William Wright
@wwrighID
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ABIM Infectious Diseases | ABP Clinical Microbiologist (Yale) | MPH Biostatistics Epidemiology | Clinical Researcher | Clinical Director | OPAT Director | FIDSA
Baltimore, MD
Joined July 2023
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#IDTwitter
#SIDPharm
#MedEd
#MedTwitter
1/
#Biostatistics
and
#Epidemiology
rounds discussion on pre- and post-testing probabilities and likelihood ratios.
How to quickly determine these numbers in practice!
(*2x2 table and formulas added for reference)
1
52
140
#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
#TwitteRx
@IdVilchez
#AMRrounds
#IDrounds
@JHMed_ID
@HopkinsMedicine
@JohnsHopkinsSPH
Thank you
@IDSAInfo
for this wonderful opportunity to be recognized as a fellow (
#FIDSA
) in such a great society!
12
1
85
#IDTwitter
@ID_fellows
#SIDPharm
@ASMicrobiology
@TxID_Fellows
@IdVilchez
1/
#IDrounds
: Cerebral Spinal Fluid (CSF) analysis is the most valuable indicator of infectious diseases of the Central Nervous System (CNS).
Understanding the three (3) basic CSF types can be useful.
2
29
67
@IdVilchez
@BradSpellberg
@DrToddLee
@OncIDPharmd
@davidvanduin
@PriyaNori
@ClancyNeil
@EB_Hirsch
@JGPharmD
@dralicehan
@JamesWilsonDO1
@JonathanRyderMD
TY for sharing Gabe! Suspect this is over expression of TEM-1 👇
4
2
56
#IDTwitter
#SIDPharm
#ASMClinMicro
@JHMed_ID
Honored and tremendously excited at this opportunity to join
@jac_amr
to disseminate more
#AMRrounds
cases that provide education regarding difficult to treat infections caused by multi-drug resistance organisms globally!
7
3
52
#IDTwitter
#IDFellows
#MedEd
#MedTwitter
#SIDharm
#Biostatistics
rounds today discussed:
1.) How to calculate the absolute risk reduction or increase from a systematic review and meta-analysis.
2.) And calculate the number needed to treat or harm (NNT or NNR)
2
17
46
#IDTwitter
#IDFellows
#MedEd
#MedTwitter
#SIDharm
#Biostatistics
rounds today discussed this study () in which researchers investigated the risk of ventilator-associated pneumonia (VAP) after 3-days nebulization of amikacin vs placebo.
1
12
39
#IDTwitter
#IDFellows
#MedEd
#MedTwitter
#SIDPharm
#ASMClinMicro
#AMRrounds
(doi: 10.1093/jacamr/dlad097) called about this microbiology confirmed isolate associated w/ clinically confirmed infection inquiring about resistance mechanisms & if CRO is acceptable treatment option.
2
9
34
1/
#IDTwitter
@ID_fellows
#SIDPharm
@ASMicrobiology
@TxID_Fellows
@IdVilchez
#AMRrounds
: called about this microbiology confirmed isolate from urine inquiring about mechanisms of resistance for ampicillin and ampicillin-sulbactam but susceptible to amoxicillin-clavulanate.
2
9
34
#IDTwitter
#SIDPharm
#ASMClinMicro
#AMRrounds
delighted to share our
@jac_amr
publication doi: 10.1093/jacamr/dlad097 was selected among the top 10 publications 2023!
@liunezolid
@andreaprinzi
Jovan Borjan, PharmD
@P_A_Bradford
@OncIDPharmd
4
4
32
#IDTwitter
#SIDPharm
@ASMicrobiology
@IDSAInfo
@CIDJournal
@JIDJournal
Humbled at this tremendously kind and generous invitation to join
@OFIDJournal
editorial board, thank you! And thank you
@Darcy_ID_doc
for trusting in my reviews!
