Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
What steps do you take to ensure that partners of patients diagnosed with chlamydia receive treatment?
This is an important question. A lot of "re-infections" occur because partners aren't treated.In my clinical practice, and from a public health perspective, we really try to get the partner(s) into *our clinic* to get treated. We have a walk-in STI program and try our best to get the patient to tell...
How do you approach a persistently positive Mycoplasma genitalium cervical swab PCR in a patient who has undergone multiple courses of the standard CDC-recommended therapy but continues to experience pelvic symptoms and vaginal discharge?
This is a tough one. The first question is whether M. genitalium is in fact the cause of the problem. The second is what "pelvic symptoms" she has. Is a gynecologist involved? If suspicious for PID -- e.g., adnexal and/or uterine tenderness on bimanual exam -- the diagnosis should be confirmed at le...
In patients with possible Bartonella henselae infection and elevated IgG titer, what is the best way to confirm the diagnosis: tissue biopsy with Warthin-Starry staining, tissue sent for Bartonella henselae PCR, or tissue sent for culture?
First of all, it is important to only test people with a compatible clinical syndrome. If the syndrome is not that of babesia, then any positive tests are likely to be false positives. This is a basic testing principle. A very low pretest probability is likely to lead to false positive testing. The ...
How would you recommend dosing the MMR or other live vaccines for patients with rheumatoid arthritis on immunosuppressive medications such as DMARDs and anti-TNF alpha therapy?
It is rarely necessary for any live virus vaccine to be mandatory as most employers will accept waiver letters, as will most countries requiring yellow fever vaccination to enter. The risk of disease exposure, illness must be balanced against disease flare holding therapy. Fortunately, with the adve...
Do you routinely treat chronic sacral osteomyelitis when there is no plan for debridement or flap?
I would treat acute febrile cellulitis with a relatively brief course of antibiotics but not with a long course of IV antibiotics attempting to cure osteomyelitis, if surgical debridement is not performed.
What is your approach to management of CIED in a patient with community-acquired Staph aureus bacteremia who clears blood cultures quickly with negative follow up blood cultures within 72 hours of antimicrobial therapy and negative TEE?
The recent 2023 guidelines on AHS CIEDI defined definite CIED infection as 2 or more sets of blood cultures positive for staph aureus or CoNS + (positive TEE and/Or positive PET/CT). The guidelines stated that the organism isolated from blood cultures determines the likelihood of CIEDI, and coagulas...
What is your approach to duration of systemic antibiotics for treatment of isolated bacterial endophthalmitis in the absence of bacteremia or other deep-seated metastatic foci of infection?
Post-surgical (exogenous) endophthalmitis is an uncommon complication. The incidence ranges from 0.04%-0.3%, 0.019%- 0.54%, and 0.11% - 0.03% following cataract surgery, intravitreal injection, and vitrectomy, respectively (Soliman et al., PMID 32467482). Initial management of exogenous endophthalmi...
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...