 given the new CDC guidelines?

CDC Healthcare Guidance CDC Isolation and Work Restriction Guidance CDC Immunocompromised Guidance

Do you use standard dose or "meningitis dosing" of antibiotics when treating epidural abscesses, in the absence of CNS symptoms?

4 Answers available

What antibiotic, antifungal and antiviral prophylaxis you give post CAR-T therapy, and what is the duration?

In which patients do you prefer daily standard three-drug therapy for non-cavitary pulmonary MAC as opposed to three times a week dosing?

What is your preferred third antimicrobial agent for a patient with treatment-naive pulmonary MAC without cavitary disease and strict contraindications to utilization of rifampin or rifabutin?

Do you repeat a lumbar puncture in a patient living with HIV diagnosed with and treated for neurosyphilis and if so, when?

What duration of therapy do you use for treatment of Legionella pneumonia in an immunocompetent host without associated empyema or extrapulmonary infection?

In patients with HTLV-1 associated acute T-cell leukemia, is there any clear benefit of adding antivirals?

If yes, would you go with Zidovudine monotherapy versus combining with interferon-alpha? And what would be the preferred dose and duration?

How long would you treat a patient with recent history of TAVR presenting with E faecalis bacteremia with unclear source with TEE showing thickened valves but no obvious vegetation?

How do you counsel HIV patients with an undetectable viral load on breastfeeding?

Do you add adjunctive gentamicin and/or rifampin for treatment of prosthetic valve Staphylococcus aureus endocarditis?

Is there a role for beta-lactams as step-down oral therapy for uncomplicated gram-negative bacteremia?

If so, what antibiotic regimens do you use?

6 Answers available

Do you recommend testing for HPV in patients with oral lichen planus?

Should checking a urinalysis with reflex to culture be part of the standard work up for fever in an ICU patient with a urinary catheter?

Can non-16/18 HPV types cause ASCUS and squamous cervical metaplasia on biopsy within 3 months of acquisition, or would it take longer?

What is the preferred treatment regimen for cardiovascular syphilis, specifically syphilitic ostial coronary artery disease?

How do you approach biologic initiation in patients with inflammatory arthritis and repeatedly indeterminate Quantiferon?

5 Answers available

Given recent data for use of doxycycline as post-exposure STD prophylaxis, how have you applied its use in clinical practice?

How do you approach ongoing screening for TB in patients with a history of treated latent TB, but who have ongoing use of DMARDs and/or biologics given Quantiferon testing and PPD can remain positive?

How do you approach ongoing screening for TB in patients with history of treated latent TB, but have ongoing use of DMARDs and/or biologics given quan...

For patients on PrEP, is there a role for HIV RNA PCR screening in addition to 4th generation antigen/antibody testing?

Do you take into consideration a patient's serum albumin level in your decision to use ertapenem?

What is your approach to working up diarrhea in an immunocompromised patient?

Do you typically adjust or hold immunosuppression in a well-controlled RA patient who is being treated for Mycobacterium avium-intracellulare (MAI)?

What is your approach to starting antiretroviral therapy in a patient living with HIV who is diagnosed with cryptococcal meningitis?

What else do you consider in the differential diagnosis for pulmonary-renal syndromes if there is low clinical and serologic evidence of AAV, Goodpasture's or other rheumatologic disease (SLE, RA, APS, Scleroderma)?

Do you utilize post-vaccination IgG titers to detect common variable immunodeficiency in patients who are about to start or are actively on B cell depleting therapy?

For AML patients, when do you stop antiinfective agents?

At the time of count recovery or do you continue it throughout induction and consolidation?

When would you add a third antibacterial agent in addition to macrolide and ethambutol for treatment of a patient with HIV and disseminated MAC?

For how long do you treat an early spinal hardware infection secondary to MSSA after operative washout and retention of hardware?

Do you treat patients with HIV-AIDS and positive cryptococcal antigenemia but negative CSF cryptococcal antigen with standard meningitis treatment given the potential for the postzone effect?

When should vaccines be given if not received prior to the start of high dose radiation (40-50 Gy) to the spleen?

In a patient who is on oral DMARDs and has received 3 COVID boosters, but recently had COVID-19 infection, is bivalent booster still recommended 3 months later?

4 Answers available

How do you manage a patient with severe RA or SLE that worsens after stopping immunosuppressants due to having chronic foot ulceration?

Do you consider anti-viral prophylaxis in patients taking JAK inhibitors who have recurrent uncomplicated Zoster infection, but would prefer not changing therapy?

