Lina Meng, PharmD

🩺 Clinically, identifying a lactose fermenting GNR is particularly useful for ruling out Pseudomonas.

⚠️ Many non-lactose fermenters (especially Stenotrophomonas, Burkholderia, and Acinetobacter) can be very challenging to treat. ID consultation should be considered for invasive infections.

🌟 ABX Pearl of the Day:

❓ Q: When should I empirically cover for Pseudomonas aeruginosa in diabetic foot infections (DFIs)?

#IDsky #medsky #meded #pharmsky #skyRX #AMSsky

🌟 ABX Pearl of the Day:

❓ Q: Candida only grew in 1/4 bottles. Is this a contaminant?

#IDsky #medsky #meded #pharmsky #skyRX #AMSsky

Yay! Tara's our awesome ASP track fellow this year - so lucky to get to work with her! @stanfordasp.bsky.social @linameng.bsky.social @dhpharmd.bsky.social @polishmd.bsky.social

Risks of ABX overuse greater than benefit? 🤔

The same treatment was associated with negative outcomes, including increased hospital readmissions, transfers to the ICU, and longer hospital stays. 🏥

The outcome: After adjustment, empiric broad-spectrum antibiotic treatment was not associated with a lower mortality rate. 🚫

🔎 The findings: In 2,706 moderately ICH patients with pneumonia, MRSA and resistant GNB were rare, found in just 3.5% of cases. 📉

Is empiric MRSA and PsA coverage needed for all moderately ICH with pneumonia? A recent study in CID offers a data-driven look.

So what to do? Check out our ABX pearl on which ICH patients are best candidates for expanded empiric ABX coverage in CAP. ✅

#amssky #Idsky #medsky #pharmsky

🌟 ABX Pearl of the Day:

❓ Q: My immunocompromised patient is admitted to the ICU and starting ABX for presumed CAP. Do they need empiric MRSA and Pseudomonas coverage?

#IDsky #medsky #meded #pharmsky #skyRX #AMSsky

🌟 ABX Pearl of the Day:

❓ Q: My patient is growing yeast in blood cultures. Is this Candida?

#IDsky #medsky #meded #pharmsky #skyRX #AMSsky

Check this-CLSI eliminated gentamicin as tx option for PsA.

"Review of modern PK/PD) data against members of the Enterobacterales and P. aeruginosa demonstrated:

• No safe aminoglycoside dosing regimen was predicted to achieve bacterial 1- or 2-log killing, regardless of the breakpoint applied."

🔥Finally published🔥
IDSA Guidelines on the Treatment and Management of Complicated Urinary Tract Infections (cUTI)
#idsky
www.idsociety.org/practice-gui...

I'm hoping it's because they were super users at baseline 🤓

Implementing microlearning via ABX Pearls emailed to clinicians and trainees weekly at our hospital. 81% reported an impact on their practice, across multiple stewardship domains. 👇🏻

Library here:
med.stanford.edu/bugsanddrugs...

#IDPharmacistsDay #medEd #AMSsky

Hi! Lina here from Stanford, CA. I love working with the innovative, bright, open-minded ASP team here @stanfordasp.bsky.social and learning from amazing, dedicated pharmDs/MDs nationally that have propelled ABX stewardship forward tremendously in recent years. #IDpharmacistsday

Excited to share our newest paper from my PhD: a post-hoc analysis of the BALANCE trial where we explored heterogeneity of treatment effect (HTE) in duration of antibiotic treatment for patients with bloodstream infection. A thread:

doi.org/10.1016/j.ec...

#IDSky @eclinicalmed.bsky.social

🌟 ABX Pearl of the Day: Linezolid drug interactions

❓ Q: I'd like to prescribe linezolid but my patient is on serotonergic agents. What is the incidence of serotonin syndrome with this combination?

#IDsky #medsky #meded #pharmsky #skyRX

We're looking for a new Division Chief in Adult ID at Stanford. We have a great ID/Medicine family here and the division has been growing by leaps and bounds. We also have great Pedi ID, Micro, Immunology and Transplant teams. Please share!

Ongoing UCx stewardship efforts at Stanford 🤝 in partnership with infection control, CAUTI taskforce, micro lab, RNs
✔️ 2017: switch to UA with reflex only of wbc>10
✔️2024: a creation of UCx order panel.
🚧 remove UA/UCx orders from surgery pre-op ordersets?
#IDsky #AMSsky

#idsky #amssky Anyone using Tamiflu after IV peramivir in ICU patients that gain enteral access? Do people trust IV peramivir efficacy in severe/hospitalized flu?
pubmed.ncbi.nlm.nih.gov/39181595/

I learned about this meropenem/VPA drug interaction the hard way as a new practitioner after unsuccessfully dose titrating VPA for days (and wasting 💰). Fortunately VPA indication was for alcohol withdrawal (non benzo ICU protocol at Stanford), not seizures!

See useful tidbits on this interaction👇

Yes Epic+beaker. Agh that's tough when you have lab limitations

For ceftriaxone-R Enterobacterales from blood, our micro report shows MIC but no interpretation. Instead, displays cautionary comment. Chance for ASP-micro lab collab! 🤝

Study shared by esteemed👇 on
pyuria cutoff (in elderly♀️)"At a cutoff of 264 leuk/µL, sensitivity and specificity of microscopy were 88% (positive and negative likelihood ratio: 7.2 and 0.1, respectively). The commonly used cutoff of 10 leuk/µL had a poor specificity (36%) and a sensitivity of 100%."

Thrilled to see @conanmacdougall.bsky.social join! 🌟 Your insights are always spot-on. This graph on new ABX approval is spot on. 😂 So true about the emotional rollercoaster—though here, prescribers don't pay attention to drug cost unless formulary restricted. #IDsky #AMSsky #pharmsky #skyrx

Love our peds ASP colleagues and their amazing tools! ♥️ One of our ED's go-to favorites is their pediatric Amox-Clav Dosing Guide—because seriously, who can keep track of all those doses and formulations/ratios?

Welcome to Blue Sky! 🌟 #AMSsky #IDsky #pharmsky #skyRX #medsky

The look I get from SICU when I tell them they can stop ABX 24 hours after early GI perf repair 👀👽 #IDsky #pharmsky #AMSsky

I miss having you around here! Especially miss your sense of humor. 🥰

True. Would be great to get away from FQ in terms of C.diff etc. I think urinary source is where the data's strongest for PO BL leniency. Even if we can get prescribers to remember to use higher than usual doses, nobody wants to (or can remember to) take a med 3-4x/day!