Ben Ladner

M-I-Z!!!

Great post as usual. But please don't ever mention SMART criteria again--I go right into hypertensive crisis!

I guess "gold standard" science is actually just... anecdotes?

Monster.

Toxic policy. They will have a hard time recruiting new faculty.

Agree, this is unnecessary and misguided.

Related: why is opioid equivalency not routine learning in medical school or at least IM residency? I get a lot of confused looks when I ask learners how they compare dosing of different drugs.

I mean that with community-acquired S aureus bacteremia, I think the pre-test probability of endocarditis is too high to treat with only 2 weeks of antibiotics without a TEE. If a TEE is not done, would treat for at least 4 weeks.

You didn't mention that curative amputation is planned. In that case TEE can change management, and I would recommend.

If the TTE, clinical exam, and duration of bacteremia do not support a need for valve surgery, then a TEE is unlikely to change management, and I do not recommend it in this general scenario.

Clown show.

Hammer him with questions that expose that he has no expertise in the field he is operating in.

What is your understanding of the most severe manifestations of (insert vaccine-preventable disease: polio, Hib, measles, etc.), and what has the effect of vaccination been on those presentations?

Insane prior auth requirements for linezolid continue to threaten delays of discharge, until I intervene and show people it's like $20-$30 with a GoodRx coupon.

Notably most of the MDs around this administration don't practice, quit training, etc.

What was the Strep species, PCN and ceftriaxone MICs, and operative culture result?

In general 4 weeks should be adequate with a debrided Strep infection. I suspect the culture at many institutions would favor 6 for the case you describe.

Grifter who quit residency is definitely the right framing.

I think some ID clinicians remain biased in favor of more toxic/inconvenient/"old school" therapies, conflating those characteristics with efficacy and "standard of care." See IV antibiotics over oral therapy when the latter is appropriate, adjunctive aminoglycoside as you describe, etc.

At this point it is certain that the DOGE stupidity will not only not save money, but will end up costing the country hugely.

But he sure knows "golden standard" science when he sees it!

As an alumnus of Stanford and the University of Missouri, disappointed to see neither is signatory here.

Yep! Would love to see the NNT for 1 airborne infection avoided due to annual fit testing... 🤔

I do not know why on earth we have not implemented similar policies in the US. The waste on contact precautions is enormous.

I didn't mean to imply you had--just offering my perspective on the clinical question. All of my employers have accepted a document that records the positive titers and has a note that I was boosted for the 1 low one.

I had 1 low MMR serology when I started medical school and did receive a booster. If an adult has normal childhood MMR series and 1 adult booster, I would not recheck titers or revaccinate.

Ha! Why wait until September?

More "golden standard" science from this clown.

I remember at IDWeek 2023 when RNA monitoring on CAB PrEP was being referred to as "settled science"!

Pretty incredible.

That is why I restrict my polar bear liver intake to once weekly.

Based on the graphical abstract, they are on the right track, but I do wonder if the complicated versus uncomplicated UTI language is not salvageable, and we should be referring to cystitis versus upper UTI/UTI with systemic toxicity.