Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
How would you manage a patient with strongly suspected Lyme arthritis and negative bacterial synovial fluid cultures who was started on empiric antibiotics against typical bacterial pathogens arthritis before arthrocentesis and collection of cultures?
In a patient with a high clinical suspicion for Lyme arthritis who has negative synovial fluid bacterial cultures after receiving empiric antibiotics for presumed septic arthritis, management should be guided by clinical probability rather than the culture results. Antibiotics given before arthrocen...
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 treat diabetic foot osteomyelitis without surgical resection with a fixed 6-week antibiotic course, or do you shorten duration based on clinical and inflammatory marker response?
The real key factor in successfully treating diabetic foot infections is adequate debridement (and sometimes amputation, like TMA) in the setting of infected bone. We have excellent Podiatrists at our County Hospital and VA, and foot/ankle and vascular surgeons at our University Hospital. You can't ...
How long do you treat Staphylococcus aureus pyomyositis with antibiotics?
I agree, and certainly evaluating for bacteremia that can be associated with these types of infections, which would alter the duration of therapy.
What is your approach to symptom management in patients with infectious diarrhea?
When it comes to infectious diarrhea, I would consider a short course of loperamide for symptomatic relief, provided that my suspicion for C. diff colitis and/or dysentery is low. Antimotility agents in the setting of toxin-producing infectious diarrhea can increase the risk of toxic megacolon (in C...
How do you typically manage a patient with a single positive blood culture from two sets growing Candida species in a stable patient without prosthetic devices or material?
Candidemia is defined as the presence of Candida species in the blood, and even a single positive blood culture specimen is considered significant and warrants treatment as candidemia. Initial management should include: Initiating antifungal therapy with an echinochandin (micafungin, capsofungin, o...
What is your approach to management of patients with recurrent orolabial herpes?
Recurrent orolabial herpes is fundamentally a disease of viral latency with episodic reactivation, so my approach focuses less on “treating infection” and more on reducing recurrence burden, shortening symptom duration, and improving quality of life. First, I make sure we are actually dealing with H...
What, if any, oral or IV antibiotic suppression options would you consider for a patient with a history of recurrent fluoroquinolone- and TMP-SMX-resistant ESBL E. coli bacteremia with relapsed ESBL E. coli lumbar spinal hardware infection who previously underwent lumbar I&D with hardware retention and is not a candidate for further surgery?
This is a challenging case and difficult to answer definitively without additional details, particularly the full antibiogram and patient context. In general, while suppressive antibiotics are sometimes used when infected hardware is retained, and further source control is not possible, this is alwa...
What is your approach to iron supplementation in patients with an active infection?
In patients with active infections, I generally avoid intravenous iron due to the potential for promoting pathogen growth, a practice supported by cautions from nephrology and gastroenterology society guidelines. However, evidence for the risk of infection with IV iron is inconsistent, underpowered,...
Do you add an adjunctive echinocandin in patients with Pneumocystis?
Though there is emerging literature suggesting that echinocandins may have a role in treating PJP, the dose has not been defined, and TMP-SMX remains the first-line agent.