Shivan Shah

🚨BREAKING: IDSA, along with AAP, APHA, ACP and others, has filed a lawsuit against HHS/Secretary Kennedy to stop unlawful changes to vaccine policy and defend public health.

We refuse to stand by while America’s public health safeguards are torn apart. bit.ly/4lm7UkW

@astct.bsky.social has #ID #HSCT #CAR-T guidelines in TCT Journal
transplantid.net "GUIDELINES"▶️ "ASTCT Guidelines"📁

#️⃣ 🔟 : Management of parainfluenza and hMPV after HSCT and CAR-T
Thanks Aneela Majeed @clevelandclinic.bsky.social!

transplantid.net/5WJIIMGH

🧪 ISA prophylaxis in 991 patients (69.9% with AML/MDS) showed 7% bIFI incidence (95% CI, 4%-12%). Common pathogens: Aspergillus (43.1%), Candida (22.4%). Mortality >50% in most studies.

#idsky

#IDOnc

In 110 KTRs, everolimus vs MMF showed similar COVID-19 antibody titers (308 vs 327; P=.83) but lower T-cell responses (118 vs 228; P=.02). HZ vaccine titers improved with everolimus (2192 vs 1101; P=.004). More infections with everolimus (27.3% vs 11.1%; P=.03).

#idsky

What intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients Patients with overt immunosuppression are at risk of cytomegalovirus infection, which can lead to, or develop during, ICU admission. Learn more about its broad clinical presentations, risk factors…

Patients with overt immunosuppression are at risk of cytomegalovirus infection, which can lead to, or develop during, #ICU admission.

Learn more about its broad clinical presentations, risk factors and management strategies, with this #EdsChoice review.

👉 buff.ly/GQHzurR

#IDSky #MedSky #CMV

#IDOnc

Deficient Generation of Spike-Specific Long-Lived Plasma Cells in the Bone Marrow After Severe Acute Respiratory Syndrome Coronavirus 2 Infection By studying the bone marrow aspiration samples of 20 individuals with prior coronavirus disease 2019, we showed deficient generation of spike-specific long

and without mitigations neither infections or vaccinations do not provoke long lasting plasma cells - no immunity past ~4 months with short lasting plasma cells:
Infections:
academic.oup.com/jid/article/...

🦠 From 2019-2023, 11,552 blood cultures showed 693 (6.0%) fungi. C. albicans dropped from 60% to 43.1%, while NAC species grew, e.g., C. parapsilosis from 23.6% to 28.8%. Resistance to amphotericin B rose to 22.5%.

#idsky

#IDOnc

Cytomegalovirus (CMV) infection in immunocompromised ICU patients can lead to severe complications like pneumonia and encephalitis. Distinguishing between reactivation and active disease is essential for targeted treatment and improving outcomes. zurl.co/dCQvA

Stenotrophomonas maltophilia - the cockroach of the ICU. After broad-spectrum abx nuke a patient’s microbiome, it’s often the last one standing—esp. in vented patients. (VAP in a patient on mero, think Steno)

For years, TMP-SMX was the go-to, but alternatives are needed.

🧵(1/6)

AUC0-24/MIC for two different durations of antifungal treatment in ICU: 1-3 days vs 4-7 days, shown for various antifungals (and for caspofungin and anidulafungin shown separately for C albicans and C glabrata) PK/PD target-related exposures per occasion of the study antifungals prescribed for treatment. The shaded area represents the PK/PD target used in this study. For fluconazole, 15 data points are outside the y-axis limits (max AUC0-24/MIC value was 3250.3); ICU intensive care unit; AUC0-24 area under the plasma concentration-time curve from zero to 24 h; fAUC0-24 free AUC0-24; MIC minimum inhibitory concentration; Cmin minimum observed plasma concentration; Cmax maximum observed plasma concentration

Are contemporary antifungal doses sufficient for critically ill patients? Outcomes from an international, multicenter PK study for Screening Antifungal Exposure in Intensive Care Units (SAFE-ICU)

J Roberts etc

TLDR: ++variable, need tailored approach w TDM

link.springer.com/article/10.1...

