Case Report @thelancet.bsky.social ID Grand Rounds:

Endocarditis of aortic/mitral valves and myocarditis due to syphilis! Discussion of cardiovascular syphilis history too

Wasn't on my DDx for Cx neg IE!

www.thelancet.com/journals/lan...

A. DAIR
B. One stage exchange arthroplasty
C. Two stage exchange arthroplasty
D. Permanent Resection with antibiotics spacer

late 60s no comorbodites, with P. aeruginosa left knee periprosthetic joint infection. Few years ago had first L knee PJI with P. aeruginosa treated with DAIR and 6 weeks cefepime. Seem like recurrent infection, what surgical approach would you consider

New study in @cidjournal.bsky.social from France looking at molds (no yeast/dimorphics) found in blood cultures.

n=80 isolates from 2012-2022

2/3rds were Fusarium, 10% Lomentospora, 5% Trichoderma, 5% Mucorales, 5% Aspergillus

70% Hematologic malignancies

academic.oup.com/cid/advance-...

But if you don't know it is not ESBL, based on the abx susceptibility panel alone, it looks like an ESBL producer based on ceftriaxone Resistance. Would you still use cefepime?

PRO: Testing for ESBL production is necessary for ceftriaxone-non-susceptible Enterobacterales: perfect should not be the enemy of progress - PubMed The MERINO trial has seemingly laid to rest the question: 'Are carbapenems the preferred therapy for ESBL-producing infections?' It has, however, brought another important question to the forefront: '...

pubmed.ncbi.nlm.nih.gov/33987537/

do you think we should routinely test Enterobacterales for the presence of ESBL or just base or treatment on ceftriaxone Resistance? How would you treat this UTI with bacteremia (assuming is TMP-SMX qnd FQ resistant)

Secondary Prevention Guideline recommendations: To prevent fungal peritonitis, we recommend that anti-fungal prophylaxis be co-prescribed whenever PD patients receive an antibiotic course, regardless of the indication for that antibiotic course (1B). Even though this anti-fungal prophylaxis recommendation is unchanged from the 2016 ISPD guidelines, not all nephrologists apply this routinely. Data to support this comes from a Cochrane meta-analysis including 2 randomized controlled studies on anti-fungal prophylaxis with oral nystatin or fluconazole showed a risk ratio of 0.28 (95% CI 0.12–0.63) for fungal peritonitis occurring after an antibiotic course (Lo et al, AJKD 1996; Restrepo et al, PDI 2010; Campbell et al, Cochrane Database Syst Rev 2017). However the evidence is based on just these 2 studies with relatively low GRADE due to high risk of bias in the old 1996 study and very few events in the other.

If you have a large volume of PD patients, and you don’t do this, you will see fungal peritonitis

It’s a 1B from @ispd1.bsky.social www.nephjc.com/news/ispd202...

I can’t imagine the replies which say you need not 🤦🏽‍♂️

Also came up on the pod: www.nephjc.com/freelyfilter...

I tend not to but understand if people do it. Once patients get fungal peritonitis the nephrologists tend to remove the catheter and put them on HD which can have a big impact on QoL.

This is perhaps a more common reason to explain this phenomenon, the case of a polymicrobial culture in which one has mecA gene. But as Alice shared, at least 3% could occur in monomicrobial infection with a Staph aureus mec A gene positive but oxacillin susceptible

Reversion From Methicillin Susceptibility to Methicillin Resistance in Staphylococcus aureus During Treatment of Bacteremia Approximately 3% of Staphylococcus aureus strains that, according to results of conventional phenotypic methods, are highly susceptible to methicillin-like antibiotics also have polymerase chain react...

I really didn’t know heteroresistance in staph aureus was also a thing. But the lab is supposed to report as R if mec A gene found.

pmc.ncbi.nlm.nih.gov/articles/PMC...

Genomic Basis of Occurrence of Cryptic Resistance among Oxacillin- and Cefoxitin-Susceptible mecA-Positive Staphylococcus aureus | Microbiology Spectrum The oxacillin- and cefoxitin-susceptible mecA-positive Staphylococcus aureus is a novel type of “stealth” methicillin-resistant S. aureus (MRSA), which is difficult to be detected using conventional m...

journals.asm.org/doi/10.1128/....

In theory, at least in vitro and one case report, it could develop reversion to oxacillin resistance upon exposure to beta lactams

how would you treat and ICD infection with lead and valvular vegetation that grew Staph aureus mecA gene positive per Biofire but Oxacillin susceptible per routine blood culture? Would you treat as MSSA with cefazolin or as MRSA with Vanco or Dapto ?

