Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Would you consider using long-acting injectable cabotegravir/rilpivirine for pregnant women with HIV?
At this time, long-acting injectable cabotegravir/rilpivirine (CAB/RPV) is not generally recommended during pregnancy due to limited safety data and unknown effects on the developing fetus. So far, there have not been any reported safety concerns regarding harm to the fetus for either long-acting in...
Do you recommend surveillance lumbar punctures for patients with Mollaret's meningitis after diagnosis or in between clinical episodes?
No. My focus with these patients is to establish the diagnosis, which is often difficult, with false-negative CSF PCR tests, and then do everything I can to prevent and alleviate the attacks. I see no role for surveillance LPs because either the patient is better clinically or they are not, and CSF ...
What factors should be prioritized when deciding the timing of CIED extraction in patients with high surgical risk or multiple comorbidities?
I'll do my best to respond, though the question isn’t entirely clear to me. If the intent is to determine which patients should be prioritized for CIED extraction, the key consideration is whether the benefits outweigh the risks. The most straightforward case is persistent bacteremia, especially in ...
Do you routinely consider FDG PET/CT imaging for workup of fever of unknown origin?
The landscape of FUO and IUO and our clinical approach to diagnosing its cause has changed significantly over the past several decades. More sensitive microbiologic screening for infectious etiologies, including syndromic molecular panels and next-generation sequencing are now clinically available a...
What is your approach to dental prophylaxis for patients on biologics?
My approach has been to not recommend antibiotics prior to routine dental care for patients on biologic therapy. I'm not aware of any compelling evidence or guidelines supporting preventive antibiotic treatment for such patients. Of course, there may be exceptions to this. Antibiotic prophylaxis mig...
What is your approach to anal pap screening among MSM with HIV, and if routinely recommend, starting at what age (assuming access to HRA)?
We taught our nurses and patients how to do self-collection, which cut down on the amount of time it takes. Multiple guidelines for HPV have been revised in the past few months based on more recent studies (although the emotional reaction to having multiple of my patients diagnosed with anal cancer ...
What agent and for how long would you treat a patient with asymptomatic azole-resistant C auris candiduria who is planning to undergo a urological procedure?
I would be cautious here. If there are reasonable MICs to fluconazole (SDD but achievable), this would be preferred. Intravesical amphotericin is a good option. But, if this were impossible to achieve, I would be reluctant to use IV amphotericin in any formulation, since there's a risk of harm, and ...
What is your preferred agent for fungal prophylaxis in a patient post lung transplant with abnormal LFTs?
Isavuconazonium tends to cause less elevations in LFTs.
How do you integrate next-generation sequencing with traditional culture methods to improve the identification of fungal pathogens, especially in cases where routine cultures are negative when evaluating suspected prosthetic joint infections?
To my knowledge, there is no evidence that molecular studies improve the detection of fungal pathogens in periprosthetic joint infections. The vast majority of fungal PJIs are caused by Candida species, while mold infections are rare and typically diagnosed through fungal cultures. If a PJI remains ...
Do you add gentamicin when treating prosthetic valve endocarditis secondary to viridans group Streptococcus with a penicillin-intermediate isolate (MIC >0.125 - <0.5)?
No, we do not treat patients with such infections with a combination of penicillin and gentamicin. For these infections, we treat with ceftriaxone alone. Monotherapy with ceftriaxone is a more reasonable option than a combination of penicillin and gentamicin because we have every reason to consider ...