Robert Chris

@MarkBelkinMD @JJheart_doc Where is this from? Thanks!

@JJheart_doc One of my favorite figures!

@JJheart_doc Any articles on this? Was trying to convince my staff to start today!

@ShohamTxID Have used Remdesivir x 5 days. Seen in patients on rituximab often. Worth a try.

Transplant patient on tacrolimus with COVID-19 ten weeks ago. Dyspnea on exertion is lingering but getting better. CT scan of chest abnormal. Cycle threshold in mid 20's. Workup for other infections negative. Treat with IV remdesivir, molnupiravir, CCP, paxlovid? No treatment?

@ChristosArgyrop Why indapamide over chlorthalidone/hctz?

@ChristosArgyrop What is your order of anti hypertensive agents? Ace/arb, thiazide, CCB. Then spiro? I see a lot of metoprolol labetalol etc

Get your first 2023 CE credits. Attend our FREE MAD-ID #webinar featuring @ErinMcCreary, @OncIDPharmD and @cleverwebber “A Pro/Con Debate on Fluoroquinolone Prophylaxis for Neutropenic Fever” on 1.25.23. Register: bit.ly/3VbQLMU

@DrToddLee @CADTH_ACMTS @DanielJDrucker And overuse of sitagliptin !!

It is time to replace sulfonylureas as the second line agent in diabetes for most patients without high competing risk of death. Either sglt2i or glp1 should, imo, get the nod depending on body mass and cardiovascular or renal risk. @CADTH_ACMTS @DanielJDrucker

@JonathanRyderMD @ABsteward @DrToddLee @InfectiousDz @CIDJournal Mortality rate of 9% for COVID in 2022 excluding patients with "severe comorbid conditions" and 40% outpatient ? Very odd.

@ABsteward @DrToddLee @InfectiousDz @CIDJournal Just reading the abstract, I'm disappointed they let them suggest their study shows improvement in mortality and duration of symptoms, when the CI's clearly show that it didn't suggest that

🔥VIZIR RCT🔥 The first double blind RCT for Zinc in #COVID19 patients High dose (50mg/d) oral zinc in the treatment of hospitalized & outpatients with #COVID19 Would you recommend zinc for COVID19 patients based on this study? Criteria?Age etc. #IDTwitter academic.oup.com/cid/advance-ar…

@JonathanRyderMD Any comments from the guideline authors?

While gent and rif are class 1, level B guideline-recommended therapies for Staph PVE, the evidence base for these therapies is largely in vitro and in vivo studies or surrogate outcomes (clearance of valve cultures)

So excited to share an #IDTwitter collaborative article! Together with @Cortes_Penfield @DrToddLee @syctong @DrEmilyMcD @JGPharmD and Irani Thevarajan, we did a systematic review & meta-analysis on gent & rifampin in Staph prosthetic valve endocarditis! academic.oup.com/ofid/advance-a…

@IUIDfellowship @ruwandi_k91 Why gent ?

#idboardreview #idtwitter #granulicatella #abiotrophia nutritionally variant #strep #Endocarditis

Myths in medicine: Why Was There Ever a Warning Not to Use Cephalosporins in the Setting of a Penicillin "Allergy"? - PubMed pubmed.ncbi.nlm.nih.gov/34303019/

@kaj401 @OncIDPharmd Why dapto/vanco for MSSA ?

@OncIDPharmd I would only if already cleared cx, stable, afebrile, and if only using for a portion of the MSSA course. If not and absolutely needed unasyn, I would consider keeping on cefazolin or adding daptomycin (or possibly vancomycin) in hopes of synergy

@AntibioticDoc @BradSpellberg @IdVilchez @wfwrighID @Boghuma @Cortes_Penfield Doxy???

@BradSpellberg @IdVilchez @wfwrighID @Boghuma @Cortes_Penfield Limited option space! I didn’t specify route for penicillins and thought IV cephs may be common -high dose Amoxicillin seems maybe useful but I haven’t done it. Seeing more reverse shoulder arthoplasty infections recently.

#IDTwitter… curious. Poll and comment…. For the antibiotic part of Cutibacterium acnes prosthetic joint infections, your go to is…. Priming with @IdVilchez @wfwrighID @Boghuma @Cortes_Penfield @BradSpellberg

@gunnar_heine @hswapnil @hswapnil why are beta blockers included as first line option in Canadian guidelines for patients <60?

Impact of Antihypertensive Drug Class on Outcomes in the SPRINT ahajournals.org/doi/10.1161/HY… Again: Betablockers should not be our first option in arterial hypertension. Unfortunately, current ACC / AHA and ESC guidelines are not yet generally followed by us in our clinical practice!

@Carlosportal3s @adamcifu You can even stop antibiotics…

@adamcifu In FUO/neutropenia you need to continue IV antibotics until ANC >500 even if patient is afebrile and doing well

One last question for twitter today. What "medical myths" do you find particularly pernicious, persistent and irritating? What are your medical myth pet peeves?

Pharmacists responsible for antimicrobial stewardship spend nearly half their time on indirect or non-ASP activities. Providing ID training and more protected time for ASP responsibilities may help programs to target higher level interventions. cambridge.org/core/journals/…

Recently published by @EB_Hirsch ; @MLBixby ; @Brian_Raux : Opportunities for antibiotic stewardship in emergency department or hospitalized patients with asymptomatic bacteriuria: identifying risk factors for antibiotic treatment cup.org/3GM0hPF

The silent pandemic is silent no more #AMRSOS @IDSAInfo @LevyCIMAR @Wellcome_AMR @CARB_X @UKAMREnvoy @ARLGnetwork

@IUIDfellowship what about oral amoxicillin?

#cutibacterium #PJI treatment removal of hardware and penicillin based on susceptibilites. Alternatives cefazolin or ceftriaxone. Initial 2 weeks of iv abx f/b oral abx to complete 6 wk course. oral options 1st gen cephalosporin, alternative clinda, linezolid

#idboardreview 50 M severe arthritis s/p R shoulder arthroplasty 15 mo ago now w/ ⬆pain & stiffness in R shoulder x3 months. Denies fever, redness or swelling. Inflammatory markers normal. Cloudy fluid wbc 2500, gram stain negative. OR culture+. Dx? #medEd #idmedEd #idtwitter

@DrToddLee @gushamilton @GermHunterMD @ABsteward @NEJM "Most recurrences of C. difficile infection during this 8-week time frame were observed within days to 2 weeks"... more vanco needed

@robert_c1234 @gushamilton @GermHunterMD @ABsteward @NEJM Study was done in North America, too. Maybe the timing of the 3 episodes was such that the third world essentially be treated as a first?

ECOSPOR III RCT✨✨@NEJM In patients with recurrent CDI a 2 pronged treatment approach of SOC Antibiotics followed by SER-109 an oral microbiome therapy composed of purified Firmicutes spores was superior to placebo in ⬇️ the risk of CDI recurrence nejm.org/doi/full/10.10…