Emir Kobic

@bryan_p_white 4.5g Pip/tazo dosing for SDD, you can still achieve 90+% PTA. Carbapenems use is higher than 5 years ago d/t rising ESBLs in the community/inpatient, adopting FDA would only lead to more Carbapenem use IMO.

With the FDA and CLSI taking different approaches to pip/tazo breakpoints for Enterobacterales, I’m curious to what others are doing. CLSI breakpoint of 16 as SDD and the FDA doing intermediate for 16. I’m curious as to what other people are doing. fda.gov/drugs/developm…

@jeffpears0n @KatyBowmanMD Send out Fetroja for MIC testing, we’ve seen discordances w intermediate KB tests vs the MIC. There are report of Vabomere/Aztreonam use-we’ve had clinical response. Meropenem/Xeruborbactam would be on my wish list here, broader NDM activity than Taniborbactam

Alright #IDTwitter, what would you recommend in the situation below? Source control unattainable, infected graft so hoping for short-term acute treatment and long-term suppression. NDM positive Providencia rettgeri

@ABsteward I don’t think this answers it. Median vanco duration of 2 days - AKI with short use vanc/Zosyn hasn’t been demonstrated. Association with use >72 hrs 👍

A final answer for this question? Does Vancomycin Piperacillin-Tazobactam Cause Pseudo-AKI, True Nephrotoxicity? So, according to this RCT/ the highest level of evidence, it's probably pseudo-AKI ! #IDWeek2023 #IDXposts

Albumin </=3 associated w ↓ posa trough goals for treatment. Retrospective study but interesting finding from Moffitt Cancer Center. Consider 400mg DR tabs for initial dosing

IDSA should draft Guidance on the Treatment of Difficult to Treat Gram-POSITIVE Infections: A focus on Staph aureus, Enterococcus, and ________ (comment other bugs below) @OncIDPharmd @IDSAInfo

@OncIDPharmd Maybe we need a yes/no poll on whether IDSA should draft GP resistance guidance to provide expert opinion?

@criley_md @IDstewardship @physicianswkly @DrLindaMD @IdVilchez @PaulSaxMD @ClancyNeil @tmhohl71 @TakaMatsuo_ID @BradSpellberg @LAGeneralMed @jonbachna_PAST Submit to FDA Med watch so they can investigate

An elderly patient got a bottle of Amoxicillin and Clavulanate Potassium tablets from a local pharmacy. Have you ever witnessed transformation of pills like this, overnight? The inside of the pills is not white any longer but looks like a sawdust. 1/🧵 #pharmacy #pharmacists

@IDPharmacometrx @IdVilchez If reported AKI rates with vancomycin are ~10% in literature and your facility has close to half that rate, why do AUC? Where’s the benefit if you have to spend more $$$ for a 1 level Bayesian software vs more $$$ for 2 levels + more nursing/lab/pharmacist time combined

@lilhwn2 @SIDPharm @accpinfdprn @IDstewardship @MAD_ID_ASP There’s a great presentation by Dr. Sarah Parker “making your case to the C-suite.” It’s part of new content for SIDP’s Antimicrobial Stewardship certificate this year. I’ll dm you a contact but I’m not sure if it’s ready for release yet

Hey @SIDPharm @accpinfdprn @IDstewardship @MAD_ID_ASP I need help! Anyone have a proposal to justify an Antimicrobial Stewardship Pharmacist position that they are willing to share? Asking for a friend!! We both wonder why we need to justify this position, but we do! #TwitteRx

@gracilizumab @MitchBPharmD How endearing, thank you! GB is now gonna be the star patient at a round table I’m having in a couple months 😂

@HOGTOWN_DOC Applications for general pharmacy residency are down this year as well

@drtimothyli These were pre-pandemic, can’t remember full hx other than elderly & high dose 500mg QID.

@emirkobic20 Wow what cases are those? ESRF? Very severe C diff? I have seen detectable levels but definitely not that high

#IDTwitter Name an antibiotic that does not require dosage adjustment in renal impairment I will start first Oral vancomycin

@DrToddLee We don’t order on admission, only if PNA is suspected and vanco started. MRSA prevalence increases with time in ICU -I haven’t seen a study go into Nares performance here and would rely on respiratory cultures at 48-72hrs in very sick patients.

@emirkobic20 And if you've low prevalence, you've low colonization pressure to drive nosocomial spread.

More data on MRSA Nares use in ICU’s 🚨 Nares based culture took ~1.5 days to result but retained high NPV in low MRSA prevalence. We weren’t able to tease out NPV value with use >7 days of ICU admission. Studies in late onset HAP/VAP needed. pubmed.ncbi.nlm.nih.gov/36575978/

@DrPHO_ID @Billicillin Would prefer PCR but yes it’s more $ and our micro lab works w/ a strict budget. Nares results are batched and released twice a day in PM. PCR would save half a day but ultimately we have other assays on our wish list and we’ve opted for electronic alerts that pharmacy acts on

@emirkobic20 @Billicillin Do y’all like culture over PCR or just easier/cheaper?

We’re hiring a 2nd ID pharmacist!🚨Check out this job at Banner Health: Antimicrobial Stewardship Clinical Pharmacist Specialist linkedin.com/jobs/view/3411…

@EB_Hirsch @OFIDJournal @mmPharmD @kristadgens @mnhealth @UMN_ECP @umnCVM @UMN_Pharmacy @AllinaHealth @MHealthFairview @id_kellyharris Sweet! Congrats!

@syctong Had the same question

@celinegounder @GrantWahl My condolences, absolutely tragic.

I am so thankful for the support of my husband @GrantWahl's soccer family & of so many friends who've reached out tonight. I'm in complete shock.