Providence OR ID/Antimicrobial Stewardship Program

📢 📢📢 We are delighted to announce that we have begun to assemble a team for UTI WikiGuideline. Join us to create guidelines with the humility of uncertainty. Use the link below to begin the process by April 9, 2023 forms.office.com/r/Tyb8R0iM8X #MedTwitter #IDTwitter

@DrToddLee @GermHunterMD @drtimothyli Agree. A lot of ASPs are doing meropenem stewardship by changing people to ertapenem. Not sure they’re equivalent.

#IDtwitter Bloodstream infection due to ESBL-producing Enterobacterales, susceptible to ertapenem No oral option available Clinically improving on meropenem Do you switch to ertapenem for completion of treatment?

@BradSpellberg @mmPharmD @zacroBID @Wiki_Guidelines @ABsteward

@mmPharmD @zacroBID @Wiki_Guidelines @ABsteward No idea. And not sure why that matters?

@IdVilchez @BradSpellberg @DrToddLee @ABsteward Yes S to all the usual agents. We generally have highly S Acinetobacter (thankfully). tmp/smx and minocycline sensi is pending, so it may turn out to be not quite everything else.

@ProvOregonIDASP @BradSpellberg @DrToddLee @ABsteward everything else? I am going to let the worst of me take over and to disappoint @BradSpellberg but unless is susceptible to TMP-SMX would treat with ampicillin sulbactam and meropenem, not sure for how long, I am to afraid of acinetobacter. PO TMP-SMX/Levo +rifabutin as PO tx

#IDTwitter How would you treat A. baumannii native valve IE? I to CIP, sensitive to all other abx. Amp/sul alone? Combination? If so, what combo? @BradSpellberg @DrToddLee @ABsteward @IdVilchez

The authors estimate the pricing required for fidaxomicin to be cost saving through preventing recurrence at $1140 USD and $860 CAD, respectively doi.org/10.1093/jacamr… @DrToddLee @ASPphysician @DrEmilyMcD @BrentFooter @AntibioticDoc @BradSpellberg #JACAMRNews

Stumbled across this ID consult note gem, " pt able to follow and contribute to our conversation in-between a classic @SouthPark episode on TV." #IDTwitter - what "classic" episode was on? #CasaBonita #ScottTenormanMustDie #MakeLoveNotWarcraft

@wfwrighID @OncIDPharmd @ABsteward @ErinMcCreary @IdVilchez @coltont00 Thanks. Hadn’t seen this yet.

#IDTwitter KPC via Cepheid with Ertapenem S (< 0.5) and Meropenem R (>16), Imipenem R (8) tested on Vitek. We see this phenotype has been reported but not clear on mechanism. Any thoughts? @OncIDPharmd @wfwrighID @ErinMcCreary @ABsteward @IdVilchez @coltont00

@OncIDPharmd @ABsteward @wfwrighID @ErinMcCreary @IdVilchez @coltont00 First one we’ve seen. Carbapenamases extremely rare in OR. N=9 for the entire state ytd.

Speaking of updating WikiGuidelines in real-time, we are grateful to have @ABsteward to keep us informed on the latest publications.

@ABsteward @ProvPPMC_RxRes @FoxEPharmD bmcinfectdis.biomedcentral.com/articles/10.11…

@ProvOregonIDASP @ProvPPMC_RxRes @FoxEPharmD Thanks for sharing, link please

Awesome publication from former @ProvPPMC_RxRes PGY1 resident and budding ID superstar @FoxEPharmD. Love to see former residents doing great work. #IDTwitter #TwitteRx @ABsteward