What is your approach to vaccinations and titers for patients with myeloma, who are immunosuppressed and do not have appropriate antibody responses to vaccines?

E.g., for a patient with myeloma, s/p induction therapy, and high-dose chemotherapy, followed by autologous rescue with inappropriate antibody respons...

What is your approach to determining the need for continued isolation in the dialysis unit for an ESKD patient who had a positive hepatitis B surface antigen one year ago but who now has a negative HbsAg in the absence of treatment?

What is the recommended treatment regimen for Mycoplasma genitalium in a pregnant woman?

Is there ever a role for the use of CMV immune globulin for treatment of CMV viremia and/or disease?

How do you approach immunosuppression in patients with a positive Interferon Gamma Release Assay and prior intravesicular BCG treatment for bladder cancer?

Assuming no symptoms of TB, should patients be treated for latent TB prior to starting TNF inhibitors or other immunosuppressive agents?

Do you treat Stenotrophomonas maltophilia bacteremia with combination therapy and if so, what is your preferred combination of antibacterials?

For how long do you treat uncomplicated CRE bacteremia in an immunocompetent patient?

Is history of GBS a contraindication for all future flu vaccines?

What is your approach to monitoring patients with the indeterminate form of Chagas disease?

Do you have a preference between Quantiferon Gold and T-spot TB for screening in patients starting immunosuppressive agents?

How do you approach a patient on anti-TNF with positive Quantiferon (previously negative) with negative chest x-ray and no symptoms?

Would you consider stepping down from an echinocandin to azole therapy prior to the end of an initial six-week course for fluconazole-susceptible Candida albicans endocarditis in the absence of valve surgery?

Do you use letermovir as CMV prophylaxis in solid organ transplant patients?

In patients taking biologics who are planning joint replacement and are known MRSA carriers do you perform decolonization prior to surgery?

Given recent data from the REPRIEVE trial, how will you adapt your practice with regards to prescribing statins to patients living with HIV?

How do you approach a well controlled HIV patient with diffuse cutaneous kaposi sarcoma who failed to respond to radiation, paclitaxel and monthly liposomal doxorubicin?

Does management of NMDA receptor encephalitis change in a patient with HIV/AIDS?

Would you anticoagulate a patient with splenic infarctions in the setting of CMV viremia?

If so, for how long?

Are there instances when you do not recommend tunneled dialysis catheter exchange in patients on hemodialysis who are found to have bacteremia?

How would you approach immunomodulatory treatment for systemic lupus associated protein losing enteropathy (PLE) in a patient whose clinical course has been complicated by significant infection?

Additionally, is it correct to assume that IV therapies might be preferred vs oral treatment given alterations in GI absorption in PLE?

Are there any non-beta-lactam antibiotic options for treatment of neurosyphilis in non-pregnant adults?

After a course of treatment for neurosyphilis, do you administer an additional IM dose of penicillin G one week after finishing the course of IV penicillin therapy?

How long do you continue surveillance with imaging and sputum cultures in a patient with NTM with no indications for treatment?

How would you approach the use of JAK inhibitors in a patient with stable RA who is now starting treatment for pulmonary MAC infection?

Patient previously failed abatacept and Rituximab.

What is the risk of serious bacterial infection in a febrile solid tumor patient who has not yet started cancer-directed therapy and has normal cell counts with no central line?

When would you consider percutaneous mechanical aspiration of vegetation in right-sided endocarditis?

What is the optimal timing for Zoster vaccine administration for a patient who recently recovered from herpes zoster infection and is now planning to start B-cell depletion therapy?

How do you approach management of patients with active RA and recurrent non-severe C.diff?

(Patient with active RA despite hydroxychloroquine)

How do you approach the workup for a patient with persistently elevated inflammatory markers (CRP and ESR) whose history and exam do not point to a clear cause?

4 Answers available

Do patients on eculizumab or ravulizumab require repeat vaccination against meningococcal infection after a certain interval?

What is the antifungal prophylaxis regimen that you use in patients on peritoneal dialysis who are receiving antibiotics?

What is your approach to BK hemorrhagic cystitis not responding to cidofovir?

How do you approach treatment of RA with methotrexate in a patient with treated Hepatitis C and normal liver function?

Do you recommend continuous antibiotic prophylaxis for patients on complement inhibitors such as eculizumab?

Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?

Would you consider prophylactic antifungal treatment prior to immunosuppressive therapies in a patient with previously treated pulmonary coccidiomycosis and residual parenchymal changes?

