Timothy Li

Colour-COPD RCT from 🇬🇧

Use of sputum colour chart is unlikely to be a useful addition to usual care for guiding antibiotic self-treatment in COPD in primary care

Sputum colour did not relate well to bacterial load

Caution: severe under-recruitment

doi.org/10.1136/bmjr...

#IDSky

Radiologic and pathologic findings from a fatal pneumocephalus case caused by hypervirulent Klebsiella pneumoniae in 🇩🇪

The patient also had pneumonia, liver and prostate abscesses, and septic shock

doi.org/10.3201/eid3...

#IDSky

Recommended treatment regimens for select sexually transmitted enteric pathogens

doi.org/10.1128/cmr....

#IDSky

CSF testing for suspected neurosyphilis

➡️isolated ocular or otic features: LP not needed

➡️CSF VDRL: specific but not perfectly sensitive
➡️CSF treponemal test: high negative predictive value, for cases with high suspicion despite negative CSF VDRL

doi.org/10.1002/ana....

#IDSky

Direct oral challenges are a safe and effective strategy for delabeling low-risk cephalosporin allergy labels in adults in the outpatient setting.

doi.org/10.1016/j.ja...

#IDSky

Molecular mechanisms underlying cefiderocol treatment failure in A.baumannii

💣Point mutations in TonB iron receptors
💣Two-component system (TCS)-mediated upregulation of the MacAB-TolC efflux pump
💣β-lactamase-mediated hydrolysis

doi.org/10.1128/cmr....

#IDSky

Anti-interferon-γ autoantibodies (AIGAs) syndrome is a rare, adult-onset immunodeficiency characterized by ⬆️susceptibility to various opportunistic infections (E.g. disseminated NTM, talaromyces, salmonella)

Pathogenesis and commonly affected organs👇🏻

doi.org/10.3389/fimm...

#IDSky

A clinical practice guideline for tuberculous meningitis @thelancetinfdis.bsky.social

➡️Diagnostic approach
➡️Treatment and follow-up

doi.org/10.1016/S147...

#IDSky

This retrospective cohort from 🇫🇷showed that oral switch is a suitable option for treating IE, even for POET-ineligible patients

➡️treatment failure HR=0.55 favoring oral, 95%CI 0.27-1.17
➡️more days alive outside 🏥 in oral group (59 vs 47, p=0.001)

doi.org/10.1093/cid/...

#IDSky

Amoxicillin crystalluria (AC) and amoxicillin-induced crystal nephropathy (AICN): a narrative review
➡️pathophysiology
➡️step-by-step diagnosis

HDIVA = high dose IV amoxicillin (≥150 mg/kg or ≥8 g per day)

doi.org/10.1016/j.ki...

#IDSky

Sulfonamide allergy usually involves sulfonamide antimicrobials (e.g. TMPSMX) due to their N1 and N4 side chains

Risk of cross-reactivity to non-antimicrobial sulfonamides or non-sulfonamide sulfur drugs is very low because of structural difference

doi.org/10.1016/j.ja...

#IDSky

Timeline of chikungunya fever

Typical viral load, symptoms, involved immune cells, and antibody titres during different phases of disease are depicted

doi.org/10.1080/2150...

#IDSky

Unlike most drugs, fluconazole dose needs to be INCREASED during CRRT

Why?

Under normal conditions, >80% of fluconazole is renally excreted as unchanged drug, followed by extensive tubular reabsorption

And this process is bypassed during CRRT

Narrative review on fungal diagnostics @cmijournal.bsky.social

doi.org/10.1016/j.cm...

#IDSky

I agree with you and I don't do that.
I still stop antibiotics in most patients once they tested positive for resp viruses, maybe except rhinovirus or some of the most severe ones like those on NIV (case by case)

🔑 for ATS CAP guideline 2025:
1. Lung USG 🆗 for dx
2.Empiric abx suggested for CAP tested +ve for resp virus if in-pt or have comorbidities
3. <5 days abx (min 3 days) if stable, except for in-pt with severe CAP
4. Systemic steroid suggested for in-pt with severe CAP

doi.org/10.1164/rccm...

