Lina Meng, PharmD

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!

I sense a debate or update brewing for ID Week 2025/SIDP: team FQ vs b-lactam for uncomplicated GNR bacteremia? 🎙️👥
@idsainfo.bsky.social
@sidpharm.bsky.social

#IDsky

Right this should be prospective studied. With standard doses used, "Recurrent BSI at 90 days was the main driver for the composite outcome occurring in 64 (5.4%) and 107 (9.4%) patients of the highly and less-bioavailable groups, respectively (p < 0.001) (aOR, 0.56; 95% CI, 0.40–0.78)"

Couple of our providers anecdotally have preferentially used BL over FQ. No diff in 30-d mortality with FQ vs BL in urinary source BSI (Sutton, Saad). But systematic review (Punjabi) found higher recurrence rate 5.5%BL vs 1.9% FQ, OR 2.05 from all sources; Similar signal in Mack; variable BL use 🤷‍♀️🤔

ID team Q: recs on amoxicillin PO dose for stepdown for uncomplicated strep bacteremia on day 5?

Me: Pick anything. You're just about done with treatment!
...1g q8h

#IDsky #medsky #pharmsky #RXsky

Evaluating antimicrobial duration for Gram‐negative bacteremia in patients with neutropenia due to hematologic malignancy or hematopoietic stem cell transplantation In the management of immunocompromised patients with neutropenia and Gram-negative bloodstream infection, short antimicrobial courses (≤10 days) had comparable propensity score-adjusted 90-day outcom...

Congratulations to @nischalr3.bsky.social and his team for their paper being selected as the @thetxidjournal.bsky.social 2024 Bob Rubin Clinical Impact Awardee - this award selects the paper felt to have the biggest impact on clinical care in #TxID!

#IDSky

onlinelibrary.wiley.com/doi/10.1111/...

Back to ASP work on Monday, and it feels like everyone has aspirated over the weekend and is on ABX. 🫠 Perfect timing for this ABX pearl on distinguishing aspiration pneumonitis from pneumonia. 🔑 Hyperacute resolution? Skip the ABX. Check it out! 👇 #USAAW24 #AMSsky #IDsky #pharmsky #MedEd

Shout out to our amazing ASP team members @dhpharmd.bsky.social and @marisa-holubar.bsky.social for this fun idea! 🦠💜 Loving the micro nerd energy at Stanford for #USAAW24. 🙌 What’s everyone else doing this week? #IDsky #Medsky #pharmsky #amssky

Need help! 🙏 #IDsky #Medsky #AMSsky @joshparkpharmd.bsky.social—looking for ideas/must-haves to build a simple ED dashboard 📊 for tracking ABX use & outcomes. We’re on Epic and keeping it basic for the first go. CC: @dhpharmd.bsky.social

Multiple RCTs comprised patients with gram negative bacteremia from predominantly urinary sources demonstrate noninferiority of 7 days compared with 14 total days of treatment for a variety of patient-oriented outcomes, such as clinical cure, clinical failure,relapse, and all-cause mortality. #idsky

Hi #IDsky & #PharmSky! 👋 I'm an ABX stewie (formerly critical care) at Stanford:
✨ Passionate about learning from others in ID, ASP, & RX.
🛠️ Love creating tools & education for frontline clinicians.
📚 Started Stanford ABX pearls series and Obesity ABX Guidance

Excited to connect and share ideas!

🔄 Just got this consult question this week from our ICU pharmD—a great reminder during our blood culture and IV fluid shortages! 💡💊
Love it when I can reply back ✂️🗒️ with our team's ABX Pearl #IDsky #MedEd #pharmSky #RXsky

🔗ABX pearl library here: med.stanford.edu/bugsanddrugs...