absteward.bsky.social - Profile | ThreadSky | a Reddit-style client for Bluesky

"The available clinical evidence does not support replacing the recommendation of trimethoprim-sulfa as first line therapy. However, considering the PK/PD findings, it is equally possible to conclude that in these studies suboptimal agents were compared to suboptimal agents" #idsky

submitted 2 days ago • 0 comments

All treatment recommendations are confounded by the fact that the isolation of S. maltophilia from clinical specimens other than blood cultures often represents colonisation rather than active infection where the benefits of antimicrobial treatment are doubtful #idsky

submitted 2 days ago • 0 comments

🆕💫 New narrative review challenges the longstanding reliance on TMP-SMX for the treatment of Stenotrophomonas infections—citing PK/PD concerns and rising resistance. Also questions mono vs combo use. Clinical data still limited. Worth a close read #idsky www.sciencedirect.com/science/arti...

submitted 2 days ago • 2 comments

Leukocyte esterase has also performed poorly in various studies. Maybe the entire dipstick needs to be retired for UTI 🤔 #UTISky

submitted 3 days ago • 1 comment

🆕💫 Viewpoint JAMA Nitrites for Urinary Tract Infection—Time to Say Goodbye? #idsky #EMIMCC #UTIsky jamanetwork.com/journals/jam...

submitted 3 days ago • 3 comments

🆕🔥Updated systematic review & meta-analysis (+REMAP CAP) 30 RCTs,N=7519 Corticosteroids probably 🔽 short-term mortality 🔽the need for invasive mechanical ventilation & likely 🔽duration of ICU stay in adult pts hospitalised with non viral CAP #idsky #EMIMCC link.springer.com/article/10.1...

submitted 3 days ago • 1 comment

For streptococci, blood cultures virtually always cleared by day 2, so clearing quickly is not helpful. In contrast, for MSSA, MRSA, and E faecalis, clearance of blood cultures after 1 day of therapy was also very helpful at negatively adjusting the risk of IE. #IDSky

submitted 6 days ago • 0 comments

All species had significant negative LRs if only 1 of 4 blood culture bottles was positive on admission. This includes S aureus, challenging the current practice that every patient with S aureus community-acquired bacteremia requires a TTE for further work-up. #IDSky #EMIMCC

submitted 7 days ago • 0 comments

🆕🔥Case-control study @bradspellberg.bsky.social Just 1/4 blood cultures positive (≥2 sets drawn) or early clearance → low IE probability. Persistent bacteremia or 4/4 bottles ↑ pretest probability Simple bedside clues to sharpen your endocarditis game. #IDSky #EMIMCC jamanetwork.com/journals/jam...

submitted 7 days ago • 1 comment

I don’t usually post around this time—unless something 🔥 drops. Time zones don’t matter when it’s this good Worth breaking the pattern #IDsky #EMIMCC

submitted 7 days ago • 0 comments

🆕💫New Hope, New Threat: Ceftazidime/avibactam brought promise—resistance followed fast. England’s 4-year data shows why real-time surveillance and stewardship matter more than ever. A must-read #IDsky pmc.ncbi.nlm.nih.gov/articles/PMC...

submitted 7 days ago • 0 comments

SOT patients have been systematically excluded from most RCTs on treatment duration, leading to prolonged courses still being the standard of care in many centers, even for non-complicated infections. (🧵1/3) #AMSky #IDsky #TxID

submitted 8 days ago • 1 comment

🆕🔥 State of the art review article @cmicomms.bsky.social Approach to Clostridioides difficile Diarrheal Infection ( CDI) Excellent discussions about the management of CDI #IDsky #mustread www.sciencedirect.com/science/arti...

submitted 7 days ago • 1 comment

Treating sepsis early & aggressively (within 3 hours of recognition, 1 hour if shock present) is vital to success but it's imperative to employ best practice antimicrobial stewardship policies. Take cultures & switch to narrow spectrum ASAP for sensitive bacterial infections. @absteward.bsky.social

submitted 11 days ago • 0 comments

Just 23% of patients received AMS support in transplant units. A lot to do for stewies in this field yet! Let’s get to work #AMSky & #TxID! 💪🏼

submitted 14 days ago • 0 comments

🆕💫Large Multicentre cohort study Epidemiology, Treatment, and Outcomes of Gram-Negative Bacteremia in Solid Organ Transplant Recipients #IDsky onlinelibrary.wiley.com/doi/full/10....

submitted 14 days ago • 1 comment

Tetracyclines, esp doxycycline and minocycline, are of interest because of their broad-spectrum activities,good oral bioavailability, and potential efficacy in treating BJIs 🆕💫Review Oral tetracyclines for bone and joint infections: what do we know? #idsky jbji.copernicus.org/articles/10/...

submitted 14 days ago • 2 comments

Wow! If anyone ever doubts the power of crowd sourcing, look at the vaccine RCT table that has been built already, in under 24 h! Unbelievable work by @jakescottmd.bsky.social Dr. Abdhay Dand, @alejodiaz81.bsky.social and Dr. Ali Meza Vazquez! bradspellberg.com Vaccine RCTs | mysite

submitted 15 days ago • 1 comment

A 25 yo man from Guatemala with 5y sore throat, odynophagia & oral papules. Biopsy: non-necrotizing granulomas, multinucleated cells + budding yeasts. All cultures neg x8w. Hx: childhood exposure to coffee crop soil. What’s your differential?! #idsky #idxposts academic.oup.com/cid/article-...

submitted 15 days ago • 1 comment

REMAP-CAP (steroids arm) reignited debate—again. Past RCTs gave mixed signals, and this trial adds fuel and lessons. Yes, it has pitfalls, but even “negative” studies push the field forward. Innovation in trial design is a double-edged sword. Grateful for the dialogue on X & BlueSky #idsky #EMIMCC

submitted 15 days ago • 0 comments

REMAP-CAP has dropped insanely underpowered in terms of its mortality endpoint (117 patients in one arm) based on statistical power & methodologic problems, it adds nothing to CAPE-COD my take hasnt changed since my discussion of CAPE-COD here https://emcrit.org/pulmcrit/cape-cod/ #EMIMCC

submitted 15 days ago • 5 comments

Response adaptive randomization adjusts allocation probabilities over the course of a trial, based on accumulating data. RAR increases allocation to arms performing well, and decreases allocation to arms performing poorly. In multiple arm trials, this has advantages over fixed randomization.

submitted 16 days ago • 4 comments

Not gonna lie, I’m still wrapping my head around RAR (Response-Adaptive Randomization). Anyone have a simple breakdown? #idsky

submitted 16 days ago • 2 comments

Plenty of critiques floating around X platform about the design of this adaptive RCT—what are your thoughts? #idsky #EMIMCC

submitted 16 days ago • 2 comments

2 recent RCTs: ESCAPe MP ❌️ CAPE COD HC ✅️ ➕️ Meta-analyses ✅️ Now REMAP CAP ❌️ A 🔥 topic in critical care & ID #idsky #EMIMCC

submitted 16 days ago • 0 comments