Alice Han
@dralicehan
Followers
3,029
Following
1,347
Media
1,141
Statuses
5,778
ID physician @MIDCUSA - transforming private practice ID with an academic and lifestyle focus. Trained @RushCCH_ID . Opinions my own👩🏻⚕️🧫🩺
Chicago, IL
Joined August 2021
Don't wanna be here?
Send us removal request.
Explore trending content on Musk Viewer
MOONLIT FLOOR OUT NOW
• 262478 Tweets
JUMP
• 209784 Tweets
Mets
• 163607 Tweets
Falcons
• 66985 Tweets
Baker
• 64425 Tweets
天使の日
• 50895 Tweets
Pete Alonso
• 47049 Tweets
Diana
• 41942 Tweets
Bucs
• 27873 Tweets
Kirk Cousins
• 27492 Tweets
#PowerGhost
• 24940 Tweets
Bijan
• 21801 Tweets
Mooney
• 17983 Tweets
HAVE A SAFE FLIGHT JIN
• 16792 Tweets
Hayırlı Cumalar
• 16229 Tweets
ワートリ
• 15554 Tweets
#PowerBook2Ghost
• 14552 Tweets
Tariq
• 14094 Tweets
感謝マルチガチャ
• 13920 Tweets
Cane
• 13295 Tweets
Bleed
• 11622 Tweets
PRABOWOsiapkan YangTERBAIK
• 11411 Tweets
最大4体ゲット
• 11045 Tweets
人達同士
• 11007 Tweets
KEKUATANkita PERSATUANkita
• 10838 Tweets
Hodge
• 10268 Tweets
Bielsa
• 10053 Tweets
Pinned Tweet
Grateful to have the opportunity to talk to
@PaulSaxMD
🙏🙏🙏
Let’s talk about the 🐘 in the room:
Fair compensation
We talk about our
@MIDCUSA
survey and our numbers
@BLeeMDPhD
@okwalding
👇
“We need to start dispelling the myth that you're not able to make money doing [what you love].”
In a new
#LetsTalkID
podcast out tomorrow,
@PaulSaxMD
speaks with
@dralicehan
about being an ID physician in private practice.
Out tomorrow. Available wherever you listen to
6
13
61
11
9
77
@DMAronoff
@iFightForKids
@PeterHotez
@RobertKennedyJr
@joerogan
@merissahansen17
Just terrible.
@PeterHotez
handled it so graciously. What has our society come to? Let him enjoy his Sunday afternoon in the peace of his own home.
15
10
1K
Finally! Some data on
#paxlovid
for VACCINATED pts. This comparative retrospective cohort study found tx w/ paxlovid ⬇️ all cause ER visits, hospitalizations & death: 14.4% to 7.8%, OR 0.507.
@SarjuGanatraMD
@PaulSaxMD
@Bob_Wachter
@McQHoya81
@EricTopol
20
222
702
@hankgreen
My dad told me there’s a really popular restaurant at the mall called “chick”. He thinks they sell chicken sandwiches, but there’s a long line all the time.
Chick-fil-A, dad?
2
0
700
I am seeing so many patients with breakthrough infections report negative antigen tests the first week of symptoms. This graphic from
@michaelmina_lab
explains why. Please see his post for full explanation. Symptomatic DOES NOT = contagious in vaccinated individuals. 🤯
40
173
522
41 yo microbiologist presents with this rash. Her cat ALSO has a paw infection, tx’d with amp to no avail. She undergoes bx after failing doxy. She refuses clinda, and requests ID consult! Thank you
@rodrigues_bio
for sharing this interesting case w/ me!
22
109
498
@kenzianidiot
I need to know more about the backyard bird battles. I am intrigued.
🦅 vs 🦉?
🐕 vs 🦅?
🚶vs 🦆?
Sounds like a fun friend group.
No nuts in brownies please
5
1
344
@hankgreen
But do you know where are all the secret candy is hidden? Hint: usually with reception on the floors or in the case manager’s offices. Sometimes the nurses also have a secret candy drawer.
1
0
274
Nice! I am going to keep these antibiograms bookmarked for a ☔️day. Susceptibility testing takes forever!
At the
#NTM
Research Consortium meeting - great update on antimicrobial susceptibility (rapid growers: ; slow growers: ).
