Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
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?
Do you recommend antibiotic prophylaxis for an ESKD patient with a tunneled dialysis catheter who is planned for a dental procedure?
I do not. Which procedures require antibiotic prophylaxis has always been a very confusing issue for me. It also seems to change often. However, with dental procedures, the main organism responsible for bacteremia is streptococcus of viridans group which is an unlikely cause of line infection. I thi...
Would you consider prophylactic antifungal treatment prior to immunosuppressive therapies in a patient with previously treated pulmonary coccidiomycosis and residual parenchymal changes?
If the pulmonary coccidiomycosis was treated in the past, I would not necessarily prescribe prophylaxis, but that also depends on the meaning of "residual parenchymal changes.” If you’re referring to post-inflammatory fibrotic changes, then prophylaxis likely is unnecessary. If you’re referring to c...
Do you routinely recommend suppressive antibiotic therapy for patients with spinal hardware infections who have undergone surgical debridement with retention of hardware?
Executive Summary: "State-of-the-Art Review: Diagnosis and Management of Spinal Implant Infections" was published in Clinical Infectious Diseases, December 15, 2024 issue, by Tai and colleagues from the University of Minnesota, Mayo Clinic, Hospital for Special Surgery (New York) and the University ...
What is your approach to treatment of patients with fulminant C difficile infection who required ileostomy creation or colectomy?
Great question. If the entire colon has been removed, I do not see a role for oral vancomycin.