JD Talbot

Response adaptive randomization adjusts allocation probabilities over the course of a trial, based on accumulating data. RAR increases allocation to arms performing well, and decreases allocation to arms performing poorly. In multiple arm trials, this has advantages over fixed randomization.

Todd Lee, “The urine is innocent until proven guilty.”
Brad Spellberg, “The urine should file a class action lawsuit against the medical community for malicious prosecution.”
@infectedterran.bsky.social: “Has anything on earth been as unjustly demonized and blamed for problems as an abnormal UA.”

2- If the complication is osteomyelitis, the bone penetration of amix is 10-20%, depending on the study. Again, with MICs of 4-8, it might not be enough (I’m even unsure if MICs 1-2 are attainable).

For these specific situations, I’d welcome more clinical data.

For LZD, I wholeheartedly agree.

For amox, I have some nuances :
1- In the POET substudy, they note a good PTA using actual MICs, but the PTA using a BP of 4 was 75-85% (we usually want 90%+). This is the EUCATS BP. CLSI uses 8 as a BP. With MICs of 4 I’d be cautious, and I wouldn’t use it if 8

Nice!

No mention of sex in the algorithm. Do I (fore)see official IDSA endorsement of 7 days total for men with pyelonephritis?

We typically go for 1000/125 TID (combining amox/clav 500/125 + amox 500)

Usually well tolerated, although some GI disturbances do happen.

My first reflex would be to confirm with the lab that there really were a MSSA & MRSA in the blood culture.

If assumed true, I’d probably go for dapto+cefaz or LZD, transitioning eventually to LZD *or* tmp-smx.

Vanc MIC of 2 is of concern, esp. w/ a young adult.

No special concern for GNR.

I agree.

Yet I find it less troublesome since I :
- Use a weightlifting belt
- Have new shoes (UA Reign 6)
- Added hip thrusts to my routine

I feel much more stabilized and my squats are less dependent on my quads doing all the work

Pharmacokinetics of Cefadroxil and Cefaclor During an Eight-Day Dosage Period The concentrations of cefadroxil and cefaclor in serum were studied in eight healthy volunteers receiving 1,000 mg of both substances three times per day for 8 days. Intraindividual comparisons showed...

Only data I’ve ever found on cefadroxil 1g TID

pmc.ncbi.nlm.nih.gov/articles/PMC...

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a woman sitting in a car with the word blissfully unaware in yellow ALT: a woman sitting in a car with the word blissfully unaware in yellow

Ah, the ID Curse™

@sebpoule.bsky.social

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Time to Staphylococcus aureus Blood Culture Positivity as a risk marker of Infective Endocarditis: A Retrospective Cohort Study Short time to blood culture positivity (TTP) was an independent risk factor of infective endocarditis in this large (N=1703) Staphylococcus aureus bacterem

🆕💫Retrospective Cohort Study
Time to Staphylococcus aureus Blood Culture Positivity as a risk marker of IE
Short TTP was associated wit IE
NPV >95% suggests that TTP>13h can be used to risk stratify pts with SAB #idsky #EMIMCC
academic.oup.com/cid/article/...
academic.oup.com/cid/advance-...

Enfin, si c’est différent de la norme, il faut prévoir dans le syst. informatique et en formation nursing le scénario 2 ponctions.

Bref, c’est toute une gestion de changement d’implanter la ponction unique. Ça ne se fait pas « top down » en publiant un document directeur sans crier gare…

Je vois un enjeu pour les infections endovasc : comment différencier une contamination répandue à toutes les bouteilles d’une vrai bactériémie CoNS quand on est consultés et que le patient est déjà traité?

Je ne peux tout de même pas faire un TEP scan à tous mes patients avec pontage/valve/etc

Je suis peut-être cynique, mais je crois que mes bouteilles ne seront pas plus remplies que maintenant et que le nombre restera le même. On manque d’espace dans l’incubateur, on ne fait que 3 bouteilles…

Bref, pas d’avantage côté volume sauf si on perd l’accès veineux entre les 2 ponctions.

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🪩🍾Have a holiday party coming up? Need some conversation starters? Maybe this will help!

📲 www.idstewardship.com/peculiar-art...

❤️ Feel free to share & suggest additions!

🙏 Thank you to those who offered suggestions for this list.

#IDsky #PharmSky #MedSky #Medicine #Pharmacy

Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial To determine whether remote, retroactive intercessory prayer, said for a group of patients with a bloodstream infection, has an effect on outcomes. Double blind, parallel group, randomised controlled ...

I love that one

pmc.ncbi.nlm.nih.gov/articles/PMC...

It was shoved down our throats without warning, discussion, or even explanation.

There is probably a good case for it, but it changes noticeably our interpretation of blood cultures and thus needs to be explained and the way the test is interpreted, adapted.

@sebpoule.bsky.social

Based on your experience, is it troublesome to manage CoNS in multiple bottles with patients with a mechanical heart valve, or with a prosthetic vascular graft?

Do you ask for 2x2 blood cultures when you suspect a vascular infection? Why or why not?

Will contamination spread to all bottles though?

Data about diversion devices show a 50-66% reduction in contamination. Based on this, the majority of contamination *should* be limited to the first bottle.

For the remainder of contamination, I absolutely agree that it will cloud interpretation.

Its Real Phil GIF ALT: Its Real Phil GIF

After 10 years of practice;
First case of Melioidosis at my 🏥
#IDsky

WOW 🔥
Our article is still on the most viewed list in the last 7 days from #JAMANetworkOpen
@zacrobid.bsky.social
@dremilymcd.bsky.social @drtoddlee.bsky.social @bradspellberg.bsky.social #idsky #medsky #utisky #EMIMCC

Virtual Home Care for Patients With Acute Illness This cohort study compares outcomes of patients receiving care in an outpatient, virtual, home-based acute care model with outcomes of patients receiving standard hospital care.

For my inaugural post, Im proud to announce the publication of our Safer@Home care model. This is going to change how medicine is practiced. No need to admit pts "for IV antibiotics" anymore. Or just for IV diuresis in CHF. Or just for EtOH withdrawal. Etc.
jamanetwork.com/journals/jam...

Bacillus sp is usually identified as S paucimobilis by the GNR Vitek cards.

Happens every now and then as Bacillus is (too) easily decolorized

Absolutely

Besides usual prevention recommendations, I take care to wish a good next hunting season when the follow up ends 😉

I think that’s a case where I’d like the grappe Optilab LLL to have at least one sensititre to use as a gold standard.