Excited too by emerging therapies with data coming soon.
2
21
66
8
79
266
A 🧵 about the upcoming BA.4/5 COVID-19 booster.
On 8/22/22, Pfizer submitted a EUA request to the FDA for an adapted Bivalent Omicron BA.4/5 30 µg COVID19 vaccine booster for individuals > 12 yo
5
62
259
#IDX
🧵 1/4
This is a phenomenal comprehensive summary looking at glucocorticoids & infection risk
🔑 takeaways 👇
*Glucocorticoid potency/effect on immune system varies on type
Ex: dex 10x more potent at inhibiting lymphocytes compared to prednisolone
2
57
207
Suprised to see that in Germany, 7806 children < 5 yo received
@pfizer
“off label”. Found to be safe, similar to other vaccines. Local reaction most common. Still need to see more data re: dose, efficacy. But a reassuring start.
#COVID19vaccine
#IDTwitter
12
35
189
#IDPhoeniX
This document is a monster 👿
244 pages.
Will highlight points I found most salient
IDSA/ASM
Guide to Utilization of the Microbiology Laboratory
🧵
3
59
176
This extraordinarily comprehensive comparative analyses of 18 RAT vs RT-PCR for COVID19 quarantine shows that RA test REDUCES transmission better than at single RT-PCR test w/ 24 delay w/ shorter quarantines.
@michaelmina_lab
3
49
173
Catching up on
@IDWeek2022
lectures
This one was an excellent review on syphilis and what we are seeing currently in the US
Lecture starts with Dr. Vivian Levy
What’s your approach to diagnosing syphilis?
Are we missing opportunities to diagnose syphilis?
2
40
165
@melissablake
I like your smile and face too. Beautiful. Love your hair also. That color is lovely. ☺️
1
1
159
#IDTwitter
Cheat sheet for intrinsic mech of resistance 📑
What’s your favorite step of
#AMRrounds
?
Mine was always Step 4!
Understand acquired resistance mech & interpretive antibiogram
@zacroBID
@JonathanRyderMD
@drtimothyli
@IDiots_pod
@jendel0717
6
43
151
Tocilizumab helps w/ severe COVID, but does it impair long term immunity? It does NOT! In fact, pts w/ severe COVID who received toci had ⬇️ reinfections, ⬆️ higher Ab & T cell responses 1 yr later. Toci prevents COVID lymphopenia -> the 💪 immunity
7
41
140
@Neurofourier
I agree. Universal masking has been a game changer in the hospital. Nobody understands the idea of “universal precautions”, actually using PPE during high risk transmission events. They define PPE by the infection instead of the activity. We don’t know what we don’t know.
0
10
130
#IDTwitter
I am a big fan of the new complicated UTI guidelines
Finally! Guidelines that are focused on the things that matter: clinical outcomes, mortality.
Here we go.
@bwtrautner
@Cortes_Penfield
9
36
129
Study about
#LongCOVID
1 YR LATER. SOB, asthenia, depression, memory issues, anosmia, insomnia, arthritis, tachycardia... At 6 mo- 30% persistent sx. At 12 mo- 25% persistent sx. Memory/concentration deficits worry me the most!
@WesElyMD
@CIBScenter
4
42
113
#IDTwitter
Who should be offered suppressive abx therapy for PJI post DAIR?
This table is great.
Bookmark it.
@Cortes_Penfield
@laura_certain
1
33
113
#IDTwitter
Phenomenal review of pneumocystis!
This was literally a book chapter so I will go through my favorite parts 1/7
3
36
108
#IDPhoeniX
🧵 1/5
Taniborbactam is a bicyclic boronate β-lactamase inhibitor w/ activity against Ambler class A, B, C, & D enzymes, including serine & metallo-β-lactamases.
Cefepime–taniborbactam is active against most CRE, MDR Psar
DOI: 10.1056/NEJMoa2304748
3
33
106
@DrNeilStone
That’s insane! We have “elective” rotations where people can choose to rotate at a specific hospital, location for a particular area of interest, but otherwise, training is all in the same city.
UK has extraordinarily high expectations of sacrifice for their doctors.
