Travis Kremmin

@ABsteward @wgutierrezchile @AlastairMcA30 Eravacyline is carbapenem sparing and has a potential benefit for pts with history of cdiff but seems like it's under utilized (and cost isn't terrible either)

@wgutierrezchile @AlastairMcA30 Exactly, like ceftolozane tazobactam it's carbapenem sparing but more expensive plus we need it for CRPA

We often talk about “carbapenem-sparing strategies”… but in real-world practice, what are we actually sparing carbapenems for, and what data actually supports that approach? #idxposts

@BradSpellberg @BJegorovic @ABsteward @DrToddLee @drgabx @zacroBID @IDstewardship

@tckremmin @BJegorovic @ABsteward @DrToddLee @drgabx @zacroBID @IDstewardship For the record, this is an incredibly well thought out response, and I agree with every word here. Thank you sir.

#IDXposts Patient on linezolid 600 mg q12h. You perform TDM, and found that trough concentration is 1.5 mg/L. What corrected dosing strategy would you use? Any particular formula for corrected dose? @ABsteward @BradSpellberg @DrToddLee @drgabx @zacroBID @IDstewardship

@BJegorovic @ABsteward @BradSpellberg @DrToddLee @drgabx @zacroBID @IDstewardship @Zaydovudine and the previous dose would have been enough for clinical improvement for the patient. We have a lot of data that shows that linezolid works quite well at this dose and very little (or any??) that TDM improves patient outcomes and that’s why I question if its necessary.

@BJegorovic @ABsteward @BradSpellberg @DrToddLee @drgabx @zacroBID @IDstewardship @Zaydovudine . When a patient has an AUC that comes back at 300 but they have improved clinically should we increase the dose or continue? And that would be my question in your scenario maybe you should increase to 600mg Q8H, or maybe that increase would be enough to cause an ADR

@BradSpellberg Great explanation like always!

There have been a number of questions raised about my statement that GRADE should be abandoned as a basis for drafting clinical guidelines. It's a simple issue that can seem complex. And people have some preconceived ideas that I want to clarify in this string. 1/16

@BradSpellberg @zacroBID Doesn't surfactant also decrease during pneumococcal infection?

@zacroBID Yes, the dapto evidence is included in the historical review in that position paper. My guess is that even inactivated dapto is probably better than placebo. The evidence of abx reduction of mortality for pneumococcal CAP is overwhelming.

Several important points here. First, historical data on abx efficacy for PNA is not relevant to Q you are asking bc when the historical data were generated, there were no vaccines for pneumococcus or H flu. So they accounted for the vast majority of PNA (particularly S. pneumo).

This got through peer review without anyone noticing that an entire guideline directly relevant to the content was omitted? Perplexing… @Wiki_Guidelines #IDTwitter jamanetwork.com/journals/jaman…

@IdVilchez @DrToddLee @BradSpellberg @Wiki_Guidelines @ABsteward @dralicehan @ApuAkkad1 @BJegorovic @Cortes_Penfield I'd bump to 2gm q4 vs 3 gm dose if not CI

@DrToddLee #IDTwitter do you routinely use cefazolin 3g IV every 8 hours or continuous infusion 6 vs 8 g daily for severe/deep seated/bacteremia/Endocarditis MSSA infection? For obese >120Kg @BradSpellberg @Wiki_Guidelines @ABsteward @dralicehan @ApuAkkad1 @BJegorovic @Cortes_Penfield

Making slides for a talk I'm giving in ~2 weeks. Long live the king.

@drrghimire @BradSpellberg @KASIC_MDRO Plenty of AKIs have occurred because of vancomycin .. plenty of thrombocytopenia with linezolid... Cpk elevation with dapto... Side effects and side effects with poor monitoring happen regardless of how the abx gets in your body

@BradSpellberg @KASIC_MDRO Our young trainees appear so excited about orals and forget what their patients protoplasm is. Just saw a patient with hyperkalemia and AKI of a diabetic patient with abscess and MRSA bacteremia in ACE I who ended up in HD when high dose bactrim was used. I’m careful teaching!

A pt is on D4 of vancomycin for MRSA bacteremia 2nd to a drained skin abscess. Pt is afebrile and wbc wnl. Repeat blood cultures are no growth to date. The MRSA vancomycin MIC is 2 mg/L. Change vanco to dapto?

@DrNeilStone If it wins a Nobel prize it obv mean it treats every condition known to man plus 15 not yet known

I'm an infectious diseases specialisy which means I prescribe ivermectin more than probably 99% of all doctors Yet I'm being told I "know nothing about it" And the Nobel Prize was for its use in parasite infections - which is what I prescribe it for Not cancer or Covid!!

@KASIC_MDRO @SaiduluGanta @KYHealthAlerts @KYIPTraining Easy, linezolid 😄

Treat a Patient, Not a Number. Check out this week’s KASIC pearl to learn What To Do When the Vanc MIC is 2? kymdro.org/kasic/?p=8844 #IDTwitter #IDXPosts #AntimicrobialResistance #antimicrobialstewardship #rxtwitter #pharmacy #FOAMed #NPs #PAs @KYHealthAlerts @KYIPTraining @KYAbxAwareness @KYHospitals @KAHCF1 @KyMedDirectors @SIDPharm @UKAbxStew @Arif_Nazir_MD @KyNPsLead @UofLDID

@ABsteward Definitely interesting....also wonder if maybe 3 days of IV is sufficient vs 7 days?

Super interesting! Cefazolin MIC as a surrogate marker for transitioning to po Cephalosporins UTI/BSI. 🆕⚡🟢Retrospective, exploratory cohort study of 148 patients found no difference in 30-day treatment outcomes based on the blood culture cefazolin MIC (≤2 mcg/mL Vs 4–16 mcg/mL) for patients transitioned to PO cephalosporins for the treatment of E.coli, Klebsiella pneumoniae, or Proteus mirabilis bacteremia secondary to a urinary source The median duration of antibiotic treatment for bacteremia was 7 days in both cohorts, with most patients receiving 3 days of IV antibiotics before transitioning to a PO cephalosporin on day. PO cephalosporins might be an appropriate alternative, even when the cefazolin MIC is considered intermediate #IDXposts Background:: CLSI recommends using cefazolin as a surrogate marker for PO cephalosporin susceptibility for the treatment of UTI secondary to Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis They further suggest differing susceptibility breakpoints for the treatment of uncomplicated UTI vs systemic infection, with a cefazolin MIC ≤16 mcg/mL and an MIC ≤2 mcg/mL considered susceptible respectively. This means a cefazolin MIC of 4-16 mcg/mL is considered sensitive for uncomplicated UTI but intermediate for bacteremia. Therefore, a urine culture may suggest susceptibility to PO cephalosporins based on the cefazolin MIC, while a blood culture susceptibility report may suggest the same organism is not susceptible to cefazolin based on an intermediate MIC. As clinicians may use either the urine or blood culture to guide transition to a PO agent for the treatment of bacteremia secondary to UTI, the evaluation of clinical outcomes when using an intermediately susceptible agent is warranted. journals.asm.org/doi/10.1128/aa…

@ABsteward Wonder if same protection would carry over to neurosyphilis

🆕🔥EMPHASIS RCT A multicentre, double-blind, RCT N:1724 Minocycline therapy initiated within 72 h of acute ischaemic stroke provided a significant functional outcome benefit compared with placebo at 90 days, without safety concerns #IDXposts thelancet.com/journals/lance…