🆕️🔥Fantastic review 🌟 by 🌟s
Russell Lewis Matteo Bassetti
David Denning
Triazole antifungal drug interactions—practical considerations for excellent prescribing #IDXposts academic.oup.com/jac/article-ab…

Newer generations tetracyclines (tigecycline, eravacycline, omadacycline)

⭐ Enhanced antibacterial activity due to modification at C-9 position
⭐ Bioavailability of omadacycline is higher (oral form available) because the C-9 side chain is different

doi.org/10.1007/s40265…

Here are the cliffnotes on antibiotic prophylaxis in primary care.

#IDTwitter
#MedTwitter

14/14

Wait, but Ortho said we should do it before my patient's knee replacement!

Don't do it. The knee is not connected to the urinary tract. It doesn't help.

10/

Let's stick with procedures for a minute.

When should we be getting preoperative urine cultures?

UROLOGIC procedures. That's it.

This is screening for asymptomatic bacteriuria. That's for pregnant patients and those getting urologic procedures. That's about it.

9/

Ok, how about abx ppx for dental procedures to prevent endocarditis?

Eh, maybe for select high risk patients.

But don't sweat it if you forget. Evidence is pretty weak and elsewhere people seem to do fine without it.

8/

Ok, how about abx ppx for dental procedures to prevent prosthetic joint infections?

Nope.

Tell your Orthopedic surgeons and dentists: no evidence for this.

Guidelines have been unhelpful, but are finally starting to come around. Nice summary here in paper by Debbie Goff.

7/

Bottom line on antibiotic prophylaxis in recurrent UTIs:

Older patients: Non-antibiotic ppx only

Younger patients:
➡️ Try non-abx ppx first
➡️ If you use it, use Nitrofurantoin, and favor intermittent and non-long-term strategies

6/

What about younger patients with recurrent UTIs?

Most data older, but antibiotic ppx can work.

But:
➡️ No long term studies
➡️ Still associated harms
➡️ Methenamine hippurate might be just as good

5/

🆕️🔥Systematic review & meta-analysis Critical Care
Impact of attaining aggressive vs. conservative PK/PD target on the clinical efficacy of beta-lactams for the treatment of Gram-negative infections in the critically ill patients #IDXposts
ccforum.biomedcentral.com/articles/10.11…

Excellent narrative review🌟
The clinical challenge of diagnosing Non-Ventilator Hospital Acquired Pneumonia and identifying causative pathogens #IDXposts #HAP
sciencedirect.com/science/articl…

Everyone who's treating MRSA Bacteremia should read this article now!
An excellent review by Vance Fowler et Al Clinical Infectious Diseases
Persistent MRSA Bacteremia: Resetting the Clock for Optimal Management
🌟Excellent figures 🌟
SNAP Trial
Thoughts 🤔 #IDTwitter
academic.oup.com/cid/article-ab…

Beef emits 31 times more CO₂ per calorie of food than tofu does. By cooking so many cows, humans are cooking themselves, too. Forgoing steaks may be one of the most efficient ways to reduce our carbon footprint econ.st/3vhtpyo 👇

Ocean Plastics impact human and ocean health. Researchers from the fields of healthcare, ocean science, and social science have collaborated to quantify plastic’s considerable risks to all life on Earth. The Minderoo-Monaco Commission on Plastics and Human Health report presents…

Christian Weaver, MD Jaimes et al found that fever was not a useful independent predictor of bacteremia and needed to be considered in light of other factors, such as hypotension, white blood cell (WBC) counts, and the presence or absence of shaking chills. #IDTwitter

doi.org/10.1086/380967

When we published our study <evidence.nejm.org/doi/10.1056/EV…> of ODS and hyponatremia we were pummeled for including people at low risk of ODS because we included Na levels between 120 and 130. They said it is well known 'that ODS is incredibly rare/non-existent at those levels.' 1/4

This one is really interesting!
🆕️⚡️Journal of Hospital Medicine
Things We Do for No Reason™: Discharge before noon #IDXposts #MedEd
…mpublications.onlinelibrary.wiley.com/doi/10.1002/jh…

On ID consults, pulled out this old letter to editor, criticizing guidelines for recommending CT before LP. I been howling at the moon for 20 yrs. Scary. Take a good look Todd C. Lee and Emily McDonald and team WikiGuidelines at your old & cranky future...

academic.oup.com/cid/article/40…

🆕️🔥Retrospective study Pentamidine administered IV monthly for PCP prophylaxis is safe & effective in adult patients wh hematological malignancies
An option during respiratory virus pandemics [aerosolized meds discouraged] or TMP-SMX can't be used
RCT?
ijidonline.com/article/S1201-…

Further reading: doi.org/10.1001/jama.2…