7
10
100
What is your risk of
#LongCovid
with Omicron? This study suggests that it far lower with Omicron, similar to negative controls, and that vax decreases risk significantly
@EricTopol
@BradSpellberg
@jakescottMD
@MonicaGandhi9
What is the risk of PASC with Omicron? In this study, 11.7% of pts 12 wks post Omicron (BA.1 & BA.2) had persistent sx compared to 10.4% of negative controls. Far less common in vax vs unvax (9.7% vs 18.1%).
@iguessous
@LaurentAFKaiser
@mayssamnehme
0
4
13
6
26
102
@CherylJ11011655
@DMAronoff
@iFightForKids
@PeterHotez
@RobertKennedyJr
@joerogan
@merissahansen17
I don’t think anyone should be harassed at their homes. There’s a time and place for discussion, debate, and understanding. A person’s home on a Sunday without an invitation is not that time or place.
5
1
95
Yup. 💯. They are some of my favorite doctors on Twitter and in real life
1
6
100
I had an immunocompromised pt last week with a MSSA epidural abscess & I was torn between cefazolin vs oxacillin. WWYD
#IDTwitter
?
@IdVilchez
@BradSpellberg
@IDiots_pod
@BJegorovic
@ABStewardess
@PaulSaxMD
@sebpoule
@ABsteward
@AntibioticDoc
@JonathanRyderMD
@GermHunterMD
Which antibiotics penetrate the CSF? See 👇 Reference:
5
139
433
9
10
93
#IDTwitter
Can you switch to oral abx for beta-hemolytic strep bacteremia in pts who are severely immunocompromised?
Let’s find out 🧵
@MKeintzMD
2
22
88
TAF is sold as better for kidneys/🦴, but ⬆️wt gain, worse lipid profile. In this study, when switched back to TDF/3TC/DTG, women lost weight. Should we be opting to start with TDF or switching back to TDF?
@PaulSaxMD
@drlaurajwaters
@sebpoule
@HIVDocSK
12
10
83
#IDPhoeniX
Let’s talk about syphilis 🧵
Rates of syphilis have ⬆️ from 5,979 in 2020 to 133,945 in 2020 (2,140% ⬆️)
T. Palladium are obligate microaerophilic spirochete, with an extremely fragile outer membrane
Few exposed lipoproteins & phospholipids make up the surface
1/8
8
27
81
#IDTwitter
Last part:
Beyond the 101: Pondering Perplexing Prescribing Issues
Are Adjunctive Rifampin and Gentamicin Necessary for the Treatment of Staphylococcal Prosthetic Valve Endocarditis?
@JGPharmD
4
25
78
Mind over Material: Cefazolin for Treatment for CNS infections continued
#IDTwitter
Cefazolin does penetrate 🧠 tissue! Better than nafcillin
5
10
76
But WHY do we keep changing names of organisms?
Any guess as to what this was before without looking it up? No cheating.
13
6
74
#IDTwitter
#IDPhoeniX
Has anyone seen a MEM-R Strep pneumo? I haven’t seen this before.
@DrToddLee
@IdVilchez
@JGPharmD
@JonathanRyderMD
21
10
72
A 🧵 about Cabotegravir PREP:
In 2021, women and girls in sub Saharan Africa accounted for 3 out of 5 new HIV infections.
Young women aged 15-24 yrs were 3x more likely than men in the same age group to be infected with HIV
2
29
69
Thank you
@IDSAInfo
@IDWeekmtg
for including me in the Careers for Clinical Practice roundtable discussion for fellows this year!
I had a wonderful time. I hope it was valuable for all who attended. Appreciate everyone who came 🥰
#IDTwitter
1
1
69
Patient with septic shock from pneumonia. Sputum cx w/ MRSA, Klebsiella pneumoniae. Sensitivities below. KPC and NDM PCR positive. How do you tx and why?
@wfwrighID
@DrDidwania_ID
@jendel0717
@GERMANESPARZA_
@OncIDPharmd
@JGPharmD
@InYourFAECIUM
@IdVilchez
15
13
63
E. coli in the urine & blood. Is this an ESBL? If not, what’s the mechanism of resistance?
#IDtwitter
@jendel0717
@VickyG_PharmD
@wfwrighID
@GERMANESPARZA_
@MicroLukas
@Sara_E_Boyd
13
18
59
I’m just going to say it.
