Jonathan Ryder, MD

The STRAP study (modelled off SNAP) has a randomisation domain on IVIG for severe StrepA alongside domains on baseline antibiotics (penicillin vs ceftriaxone) and adjunctive antibiotics (nothing vs clindamycin vs linezolid) and should hopefully give proper data on this question.

This is a study where the results are all in the eyes of the beholder

I guess I’m lucky? (And maybe uncultured lol)

Effectiveness of Doxycycline in Combination with Other Antibiotics for Gram-Positive Periprosthetic Joint Infections: a Causal Inference Study AbstractObjectives. Doxycycline is occasionally used as step-down therapy in periprosthetic joint infections (PJI), but evidence supporting its efficacy is

New PJI study in @ofidjournal.bsky.social:

Largest restrospective study to date of doxycycline use for PJI treatment with encouraging results

All doxycycline use was in combination though, primarily rifampin. Limited to Staph, Coryne, & Cuti

#IDSky #OrthoID

academic.oup.com/ofid/advance...

Time for me to give another ID Journal Club! Anybody have any interesting or high-impact papers they've seen in the last 6 months that would make for a good presentation? Can't be DOTS tho, already did that! #IDsky

Initial Vancomycin Taper for the Prevention of Recurrent C difficile Infection This randomized clinical trial tested whether a 4-week pulse and taper vancomycin regimen was superior to a 2-week pulse regimen for preventing recurrence among patients with a first episode or first ...

The just published TAPER-V trial has lots of fun journal club things to discuss: jamanetwork.com/journals/jam...

Totally normal to discuss journal articles at a Normal Club. That’s normally what normal people do

Agreed. The history of studies with IVIG and STSS is riddled with these issues, which makes it quite challenging!

Interesting case report. I agree monitoring LFT is fairly reasonable. But I'm not sure routine TDM is warranted based on a single case report of asymptomatic LFT abnormalities that were caught by much less expensive LFTs. Even without TDM, one would stop the drug here I would hope

Figure 1. Bacteria Cultured from Injured Ukrainian Service Members. Shown are bacteria cultured from the wounds of 127 injured Ukrainian service members, with percentages assigned to each bacterial family and to each genus within the Enterobacteriaceae family. Percentages may not total 100 because of rounding.

Battlefield injuries are often contaminated with potentially infecting microbes. In this study, swabs obtained in the field after injury were profiled. Microbes and potential antimicrobial-resistance genes were characterized. Full study results: nej.md/4l1hpqk

#MedSky #IDSky

New study in @ofidjournal.bsky.social

Retrospective study (n=106) of IVIG for Strep Toxic Shock Syndrome

After accounting for covariates & immortal time bias, the lowered mortality seen in crude analysis disappeared.

I suspect historic studies for STSS had similar biases when showing benefit

Feasibility Trial of Prolonged versus Single-Dose Challenge in Penicillin Allergy We aimed to evaluate the feasibility of conducting a multicenter, double-blind, placebo-controlled trial of prolonged (i.e., multidose) compared with single-dose amoxicillin challenge in patients w...

#PROSPECTOR Trial is out in NEJM Evidence 🔥

➡️ evidence.nejm.org/doi/full/10....

✅ 1st double-blind, placebo RCT in #drugallergy
✅ Pilot feasibility RCT
✅ 1-dose vs 5-day amoxicillin challenge in delayed/unknown #penicillinallergy

We’re going to answer… Is 1 dose ever enough? 👀 #PROSPECTOR2

In a new @nytimes.com op-ed, immunologist Elisabeth Marnik, PhD, reflects on growing up unvaccinated and explains why empathy, not shame, is key to addressing vaccine hesitancy. bit.ly/3MBIbc5

758 pts with enterococcal BSIs: 14d mortality 24%, 30d 42%. Early anti-enterococcal therapy (EET) showed no overall mortality benefit, except ↓14d death in vancomycin-resistant cases only.⚠️

Congrats to @drtoddlee.bsky.social & @dremilymcd.bsky.social on conducting this and getting it out there for us. Look forward to wading through the details soon!

That's how I interpret this. Might help some patients in the hospital who are severely ill get through their initial episode without a recurrence for awhile longer, but not sure how much this helps my stable outpatient who is either going to recur or not recur no matter how much PO vanc I give them

Initial Vancomycin Taper for the Prevention of Recurrent C difficile Infection This randomized clinical trial tested whether a 4-week pulse and taper vancomycin regimen was superior to a 2-week pulse regimen for preventing recurrence among patients with a first episode or first ...

