Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Do you treat complicated pneumonia with a drained empyema longer if Streptococcus anginosus is cultured, either in isolation or with other organisms, compared to cases in which it is not?
Targeted antimicrobial therapy for any bacterial etiology of an empyema will be individualized for each patient but a general duration of 4-6 weeks. I would not consider strep anginosus differently in this regard. What I am looking for is adequacy of drainage with clinical improvement. Radiographic ...
When would you consider glucocorticoids as adjunctive therapy for for community-acquired pneumonia outside of the ICU setting?
Thank you for bringing this new study to my attention; I hadn't seen it yet. After reviewing the article, my practice regarding steroids remains unchanged. While the trial was well-executed, and it is laudable to see such research coming out of a limited-resource setting, that environment differs si...
What specific criteria or patient conditions would make you hesitant to use fluoroquinolones early in the treatment course for managing MSSA joint infections with oral antibiotics?
For MSSA joint infections, I have moved away from using FQ to using high-dose cephalosporins as a step-down therapy, particularly cefadroxil 1 g twice daily, given less frequent dosing/increased adherence. Considering the risk-benefit analysis, I prefer using FQ as an oral option in polymicrobial an...
How would you approach treatment of latent TB for patients who cannot tolerate rifamycins or isoniazid due to allergy, intolerance, or drug-drug interactions?
Levofloxacin or moxifloxacin. Duration is 6-9 months.
Do you use an antibiotic with antitoxin activity for the entire duration of therapy for patients with necrotizing MSSA or MRSA pneumonia or just until definitive clinical improvement?
I misread the question. I assumed a necrotizing S. aureus infection meant a necrotizing skin and soft-tissue infection. I’m not sure how “necrotizing pneumonia” is being defined here. Regarding MRSA pneumonia with toxin-mediated tissue injury, there are data suggesting that linezolid may yield bette...
How do you weigh the risk of urinary catheter or fecal management system placement with that of soiling sacral wounds?
This question is an important question that arises for many of our bed-bound and poorly mobile patients, as sacral wounds commonly develop due to pressure injury. They become very challenging to treat due to fecal and urinary contamination, which can lead to further infection. Fecal and urinary dive...
How do people approach non-HIV patients with hepatitis B, a negative Hepatitis B E antigen, normal LFTs and relatively low HBV DNA between 2000-20000?
Treatment of chronic Hep B is recommended to prevent maternal-fetal transmission, reactivation during chemotherapy, recurrence after liver transplantation, and in patients with decompensated cirrhosis. Treatment has been shown to reverse fibrosis and cirrhosis. Specifically referring to the above sc...
Would you recommend empiric coverage for vancomycin-resistance enterococcus in an unstable patient with sepsis, multiple comorbidities, and a recent ICU stay in a high VRE prevalence unit, despite recent cultures without growth of VRE?
I would go back to the assessment of community onset vs hospital onset as to when the sepsis is "setting in." If patient is coming from the community, hasn't had antibiotics in the last 90 days, hospitalized in the last 90 days, has no positive microbiology for VRE in the last year, then no, I would...
Do you routinely prescribe linezolid to patients who are concomitantly on methadone?
There are a few ways to interpret this question: Potential for serotonin syndrome with possible interaction between methadone and linezolid. Potential for further QTc prolongation with the addition of linezolid to methadone. Whether empiric oral antibiotics (when IV antibiotics could be used) are ...
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.