Its imperfect data. But its some data and it suggests benefit. 5% absolute reduction in the RCT.

I consider this to be a fairly low risk, high reward intervention. Short courses of fluc are generally well tolerated and there is evidence of benefit that's better than many things we do in ID

The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis La eficacia de fluconazol como estrategia profiláctica en los pacientes con enfermedad renal crónica (ERC) sometidos a diálisis peritoneal (DP) con ex…

I usually follow the kidney society guidelines for PD peritonitis, which does recommend it.

There is some evidence to support its use, albeit not the highest quality:
Cochrane Review: pmc.ncbi.nlm.nih.gov/articles/PMC...
SR/MA: www.sciencedirect.com/science/arti...

if you have a patient with peritoneal dialysis catheter related peritonitis and you decide to treat with PO and/or intraperitoneal antibiotics, do you routinely recommend fluconazole prophylaxis?

The Four Moments of Antibiotic Decision Making
Random image #idsky #medsky #AMSsky

🆕 #Breakpoints Episode: Drs. @annegretemartson.bsky.social, Megan Wimmer, and Evan Clemens join me to discuss all things (Val)ganciclovir!!! #idsky #pharmsky #amssky @sidpharm.bsky.social

🎧 sidp.pinecast.co

"If you’re going to give antibiotics to patients who don’t need them, at least do the courtesy of giving them for a brief period of time." #IDQuotes @bradspellberg.bsky.social
#idsky #medsky #AMSsky #utisky

The ‘Big Five’ carbapenemases:
1️⃣VIM
2️⃣IMP
3️⃣NDM
4️⃣KPC
5️⃣OXA-48
🌟Timeline representing the introduction of carbapenems & the appearance of carbapenemases worldwide. 🌟 #idsky #medsky #microsky

Rewriting the Script Natasha Spottiswoode, MD DPhil, Daniel J Minter, MD, Rachel Friedman-Moraco, MD; Rewriting the Script, Clinical Infectious Diseases, , ciae589, https://doi

Inaugural article in a new section in @cidjournal.bsky.social called

“Clinical Dilemmas in Infectious Diseases”

led by IDMedEd superstars Daniel Minter and Varun Phadke designed to teach clinical reasoning

Rewriting the Script

academic.oup.com/cid/advance-... #IDSky

Harper's Bazaar, November 1933, by Romain de Tirtoff aka Erté

#IDsky
I’m currently going through my old twitter feed to find old posts I liked to find out who’s missing from 🦋
LBaddour
Javier Villafuerte
IDdocAdi
Marc Scheetz
German Esparza
Jason Pogue
Hemi Sulaiman
Brad Spellberg
Sumon Chakrabati
Zain Chagla
Jose Montoya
Lance Burkhart
Jake Scott
Laura Marks

🆕🔥"Is Antibiotic De-Escalation Safe and Beneficial to Patients with Sepsis?"
Our new article is out today:
👇
#IDSky #MedSky #PCCSky #ICUSky #emimcc #Ansky #EMSky #AMSSky #TxID #meded #Pharmsky #RXSky
@unmc.bsky.social @unmccom.bsky.social
⬇️
bit.ly/4g7bGLE

2025 CDC Adult Immunization Schedule

2025 CDC Adult Immunization Schedule 💉
www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html
#VaccinesWork #IDSky #MedSky #immunization

Organ Procurement and Transplantation: Implementation of the HIV Organ Policy Equity (HOPE) Act The Department of Health and Human Services (HHS) amends the regulations implementing the National Organ Transplant Act of 1984, as amended (NOTA), to remove clinical research and institutional review...

Amazing news! HHS has determined that clinical research is no longer required for donors with HIV to donate their kidneys and livers for transplantation in the United States! Thank you to all the HOPE in Action teams and all the advocates for our patients!
www.federalregister.gov/documents/20...

Associations of HIV and prevalent type 2 diabetes mellitus in the context of obesity in South Africa - PubMed We found sex-specific differences in the relationship between adiposity and diabetes prevalence by HIV serostatus in South Africa. Notably, females living with obesity and HIV had lower prevalence of ...

pubmed.ncbi.nlm.nih.gov/39492946/

New virtual meeting for Immunocompromised Host Society: Addressing the Landscape of CMV Management in Transplant Recipients. Free to members or $25 plus a free membership for those not already members!

Forward on to your residents, fellows, grad students, and international colleagues

#TxID #CMV