Stuart Greaser, PharmD, BCIDP

#IDSky @sidpharm.bsky.social Piggybacking on previous Q: for those that do MRSA screening pre op, do you do just nares? Multiple sites? Do you consider MRSA infection hx (any specific time) a positive ‘screen’?

Agreed. Mostly this would be for patients whom have MRSA risk factors (colonization, pre-op hospitalization duration, etc..). EP wants all device upgrades, reimplants and “high risk” to bar MRSA coverage. Still discussing that internally. Have had an uptick in MRSA infections overall but still low.

#IDSky #PharmSky @sidpharm.bsky.social Evaluating anti-MRSA surg prophylaxis logistics in cardiac device implants.. looking for thoughts on DAP use instead of vanco (we are struggling with timing pre op). Any experience out there for cardiac sx (or any service line)?

Here as well!

Interesting! Hopefully will get some more information soon. Cheers!

Ah yes. For what it’s worth that was negative (KPC, NDM, VIM, IMP, OXA-48) but not sure about validity.

A few didn’t cross over (CZA was R.. not sure about mero-vabor) Checking on tigecycline/minocycline. Setting up imi-rel as we have a few strips left. Was going to send off for colistin and cefiderocol.

CarbaR negative.

Cefiderocol was my first inclination. Will see if I can pull this tomorrow. Interesting those with pre treatment resistance responded. Was considering combo with tigecycline or inhaled colistin until susceptibility confirmed.

Carba R unfortunately. Resistant to all of our standard reported panel including TMP/SMX, Pip/taz (not surprising) and AMGs. Waiting on a few e-tests and going to send out for a few others.

🆘 #IDSky #PharmSky: XDR Achromobacter xylosoxidans presumed pneumonia (from BAL) in pt with severe bronchiectasis. Team is evaluating clinical status to determine if treatment needed but… What combos or newer drugs have you used or tested with success? Presume R to routinely tested ABx.

Assuming your shop uses Epic? Do you have beaker? Have explored these suggestions but apparently limited by our 3rd party lab system according to my LIS colleagues 🤷🏻‍♂️

Would love to see this explored more. While PK studies are great, some clinicians may be hesitant to higher than label doses without clinical outcomes data (at least in my shop🤷🏻‍♂️). Often they retreat back to IV when faced with amox/clav TID or cephalexin 4g/day.

a man with a beard is making a funny face with the words it keeps coming back from the dead above him ALT: a man with a beard is making a funny face with the words it keeps coming back from the dead above him

There has to be some preference list somewhere with it saved…or it’s coming from monthly med loads? Mainly shows up sporadically for IAI or “asp pna”and yes… I’ve checked, rechecked and had someone else check our builds.

📌 I’m still searching for where q6 is coming from in Epic🤦‍♂️it always keeps popping back up!

TID more for convenience but I try to have a discussion with patients about tolerance. Have switched to amox/clav plus amox mid day in some patients. Of course have to get to through the “PO is good too!” discussion first!