YY HAM

@BrentFooter Oooh, thanks!

📢Please join us for our next ID PRN Learner-Led Journal Club on Friday, November 10th at 12 PM Central Time! Journal articles and other details below! Zoom link can be found via email on the ID PRN Listserv. #IDTwitter @SaratoninSyndrm @GageD28 @YYHamophilus @TheApotheKeri

@MRaoRx @mmPharmD My apologies, it should obviously be “see da solution” I now hang my head in shame

@MRaoRx @mmPharmD Scedosporium? See tha solution!

Hey #twitterx, I plan to present on disseminated Scedosporium for my ID patient case presentation at the end of the month! Any ideas on a punny title? Heard you come up with the best ones, @mmPharmD!

@DrCatherineB Same thing happened to me, except the bill I received was for 154k even though it was for an outpatient procedure for which my son was awake the whole time and took about 30 minutes. Call to insurance cleared up but I can only imagine how often people just give up in shock.

My health insurance sent me a form asking if I have secondary coverage (I don’t). Because the envelope wasn’t prepaid, I was like ‘f this’ and tossed it. Well joke’s on me because now they’re refusing to pay 9k for my kid’s ear tube surgery. Health insurance is such a racket 😭

@InYourFAECIUM @Julietavancin We run about 5 percent penicillin susceptible. Something about Portland. Our acinetobacter is also fairly polite. Probably the ipa and unicycles, somehow.

@Julietavancin Did this person have a chronic OM from Staph that they acquired in the 1930’s?!? I’ve waited for years to see a Staph aureus that is truly PCN-S

I find it oddly satisfying treating Staph aureus bacteremia with Penicillin 🤩 (after verifying it’s PSSA of course)

@SmeagsIDPharmD @EricMacyMD We’re actually retooling our surgical prophylaxis allergy algorithm now. Goal being cefazolin for all where it’s first line. Biggest change being not avoiding the cefazolin even if penicillin allergy is severe as long as it’s ige mediated (so give cefaz for pen anaphylaxis)

@YYHamophilus @EricMacyMD That’s what we were told as well, and similarly we could filter or suppress differently for providers/pharm. Do you also have a policy or guideline for pcn/beta-lactam allergies?

Hey #IDTwitter, poll of who currently filters/suppresses cross-reactivity alerts in EHR for PCN to 1) Beta-lactam classes (such as cephalosporins or carbapenems) OR 2) An agent (such as cefazolin or aztreonam)? Bonus can anyone filter by reaction type (rash, anaphylaxis)?

@SmeagsIDPharmD @EricMacyMD We have quite a lot in that category. We have different protocols for cross reactivity, how to deal with allergies for surgical prophylaxis, various protocols for skin testing and direct oral challenge, and when all else fails, desensitization protocols.

@Weavofloxacin Works pretty well overall.

@Weavofloxacin I write a note for the challenge, make sure the patient is aware so that they don’t add it back themselves, and then added a note in the allergy listing under clarification needed with a dot phrase that this patient isn’t allergic and to not add back unless additional reaction.

#IDTwitter #MedTwitter #Allergy #Allergies We have been trying to de-label PCN allergies on the inpatient side, but a few times patients have come back in, only to have the label re-added. Any experience with Epic EMR alerts to stop this or another strategy?

@KimberlyBlumen1 @drtimothyli @EricMacyMD @PharmerMeg @TrubianoJason When someone is specifically reacting to pip tazo but no other penicillins, would you assume tazobactam is the culprit? Or the piperacillin side chain? Sometimes in those cases I’ll enter the allergy as tazobactam so that other penicillins are spared the alerts.

@drtimothyli @EricMacyMD @PharmerMeg @TrubianoJason Yes and in fact US drug allergy recommendations say to use amoxicillin to broadly de label penicillin allergies (exception if incident reaction was piperacillin since some of those are side chain specific).

If a patient has a remote history of non-severe ampicillin allergy being given amoxicillin and tolerated, will you delabel the allergy? @KimberlyBlumen1 @EricMacyMD @PharmerMeg @TrubianoJason

@ThoPham27 @accpinfdprn Is there a cefepime arm? The graph seems to compare to mero only?

#ASMicrobe Day 3 PTZ breakpoint pearl: PTZ is associated with ⬆️ treatment failure in AmpC-producing Enterobacterales compared to carbapenem/cefepime!

@accpinfdprn I do this at my institution. We’ve expanded beyond just penicillin, but penicillin is still the majority of the testing we do. Mostly oral challenge, very little skin testing. Our pen algorithm is in our publication: doi.org/10.2500/aap.20…

Does your site have pharmacist led penicillin allergy delabeling? If so, what pearls and pitfalls would you advise. 💊 Resource over penicillin allergy delabeling: annallergy.org/action/showPdf…

@BillJonez1 @EricTopol @JAMAInternalMed Lower dose is to match the level of nirmatrelvir in the blood with those with normal kidneys (nirmatrelvir is cleared by the kidneys). If she’d ingested the std dose she would’ve gotten a higher than normal level in her blood. I hope she’s doing better.

@EricTopol @JAMAInternalMed My wife had a bit higher kidney result on her test and she took a reduced strength Paxlovid. Did that reduce the effectiveness of the drug? Could they give a lower dose for a longer interval?

Nearly all Paxlovid drug-drug interactions can be circumvented by holding the drug or reducing its dose. A quick and practical summary @JAMAInternalMed jamanetwork.com/journals/jamai…

@BriFrescas @ABsteward I’ll read in full on Monday, but was just wondering if there’s a sub analysis for cefepime mic 1 and under?

@ABsteward Tbh it’s been a low-key goal of mine to have an article be tweeted out by @ABsteward

I wish this was an RCT 🆕️⚡️⚡️Small single-center retrospective cohort #IJAA @BriFrescas Empiric cefepime Vs meropenem for BSI caused by ceftriaxone-resistant Escherichia coli and Klebsiella pneumoniae with cefepime MICs≤ 2 mg/L #IDTwitter Limitations🤔 sciencedirect.com/science/articl…

@PhlawlessPharm How do you feel about the bigger kiddos? Do you max out at adult dose? Or go higher?

For my non peds colleagues, yes.. otitis media dosing for amoxicillin is “high”

@BriFrescas @ABsteward Ooh, was just thinking about this yesterday… can’t wait to see what you found.

Ecstatic to say that my manuscript “Outcomes Associated with Empiric Cefepime for BSI by ESBL-producing E. coli and K. pneumoniae” has been accepted for publication!! I’d update when it hits the press, but @ABsteward will probably let me know before I even find out 😉

@saltylungs Can you get 3 day remdesivir? Given anti rejection drugs, your best bet for staying out of hospital. Get better soon!

@madison_salam @jlbouchard001 Ndm? Aztreonam with ceftaz avi for the avibactam?

Bat signal to #IDTwitter: Other sensitivities are pending but pt's last PsAR (12/2022) was cefiderocol >=32 (R), colistin: 1 (I), imi/rel 4/4 (I). Help.