Nik Rae

Oral continues to shine as the new IV for antibiotics When will it be taboo to "infuse" @ABsteward @BradSpellberg

@mubark_wilkins Lads on tour

A new trip with my family.

Great to combine some infectious diseases and respiratory medicine across Iraq with friend and colleague Dr Mudher Al-Khairalla. Everyone was exceptionally welcoming and it was great to make so many new friends. The Iraqi hospitality (and food) was second to none!

@IDPharmacist @accpchest A magic 8 ball costs $9.99 on amazon & will give you answers in perpetuity with, I suspect, a similar ROC curve to CRP. So from that perspective, CRP isn't actually that cheap. It certainly isn't useful. From like, actual data, n'stuff. clinicalmicrobiologyandinfection.com/article/S1198-… CRP #zombietest

Sacubitril/valsartan compared to equivalent/sub-equivalent dose angiotensin receptor blocker or angiotensin-converting enzyme inhibitor in heart failure with reduced ejection fraction: a meta-analysis of randomized trials | Europ Jour of Clinical Pharma link.springer.com/article/10.100…

@IdVilchez @wwrighID @BradSpellberg @Cortes_Penfield @dralicehan @ABsteward @DrToddLee @DrEmilyMcD @ParasiteGal @PaulSaxMD I had one of these a few months ago. Failed multiple courses of metro and a course of nitazoxanide. After excluding underlying cause tried metronidazole + albendazole for 7 days which was successful. I found the discussion in this paper helpful. pubmed.ncbi.nlm.nih.gov/28624613/

#IDTwitter #IDXPost #IDPhoenix what is the treatment for persistent Giardiasis that has not been eradicated after 4 courses of metronidazole, the last for 3 weeks? @wwrighID @BradSpellberg @Cortes_Penfield @dralicehan @ABsteward @DrToddLee @DrEmilyMcD @ParasiteGal @PaulSaxMD

@ABsteward An absolute unicorn. A “diagnosis” bilateral cellulitis is generally a reflection of lazy medical practice with no actual thought

Bilateral true cellulitis Historically considered to be rare but is increasingly common complicating chronic dependent oedema or lymphoedema History of chronic swelling or presence of oedema Have you ever encountered bilateral cellulitis & treated with antibiotics? #IDTwitter

Great to see one of our IMTs, Michael Martin, presenting a case of Neuro-Sweet Syndrome at Clinical Grand Round at FIS conference today

A @Wiki_Guidelines Consensus Statement: For adults with infective endocarditis, oral transitional therapy was at least as effective as IV-only therapy. ja.ma/3OAfjOr @DrEmilyMcD @DrToddLee

@drtimothyli @IdVilchez If no obvious deep seated infection clinically and rapid clinical improvement then 7 days total Tx Benzylpen/Amox. 14 days Rx is only treating clinician anxiety.

Streptococcus pyogenes (group A strep) bacteremia No obvious pharyngitis No evidence of necrotizing fasciitis or toxic shock syndrome Afebrile since day 2 How long would you treat? What are the factors that would affect your decision?

Wow., it's published! @BradSpellberg et al @CMIJournal 🔥Choosing Patients Over Placebos: Oral Transitional Therapy vs. IV-Only Therapy for Bacteremia and Infective Endocarditis🔥 #IDTwitter clinicalmicrobiologyandinfection.com/article/S1198-…

Delighted to see our work in @bmj_latest, highlighting key points for generalists in the assessment and initial management of acute infections in people who inject drugs

“Good history taking is an important skill” . . Infectious disease docs: say no more

@Docroddy Glad to have been of service, hope the day got better!😂

@Nikolas_Rae is my absolute hero today. #nhsforever

@Abx_doc @anjefus @BradSpellberg @IdVilchez We use pivmecillinam a lot as oral step down in more resistant Gram negative bloodstream infections to complete course when clinically stable and limited other oral options. It seems to work well.

@anjefus I don’t have any experience with it! Do we even have it in the US!? @BradSpellberg @IdVilchez

Which abx to switch this 69 yo female to , sour of bacteremia is UTI. Patient with hx of liver transplant #IDtwitter #TwitteRX #txID

New: Risk of hepatitis C reinfection following successful therapy among people living with HIV: a global systematic review, meta-analysis, and meta-regression by @samira_hhr and colleagues thelancet.com/journals/lanhi…

@AntibioticLeeds @HCAILeeds @BSACandJAC @UKCPAPIN @ESGAP_ABS Given concerns about increasing MDROs (esp ESBLs) why are empiric aminoglycosides discouraged versus some recommending cephalosporin or aztreonam based regimens?

Mark Wilcox @HCAILeeds talking about complicated Intra abdominal infections. Pseud cover not always needed. Don’t use aminoglycosides. More diversity needed. @BSACandJAC @UKCPAPIN @ESGAP_ABS #BSACSpring2022

@InYourFAECIUM Ouch. Given in vitro does not always = in vivo activity. Sounds ill, if this was mine I would go for broke - tigecycline, imipenem + amikacin with clofazimine + macrolide for starters (Bdq worth looking at), make sure wide debridement and cross my fingers…😬

@IdVilchez @BradSpellberg @DrToddLee @wfwrighID Have had two patients with lactic acidosis on longer courses, one severe (lactate 26) that was dialysed. We monitor lactate / bicarbonate when on linezolid after that case - no evidence but treats clinician anxiety.

#IDTwitter for someone who uses linezolid very often in his practice, I tend to forget the possibility of induced lactic acidosis, we know the bone marrow suppression/neuropathy, but how often do you see this, do you think is common or rare? @BradSpellberg @DrToddLee @wfwrighID