Excited to have been awarded the
@SHEA_Epi
Jonathan Freeman Scholarship! Grateful to my mentor
@jlsalinas7
, my program
@stanforddivision
, and my division
@Stanford_Med_ID
for their support in my developing career as a Hospital Epidemiologist!
Some dermatology rotation should be included in the ID fellowship curriculum. Could be experience bias, but I feel people frequently call ID before derm for many rashes and boy they all look maculopapular to me.
Chart-reviewing in the morning after recommending stopping all antibiotics and observing, only to find the patient on linezolid IV, ceftaz/avi, metronidazole, and chloramphenicol.
Not all patients presenting with infection require blood cultures! Conditions with a pre-test probability >14% for bacteremia:
- Community-onset fever req admit
- Pyelonephritis
- Sepsis
- Meningitis
This probability increases to >40% if shaking chills.
Spiraling empiricism refers to the inappropriate or unjustifiable escalation of treatment for suspected but unconfirmed infectious diseases, often based on these fallacies. From Spiraling Empiricism–Kim & Galis. A must-read, specially for non-ID providers:
Happy for our new budding colleagues, but tough day for ID. Compensation is not the only issue. Some unfilled programs had several restrictions for the foreign trained/born. They should, if possible, revisit these restrictions. This may be a minor issue, but an issue nonetheless
Correct me if I’m wrong, but antibiotic resistance does not equal increased virulence. As far as I know, resistance genes are not intrinsically associated with extra virulence factors. In fact, I remember reading the opposite somewhere. Yet people freak out when they see “ESBL”
Please, someone publish a study in JAMA showing that GLP-1 antagonists are better than meropenem for 2-week old vancomycin and cefepime refractory shock with a septic component 🙏🏻
Wrapping up an incredible first year of ID fellowship! It was hard but learned so much from the amazing faculty at
@Stanford_Med_ID
Now excited to start the second year as Hospital Epidemiology and Infection Prevention fellow under the mentorship of
@jlsalinas7
!
@drtimothyli
From IDWeek: Patients receiving definitive therapy with ceftriaxone for MSSA bacteremia experienced a higher rate of 90 and 30-day treatment failure and a lower rate of event-free survival as compared to those treated with cefazolin or an ASP.
So grateful with my attendings (Dr.
@Marisa_Holubar
, Dr. Winslow, Dr. Banaei, and Dr. Schoolnik) and co-fellows at
@Stanford_ID
Our case was selected to represent ID fellows in North America at the
#IDWeek
-
#ECCMID
Fellows Exchange program in Copenhagen! 💪🏼
ID in training exam: Look at this Gram stain and tell me diagnosis.
Me: Okay, let me click the image and zoom in.
ID ITE: No can do.
Me: Okay. Answer C it is. Next!
Seems like yesterday I was having a blast at
@IDWeekmtg
in Boston! Excited and honored to receive this Travel Award to present our work in the city of Angels for
#IDWeek2024
@drjefemaestro
El parásito malaria y otros parásitos del phylum Apicomplexa evolucionaron de alaga marinas: pasaron del océano a ser parásitos en mamíferos terrestres.
C diff testing can be confusing. Remember, the presence of C diff doesn't necessarily mean C diff infection (CDI) without toxins. Here are 3 insightful studies on this topic.
It is said that it takes an average of 17 years for research evidence to reach clinical practice. How to close the gap? Among other things, targeting the ID fellows! Thanks
@jakescottMD
and
@BradSpellberg
for the amazing Grand Rounds at
@Stanford_ID
today!
I cannot think of a better place than Silicon Valley to combine my biggest passions: Infectious Disease, Hospital Epidemiology, Blockchain Technology, and AI. I am excited to join the amazing
@Stanford_ID
next summer!
#IDtwitter
#fellowshipmatch
@ID_fellows
Short but sweet
@IDWeek2022
for me! So happy to meet in person all the amazing people I met during fellowship interview season. Say what you want, but the ID community is something else!
#IDWeek2022
#IDTwitter
If beta-lactams are the treatment of choice for MSSA, would it be reasonable to think that ceftaroline may be a better first-line option for MRSA than vancomycin?
Around 3.5% of hospitals in the US are academic medical centers. Community hospitals likely represent the reality of healthcare. Happy to learn how they do Healthcare Epidemiology and Infection Control at
@SHC_TriValley
. Unique opportunity through the
@Stanford_ID
HE & IPC track!
When they asked me about my superpower, I didn't have an answer. Now I know it's the ability to surround myself with the very best. From my mentor
@jlsalinas7
and
@Stanford_ID
division to my best friends, co-fellows, and my wonderful partner
@GoarEgoryan
, I owe you all so much!
One of our second-year hospital epi and infection prevention/control fellows,
@G_ROD_11
, swept the Saturday session with his *three* posters in keeping with the
#IDWeek2023
theme of Mexican 🇲🇽 brilliance! Strong work, Guillermo!
Great teamwork with
@RalphTayyarMD
,
@jlsalinas7
, and our colleagues! Notably, most asymptomatic patients with a positive SARS-CoV-2 test lack replicating virus. This finding contributed to our decision to scale back routine admission testing!
Yes! Retire the SEP-1 bundle. Up to 50% of hospitalized patients meet SIRS criteria at some point during their stay, many without sepsis. An important step for diagnostic and antimicrobial stewardship!
In 7 months if ID fellowship, I have seen a handful of patients with mucormycosis with terrible outcomes. I don’t blame the patients for having diabetes. I don’t blame the Mucorales. I blame the system that prevented most of them from having early access to insulin.
Every time I rotated at the county hospital, I wondered if there were alternatives to penicillin for syphilis.
Great collaboration with Brazil to help explore that question!
