Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Are there instances when you do not recommend tunneled dialysis catheter exchange in patients on hemodialysis who are found to have bacteremia?
Generally, the answer is no. The only situation I would not recommend tunneled catheter exchange is if the patient has "run out" of catheter insertion sites and removal of the catheter poses the risk of not being able to place another tunneled catheter. That is also tempered by the organism causing ...
How do you approach biologic initiation in patients with inflammatory arthritis and repeatedly indeterminate Quantiferon?
This is an unusual but anxiety-inducing situation. Remember that an "indeterminate" Quantiferon is not an "intermediate" Quantiferon. It's not half-positive, it's uninterpretable. The result provides absolutely no reason to be more or less concerned that the patient has lTB, latent or otherwise. I a...
What patient-specific factors would influence your decision to initiate semaglutide therapy in patients with HIV-associated lipohypertrophy?
I would consider it if the patient had diabetes. But there is not much data on this question.
What is your approach to the use of Paxlovid for patients with risk factors for severe Covid-19 infection but who have received SARS-CoV-2 vaccines in light of the EPIC-SR trial findings?
Although EPIC-SR Trial may not have shown a significant benefit of paxlovid in standard-risk patients regardless of vaccination status, EPIC HR and real-world evidence have shown benefits in high-risk populations. Shared decision-making with the patient is always the best policy.Disclosure: I have r...
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.