Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Do you recommend treatment of male partners for patients with recurrent bacterial vaginosis?
I would personally recommend treatment of male partners in females with recurrent bacterial vaginosis (BV). Recent data are pretty compelling that this is effective. See here:Vodstrcil et al., PMID 40043236In the group that had their male partners treated, BV recurrence occurred in 35% compared to 6...
Do you recommend procalcitonin to help convince other providers to stop antibiotics in patients with pneumonia in whom a non-infectious diagnosis is strongly suspected?
I have looked at both of these studies in some depth. The de Jong et al., study, called SAPS, is perhaps the more impressive of the two, but regarding either or any study on so-called "biomarkers", even the RCT studies only make recommendations or give advice. And, more often than not, the doctors d...
Do you give chronic antibiotic prophylaxis for recurrent UTIs, including Pseudomonas aeruginosa, in a patient with retained ureteral stents?
If the "recurrent UTIs" are symptomatic (fever is what I would be mostly concerned about), then the stents should be changed as feasible, (I assume this has been done) and the UTIs treated as appropriate. If the UTIs continue after the change, I would just try to treat the symptomatic events as best...
How do you or your practice manage young, average-risk patients without structural lung disease referred to you or self-referred for concern of environmental mold exposure?
These individuals are generally managed by pulmonology and allergy/immunology clinics because the clinical presentation is generally more aligned with allergy-type symptoms like a chronic cough, congestion, or other symptoms associated with airway irritation. In individuals who are receiving chronic...
Would you still consider adding clindamycin for streptococcal toxic shock syndrome in situations where the isolate is considered to be resistant?
I would not use clindamycin as clindamycin works by decreasing protein production specifically by binding to 50 S ribosomal subunit and disrupting the translation process. If I'm dealing with a toxin mediated pathology such as toxic shock, I prefer using linezolid.
What patient factors influence your decision between prescribing oral pre-exposure prophylaxis and long-acting injectable PrEP for HIV prevention?
First of all, is the patient generally compliant? Most of the time we use oral, once-daily agents for PrEP, but we do have some individuals on every-2-month injectable Cabenuva now. We do not have anyone on every-6-month lenacapavir, since the VA does not offer it. Have a discussion with the patient...
How have you incorporated sulopenem etzadroxil into your antibiotic stewardship protocols, particularly for managing uncomplicated UTIs with resistant Enterobacterales organisms?
We have not incorporated sulopenem rtzadroxil into our stewardship protocols. In fact, when I contacted our pharmacy leadership about this, they did not think the drug was available.
Would you avoid using cephalosporins in a patient with a history of cephalosporin neurotoxicity in the setting of CKD?
In elderly patients with underlying CNS disease, renal dysfunction and prior history of cephalosporin neurotoxicity, I would avoid the use of Cephalosporin therapy if possible. If there are not other alternatives, I would strive to give the lowest possible therapeutic dose of the antibiotic to dimin...
Would you treat Scedosporium growth in expectorated sputum in a patient with COPD, pulmonary hypertension, and bronchiectasis, who has chronic dyspnea with exertion, thick sputum production, negative bacterial cultures, and no signs of mold infection on a high resolution CT scan, with no other clinical symptoms of infection?
In persons with bronchiectasis, almost anything that grows can be a pathogen, but it is tough to know. If the patient has COPD and no other immunocompromising conditions, I would not expect typical invasive fungal infection findings. Having said that, scedosporium is not the first common pathogen th...
Given recent data from the REPRIEVE trial, how will you adapt your practice with regards to prescribing statins to patients living with HIV?
This randomized controlled trial (Randomized Trial to Prevent Vascular Events) found that, for people living with HIV between the ages of 40 and 75 years who were taking pitavastatin calcium, the risk of major adverse cardiovascular events was lowered by 35% and the risk of cardiovascular death was ...