4
2
31
@MariamAssiMD
@IdVilchez
@ErinMcCreary
TY 4 sharing this very interesting case Mariam! Antibiogram interpretation here suggestive of OmpK36 variable expression for low-level ETP-R & FOX-R by loss of porin Omp K35 (doi: 10.4103/0255-0857.13867)
#AMRrounds
@liunezolid
@andreaprinzi
@P_A_Bradford
1
3
31
#IDTwitter
#SIDPharm
#TwitterRx
#ASMClinMicro
#AMRrounds
called about the microbiology confirmed isolate (AMR Step 1) associated with bacteremia, AKI, and QTc >525-ms with team inquiring about incident onset AmpC -R.
1
5
29
#IDTwitter
#SIDPharm
#ClinMicrobiol
#ACCP
#AMRrounds
called about this laboratory confirmed isolate associated with a clinically confirmed infection inquiring treatment recommendations and resistance mechanism(s).
3
8
27
#IDTwitter
#ASMClinMicro
#SIDPharm
@SHEA_Epi
@CDC_AR
@jac_amr
#AMRrounds
called about microbiology confirmed result (AMR Step 1) associated with a clinically confirmed ICU associated VAP (Clinical ID step 1) inquiring to potential mechanism of antimicrobial resistance (AMR).
2
6
28
@Weavofloxacin
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
0
5
27
#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
#TwitteRx
@IdVilchez
1/ Immune response to Group A beta-hemolytic streptococci (Streptococcus pyogenes) pharyngitis and pyoderma differ.
Understanding this difference can be helpful when ordering antibody tests.
3
11
26
#IDTwitter
#MedTwitter
#SIDPharm
#LabMedicine
#ClinMicrobiol
Stay tuned for our upcoming updates for best practices in
#FUO
for adults!
@JHMed_ID
@HopkinsMedicine
0
5
25
#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
#TwitteRx
@IdVilchez
#AMRrounds
: called about this microbiology confirmed clinical bloodstream isolate inquiring about AmpC resistance.
2
4
24
#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
@IdVilchez
#Medtwitter
#MedEd
@JHMed_ID
@HopkinsMedicine
#FUO
🚨Grateful for the so many incredibly talented experts
@Rovers_Chantal
@PaulPauwaert
@ABetrains
and for
@OFIDJournal
@Darcy_ID_doc
for making this project successful!
3
1
24
@BJegorovic
@dralicehan
@ABStewardess
@BradSpellberg
@IdVilchez
@CosEpiID
@mykkymcg
@DrToddLee
Studies from UK & South Korea demonstrated ERT-R (MEM-S) usually arises from combination of altered membrane porins (Omp35 & Omp36) & noncarbapenemase ß-lactamase enzymes, including AmpC & ESBL (eg, SHV, TEM, & CTX-M). PMID: 15273152, 19233898, & 27101841.
#IDTwitter
@jac_amr
2
1
23
#IDTwitter
@ID_fellows
#SIDPharm
@ASMicrobiology
@TxID_Fellows
#TwitteRx
@IdVilchez
#IDrounds
: crab fisherman working in Chesapeake Bay waters presents with painful red rash on his right hand for several days after crab spine injury. Wound culture with GP+ rod.
Most likely:
Aeromonas species
24
Erysipelothrix species
132
Mycobacterium marinum
47
Vibro species
42
3
6
22
@MicroLukas
bla(SHV) explains R to AMC. With 3rd generation R suspect either ESBL or plasmid AmpC. With ERT R this would most likely be CTX-M 14/15 ESBL with loss of OmpK36 and can also explain the Temocillin I.
1
0
19
#IDTwitter
#SIDPharm
#TwitteRx
#IDPharmacistsDay
Thank you for your remarkable efforts across the globe!
