Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
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.
For patients with spinal hardware infections, in what circumstances do you recommend 12 weeks over 6 weeks of antimicrobial therapy?
Extrapolating from PJI data, I tend to treat longer, but not always IV if there is an oral option after initial IV therapy. A big blurry line is when do oral antibiotics stop being for treatment and start being suppressive? Anyone I'm considering for long term suppressive antibiotics, really gets a ...
What are your top takeaways from ID Week 2024?
I thought there were a number of talks highlighting both the progress we’ve made and the needed areas of improvement in respiratory viruses. Some particularly good talks were by Barney Graham (Plotkin lecture), a talk on H5N1 by Timothy Uyeki (Enders lecture), a talk by Fiona Havers (from CDC), and ...
Would you consider stepping down from an echinocandin to azole therapy prior to the end of an initial six-week course for fluconazole-susceptible Candida albicans endocarditis in the absence of valve surgery?
I would not step down to fluconazole prior to completing a six-week course of echinocandin therapy. Fluconazole has poor activity against Candida biofilms in contrast to the echinocandins. Fluconazole monotherapy has also been associated with poor outcomes in endocarditis. Admittedly, most of our un...
Is there a role for chronic suppressive oral or inhaled therapy for recurrent Burkholderia cepacia pneumonia causing frequent hospitalizations in a patient with severe bronchiectasis with or without underlying cystic fibrosis?
In certain cases, certainly, suppression may be the optimal role but in conjunction with modification to the immunosuppression. Generally, the immunosuppression will need to be lowered to allow for cellular immunity to combat the infection. Other factors include whether the gemovar is a more aggress...
How do you use CD4% in clinical practice in management of patients living with HIV?
Perhaps a slightly different perspective: The CD4 percentage is invaluable in specific scenarios. Since the absolute CD4 count depends on the total WBC count and the lymphocyte percentage, the CD4 count can vary widely based on context, while the CD4 percentage is typically the more stable and relia...
What additional treatment strategies would you recommend for a patient with a Mycobacterium chelonae and Mycobacterium abscessus infection following bilateral prophylactic mastectomies and implant insertion, who has undergone multiple surgeries and an extended course of IV antibiotics selected based on sensitivities?
I assume the implants have been removed. I have had no success trying to treat with retention of the implants (because the patients all want a trial of antibiotics first at the suggestion of the surgeon). If the implants are out, all you can do is continue long courses of antibiotics based on sensit...
What is your approach to vaccinations and titers for patients with myeloma, who are immunosuppressed and do not have appropriate antibody responses to vaccines?
It depends on the vaccine and prior immunization history. Not all vaccines require an antibody response to be at least partially efficacious. In addition, with any immunocompromised host, reduced effectiveness for all vaccines is expected, but is not a reason to not vaccinate. Serologic testing is h...
Have you incorporated the use of linezolid in lieu of vancomycin plus clindamycin for empiric treatment of necrotizing fasciitis?
Clindamycin (with beta-lactam) vs linezolid use debate exists for severe invasive GAS infections like necrotizing fasciitis cases. Both inhibit protein synthesis via the 50s ribosome subunit, inhibiting translation and, thus, toxin production. The concern is rising clindamycin resistance in GAS isol...
How do you approach restarting cDMARDS/bDMARDS in a patient with active RA after incidence of disseminated CNS VZV infection while on tofacitinib?
This is a complex problem for which any response clearly is not data-driven. Disseminated VZV is a profound illness and is linked to JAKi exposure. While the majority of VZV is 'mild' all complications are increased in this setting and dissemination is among the most serious and potentially fatal co...