Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Have the growing reports about doxycycline resistance in gonorrhea isolates from patients prescribed doxy PEP for prevention of bacterial STIs influenced your use of doxycycline for this indication?
No, they have not. For 2-3 decades, the prevalence of tetracycline resistance in N. gonorrhoeae worldwide, including the US and Western Europe, has been too high to rely on doxycycline or other tetracyclines in treating gonorrhea. The rise in prevalence of tetracycline resistance in MSM, the main po...
How do you decide on supportive care vs empiric antibiotics in a patient with suspected aspiration pneumonitis (i.e., witnessed macroaspiration event within the past 24 hours) but with features that could suggest pneumonia (e.g., acute respiratory distress, fever, leukocytosis, pulmonary infiltrates, etc.)?
Great question and one that comes up all the time for me. As the patient has more signs of true infection, such as those you mention with fever, leukocytosis, and respiratory distress, I am much more likely to start antibiotics. If the patient just has chest radiograph findings of opacities and some...
How long do you typically treat mixed infections involving Actinomyces such as empyema or abdominal abscesses when adequate source control has been achieved?
In cases like this, shorter course of treatment can be given. In a case where there is no concern for residual mass, invasive disease or fistulous disease, treatment can be anywhere from 2 to 6 weeks. I would generally recommend at least 3 weeks for an empyema with Actinomyces as the cause provided ...
What is your preferred first-line treatment for chronic fatigue in patients with long COVID-19?
Assuming that a thorough workup for other causes of fatigue (anemia, thyroid dysfunction, sleep apnea, etc.) has been performed and is negative, no single medication has been proven by a randomized placebo-controlled trial to help chronic fatigue in PASC. Anecdotally, my colleagues who treat PASC ha...
How would you treat an asymptomatic patient with a positive Blastomyces antibody, evidence of prior granulomatous lung disease on imaging, and who may require immunosuppression in the future?
We practice in an area with a good bit of blastomycosis and rarely see a positive Blastomyces antibody, even in patients with culture-proven blastomycosis. The newer EIA antibody that MiraVista lab is doing may be more reliable. If the prior granulomatous lung disease has been worked up with negativ...
What are your top takeaways from IDWeek 2025?
The professional ID community is still strongly interested in the power of vaccines to prevent infectious diseases and improve the health of the world. New anti-fungal agents show promise for treating difficult mold infections Changing climate and increased mobility are shifting the traditional geo...
How do you manage gram-negative bacteremia in a patient with an aortic bypass graft, for whom there is low clinical suspicion for active graft infection?
This is a very nuanced question, and thus, there is no perfect answer. If there is low suspicion for graft infection and the bacteria is not commonly associated with biofilms (like a simple E. coli) and the bacteremia clears quickly, I would likely treat for a couple of weeks and monitor (and even c...
How do you decide on the timing and number of blood cultures for suspected endocarditis given the differences in recommendations between the ESC guidelines and the Duke Criteria?
Concern about differences in recommendations regarding specifics of blood culture collection between the two guidelines should be alleviated if one understands that these are guidelines, not dictates. It would help to lay out general principles. First, the focus of infection in infective endocarditi...
What is your typical duration and route of treatment for a lytic lesion in the metaphysis of a long bone secondary to MSSA, i.e., a Brodie abscess, following debridement in an immunocompetent patient?
For native bone osteomyelitis (including Brodie abscess) with residual infected bone after debridement, antibiotic therapy is usually recommended for 6 weeks from the date of last debridement. Data suggest that a duration of antibiotic therapy beyond 6 weeks is usually unnecessary if necrotic bone a...
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...