Impossible to personally thank everyone
@mmPharmD
@EB_Hirsch
@ErinMcCreary
@JRBPharmD
@liunezolid
@emilylheil
@caitlindamycin
@OncIDPharmd
@InYourFAECIUM
@Jill12296
1
3
19
#IDTwitter
#SIDPharm
@ACCP
@ID_fellows
#ASMClinMicro
1/
#AMRrounds
called about this microbiology confirmed isolate associated with a clinically confirmed infection inquiring about the resistance mechanism.
2
1
19
#IDTwitter
#ASMClinMicro
#SIDPharm
🚨NEW: Our paper in
@JIDJournal
led by Steven Patrick Rowe, M.D., Ph.D discusses emerging molecular imaging methods for pathogen specific diagnoses with potential for antimicrobial therapeutic drug monitoring and
#FUO
1
4
19
#IDTwitter
#SIDPharm
@ID_fellows
#ASMClinMicro
1/
#Microbiologyminutes
discussing most fundamental staining procedure in microbiology named after inventor Has Christian Joachim Gram (1853-1938) while working in the Municipal Hospital of Berlin searching for “cocci” in pneumonia.
1
1
18
#IDTwitter
#SIDharm
#MedTwitter
In
@OFIDJournal
, the international FUO & IUO research working group report results of a modified Delphi process aimed to develop
@IDSAInfo
based potential quality clinical metrics for these heterogeneous conditions.
Read:
1
5
18
@DrToddLee
@IdVilchez
@Weavofloxacin
@BradSpellberg
@ABsteward
@dralicehan
@AntibioticDoc
@mykkymcg
@TorontoIDDoc
@jessecouk
@Cortes_Penfield
@JonathanRyderMD
Concentrations of linezolid present in stool of healthy humans receiving 600 mg orally twice daily was mean of 7.1 μg/g on day 4 of treatment (S/ breakpoint C. difficile is ≤4 mg/L) but is associated with significant dysbiosis increasing risk of relapse.
0
1
18
3
12
16
#IDTwitter
#MedEd
#SIDPharm
#Biostatistics
rounds on 90% CI vs 95% CI or 99% CI
Usually 90% CI used in research studies with small sample sizes & ⬇️ power to detect an effect.
Why did study 👇 used 0.1 alpha rather than 0.05 alpha with n= 130,578?
2
2
17
#IDTwitter
#SIDPharm
#ClinMicrobiol
@theAMRdoc
@P_A_Bradford
@liunezolid
@andreaprinzi
#AMRrounds
called about this microbiological confirmed isolate associated with a clinically confirmed infection inquiring if there is an underlying class D enzyme (e.g., oxa-48).
1
3
17
#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
@IdVilchez
🚨
#IDBoards
looking forward to working with
@ABIMcert
on this role for the next 2-years, thank you
#ABIM
!
@JHMed_ID
@HopkinsMedicine
@PaulPauwaert
@enjohnsonmd
@IDSAInfo
@IDWeekmtg
5
1
17
#IDTwitter
@ID_fellows
#SIDPharm
@ASMicrobiology
@TxID_Fellows
@IdVilchez
#IDrounds
: Non-HIV male smoker admitted to MICU with severe CAP. Vitals: T 42C, RR 28, & O2 70% RA. WBC 19, Na 120, & ALT 62. Employed with cleaning horse stables at a racetrack.
Which is most likely?
Burkholderia mallei
38
Coxiella burnetii
73
Legionella pneumophila
169
Rhodococcus equi
205
14
4
16
@JamesWilsonDO1
@IdVilchez
@ABsteward
@ABStewardess
Thanks for sharing James! Suspect this is over-expression of chromosomal SHV-1 (intrinsic R to AMP) rather than plasmid-mediated IRT (which are variants of TEM-1/TEM-2) given those MIC. TZP typically retains S against IRT and in some cases is harbored with other BLs (eg, KPC).
1
1
15
#IDTwitter
#SIDPharm
@ASMicrobiology
@jac_amr
#AMRrounds
called today about this laboratory confirmed isolate associated with a secondary bloodstream infection inquiring the risk of AmpC resistance.
