Bryan

@ABsteward @IDiots_pod Ugh, dumb fingers - PK/PD*

@ABsteward Neat article. Was just curious why no mino (dual or mono) therapy was used at all despite their sensi’s. Availability issue or provider hesitancy? @IDiots_pod, what’re your all’s PK/PS thoughts on Mino-mono Tx in SM bacteremia?

🆕️✨️ The largest cohort of adult hematological patients with Stenotrophomonas maltophilia bacteremia to date ~ 70% developed breakthrough bacteremia during carbapenem therapy 28-day mortality rate of 31.43% Minocycline Susceptibility 💯% #idxposts journals.asm.org/doi/10.1128/sp…

@TBrnaughtTB Best of luck! You totally got this!!

If anyone at IDWeek is interested in hearing about our immunocompromised host ID group and position at the University of Nebraska, please reach out! I would love to meet you!

Don’t tell me outpatient stewie isn’t sexy! 😂 Thank you Erica (@EStohs), Ryan (@Stevens_AK) and Jame (@IDiots_pod) for this fantastic episode! And shout out to @Evan_Steere for the title!! 🧫💊

Consider sharing this 🔥overview with trainees on the #TxID pre-transplant eval out in @TheTxIDjournal! *⃣Pertinent history ❓ *⃣Travel screening *⃣Approach to 💉 @rebecca_kumar @GorslineChelsea @maricar_malinis @TedRader4MD @alan_koff @hboucher3 shorturl.at/yK6uH

So whats up with Meropenem vs Ertapenem in critical illness/hypoalbuminemia? Any good clinical data beyond the pharmaco/theoretical stuff? #idtwitter

@InYourFAECIUM @BlackstoneGrid Good luck!

@BDubbMD @BlackstoneGrid There will definitely be a learning curve!! I’m trying to channel my inner dreams of become a restaurant chef

After 3 years of eyeing this griddle, I finally have my own @BlackstoneGrid! My Father’s Day gift! Some epic meals are going to take place on this :)

#IDTwitter #IDXpsost late syphilis with neurosyphilis s/p 14 days of Pen G IV. Would you give additional IM Benzathine penicillin? @BradSpellberg @DrToddLee @wwrighID @Cortes_Penfield @dralicehan @ABsteward @JonathanRyderMD @sebpoule @DrEmilyMcD @BJegorovic @maudi_ahmed @drtimothyli

@IdVilchez @BradSpellberg @DrToddLee @wwrighID @Cortes_Penfield @dralicehan @ABsteward @JonathanRyderMD @sebpoule @DrEmilyMcD @BJegorovic @maudi_ahmed Awesome, question. Have a partner in my division who trained in an area with much higher rates than here. There, it was standard to give at least one dose after tx. Would love to even just see a survey in PCN prescribing practices.

🎇Welcome new #IDFellows! 🎉 Is this your first exposure to a #TxID @TxID_Fellows immunocompromised ID service? Never fear!☑️out our "CORE CURRICULUM" at transplantid.net Lots of @AST_info @ASTCT @IDSAInfo @IDSAMedEdCOP @ISHLT @TheEBMT guidelines as well!

@Zaydovudine @JonathanRyderMD @IdVilchez @Infected_Terran @morelli_md @p I can understand that. I can see running into a similar issue. Kind of interesting to think about how these risk benefit analyses differ based on the place they’re implemented. Mileage may vary! :)

@BDubbMD @JonathanRyderMD @IdVilchez @Infected_Terran @morelli_md @p We’ve made the conscious decision not to have it. The concern is that it will be used to justify abx in low pre-test probability pneumonia or sent from inadequate resp samples (endotracheal aspirates). These authors reported similar. pubmed.ncbi.nlm.nih.gov/38332718/

#IDtwitter #IDX For your all's HAP/VAP's, how receptive are your colleagues to de-escalation, and if you all utilize the Biofire PNA panel, how has it helped/hurt? @JonathanRyderMD @IdVilchez @Infected_Terran @morelli_md @Zaydovudine @p

@JonathanRyderMD @IdVilchez @Infected_Terran @morelli_md @Zaydovudine @p 100%. For that and the other reasons, "Please refer our institution's guidance document" is a Perfectserve auto-reply I'd want to built into my phone.

@BDubbMD @IdVilchez @Infected_Terran @morelli_md @Zaydovudine @p The last challenge I'll say is that I honestly have no idea how to interpret the semi-quantitative results of the PNP. Higher counts seems to correlate with culture a bit more, but its not perfect. I think these counts may be misleading in many ways due to the imperfect sampling

@JonathanRyderMD @IdVilchez @Infected_Terran @morelli_md @Zaydovudine @p @dosyn_zosyn and I we're playing out the pitfalls just like this on rounds today. :).

@BDubbMD @IdVilchez @Infected_Terran @morelli_md @Zaydovudine @p The challenge is when its used as an inappropriate diagnostic test, e.g., pan-culture for fever. It may result in de-escalation, but often the sputum cultures is contaminated or normal respiratory flora, yet they desire to treat PNP results

@JonathanRyderMD @IdVilchez @Infected_Terran @morelli_md @Zaydovudine @p Nice! That time to stop the anti-pseudomonal is really, really cool. We use MRSA nares here, which is great, but the anti-pseudomonal de-escalation a bit of a challenge.

@BDubbMD @IdVilchez @Infected_Terran @morelli_md @Zaydovudine @p Some data from our center supporting these findings about de-escalation: ncbi.nlm.nih.gov/pmc/articles/P…

@morelli_md In-house non-treponemal. Treponemal is send-out, takes about 4-5 days, but certainly longer on holiday weekends. : / Trained with reverse testing, so has taken a little getting used to.

@IDstewardship @IDiots_pod I like it! :) It gets people on here thinking and discussing. And it’s about 100x’s better than the flaming hot magma garbage my feed seems to be filling up with more and more over the past few weeks.

Have you checked your cefadroxil prices lately? The thing is all of these abx are not tested routinely so having a breakpoint for something like cefadrioxil doesn’t really matter when all you know is a cefazolin MIC. Ya is like an ad I guess. My intent with these is back to basics and making the stuff I like to create (not what these platforms try to get me to create)… but then having some attempt to raise awareness for the training website more as a tag along too. Awareness is really hard.

💊 Are you team #cephalexin or team #cefadroxil? I love the less-frequent dosing of cefadroxil and that it’s cheaper now than it used to be. One down-side is you cannot extrapolate cefazolin susceptibility in E. coli to cefadroxil like you can for cephalexin...So for UTI, I usually team cephalexin and for everything else oral 1st gen cephs work for, I’m team cefadroxil. ……… #PharmacySchool #PAschool #NursingSchool #MedSchool #LearnAntibiotics #IDstewardship #PharmLife #BCPS #BCIDP #ClinicalPharmacy ……… 🧠 Need to know about infectious diseases? 👀 Check out LearnAntibiotics.com and get 10% off any membership with code LEARNABX

@IDiots_pod @IDstewardship

@IDstewardship I know this is basically an ad, but over in EUCASTistan there is no need to extrapolate from Cefazolin for Enterobacterales as the Big 3 1g-Cephs have their OWN BREAKPOINT! Still can’t use cefadroxil though. It’s too pricey.