bladner.bsky.social
Infectious Diseases physician in Madison, Wisconsin, USA
33 posts
347 followers
315 following
Active Commenter
comment in response to
post
That is why I restrict my polar bear liver intake to once weekly.
comment in response to
post
Based on the graphical abstract, they are on the right track, but I do wonder if the complicated versus uncomplicated UTI language is not salvageable, and we should be referring to cystitis versus upper UTI/UTI with systemic toxicity.
comment in response to
post
I will have to read the full paper. I struggled with JEV recommendation when I practiced in Seattle. Many travelers to Asia technically met indication, but the very high cost of the vaccine (and potential albeit low risk of toxicity) gave me pause to recommend.
comment in response to
post
Not sure I agree. Plenty of in vitro and observational data for daptomycin and, eg, ampicillin or ceftaroline for VRE. If dapto MIC is reasonable and patient will have surgery, can try dapto 12 alone, but if there is persistent bacteremia, no surgery, etc, then would favor combination therapy.
comment in response to
post
High dose dapto plus a beta lactam.
comment in response to
post
"Pan culture" needs to go into the dustbin of history.
comment in response to
post
I am just engaging for everyone's learning. There isn't consensus here, but my interpretation of the literature and experience in practice is that cultures drawn from lines have increased contamination (with resultant increase in antibiotic use and length of stay) and do not add benefit.
comment in response to
post
Nice summary. But should we really be drawing blood cultures from CVCs, or should we prioritize 2 peripheral cultures?
comment in response to
post
Sounds like a salvage regimen for established aspergillosis. For empiric trx of invasive mold picture, consider posaconazole alone (coverage for Aspergillus and Mucorales), or the comb. of Ambisome and vori (Aspergillus, Mucorales, other difficult-to-treat molds).
comment in response to
post
I believe there is an old IDSA MRSA guideline that recommends 8 weeks for VOM. That is where I thought it came from. I am sure it is just based on expert opinion at the time.
comment in response to
post
Unfathomable.
comment in response to
post
Risk of recurrence will be low in the absence of need for augmented immunosuppression. Would offer stopping, but not a hill I would die on.
comment in response to
post
How far out from transplant was their PCP diagnosis?
comment in response to
post
What is the absolute lymphocyte count?
comment in response to
post
No. But if it's polymicrobial, you achieve some source control, and the Enterococcus clears rapidly, it will probably be fine. But you are basically acknowledging the Enterococcus in this context requires no treatment.
comment in response to
post
Good answer.
comment in response to
post
Bactrim and levo/rif both are reasonable.
comment in response to
post
For rising ID fellows I recommend the ID chapter in Harrison's Internal Medicine. For fellows and after, Mandell is a good source. Podcasts (Febrile, Breakpoints, Editors in Conversation, Clinical Problem Solvers) also excellent.
comment in response to
post
Based on patient factors (functionality, ability to tolerate surgery) I would think destination spacer (i.e. 1.5 stage) and 2-stage would be main considerations
comment in response to
post
News to me.
comment in response to
post
No test-of-cure, no re-treatment without symptoms. I am happy to be disagreed with by colleagues who have more specific focus in this area.
comment in response to
post
Are you a) doing asymptomatic screening and b) doing test-of-cure PCR for M gen?
comment in response to
post
CZA for bacteremia and pneumonia seems reasonable, unless you think they have a polymicrobial infection requiring imipenem.
comment in response to
post
What novel BL/BLI agents do you have access to?
comment in response to
post
You are right that is the situation (highly compatible syndrome; very low risk exposure history) in which a positive result may be useful. That quality of reasoning is not common though. By far the more common scenario is that the IGRA for active disease confuses the evaluation and even does harm.
comment in response to
post
I recommend against ordering IGRA in the evaluation for active TB disease. So often I see it used inappropriately/inaccurately in diagnostic reasoning for these cases.
comment in response to
post
Would consider cefadroxil 1g TID comparable to cephalexin 1g QID, and has the advantage of avoiding 4x daily dosing outpatient.
comment in response to
post
ACORN trial design is incredibly innovative. I think that is its biggest contribution to the field.
comment in response to
post
I think both--synergy and delayed dapto resistance--may be true. In a high-risk case like this, I'd consider reaching out to a subject matter expert in enterococcal infections like Cesar Arias in Houston.
comment in response to
post
Good call! I still give my dad credit for knowing a good line to pass on 🙏
comment in response to
post
Right answer! As my father always says, "a man's got to know his limitations." ID docs should probably stay out of the PFO management field, or proceed humbly if we do decide to weigh in.
comment in response to
post
High dose dapto plus a beta lactam for 6 weeks, then weekly oritavancin for another 6.