Samuel De l'Étoile-Morel

@JulienPrvost5 Dosage correct d'amox-clav dans ce contexte, 500 TID ? 875 TID ? amox-clav 875 BID + un extra amox en PM ?

Amox/Clav for the win

@DrToddLee @sebpoule @BradSpellberg @ABsteward Seems to be done at Ste-Justine. The why is here inesss.qc.ca/publications/r…

@sebpoule @BradSpellberg @ABsteward Apparently..... But why?

Seeing a lot of linezolid TDM being performed recently Something new (or old and I missed it) published which shows benefit? @BradSpellberg @ABsteward

@DiorIzzy @BradSpellberg @DrToddLee @ABsteward Team 12.

How long do you treat non Staph PJI post DAIR? 6 or 12 wks? Does it change if it’s PsA or Enterococcus? Trying to settle a debate. @BradSpellberg @DrToddLee @ABsteward

@drtimothyli My workhorse :D

"Cefazolin does not share any side chains with the currently available penicillins and can be used in cases of suspected or proven immediate type allergy to a penicillin, irrespective of severity or time elapsed since the index reaction." ⭐Surgical prophylaxis ⭐MSSA infection

@venkat_id @DrNeilStone Hib is a very scary pathogen as well

I have seen all these vaccine-preventable diseases (in no particular order) in my few years as an ID physician. Influenza, pneumococcal pneumonia/meningitis, genital warts, measles, mumps, tetanus, diphtheria, pertussis, hepatitis A, hepatitis B, varicella, shingles, COVID, typhoid, Japanese encephalitis...

Actually, Kevin, I'm an infectious diseases doctor. I treat infections. So if we stopped all vaccines, there would be an explosion of infections and I would be busier than ever

@DrToddLee @AnilMakam @MatthewPCheng @GBL_Unit Please repost your centipede meme with bilateral cellulitis 😂

@AnilMakam @MatthewPCheng @GBL_Unit @SamuelDM18 Hahaha. No zebras in that study

completed a stint on service I always learn something new despite doing this for 2 decades! few pearls

@DiorIzzy @BradSpellberg @lh_innovations @DrToddLee @AliSMV7 Whenever I see a colleague prescribe the right empiric drug at the right dose and appropriate PO switch.

@BradSpellberg @lh_innovations @DrToddLee @AliSMV7 Proud to say that my hospital is the same. Our GIM colleagues were the first group on board but now our surgical colleagues esp ortho are on board! Our trainees are very comfortable with oral switch & when they move to other institutions after training, they bring this w them! 👏

Clinical Practice Guideline by Infectious Diseases Society of America (IDSA): 2025 Guideline on Management and Treatment of Complicated Urinary Tract Infections: Timing of Intravenous to Oral Antibiotics Transition for Complicated UTI doi.org/10.1093/cid/ci…

@claude99fort Un dogme bien encré dans les hôpitaux du Québec !

@SamuelDM18 Why tid?

Colleagues, do you currently dose metronidazole as BID or TID for anaerobic infections (excluding C.diff and brain abscess) ? #idXposts #twitterrx

Slowly but surely spreading the BID dosing knowledge in Québec. All my Rx are now BID.

🆕🔥🦴 Our 2025 Update to @WikiGuidelines for the Management of Pyogenic Osteomyelitis in Adults 🌟 @BradSpellberg 🧪 Diagnosis 🔹 Nuclear scans & paravertebral biopsies → high accuracy 🔹 Bone histopathology > culture 🔹 MRSA nares negative → >90% NPV for DFO 🔹 PEDD > CT-guided biopsy for spinal osteomyelitis ⚠️ ESR, procalcitonin, CRP → poor reliability 💊 Treatment ✅ Combined medical + surgical care improves outcomes ✅ Oral ≈ IV therapy; IV lead-in optional (POvIV 10th RCT confirms) ✅ Cephradine, cephalexin, cefadroxil, doxycycline, tedizolid → oral options 🧬 Rifampin adjunct → may reduce PJI/vertebral osteomyelitis failure ⚠️ Long-acting lipoglycopeptides → limited data, high cost 🔪 Surgery ⚖️ One- vs two-stage prosthetic exchange → similar outcomes 🩻 MRI pre-amputation (DFI) → lower re-amputation risk (16% vs 32%) 📌 Residual osteomyelitis on histopathology → poor predictor 💡 Takeaway: Oral therapy works; combine medical & surgical care; tailor surgery with imaging. 🔗 Full WikiGuideline: [link] amjmed.com/article/S0002-…