3
5
16
#IDTwitter
#SIDPharm
#ASMClinMicro
#IDfellows
1/
#AMRrounds
discussion on this microbiology confirmed (AMR step 1) isolate that is associated with a clinically significant infection (Clinical ID step 1) inquiring to the mechanism of ceftazidime (CAZ) resistance.
2
5
15
#IDTwitter
@ID_fellows
#SIDPharm
@ASMicrobiology
@IdVilchez
#IDrounds
: immunocompetent patient. New fever/headache. Near drowning event/bronchitis treated with corticosteroids 1-month prior. Lymphocytic CSF pleocytosis with negative smear and cultures.
Most likely cause is:
Aeromonas hydrophila
53
Leptospira interrogates
55
Scedosporium apospermum
111
Trichosporon inkin
4
3
4
15
#IDTwitter
#ClinMicro
#SIDPharm
#MedTwitter
After 13+ weeks of exciting inpatient ID consults, 3 review manuscripts, 1 research protocol now approved by IRB, and 2 family birthdays since May 2023 now time to focus on the three (3) current
#FUO
research projects!
2
2
14
#IDTwitter
#SIDPharm
#ClinMicro
Stay tuned for the final publication
@jac_amr
of our
#AMRrounds
review article with a fantastic team of experts
@liunezolid
,
@andreaprinzi
, Jovan Borjan, Pharm.D.,
@P_A_Bradford
, and
@OncIDPharmd
1
0
14
#IDTwitter
#SIDPharm
#MedEd
#MedTwitter
1/
#Biostatistics
rounds discussion on in press article which a large retrospective single center VA study (n=156,107) using data from administrative database reported 17% ⬇️ CDI rate w/ DOX+CRO vs AZI+CRO for CAP.
1
5
14
@BayroNikolai
@IdVilchez
@DrToddLee
@BradSpellberg
@ABsteward
Others for medical students to consider following include:
@PaulSaxMD
@CarlosdelRio7
@ShohamTxID
@EB_Hirsch
@mmPharmD
@febrilepodcast
@GermHunterMD
@BrownJHM
@OncIDPharmd
@DMAronoff
@Darcy_ID_doc
@DrEllenEaton
@heather
@YunHeather
3
3
13
4/ Hint:
0
4
14
#IDTwitter
#MedTwitter
#SIDPharm
Presenting our research poster on modified Delphi consensus recommendations for
#FUO
/
#IUO
clinical care & research priorities from experts across 11 countries
@HopkinsMedicine
&
@HopkinsEngineer
annual research day!
@ABetrains
@Rovers_Chantal
0
3
13
#IDTwitter
#SIDPharm
#ASMicrobiology
#MedTwitter
Productive academic day with 1-peer review completed, 2 research grants submitted, and 1 research manuscript submitted to a peer reviewed journal.
Next stop is
@WaltDisneyWorld
0
1
12
#IDTwitter
#SIDPharm
@ID_fellows
@ACCP
#ASMClinMicro
#AMRrounds
; Among patients with or without source control procedure who have persistent MRSA bacteremia despite high-dose DAP (10-12 mg/kg) + CPT, what has been your approach to an antibiotic salvage regimen?
@IdVilchez
DAP+LZD
60
CPT+LZD
25
CPT+SMX
13
Other (please reply)
36
8
1
11
#IDtwitter
#SIDPharm
@JRBPharmD
@caitlindamycin
@dralicehan
@IdVilchez
@JHMed_ID
Terrific team of experts to bring together this
#AMRrounds
review manuscript!
1
7
12
#IDTwitter
#MedTwitter
#IDClinicalrounds
called about suspected active TB case w/ serum Ca 5.5mg/dl, albumin 2.5g/dl, Mg 0.7 mEq/l, arterial pH 7.6, & K 2.3 mEq/l.
At bedside evaluation, team attempted bilateral CNVII Chvostek test over pre-auricular region without “reflex”.
