Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
For a patient on appropriate treatment for invasive aspergillosis, how do you determine if and when it is acceptable to reintroduce a TNF inhibitor that likely contributed to their acquisition of the infection but is considered essential for control of their inflammatory condition?
There is no established answer to this question. The reintroduction of a TNF inhibitor must be individualized based on the clinical situation of the patient under consideration. There are two critical questions. First, how much does the patient need the inhibitor”? The more the patient is dependent ...
How do you approach PJP prophylaxis in patients with rheumatic disease on corticosteroids?
Here is a graphic I made covering PJP Prophylaxis with Dr. @Dr. First Last if anyone is interested! As noted, one can check absolute lymphocyte count (ALC) or CD4 count as factors to further risk stratify as well.
When do you consider adding steroids alongside intravenous antibiotics for patients with orbital cellulitis?
If the orbital cellulitis is infectious, I never add steroids. There is no literature or proof that they do anything, and decreasing immunity, in my opinion, is simply a bad idea. If it is inflammatory, then absolutely. Most infectious orbital cellulitis is from the sinuses and is more common in chi...
How do you manage patients from endemic areas who have positive Lyme serology with ocular abnormalities that are rarely reported in Lyme disease (optic neuropathy, disc edema, etc)?
In patients from Lyme-endemic areas, I try very hard not to let a positive serology become the diagnosis. A positive two-tier Lyme test tells me the patient has been exposed to Borrelia at some point; it does not necessarily tell me that Borrelia is responsible for the ocular findings in front of me...
Is there a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients?
There is no good-quality evidence supporting a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients. The efficacy of nitazoxanide in viral gastroenteritis is supported by a small manufacturer-sponsored randomized, double-blind trial in non-immunocompromised ...
In a patient with multiple organ abscesses, no known predisposing factors, negative genetic panel testing for CGD and normal oxidative burst, what other testing modalities should be considered?
I would work the patient up for CVID. Also, I would find all the culture and sensitivity results to ensure it’s not MRSA. Also, culture results may open the door to other etiologies.
Do you have any concerns about using long-acting cabotegravir/rilpivirine in obese patients with HIV?
There have been concerns raised about adequate drug levels being maintained in patients with high BMI. One concern is that injections may be deposited in subcutaneous rather than intramuscular tissue. A recent computer modeling study also indicated subtherapeutic drug levels in patients with BMI >40...
Do you routinely transition to PO antibiotics for patients with native joint septic arthritis whom have undergone washout and the organism is not S. aureus?
Yes. Even if the organism is Staph aureus, I would feel comfortable with an appropriate, highly bioavailable oral antibiotics after appropriate source control (linezolid in the case of Staph aureus).
Do you manage antibacterials for enterococcal bacteremia differently in patients with severe immunosuppression?
No.
In what situations do you recommend secondary prophylaxis for Nocardia after completion of treatment?
I do not recommend routine secondary prophylaxis after completion of treatment for Nocardia infection. While recurrence can occur, particularly in immunocompromised individuals (organ transplant patients), outcomes with repeat treatment are generally favorable. More importantly, there is no strong e...