🔥Just published 🔥
TAPER-V RCT
In this RCT of 256, a 4-week vancomycin pulse and taper regimen *had a probability of 74% to be superior to a standard 2-week pulse regimen in patients a first episode or first recurrence of CDI
Vanco for 10d is obsolete! #IDSky #EMIMCC
jamanetwork.com/journals/jam...

General ID team powering through Friday rounds!

#SelfiesonService @drjrmarcelin.bsky.social

State-of-the-Art Review: Chagas Disease—an Enduring Challenge Chagas disease remains the most significant neglected tropical disease in the Western Hemisphere. In this review, we examine critical aspects of patient ca

The most comprehensive Chagas’ disease review I have read in @cidjournal.bsky.social

Congratulations and thank you to @andhen25.bsky.social and team on such a useful paper!

#IDSky

academic.oup.com/cid/article/...

Strong real-world evidence that a single dose of benzathine penicillin G or a 28-day course of oral doxycycline is not inferior to three doses of benzathine penicillin G for the treatment of late late... Noah Kojima, Jeffrey D Klausner; Strong real-world evidence that a single dose of benzathine penicillin G or a 28-day course of oral doxycycline is not inf

Editorial is definitely worth a read - it goes into some of the historical aspects of #syphilis and treatments.

Interesting (but not terribly surprising) to learn that 3-dose regimens were based on very low quality evidence and haven't changed in 50 years! 🤯

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

Is three really what we need? Relative effectiveness of benzathine penicillin G and doxycycline treatment regimens for late or unknown duration syphilis in 6 United States jurisdictions, 2016–2021 In this retrospective cohort analysis using surveillance data, appropriate serological response by 24 months was comparable among persons with late or unkn

Important paper about how we treat #syphilis - are 3 doses of benzathine #penicillin G needed for late or unk duration infections? Using surveillance data, no differences in 1 v 3 doses of BPG (or vs 28d of #doxy) were observed.

We need a trial👇🏽!

#IDsky #STIsky

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

Antimicrobial stewardship during extracorporeal membrane oxygenation: challenges and new perspectives Extracorporeal membrane oxygenation (ECMO) has emerged as a crucial modality in managing severe cardiac and respiratory failure; however, nosocomial infections and complex antimicrobial prescribing ch...

Important review of stewardship in ECMO

#IDSky

🔑 points:
-ID should be part of multi-disciplinary team
-More interventions not associated with 👍 outcomes
-Lots of gaps in 📚

Thanks to @mirandapharmdmph.bsky.social and team for writing!

www.clinicalmicrobiologyandinfection.org/article/S119...

#IDsky sharing one of the Stanford's ID fellow's meded site infectiousdiseasehub.com #idmeded #meded

Tecovirimat for the Treatment of Mpox | NEJM Tecovirimat is approved for smallpox treatment under the Food and Drug Administration Animal Rule on the basis of efficacy in nonhuman primate models of mpox (previously known as monkeypox). Howeve...

The STOMP/A5418 Trial is out:
- Clinical Resolution: 83% tecovirimat, 84% placebo
- No significant differences in pain, time to lesion healing, or viral DNA clearance
- Similar results to PALM007 for clade 1 MPXV

*Tecovirimat seems to lack efficacy in clade I and II

www.nejm.org/doi/full/10....

The summary page of the WikiGuidelines endocarditis section on nutritionally variant streptococci

The @wiki-guidelines.bsky.social endocarditis guidelines are awesome, but very special thank you to the folks in charge of the nutritionally variant streptococci section.
This page was so useful this week in informing treatment choices 😇🥰

@bradspellberg.bsky.social thanks to y’all!
#IDSky #MedSky

Emergence of dalbavancin, vancomycin, and daptomycin cross-resistance in MRSA during long-term LVAD suppression with vancomycin followed by dalbavancin: genomic insights and synergy with cefadroxil

✅ Just Accepted
🔗 https://bit.ly/4azpqPJ

@marinschweizer.bsky.social: Among younger, immunocompetent patients who underwent debridement, antibiotics, and implant retention for PJI, receipt of suppressive antibiotic therapy was associated with ⬇️ death or treatment failure but also associated with side effects. doi.org/10.1017/ash....

Really enjoyed this episode, especially the parts on plague doctors (admittedly I dressed up as one this Halloween!)

Yes second of these studies. Historically the dose was set roughly like this:
1) Establish MIC in the rabbit
2) WHO group said well for humans lets go 6-10* higher than that for safety
3) And for late syphilis lets go three times dosing too

Ripe for a proper trial.

Wow. Had no idea where that dosing came from. So many rabbit models in ID determining doses and durations. I was happy to see this coming from CDC. Hope they can spur funding for a trial. Could be huge during PenG shortage and for stewardship