Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
What is your approach to use of D-mannose for prevention of recurrent uncomplicated cystitis?
Unfortunately, in light of Hayward et al., PMID 38587819, I think there is a very limited role for the use of D-mannose for the prevention of recurrent uncomplicated cystitis. Our evidence-based options for the prevention of recurrent uncomplicated cystitis in postmenopausal women without catheters ...
Does management of NMDA receptor encephalitis change in a patient with HIV/AIDS?
In a patient who is immunodeficient, one must be mindful of the risk of opportunistic infections from additional immunosuppression. With that being said, I would still proceed with first-line therapy (pulse steroids and oral taper, IVIG) and symptomatic/supportive care with anti-seizure medicines an...
Do you treat HIV/AIDS-associated CNS vasculitis with antiretrovirals alone or in combination with steroids?
This is a tough question and like most viral associated forms of vasculitis i.e., HCV, VZ, other... of unclear immunopathogenic mechanisms, it is approached empirically. Antiviral therapy is the cornerstone but at least short-term immunosuppression is generally needed in the acute phase as host medi...
How do you counsel HIV patients with an undetectable viral load on breastfeeding?
People who are virally suppressed on ART are at very low risk of transmission to infants through breastfeeding, less than 1%-- however, the rate is not 0, and any infant with HIV is heartbreaking. The risks are particularly high in infants who are transitioning to solid foods (potentially related to...
Do you periodically check a urine culture for patients without dysuria but who have a history of struvite kidney stones and urinary tract infections with urease producing organisms?
Struvite nephrolithiasis is caused by a high urine pH (usually>7.0). Typically, a urine this alkaline requires urinary infection with a bacterium that produces urease, (Proteus, Providencia, Klebsiella) which in turn splits naturally occurring urea into ammonium, driving the pH to supraphysiologic l...
For AML patients, when do you stop antiinfective agents?
Our practice is typically to continue an anti-viral throughout induction/consolidation without stopping the agent. We typically utilize anti-bacterial and anti-fungal when the absolute neutrophil count (ANC) is under 500 and then stop them once the ANC recovers to above 500. Our preferred anti-funga...
What duration of therapy do you use for treatment of Legionella pneumonia in an immunocompetent host without associated empyema or extrapulmonary infection?
We have little experience of legionellosis, especially in immunocompetent patients. Based on the available information and the published recommendations (these follow), I would generally treat patients for 5-7 days, depending on clinical response.A recent review: Viasus et al., PMID 35505000IDSA/ATS...
What is your approach to determining the need for continued isolation in the dialysis unit for an ESKD patient who had a positive hepatitis B surface antigen one year ago but who now has a negative HbsAg in the absence of treatment?
I have not encountered this situation before. Assuming that both checks are accurate and not the result of vaccination, then I would continue to isolate for another 6 months, repeat Hep BsAg and viral load. If still negative would take off isolation.
How long would you treat a patient with recent history of TAVR presenting with E faecalis bacteremia with unclear source with TEE showing thickened valves but no obvious vegetation?
Treatment duration depends on other additional factors.TEE showed leaflet thickening- a non-specific finding, not a feature per Duke's major imaging criteria. Another feature to consider would be an associated new-onset valvular insufficiency that might increase the likelihood of IE. In such cases, ...
What topical or oral treatments do you recommend for patients with recurrent MRSA infections?
In my experience, the best way to evaluate recurrent MRSA infections is to check the nasal cultures of the patient and caregivers. Sometimes cutaneous carriage of the organism also needs to be checked and treated. Good hygiene with regular hand washing or alcohol sanitizers is essential. Treatment w...