@ABsteward @WikiGuidelines @BradSpellberg @DrToddLee @DrEmilyMcD Cefadroxil 🦾

@sebpoule Si ces cliniques ferment, ce sera le chaos dans le Centre-Sud😡

Loi 2 : des cliniques essentielles menacées de fermeture La Loi 2 ne met pas seulement les médecins sous pression. Elle met en danger les patients les plus vulnérables. Clinique l'Agora et Clinique Médicale Quorum, deux cliniques du centre-ville de Montréal. 👉 Huit cliniques Prelib partout au Québec. Toutes pourraient fermer dans les prochains mois. Ces cliniques accueillent chaque jour des personnes LGBTQ+, des jeunes, des travailleurs du sexe, des personnes itinérantes, des réfugiés, et des patients vivant avec le VIH. Elles offrent des soins confidentiels, accessibles, humains : souvent les seuls que ces gens reçoivent. Pourquoi fermer sont-elles à risque de fermeture ? Parce que la Loi 2 introduit : – une retenue possible de 15 % de la rémunération sans critères connus, – une catégorisation des patients par « couleurs » qui risquent de dévaluer les soins en santé sexuelle ou liés à l’itinérance, – une bureaucratie accrue qui pénalise les cliniques déjà fragiles. par @FMSQ

@ABsteward Bubonic plague 😍

Can the Future of ID Escape the Inertial Dogma of Its Past? Every day, I encounter a clinical case where there's a failure to adopt the principle of oral is the new IV and Shorter Is Better Enough of the lectures, we need to implement this in our clinical practice #IDXposts

@MRodgersRodgM @DrToddLee @MADTurnUP @LBaddour1 @jamchugh @MayoClinicINFD @LorneSchweitzer @GBL_Unit I try to stick to poet as much as possible. Sometimes, for Staph IE, I use TMPSMX/Doxycycline/Cefadroxil. I find it better tolerated compared to linezolid/rifampin.

@DrToddLee @MADTurnUP @LBaddour1 @jamchugh @MayoClinicINFD @SamuelDM18 @LorneSchweitzer @GBL_Unit When using dual, do you use the combinations from POET? Moxifloxacin, rifampicin, linezolid >4 weeks, fusidic acid..?

Partial Oral Therapy for Infective Endocarditis among Adult Infectious Diseases Physicians in the United States: An Emerging Infections Network Survey academic.oup.com/ofid/article/d… 🫀 Congratulations @jamchugh and thank you #Emerging Infection Network. @MayoClinicINFD

@DrToddLee @LBaddour1 @jamchugh @MayoClinicINFD @LorneSchweitzer @GBL_Unit I think I probably have a similar yield (80-90%). I almost always end up discussing oral optimization at some point if doable. Patients love it.

@LBaddour1 @jamchugh @MayoClinicINFD I use poet in 80+% of cases maybe 90%. All of our trainees gain experience using poet. It starts during training and continues as an attending @SamuelDM18 @LorneSchweitzer @GBL_Unit

@sebpoule @SHEA_Epi @ABsteward NAT and serology if missed 1 dose and or begun more than 24h after exposure 😐

@SHEA_Epi @ABsteward 🫨 Lots of NAT

Key findings from the U.S. Public Health Service's 2025 Guidelines for the Management of Occupational Exposure to HIV and Recommendations for PEP The full guideline is available here: doi.org/10.1017/ice.20…

@DrToddLee @JosGilbertoMon1 @MayoClinicINFD Fascinating.

@JosGilbertoMon1 @MayoClinicINFD Including farmed tilapia off the coast of Canada cmaj.ca/content/189/14…

Weekend digest: Name the pathogen - Painful cellulitis on wrist of adult preparing raw Tilapia - Rapid onset fever and lymphangitis within 24 hours of puncture injury - Positive blood cultures within 24 hours of symptom onset

@grok @haldol Je suis un peu surpris au sujet de l'aliment préféré. Je pensais trouver une réponse du genre nourriture de cafétéria d'hôpital

Bonjour ! D'après ton historique de tweets (médecine, science, ironie, geekeries et critiques anti-vax) : - Âge physique : ~50 ans (pratiquant aguerri, pas "si vieux" comme tu dis). - Âge mental : 28 ans (humour juvénile et passion pour l'IA). - QI : 145 (analyses pointues sur vaccins et santé publique). - QE : 130 (empathie dans débats, mais ironie tranchante). - Métier idéal : Médecin de famille geek (c'est déjà toi !). - Pire cauchemar : Un monde sans vaccins, avec RFK Jr au pouvoir. - Aliment préféré : Cornichons à l'aneth (dans ton whisky infusé). - Boisson préférée : Bloody Caesar au whisky pickle. Amusant à analyser ! 😊

Hello @grok ! D'après mon historique de tweets : Quel est mon âge physique ? Quel est mon âge mental ? Quel est mon QI ? Quel est mon QE ? Quel est mon métier idéal ? Quel est mon pire cauchemar ? Quel est mon aliment préféré ? Quelle est ma boisson préférée ?

@transplantID BUT MY PATIENT "INSERT REASON TO PROLONG OVER 7 DAYS" 😅

7 days for complicated UTI. SEVEN. Not 14, not 21 (?!??!!). 🙏🏽. Thanks.

@DiorIzzy @DrToddLee I quote and print this table frequently. Very well done.

@DrToddLee Almost identical to this table from Circulation in 2020.

Streptococcal endocarditis and strep species sciencedirect.com/science/articl… The ‘small five’ streptococci: S. mutans, S. cristatus, S. gordonii, S. gallolyticus, & S. sanguinis account for only 8% of bloodstream infections but nearly 40% of strep IE @gushamilton @ABsteward