Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
What duration of therapy do you recommend for patients with a vascular graft infection in which the graft has been removed and another graft placed in the infected space?
The duration of antibiotics would also depend on whether the patient had positive blood cultures. At the time that a new graft is placed, graft site cultures should be obtained. This is because the patient may have received antibiotics prior to the procedure for a period of time. It is helpful to ha...
What is current best practice with regards to antibacterial prophylaxis in patients with hematologic malignancy and resolved neutropenic fever (>72 hours)?
For patients with febrile neutropenia, recent literature has demonstrated that early de-escalation and discontinuation of antibiotics may be safe for some patients. Since ECIL guidelines have recommended modification of the initial regimen at 72-96 hours based on the patient's clinical course and mi...
Do you routinely check cefepime levels in patient's with suspected cefepime-induced neurotoxicity?
No. I would never get the result soon enough. I just change the antibiotic.
What antibiotic, antifungal and antiviral prophylaxis you give post CAR-T therapy, and what is the duration?
This is a critical issue as more patients are being treated with CAR-T cell therapy. My approach would be as follows: Antiviral PPx: I usually consider acyclovir PPx for at least 1 year Antifungal PPx: Consider fluconazole PPx for initial neutropenia if it is prolonged beyond a week ---> once the c...
How do you approach COVID-19 vaccination in those with a prior history of glomerular disease?
It is well documented that patients with kidney disease are at increased risk for morbidity and mortality from SARS-CoV2 infection including increased rates of hospitalization, AKI and death. Those with preexisting glomerular disease (GD) have demonstrated impaired GFR recovery following AKI in the ...
What is your preferred agent and duration to treat an epidural abscess due to azole-resistant candida species?
I would treat it like osteo, e.g., 9-12 months.
How long do you continue PJP prophylaxis in a patient with GPA who is able to wean steroids and remains only on rituximab for maintenance therapy?
Great question! For my ANCA patients and the OSU vasculitis clinic, we leave them all on Bactrim for the life of the disease. Less about PJP, and more about helping minimize infections due to the sinus and respiratory inflammation creating a nice environment for bacteria to live. Also, there is some...
What is your approach to starting antiretroviral therapy in a patient living with HIV who is diagnosed with cryptococcal meningitis?
For newly HIV-diagnosed persons with cryptococcal meningitis, the current guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV recommend deferral of ART initiation until after the first 4-6 weeks of cryptococcal meningitis treatment, due to findi...
Do you favor timely bronchoscopy for diagnostics over close surveillance in mildly symptomatic patients with CT findings suspicious for NTM infection who are not able to expectorate?
Yes, I do favor FOB to obtain BAL in symptomatic patients with suspected NTM.
What is your approach to recurrent asymptomatic bacteriuria in pregnancy for patients without personal history of recurrent UTIs or pyelonephritis?
There is a paucity of good data in this field. In my opinion: The data remain weak (after 70 years of study) that we should be screening for ASB in pregnancy in the first place (whether or not they have a history of recurrent UTI or pyelonephritis). However, guidelines generally agree that screenin...