@MatiH_ID
is THE ⭐️ on the opening plenary session. She is not afraid to say it like it is.
She is refreshing, real, and engaging. Watch out. She is coming and I am here for it 👏👏
@IDWeek2022
#IDTwitter
2
6
59
#IDTwitter
Catching up on articles.
No benefit in adding beta lactam to SOC for MRSA bacteremia.
I’m behind. What was the theory on why a combo beta lactam would work for MRSA?
@syctong
4
12
60
#IDTwitter
Ever thought of using linezolid for syphilis based on in vitro data?
Don’t do it. It was inferior to standard of care.
This is exactly why we need randomized clinical trials!
7
8
57
Did you know coccidioidomycosis IgG Ab always indicates fungal replication/active fungal disease?
#FunFungalFacts
@IDWeek2022
1
10
55
Interested in learning more about clinical practice? Meet me
@IDWeekmtg
on Fellows’ Day! Would love to answer any questions.
And if you haven’t heard already, check out my convo with
@PaulSaxMD
, where we talk 💵
3
9
53
#IDtwitter
Anyone have experience with using pivmecillinam?
Surprised to read that it frequently maintains activity amongst esbl and CRE isolates.
Recently approved by US FDA.
Is there a catch?
16
6
52
I am slowly working my way through the 169-page supplement. Incredible!
It is a book chapter on IE for all you
#IDtwitter
nerds 🤓
But if you can’t get through it all, bookmark Suppl. Table 3 & play the game: who should get a TEE? (Page 48)
@DrEmilyMcD
🔥🔥 Just published 🔥🔥
Our second
@Wiki_Guidelines
@JAMANetworkOpen
@DrEmilyMcD
@BradSpellberg
@DrToddLee
and many 🌟s
Guidelines for Diagnosis and Management of Infective Endocarditis in Adults
A
@Wiki_Guidelines
Group Consensus Statement
#IDTwitter
12
213
509
0
9
51
#IDTwitter
We are seeing a bunch of vibrio cholerae infections in the community. Whoever needs to hear this, stop eating raw crab 🦀 !
Apparently, there is a TikTok trend to promote Yangnyeom-gejang
Folks, stop eating this. This is dangerous!
4
8
50
#IDTwitter
I have been seeing more invasive pneumococcal disease this year than ever.
This is a nice quiz to help refresh your memory about IgG subclasses deficiencies. 👇
5
5
48
#IDtwitter
do you check baseline cocci serology in your pts with HIV w/ CD4 < 250?
Do you start primary histo ppx for CD4 < 150?
@IDWeek2022
8
11
48
@BradSpellberg
I don’t think enough people are talking about it. This is my favorite line from this article “Other drug characteristics such as optimal dosing, pharmacokinetics, and tissue penetration may be more important efficacy drivers.” That’s the message.
0
17
48
Who knew that a meningococcal vaccine could be also effective against N. Gonorrhea? Is this a feasible strategy for combating N. gonorrhea in the setting of increased antimicrobial resistance patterns?
@serotavirus
@sebpoule
@PaulSaxMD
Neisseria meningitidis vs Neisseria gonorrhea. Clinically VASTLY different, but turns out they SHARE antigenic determinants including outer membrane vesicles. 4CMenB Vaccine for N. Meningitidis appears PROTECTIVE against infection with N. Gonorrhea
0
6
19
2
6
47
@jakescottMD
I can’t tell u how happy it makes me to see these pts going home. My 90 yo pt told me today about how she’s always been “gassy“. I laughed bc I knew I would be able to laugh w/her about it again tomorrow. A yr ago, I was talking to families about saying goodbye. Very grateful!
2
0
46
Excellent lecture from
@IDWeek2022
by
@hymanscott
reviewing the best laboratory detection methods to diagnose acute HIV in patients on PrEP
Session 178
@hymanscott
is the medical director for the SF AIDS Foundation
The foundation diagnoses 30K STDs/yr; they have ~3K on PrEP
2
11
47
80 yo man w/ DLBCL, hypogammaglobulinemia p/w 4 mo of dysuria, urinary frequency, pyuria, & numerous negative urine cx’s . Now with septic shock, cystitis & pyelonephritis.
