Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
What factors should guide the choice between fosfomycin and nitrofurantoin for uncomplicated cystitis, given the reduced efficacy of fosfomycin?
I agree with the authors you reference that, though fosfomycin is listed as a first-line option in the 2011 IDSA UTI guidelines for uncomplicated cystitis, our assessment of its efficacy has changed somewhat since then.We now have two larger randomized controlled trials that demonstrate that women r...
Do you regularly recommend an immunological workup for patients with suspected immunodeficiency or defer to immunology?
I defer after a very preliminary work-up based on the type of immunodeficiency expected. I try to direct the consult to a provider most likely to have expertise in the problem I suspect. Often, I suggest consulting with a provider at NIH.
Would you recommend treating asymptomatic bacteriuria in a kidney transplant patient who has a ureteral stent in place?
An exercise in futility. You can eradicate for a short period - long enough to safely perform a urologic procedure. But longer term? Fugetaboutit.
Do you recommend to continue acyclovir to prevent HSV infection in an HIV patient with CD4 count more than 200 and with high viral load?
The intent of this question isn't clear. Are you considering treatment of a person to prevent acquisition of HSV? Or to prevent transmission by an infected patient? The wording sort of implies the latter, so that scenario first. There are no data that document efficacy of antiherpetic therapy (acycl...
When do you discontinue contact precautions in patients known to be colonized with ESBL-producing Enterobacterales?
There is no widely accepted guideline regarding the timing of discontinuation of isolation for ESBL-producing organisms. However, according to the article “Duration of Contact Precautions for Acute-Care Settings” published by ICHE in 2018, Maintaining contact precautions for ESBL-E and CRE for the d...
Do you ever stop tobramycin prophylaxis in a patient with chronic bronchiectasis previously colonized with pseudomonas?
Yes, I will often stop tobramycin if there are issues with tolerance, antibiotic resistance, or treatment fatigue. Further, in more mild bronchiectasis (cylindrical vs. varicoid or cystic morphologies), sputum bacterial cultures will negatively convert on chronic cycled inhaled tobramycin, and this ...
Can non-16/18 HPV types cause ASCUS and squamous cervical metaplasia on biopsy within 3 months of acquisition, or would it take longer?
It isn't clear that HPV causes ASCUS. I'm not sure how to interpret "squamous metaplasia" as opposed to dysplasia, but certainly many HPV types other than 16 and 18 cause cervical dysplasia, and probably can do so within 3 months of acquisition. However, I would be cautious in telling a patient that...
Would you consider antifungal prophylaxis for immunocompromised patients with COVID-19 requiring mechanical ventilation, considering the high risk of invasive pulmonary aspergillosis in patients with severe COVID-19?
I don't universally add anti-mold prophylaxis in all immunocompromised patients with severe COVID-19 requiring intubation, but I am always considering it. Factors that might push me to add would be: positive fungal markers (Beta-D-Glucan or galactomannan) on BAL or blood at time of intubation, use o...
Do you treat Stenotrophomonas maltophilia bacteremia with combination therapy and if so, what is your preferred combination of antibacterials?
Yes, I would use two agents, at least up front, as recommended in the 2024 IDSA guidelines (Tamma et al, PMID 39108079). The guidelines suggest two of the following agents should be used, unless the combination of ceftazidime-avibactam plus aztreonam is used instead: cefiderocol, TMP/SMX, levofloxac...
In light of recent measles outbreaks, have you adjusted your vaccination counseling or preventive strategies for adult immunocompromised patients?
Check measles antibody (once) in individuals working in public places, especially when working with kids.