Fun fact: I used a customized AI to help me complete my part of the review.
@enlaceacancha
No sé absolutamente nada de box pero los comentaristas de
@NBCOlympics
mencionaron que el estilo mexicano se enfoca en boxeo profesional y el uzbeko en competencia internacional como los JJOO 🤷🏼♂️ Por esa razón no se ven mexicanos destacar frecuentemente
Imagine a world where people used chemo as they use antibiotics. Fever? Let’s give empiric R-CHOP before lymph node biopsy. Breast mas? Empiric docetaxel and cyclophosphamide! Shortness of breath and lung consolidation? Admit and start pemetrexed and cisplatin!
Surgery: Hey, we would like a consult for “antibiotic optimization.”
ID: *After seeing the patient* - We recommend source control optimization.
Surgery:
Honored to meet Dr. De la Rosa Zamboni, President of the Mexican Association for the Study of Nosocomial Infections (
@ameinac
), the Mexican counterpart of
@SHEA_Epi
Looking forward to fostering stronger connections within the Hospital Epidemiology communities in both countries!
As much as I like teams to consider non-infectious causes of fever, atelectasis is not one of them. This old myth came from a rat model, where they surgically exposed and ligated one main bronchus to collapse the lung and then harvested macrophages to measure IL and TNF LOL
I’m thrilled to see many Latinx matched today! One in 10 people on the US is a native Spanish speaker. Speaking their language can significantly improve the patient experience. By doing so, you’re becoming an essential part of the healthcare task force!
#LatinxInMedicine
@MParis2024
No se absolutamente nada de box pero los comentaristas de
@NBCOlympics
mencionaron que el estilo mexicano se enfoca en boxeo profesional y el uzbeko en competencia internacional como los JJOO 🤷🏼♂️ Por esa razón no se ven mexicanos destacar frecuentemente
So happy to be back and have the opportunity to share the knowledge I have gained at
@Stanford_ID
I am convinced I was able to land the diagnosis on a middle age patient with liver transplant (disseminated nocardiosis) thanks to our strong immunocompromised host service!
I wasn't interested in fungi until
@vivagoar23
introduced me to
@GermHunterMD
. Now, I'm eager to combine my Infection Control and Hospital Epidemiology training with knowledge about fungal infections!
#ECCMID2023
Thankful to Santa Clara Valley Medical Center and
@Stanford_ID
! Very challenging to start fellowship in a safety-net hospital, but very grateful for the support of the attendings and residents, the learning experience, and the opportunity to collaborate with the
@CDCgov
!
Great to reconnect with the
@ESCMID
Clinical Grand Round Fellows Class 2023!
Great cases, excel discussions, and friendship. Such an amazing experience!
On call during IDWeek abstract submission deadline. Everyone getting cefiderocol, omadacycline, ampho, chloramphenicol and remdesivir overnight. Will de escalate in the morning.
Great talk by
@dvilarc
on Infection Prevention challenges in low- and middle-income countries! One of the most influential teachers in my career and in Healthcare Epi in Mexico. Introduced me to evidence-based medicine and clinical epi in Med School! Orgullo
@FacMedicinaUNAM
Pro tip. Staph lugdunensis has a foot fetish and likes the great toe🦶If you have a patient with unexplained Staph lugd bacteremia, don’t forget to examine the feet.
Congrats
@Marisa_Holubar
! An amazing clinician and brilliant antimicrobial steward, but also an outstanding mentor and, most importantly, a genuinely kind soul! We're fortunate to have you with us at
@Stanford_ID
@Stanford_Med_ID
Leading this work with the guidance and support of
@jlsalinas7
,
@ValeriaFabreMD
, and
@StanfordMed
has been a highlight of my HE & IPC fellowship at
@Stanford_ID
! Advancing care with evidence, and learning the political and operational aspects of IPC!
Feliz Día de Muertos! We celebrate the lives of those who are no longer with us with smiles and by offering them the things they loved when they were here.
Catrinas collection by
@GoarEgoryan
Today, I had the opportunity to debunk the atelectasis myth during a surgery morning report. Hopefully, it won't backfire, and they'll call ID more often to work up a postop fever! Lol
As much as I like teams to consider non-infectious causes of fever, atelectasis is not one of them. This old myth came from a rat model, where they surgically exposed and ligated one main bronchus to collapse the lung and then harvested macrophages to measure IL and TNF LOL
A middle-aged patient with perfect renal function, electrolytes, QTc, and tendons is admitted for E. coli bacteremia due to urinary tract infection. Susceptible to all abx and afebrile for 3 days. You do:
Exciting times ahead for
#IDweek2023
! If you have some time, we invite you to explore the work of our Hospital Epidemiology and Infection Control team at
@Stanford_ID
and
@Stanford_Med_ID
, as well as our collaborative projects. See you there!
#IDTwitter
@reverendofdoubt
PCT is useful to decrease exposure to antibiotics. A systematic review w/meta-analysis on 26 RCTs showed benefit in shortening abx duration and side effects. Also showed decreased morality but let’s be conservative and say didn’t impact mortality
# Concern for UTI
Plan: Urine cultures pending. Patient is asymptomatic. No empiric antibiotics. Continue to monitor.
Good, no abx! But if no symptoms, why test?
We have made important advances on antibiotic stewardship, but boy there is work to do on diagnostic stewardship.
My totally unbiased Twitter feed is filled with new ID trainees. Welcome to the medical specialty that has shaped the evolution of life in planet Earth the most: from the RNA world to mRNA vaccines (see what I did there?) 😃
Why do we keep using “nadir” but stopped using “zenith”? Next time, my consult note will be “blood cultures were collected during the zenith of their leukocytosis.” Totally ID appropriate 😂