Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Would you anticoagulate a patient with splenic infarctions in the setting of CMV viremia?
Based on my general knowledge/experience, I would consider CMV viremia as temporary, short-lived risk factor for a thrombotic event on a part of other inflammatory conditions, and outside of other indications for anticoagulation (e.g., atrial fibrillation, etc), my inclination would be to conclude ...
What is your approach to working up diarrhea in an immunocompromised patient?
Tough question and very common in clinical and research management. The approach is going to mirror any new complaint and start with a history. Diarrhea means many things to many patients/clinical trial subjects, so characterizing duration, frequency in a day, nocturnal events (diarrhea that occurs ...
How do you manage a patient with severe RA or SLE that worsens after stopping immunosuppressants due to having chronic foot ulceration?
Fear the foot ulcer! These portals of entry for microorganisms can wreak havoc in immune-compromised patients. Rheumatologists must ensure that these lesions are being properly managed. Since healing can often be prolonged in some of our patients, the decision of whether and when to resume immune su...
What is the recommended treatment regimen for Mycoplasma genitalium in a pregnant woman?
Great question for which there isn't a great answer. I would consider why the patient was tested. Asymptomatic pregnant people should not be screened for M. Genitalium. For asymptomatic people who are tested for whatever reason for M. Genitalium, it should be a discussion and a shared decision betwe...
Are contact precautions effective at preventing MRSA transmission in healthcare settings?
I have a major axe to grind here. Whenever this has been looked at it seems that the answer is that, outside of an outbreak situation for example, so long as people wash their hands, this adds nothing but waste of medical equipment. See the following articles: CID review: Diekema et al., PMID 377385...
During induction therapy for acute leukemia, when do you decide to discontinue the antimicrobial prophylaxis?
Antimicrobial prophylaxis (PPX) during treatment of acute leukemia can take several forms, and it is not always directly associated with blood counts.Fungal PPXDuring induction for AML, there are randomized data supporting posaconazole over fluconazole or itraconazole (Cornely, et al. New Engl J Med...
What isolation policies are Rheumatology offices employing for both staff and patients diagnosed with COVID-19 given the new CDC guidelines?
Still the same: masking in all settings.
What is the risk of serious bacterial infection in a febrile solid tumor patient who has not yet started cancer-directed therapy and has normal cell counts with no central line?
This depends on the type of the tumor, the location, and the individual circumstances. It may not be wrong in this scenario to draw blood cultures and give a dose of ceftriaxone pending 24-hour results, but this practice may also vary based on these different variables e.g. RMS of paranasal-ear area...
For how long do you treat uncomplicated CRE bacteremia in an immunocompetent patient?
Assuming rapid resolution of the systemic inflammatory response, I generally recommend 7 days of antibiotic administration – and I am not aware of data that this should be prolonged when the pathogen is a CRE. One of the studies listed below [Soto et al] addresses CRE bacteremia and the duration of ...