2 sets of blood cultures 👇
Any guesses?
#IDtwitter
#Medtwitter
#FunIDcases
18
6
46
#IDTwitter
ICYMI
(Tbh I missed this with all the steno noise!)
New breakpoints for AG for Pseudomonas and Enterobacterales
🔑 points:
🚫 gent for PsAR (intrinsic R)
Amikacin for PsAR UTI only
Tobra remains theoretically S
4
10
44
Good morning
#IDtwitter
:40 yo with bilateral pneumonia growing 👇in sputum. What is the likely mechanism of resistance & how do you treat?
@IdVilchez
@GERMANESPARZA_
@theAMRdoc
@wfwrighID
@jendel0717
@VickyG_PharmD
@rpetrak3
10
10
44
#IDtwitter
Slowly working my way through these guidelines.
Ummm… who’s ordering a cardiac CTA, PET-CT, and MRI on every pt w/IE confirmed by TEE (👎TOE)???
Is the guideline committee solely composed of radiologists and cardiologists?
🆕️🔥2023 ESC Guidelines for the management of endocarditis🔥🆕️
#IDSLXposts
H/t
@gushamilton
It's a huge document. I will try to compare it to our IE
@Wiki_Guidelines
soon
@Inox94
#IDXposts
11
91
260
5
6
43
#IDtwitter
Catching up
@IDWeek2022
lectures
Really interesting lecture to see how our European colleagues approach PJI
@WouthuyzenB
Early infection: < 3 mo after arthroplasty, < 3 weeks of sx from hematogenous PJI - DAIR
1 week IV, then 11-12 wks of ANTIBIOFILM AB
3
8
43
This article reminds me of an
#IDtwitter
convo back in June. This article reviews how we should tx peri-partum infections. Source control and NEW & improved abx regimens.
@emilylheil
@IdVilchez
@FungalDoc
@LanceBurkhart4
@Cortes_Penfield
@JamesWilsonDO1
1
14
41
Does it matter? Should we be in line for the new BA.5? I liked this substack by
@EricTopol
summarizing his thoughts about pros/cons BA.4/5 & available data. I may wait as well. What are your thoughts?
@DrToddLee
@zchagla
@MichaelDaignau3
@DrPaulOffit
What we know and don't know about the BA.5 booster rolling out for all Americans age 12+ in ~2 weeks
27
192
652
11
4
43
#IDTwitter
2 weeks later, our legionella culture came back… kudos to
@robviau81
for sending it before transfer!
64 yo pt went to waterpark w/ grandchildren 2 wks ago. p/w fever, septic shock, dense RLL pneumonia, resp failure req ECMO.
Resp cx, bl cx, S. pneumo ag, legionella Ag, urine histo, urine blasto ag, MRSA neg
What is most likely dx?
What other diagnostic tests would you perform?
24
7
32
3
2
41
#IDTwitter
The medscape survey never really told the true story about how much 💵 ID physicians really make in the real world.
Here’s our survey.
Largest private practice ID group in the country.
67 responses (25 employees, 42 partners)
Check it out 👇
7
9
42
#IDTwitter
Do you believe in the “low-grade fever”?
Perhaps the one circumstance where it may matter…
3
9
41
#IDTwitter
What is your first line tx for CMV viremia in transplant pts?
Treatment experienced vs treatment naive?
HSCT vs SOT recipient?
Has anyone moved on to first line Maribavir based on this?
@tmhohl71
@DrToddLee
@maricar_malinis
@RazonableMD
10
14
40
#IDTwitter
I stand corrected.
GDH is a v good marker of c diff infectivity (true infection)
Can’t go by toxin/pcr alone, but GDH in combo w/ toxin assay improves sensitivity of detecting true infection (based on cycle thresholds).
@DrToddLee
@sebpoule
1
14
39
Had so much fun at the
#tweetup
! So wonderful to meet everyone IRL! I only wish I took more 📸
@IDJClub
@JonathanRyderMD
@syctong
@IdVilchez
@InYourFAECIUM
@SAIRABT
@MariamAssiMD
1
2
40
In this PROSPECTIVE
#Longcovid
study frequency/burden of sx 12 mo after acute COVID19 ⬆️w/ severity of acute illness. Heartbreaking statistic: 12.5% could not envision coping w/ their sx long term.
