Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
How do you approach using fecal microbiota therapy for recurrent Clostridioides difficile infection in immunocompromised patients?
We generally do not do the single donor FMT via colonoscopy, that was popular 5-10 years ago. We do offer both the oral and enema-based products, with a slight preference for the oral-based product due to ease of use.
How do you manage resistant infections that persist after stopping antibiotic therapy in patients with non-CF bronchiectasis?
In patients with non-CF bronchiectasis who continue to have infections after completing antibiotics, I first obtain repeat sputum cultures to identify the organism and check for any resistance patterns. I also review adherence to airway clearance techniques, as inadequate mucus clearance often contr...
Do you routinely observe inpatients for 24 hours after transitioning from IV empiric antibiotics to an oral regimen prior to discharge when the source of infection is unclear?
To be sure, this is a big question with much nuance and should be broken down into component parts. To begin with, the lack of a source is not, in and of itself, a clear justification for continued hospitalization. What should drive the decision for discharge is established clinical stability and an...
Do you administer empiric ivermectin simultaneously with urgent high-dose corticosteroids in a patient from a strongyloides-endemic region who requires immediate immunosuppression and has no prior screening?
Yes.
Under what circumstances would you consider treating uncomplicated gonorrhea with zoliflodacin instead of the standard treatment regimen with ceftriaxone and azithromycin?
The standard advice (CDC and its various counterpart agencies in other countries) no longer includes azithromycin; ceftriaxone 500 mg alone is advised as routine treatment for uncomplicated (genital, anorectal, pharyngeal) gonorrhea. If chlamydial infection is present or likely, doxycycline 100 mg P...
Do you routinely discontinue atypical coverage in community-acquired pneumonia when PCR testing (i.e., respiratory pathogen panel) is negative for atypical organisms?
In community-acquired pneumonia (CAP), here is how I approach the decision to discontinue atypical coverage (e.g., azithromycin or doxycycline) when respiratory pathogen panel PCR testing is negative for atypical organisms (most commonly, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneum...
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...
Do you consider holding PPIs in patients hospitalized with infections like pneumonia or C. diff colitis?
My practice is to try to get patients off PPIs if at all possible, and the hospital can be a good time to have that conversation with them. This is assuming no active indication for them (recent ulcer/upper GI bleed, H.pylori therapy, etc.) Use of PPIs has been associated with a higher incidence of ...
How do you manage increasing EBV viremia of 15,000 copies in a seropositive heart transplant recipient with transplant performed 15 years ago in a patient who is otherwise asymptomatic?
This begs the question as to why it was checked. Without knowing that, the answer is difficult. If the patient is truly asymptomatic, then perhaps this can be ignored. Current immunosuppression would also be relevant; for example, if there was recent rejection or a change in immunosuppressant medica...
What duration of antibiotic therapy do you use for a loculated parapneumonic effusion that does not meet criteria for empyema?
It would be great to see more prospective research in this area. I think we should be a bit more nuanced in our approach as it seems to be crude to recommend 4 to 6 weeks of IV antibiotics for every parapneumonic effusion or complicated pleural space. I think that in melding the IDSA and American As...