Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
How long do you continue empiric anaerobic coverage for brain abscesses originating from sinus or tooth infection following surgical drainage?
Since anaerobes can be difficult to culture and are certainly associated with this type of infection, I would recommend continuing anaerobic coverage along with targeted therapy for any positive cultures. Anaerobic pathogens are often seen in conjunction with other pathogens. In a study looking at 3...
Would you offer live vaccines (e.g., MMRV/measles) to patients on bispecific antibodies for multiple myeloma?
I agree with the answer here by Dr. @Dr. First Last. There are a lot of nuances, though. In regard to giving the vaccine safely and effectively, the best strategy is not to wait until patients have multiple relapses and are on bispecific therapy to vaccinate. Given the recent outbreaks of measles, i...
Do you perform routine screening for latent tuberculosis in a patient who resides in the United States, has frequent, 1-2 week trips to see family in a highly endemic country, but who otherwise has no significant risk factors or high risk exposure activities?
Absolutely. I perform annual screening on persons with the described exposures. The screen is fast, safe, and easy for the patient. A goal is to eliminate all new cases of tuberculosis in this country. To accomplish this, we must identify all potential cases and treat them accordingly.
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?
MMR titers are good correlates of protection. If any titer is undetectable it could be one of these situations: Primary failure. The components of the MMR have different efficacy. Two doses of appropriately given MMR will have 96+% against measles, but only 88% for mumps. Thus 1 in 10 appropriately...
Would you consider levofloxacin graded challenge, extended IV aztreonam, or an alternative treatment in a patient with reported anaphylaxis to penicillin, fluoroquinolones, and cefuroxime with cavitary pneumonia secondary to Klebsiella and Pseudomonas?
The first and most important thing would be to establish whether the patient had a true penicillin (as well as other antibiotic) allergy since >90% of patients who think they are sensitive to PNC really are not. If it is established that the patient does have a PCN allergy, consultation with ID is a...
Do you recommend boric acid for patients with recurrent candida vulvovaginitis?
Yes, this will be effective at 600 mg bid for 2-4 weeks. However, with recurrence, it is important to obtain a fungal culture to document species and susceptibility.
How would you manage a patient with well-controlled HIV on Biktarvy, who is interested in switching to injectable HAART but also has a history of a prior Hepatitis B Infection?
HBV is a common co-infection in people with HIV (PWH), due to shared transmission routes. Two large meta-analyses of studies published found a global a pooled prevalence of HBV infection among PWH to be between 7.6 and 8.4%, with a higher prevalence in less developed countries (10.4%) compared to mo...
Is there a specific criteria that you use to determine if a patient with respiratory symptoms should have a multiplex respiratory test performed?
If the patient is being admitted to the hospital, the information provided by this test can be useful with regards to antimicrobial stewardship (potentially avoiding antibiotic therapy or targeting it) and also with regards to infection control precautions. For outpatient scenarios, if respiratory s...
Do you routinely test for toxoplasmosis during workup of fever of unknown origin in an immunocompetent patient with significant cat exposure?
Not with evidence of scratches and/or lypmpadnopathy, which can be very impressive.Tangentially, what definition of FUO is being used?SMS
When do you consider PET/CT to evaluate for an occult source of infection in patients with persistent bacteremia if TTE/TEE does not show evidence of endocarditis?
Great question. Generally, I consider PET/CT to evaluate for an occult source of infection in patients with persistent bacteremia if TTE/TEE does not show evidence of endocarditis, in the following scenarios: Persistent bacteremia ≥72 hours. TEE was negative or nondiagnostic. No source identified o...