@WesElyMD
@GFaghe
@CIBScenter
0
17
38
#IDTwitter
Fun weekend case
70 yo pt p/w fever, myalgias, weakness.
PLT 50 (baseline 230), HB 10 (baseline 13), AST 70, ALT 60. Has a weekend cabin in Wisconsin; was fishing, camping a month ago.
Lab tech sees RBC ring forms worrisome for malaria.
What’s the dx and treatment?
11
4
37
Catching up on
@IDWeek2022
lectures after work
@ChulieUlloa
is presenting a case of persistent SAB
Session 114 Clinical Controversies in Tx of SAB
This case has me STRESSED out
11 days of persistent MSSA bacteremia!
In a 10 mo old? 😬😱
4
8
38
@DrNeilStone
Focus on the parts of the job that make you happy. For me, it’s my pts. Today, I spent an extra 30 min listening to the history of the Chicago mafia from my 90 yr old pt.
Am I behind? Yes… but I enjoyed the conversation, and I knew he wanted the company. And it makes my
1
0
34
How do you interpret a +COVID19 PCR with CT = 40 in an asymptomatic pt? Is it an early infection that is barely detectable or remnants of an old infection that was undiagnosed? Do you repeat the PCR test in 1-2d?
@michaelmina_lab
@IDvilchez
@BradSpellberg
6
10
37
Can you use fosfomycin for a MDR UTI in isolates other than E. coli or enterococcus? Evidence for/against please
@BJegorovic
@IdVilchez
@wfwrighID
@BradSpellberg
@EB_Hirsch
@ErinMcCreary
@DrToddLee
Yes
306
No
183
Maybe
197
6
9
37
This confirms what I suspected. Pts w/ ⬆️ BMI (median 36), ⬆️ wt (median 112 kg) in this retrospective study found to have ⬆️vanc accumulation (61%) & AKI (14%). Do you prefer dapto vs linezolid in pts w/ obesity?
@IdVilchez
@drtimothyli
@BWDionne
7
10
36
I found a little piece of gold in
@IDWeek2022
Session 255 Perfectionism and Fear of Failure
A wonderful talk by Dr. Latania Logan, who was one of my attendings
@RushCCH_ID
over 10 yrs ago
She is one of the most down to earth people I have ever met
So kind, so real.
2
9
35
#IDPhoeniX
What is the cost effectiveness of paxlovid to prevent one hospitalization NOW in high risk vaccinated folks?
$231k-278k 😬😧
Nice to see the actual cost breakdown from where we started.
@GidMK
@jeremyfaust
@DrToddLee
@zacroBID
2
15
35
I came across this recently published article where 223 ID specialists in Europe were surveyed to see how they would treat HSV-2 meningitis
@syctong
2
10
36
@jakescottMD
@PaulSaxMD
@statnews
That’s it. My behavior & risk management is primarily dictated by the severity of illness I’m seeing in the hospital (which is mild at worst in those w/ highest comorbidities/risk).
We are allowed to change our behavior based on current risk. We can’t be tied to 2020-21 forever.
1
3
36
#IDTwitter
Thoughts on new guidelines on MODERATE intensity statin for primary prevention in PWH w/ low-int risk of CVD?
Could low dose be as effective?
What’s your statin of choice?
@PaulSaxMD
@drlaurajwaters
@Darcy_ID_doc
@sebpoule
@HIVDocSK
5
8
35
Guess what just dropped?
2
4
34
#IDTwitter
Congrats to all the folks who matched into ID!
I promise you won’t regret it.
It is the best field,🤚 down.
It is fascinating, evolving, exciting & rewarding.
And if you didn’t know, you can make a lot of 💰 doing ID. Tell your friends.
0
1
34
@EricTopol
We are talking about going from 1.1 to 0.4 per 100,000 cases. The numbers for both are extremely low (3rd dose to 4th). Not so sure the juice is worth the squeeze.
5
0
33
#IDtwitter
Results of PURPOSE study are sinking in for me. Twice yearly injectable was 💯 effective in preventing HIV
Closest thing we have to a vaccine!
What a huge achievement, esp given issues w/vag concentrations of TDF w/ intermittent compliance
.
3
5
32