Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
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.
How long do you continue PJP prophylaxis in a patient with GPA who is able to wean steroids and remains only on rituximab for maintenance therapy?
Great question! For my ANCA patients and the OSU vasculitis clinic, we leave them all on Bactrim for the life of the disease. Less about PJP, and more about helping minimize infections due to the sinus and respiratory inflammation creating a nice environment for bacteria to live. Also, there is some...
What is your approach to starting antiretroviral therapy in a patient living with HIV who is diagnosed with cryptococcal meningitis?
For newly HIV-diagnosed persons with cryptococcal meningitis, the current guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV recommend deferral of ART initiation until after the first 4-6 weeks of cryptococcal meningitis treatment, due to findi...
Do you favor timely bronchoscopy for diagnostics over close surveillance in mildly symptomatic patients with CT findings suspicious for NTM infection who are not able to expectorate?
Yes, I do favor FOB to obtain BAL in symptomatic patients with suspected NTM.
What is your approach to recurrent asymptomatic bacteriuria in pregnancy for patients without personal history of recurrent UTIs or pyelonephritis?
There is a paucity of good data in this field. In my opinion: The data remain weak (after 70 years of study) that we should be screening for ASB in pregnancy in the first place (whether or not they have a history of recurrent UTI or pyelonephritis). However, guidelines generally agree that screenin...
Do you use steroids in the management of PJP pneumonia with severe hypoxia in HIV negative patients?
I only saw about 4 (non-HIV) patients with PJP before AIDS hit the US in 1981. Like others caring for AIDS patients in the 1980s, PJP was incredibly common I saw at least 200 cases over the years. Until AIDS, there were never enough non-HIV patients to do a RCT to look at steroids. Thanks to the wel...
What are the current treatment options for progressive multifocal leukoencephalopathy in patients without HIV/AIDS?
It depends on the underlying cause of the immunodeficiency that led to the PML. In cases of natalizumab-induced PML, this would involve stopping the drug immediately. There is controversy over whether or not to perform plasma exchange to hasten this. In some cases, this has provoked IRIS while in ot...
Do you repeat a lumbar puncture in a patient living with HIV diagnosed with and treated for neurosyphilis and if so, when?
This is a complex issue, and there isn't a one-size-fits-all approach. There are no hard and fast guidelines in place. If the initial CSF abnormalities include only reactive CSF VDRL, along with modest protein elevation and mononuclear pleocytosis (both of which are consistent with HIV infection), a...
Do you recommend testing for HPV in patients with oral lichen planus?
When I read this question I, too, thought the poster meant HSV; however I was surprised to find that there is actually some literature on HPV in LP, specifically in the etiology of LP-associated carcinoma. However, given that the role of HPV is still not clear and that the failure to recognize a mal...
Do you take into consideration a patient's serum albumin level in your decision to use ertapenem?
A 2023 IDSA guidance recommended against the use of ertapenem in critically ill patients as well those with hypoalbuminemia. The latter is based on PK data indicating rapid clearance of the free fraction of the drug, which has approximately 90% protein binding, resulting in lack of attainment of an ...