Do you ever stop tobramycin prophylaxis in a patient with chronic bronchiectasis previously colonized with pseudomonas?

Do you recommend IVIg and/or cytoreduction for patients with IgM MGUS with reciprocal depression in IgG and recurrent infections?

Infection is not part of the criteria for starting treatment both in UpToDate and in NCCN guidelines.

Do you hold IV iron in the setting of active infection?

Which medications have the lowest risk of tuberculosis reactivation in patients with uncertain tuberculosis history and active rheumatologic disease?

What is your approach to the treatment of PML-IRIS in patients with HIV who have progressed to AIDS?

How do you approach DMARD therapy in patients with rheumatoid arthritis and chronic hepatitis B?

Hepatitis screening labs revealing Hep B ag and core positivity with positive PCR

How do you approach the timing of COVID-19 vaccination for patients with multiple sclerosis on B-cell depleting therapies?

Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

Is there a role for regular hepatitis and TB screening in patients on chronic immunosuppressive therapy in the absence of new risk factors or exposures?

What infectious prophylaxis do you use for patients with newly diagnosed multiple myeloma?

How do you decide how long to continue?

How do you think about biologic use in patients with underlying HIV infection?

Do you hold tocilizumab for patients who are diagnosed with Covid and are with mild to moderate symptoms or non-hospitalized?

Is there a role for antibody testing to confirm vaccine response for patients on rituximab after COVID-19 vaccination?

When would you consider checking JC virus prior to initiating biologic therapy?

Do you routinely offer fungal prophylaxis for patients on BTK inhibitors?

Can experts comment on fungal pneumonia risk with individual BTK inhibitors as seen in ELEVATE-RR and whether this impacts their management decisions?

How are you timing the third dose of the COVID-19 mRNA vaccine in patients on rituximab?

How long would you treat with antimycobacterials before starting biologic DMARD in a patient with latent TB and active rheumatoid arthritis?

In which patients with oncologic or hematologic disorders are you recommending a 3rd dose of mRNA COVID vaccine?

How would you approach chronic isolated severe non-cyclic neutropenia with negative bone marrow and rheumatologic work-up?

Is there a role for empiric antibiotics if there is history of opportunistic infection?

How would you manage an active rheumatoid arthritis patient on suppressive antibiotic therapy for ocular HSV who has abnormal liver function tests?

Do you treat HIV/AIDS-associated CNS vasculitis with antiretrovirals alone or in combination with steroids?

How would you recommend dosing the MMR or other live vaccines for patients with rheumatoid arthritis on immunosuppressive medications such as anti-TNF alpha therapy?

For example, healthcare workers who require these vaccines for employment

How do you treat RA in patients with pulmonary mycobacterium avium complex (MAC) infections?

Are there particular concerns related to the use of B-cell depletion therapies such as rituximab for rheumatic disease during the COVID-19 pandemic?

How would you manage methotrexate therapy in an active rheumatoid arthritis patient undergoing treatment for latent TB with rifampin?

Do you stop methotrexate or adjust the dose?

When are you recommending bone marrow transplant recipients receive the SARS-CoV-2 vaccine?

Does your recommendation differ between autologous and allogeneic transplants? Does your recommendation differ in allogeneic transplant recipients wh...

How does a history of splenectomy alter how you counsel patients on the infection risk of TNF inhibitors or other biologics?

Are you recommending the mRNA COVID-19 vaccines to your patients with immune mediated inflammatory diseases?

5 Answers available

Which immunosuppressed patients with SLE would benefit from antibiotic prophylaxis to prevent pneumocystis pneumonia?

Would you hold all immunosuppressive medications for the first month of LTBI treatment, or just biologics?

How would you attempt to determine the etiology of intracranial hemorrhage in a patient with newly diagnosed lupus and an active viral infection?

Do you avoid any specific biologic therapies in HIV positive patients?

Should tuberculosis screening be performed before beginning methotrexate for treatment of rheumatoid arthritis?

In what situations do you check for HIV status in your workup for inflammatory arthritis?

What is your approach to dental prophylaxis for patients on biologics?

How do you manage patients who are Hepatitis B core antibody positive/surface antigen negative and starting a biologic DMARD (other than rituximab)?

During induction therapy for acute leukemia, when do you decide to discontinue the antimicrobial prophylaxis?

Is it at neutrophil recovery, at documentation of CR on bone marrow biopsy, or is there a different point in time?