Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Do you recommend lifelong antibiotic prophylaxis, or do you prefer a more selective approach based on risk factors in asplenic patients without a history of severe infections?
The advice is limited by the fact that there are no randomized controlled trials in adults on daily antibiotic prophylaxis post-splenectomy. There are trials in children with sickle-cell disease that do show a benefit, but it is not clear that these can be extrapolated to splenectomized adults. Furt...
For which patients could you consider direct oral amoxicillin challenge as opposed to skin testing for penicillin allergy de-labeling?
If a patient can be identified as low-risk by history they should be considered for either historical removal of the label of direct oral challenge. If the history is not compatible with allergy (e.g. they have a family history or have tolerated another drug like Augmentin), historical de-labeling i...
Do you use combination antibiotic therapy for treatment of bacterial endocarditis due to gram-negative bacilli?
The approach towards different might differ depending on whether the culprit organism belongs to the HACEK group or the nonHACEK group. The mortality rates per literature were approximately 2% for HACEK and 20-30% for the nonHACEK group. Combination therapy is usually not recommended for HACEK endoc...
Do you recommend routine ophthalmologic exam for all patients with hypervirulent Klebsiella pneumoniae bacteremia?
The incidence of endogenous endophthalmitis due to Klebsiella bacteremia, especially due to hypervirulent K. pneumoniae strains, has been increasing. Klebsiella endophthalmitis is associated with poor visual outcomes Several studies, primarily from Asia, have described risk factors for developing en...
Do you routinely recommend doxycycline for pregnant individuals with rickettsial diseases despite the historical concern for side effects in pregnancy?
It has been known for years that short courses (<3 weeks) of doxycycline are safe in pregnancy and in young children. This article just reinforces the recommendations. Rickettsial diseases have significant morbidity and mortality and should be treated with the best (and best proven) antimicrobial. T...
What is your approach to monitoring patients with the indeterminate form of Chagas disease?
Once the diagnosis of Chagas is confirmed (by at least two different serological tests), we routinely evaluate the patient for symptoms or signs of cardiac or GI complications. We also obtain an EKG with 30-second rhythm strip and schedule a transthoracic echocardiogram with contrast (because some p...
Do you usually recommend a modified diet for Clostridioides difficile infection (CDI)?
Post-infection IBS is common after C. diff infection, and some of these patients have dietary intolerances. Other than avoiding foods that exacerbate these symptoms, I do not recommend any particular diet. I also do not recommend probiotics, in keeping with society guidelines.
For patients with candida species osteomyelitis who have undergone extensive surgical debridement, do you routinely still recommend 6-12 months of antifungal therapy or opt for a shorter duration?
After removal of hardware, if present, and debridement of infected bone, my practice is to treat Candida osteomyelitis with an intravenous echinocandin for two weeks followed an oral azole, to which the fungus is susceptible, for at least six months. If full debridement is not possible, such as vert...
What infections should we rule out in patients who develop diarrhea on immunotherapy?
Immunotherapy is known to be associated with immune-mediated diarrhea and colitis (IMDC). However, it remains unclear whether cancer patients undergoing immunotherapy are at a heightened risk for Clostridioides difficile colitis infection (CDI). A retrospective study focusing on patients treated wit...
What antibiotics would you use for empiric treatment of a brain abscess in patients allergic to penicillin, metronidazole, and vancomycin?
Linezolid/Bactrim/Ceftaroline?