Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Do you switch to an alternative agent for C difficile colitis for a patient with suspected infection and positive testing who continues to have >3 watery bowel movements daily despite multiple days of oral vancomycin treatment?
The question about switching to another agent for Clostridioides difficile (Cdif) colitis in a patient who tests positive for Cdif but continues to have diarrhea despite multiple days of oral vancomycin treatment does not include any information regarding the clinical status of the patient, the pres...
With OpenBiome no longer in operation, what is your current approach for obtaining FMT for inpatients with acute severe/fulminant C. difficile infection unresponsive to antibiotics?
Consider Rebyota by enema or flex sig, similar to what you had done with standard FMT.
What specific criteria or patient conditions would make you hesitant to use fluoroquinolones early in the treatment course for managing MSSA joint infections with oral antibiotics?
For MSSA joint infections, I have moved away from using FQ to using high-dose cephalosporins as a step-down therapy, particularly cefadroxil 1 g twice daily, given less frequent dosing/increased adherence. Considering the risk-benefit analysis, I prefer using FQ as an oral option in polymicrobial an...
Are there any concerns with live vaccine innoculation and patients who are on denosumab?
This is a complicated question because while denosumab is a biologic therapeutic that has immunomodulatory effects on innate and adaptive immunity its association with serious infections complications appears modest. An increased rate of background infections and some increase in serious infections ...
Do you continue PJP prophylaxis indefinitely in patients on rituximab maintenance therapy?
Risk for PJP infection is usually in the context of moderate-high dose corticosteroid therapy or low T cell counts.
Do you offer antibiotic therapy for patients with a chronic joint infection, with no plans for surgery, and with an open draining sinus tract?
This is a complex question that requires a nuanced answer. I am assuming this is a periprosthetic joint infection. If so, why is there no plan for surgical intervention—is this because the patient’s care is comfort-focused? How old is the patient? What is the microbial etiology, and is it even amena...
How do you determine the duration of antibiotic therapy in a patient with culture-negative native valve endocarditis who is clinically improving but has no identified organism to guide treatment?
I feel like any time I run into unique endocarditis questions, I'm back in the 2015 guidelines (Baddour et al., PMID 26373316). I do think that this is one of the lingering questions that is not fully answered in the guidelines, however--they are from 2015, and medical science has come a long way. T...
Do you routinely consider FDG PET/CT imaging for workup of fever of unknown origin?
The landscape of FUO and IUO and our clinical approach to diagnosing its cause has changed significantly over the past several decades. More sensitive microbiologic screening for infectious etiologies, including syndromic molecular panels and next-generation sequencing are now clinically available a...
Do you routinely recommend a lumbar puncture for patients with suspected ocular or otic syphilis in the absence of additional CNS symptoms?
No, this isn’t necessary, assuming no other evidence of non-ocular/otic neurosyphilis. I recommend management as advised by CDC in the 2021 treatment guidelines (https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf, p. 40). An especially careful neurological exam is advised, includin...
How do you counsel patients and doctors on antibiotic avoidance in myasthenia gravis?
I generally recommend avoiding aminoglycosides and most macrolides in MG. The rationale is that there are alternative effective antibiotics for most of the infections covered by the above categories. With fluoroquinolones, however, it's not that simple, because there are some infections that are uni...