#IDSky

In this study from 🇳🇱 involving 400+ patients who underwent hip or knee explanation, the use of sonication fluid culture (vs tissue culture alone) detected additional microorganisms that could impact antibiotic choice in 8% to 20% of PJI cases.

doi.org/10.1093/cid/...

#IDSky

If discussion on ceilings of care is applicable to resuscitation, ventilatory support, or even blood taking
Why shouldn't it be applied to antimicrobial use too?

Communication strategies and skills for antimicrobial treatment discussions at end of life⬇️

doi.org/10.1016/S147...

#IDSky

Structured linezolid dose reduction (600mg/d➡️300mg/d after 9-13 weeks) had comparable recurrence free cure rates as fixed linezolid 600mg/d when given along with bedaquiline and pretomanid for 26 weeks in PreXDR TB

doi.org/10.1016/j.ji...

#IDSky

Should secondary SBP prophylaxis (SecSBPPr) still be given in cirrhosis?

In 2 US national cohorts (>11000 SBP patients), SecSBPPr⬆️the risk of SBP recurrence in multivariable analysis by 63%–68% vs no prophylaxis. And this trend worsened over time.

doi.org/10.14309/ajg...

#IDSky

Try this one

www.clinicalmicrobiologyandinfection.com/article/S119...

Candida infective endocarditis 🍄🫀🤒

➡️Suggested management algorithm based on valve type and surgical eligibility
➡️Follow-up recommendations

doi.org/10.1016/j.cm...

#IDSky

Routine weekly surveillance for MDR-GNB in hematologic patients enables early identification of colonization, often preceding MDR-GNB BSIs.

➡️Rectal swabs positive in 27.5% of patients
➡️BSI occurred in 38.5% colonised vs 12.0% non-colonised patients

doi.org/10.1016/j.cm...

#IDSky

Possible mechanisms for benefits of S. boulardii:
⭐competition with C. diff for essential nutrients and attachment sites in the GI tract
⭐produces antimicrobial substances e.g.acetic acid
⭐modulate the immune response by ⬆️production of immunoglobulins and other immune factors
⭐neutralize toxins

Is probiotic useful for treating C.diff?

This RCT from 🇹🇭 showed that adding S. boulardii to vancomycin reduced CDI recurrence (1.7% vs 13.1%) without increasing adverse events. Clinical cure rates were similar for both groups.

doi.org/10.1038/s415...

#IDSky

Among 100 patients with persistent MSSA bacteraemia who were treated with ertapenem combination therapy, those with hypoalbuminemia (<2.5g/dL) had a significantly longer time to negative blood cultures.

doi.org/10.1093/jac/...

#IDSky

Antimicrobial resistance, antimicrobial tolerance and heteroresistance in Pseudomonas aeruginosa

doi.org/10.1038/s415...

#IDSky

Pathophysiology and risk factors of ocular candidiasis

Systemic treatment:
1st line = fluconazole or voriconazole
(Posa: poor penetration
Isavu: lack data)

Lipo ampho B +/- flucytosine if resistant or refractory

Echinocandins: poor penetration

doi.org/10.1016/j.cm...

#IDSky

Suggested investigation of suspected immunosuppression*

*Also: recurrent deep abscesses, chronic diarrhoea with weight loss, recurring infections, infection requiring prolonged antibiotic therapy, persistent rash (particularly without recent antibiotic use).

doi.org/10.1016/S221...

#IDSky

In this study that included 42067 adults in 🇺🇸, long-acting lipoglycopeptides (laLGPs) were effective as step-down treatment of serious gram +ve bacterial infections, offering comparable outcomes (readmission/ED visit/90d inpatient☠️) vs SOC antibiotics

doi.org/10.1001/jama...

#IDSky