Strains of <i>Aspergillus fumigatus</i> Five Times More Likely To Acquire Resistance to Antifungals Researchers have identified strains of one of the world's most dangerous pathogens that are five times more likely to acquire antifungal resistance.

#IDOnc #medmycosky
www.technologynetworks.com/tn/news/stra...

Something cool and scary to read this morning.

Effectiveness of electrocautery, topical cidofovir and topical sinecatechins for the Treatment of Anal High-grade Squamous Intraepithelial Lesions in Persons with HIV: an open-label, randomized controlled trial Doubts remain about the best treatment for managing premalignant lesions (HSIL) associated with anal cancer.

Effectiveness of electrocautery, topical cidofovir and topical sinecatechins for the Treatment of Anal High-grade Squamous Intraepithelial Lesions in Persons with HIV: an open-label, randomized controlled trial.

✅ Just Accepted
#IDSky

#IDOnc

Analyzing the Donor Dilemma: Outcomes of Kidney Transplant Recipients From Donors With Positive Blood Cultures Obtained at Organ Procurement Abstract. Based on expert consensus, the American Society of Transplantation recommends 7–14 days of preventive antibiotic therapy for solid organ transpla

New from @ofidjournal.bsky.social

Outcomes of 56 kidney transplant recipients whose donors had positive BCx. Most pathogenic organisms were treated, while most commensals were not. No infections developed in recipients related to bacteremia

#IDSky #TxID

academic.oup.com/ofid/article...

#IDOnc

Emergence and Spread of Clostridioides difficile Isolates With Reduced Fidaxomicin Susceptibility in an Acute Care Hospital In an acute care hospital, 6 of 108 (5.6%) fidaxomicin-treated patients with Clostridioides difficile infection were infected with isolates with reduced fi

Introduce a new antibiotic (fidaxomicin), develop resistance to the new antibiotic (fidaxomicin). 😔

#AMR #IDSky #ClinMicro @cidjournal.bsky.social

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

Prevalence of injecting-related bacterial and fungal infection among people who inject drugs: a systematic review and meta-analysis Despite increasing burden of injecting-related bacterial and fungal infection, there has been no recent synthesis of their epidemiology. We performed a systematic review and meta-analysis evaluating prevalence and incidence of injecting-related infection among people who inject drugs.

Prevalence of injecting-related bacterial and fungal infection among people who inject drugs: a systematic review and meta-analysis

✅ Just Accepted
#IDSky

I don’t even have the words tbh. I truly hope this reaches people. #NurseSky #MedSky #IDSky

Definetly look at the OFID article

Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature - Kelly E. Pillinger, Jeannette Bouchard, Sarah T. Wi... Objective: To review the use of antibiotic stewardship interventions in the adult oncology and hematopoietic cell transplantation (HCT) populations. Data Source...

Agreed but the question is that is it mainly bacterial infections in pur leukemia lymphoma pts. Could it be viral or non infectious. Few more journals to help you maybe form a working group with your collegues.
pmc.ncbi.nlm.nih.gov/articles/PMC...

journals.sagepub.com/doi/abs/10.1...

Prolonged abx*

Life threatening disease or is it just the mucosa barrier and does prolonged barrier help pts or harm them. Crp may be elevated for long time in these pts but abx will not change the underlying issue.

Yup I agree I only work with oncology patients and have had to educate our onc collegues on various tests and diagnosis. Lots of time it is lack of knowledge of how to interpret tests and when abx are appropriate. Strep mitis is one of the biggest examples of this. Does strep mitis cause severe

Decreasing Crp should not be used a marker to continue current broad abx if cultures and remain negative and no source seen. Decreasing crp can be from numerous reasons and not just giving abx. Onc ID stewardship def needed

It definitely can happen the question is do they develop bacteremia, pneumonia, is it viral or fungal. Difficult to say

I think you have room for a study.

I would make sure the CRP is not related to other factors such as relapse and starting emperic abx with CRP alone will increase your resistance eventually. This all can be helpful but also lead to more CRE and steno.