1
3
12
#IDTwitter
#ASMClinMicro
#SIDPharm
#IDFellows
#MedEd
Morning
#ClinMicro
laboratory rounds finds a gram-negative rod on gram-stain. Colonies ferment glucose but not lactose. Is cytochrome oxidase C negative but produces H2S. Has flagella and can be associated with diarrhea.
Pseudomonas
8
Shigella
52
Salmonella
72
Yersinia
16
1
3
12
#IDTwitter
#SIDPharm
@ASMicrobiology
@jac_amr
#AMRrounds
called about >100K CFU/ml laboratory confirmed Aerococcus urinae associate with urinalysis below, serum BUN 26, Cr 1.12 (baseline 0.9), WBC 5, and temperature 36.9C. No urinary catheter. Symptoms unreliable (dementia).
6
3
12
#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
#TwitteRx
@IdVilchez
#IDrounds
: oncology patient on trimethoprim-sulfamethoxazole (SXT), acyclovir (ACY), & posaconazole (POS) presents w/ worsening HTN, ⬇️K, ⬆️ Na, & ⬇️ extremity edema. Stable Cr & ⬆️ HCO3.
Most likely cause:
ACY
12
Chemotherapy
15
POS
89
SXT
21
2
4
12
@Weavofloxacin
Agree! An estimated 75-90% of diagnoses are suggested by historical facts arranged in a useful manner with ~9% from examination, & ~1-10% from tests. There is no pathognomonic sign that has sufficiently high PPV for UTI. Therefore, negative signs are more helpful than positive.
1
0
11
#IDTwitter
#MedTwitter
#SIDPharm
A tremendously fantastic week on inpatient
#infectiousdiseases
consultation “rounds”
@JHMed_ID
@HopkinsMedicine
this week to start the 2024 New Year! Thank you
@OslerResidency
0
1
11
#IDtwitter
#MedTwitter
#MedED
#SIDPharm
#ASMClinMicro
#Osler
@JHMed_ID
@HopkinsMedicine
@JohnsHopkinsSPH
@JohnsHopkins
Grateful for another terrific day and opportunity to be with so many talented learners, staff, faculty, and leaders to deliver world class care to our patients!
0
1
11
#IDTwitter
@ID_fellows
#SIDPharm
@ASMicrobiology
@TxID_Fellows
@IdVilchez
#IDrounds
: Previously healthy male farmer w/ AV mobile echo density. BC prior to ABX remained negative. Records indicate Rx for culture-negative CAP w/ hepatitis 6-months prior.
Which is most likely:
Abiotrophia defectiva
5
Bartonella henselae
19
Coxiella burnetii
141
Tropheryma whipplei
11
3
3
11
@rachelpbaden
@BradSpellberg
@Wiki_Guidelines
@DrEmilyMcD
@DrToddLee
@docDavar
@BradSpellberg
is really a fantastic physician, researcher, and respected person who has helped so many people. It would be great to see how our beloved profession could advance under his leadership at IDSA as president and beyond!
#IDTwitter
1
0
11
@DrToddLee
@GermHunterMD
Ha ha ha! FUO definitions: 1.) Petersdorf & Beeson 1961; 2.) Durack & Street 1991 (4 categories); 3.) DeKleijn et 1995 introduced “non-infectious inflammatory” subcategory; 4.) 1997 the FUO qualitative criteria; & 5.) Wright et al proposed FUO 2022. .
1
1
11
@IdVilchez
@Darcy_ID_doc
@dralicehan
@DrToddLee
@JamesWilsonDO1
@Abx_doc
#IDTwitter
#SIDPharm
Thanks for sharing Gabe! Might consider Ceftriaxone (CRO)
1.) doi: 10.1038/s44259-23-00006-3
and
2.) 👇
1
2
11
#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
#TwitteRx
@IdVilchez
#AMRrounds
: called today about this laboratory confirmed culture associated with a clinical infection asking the mechanism of ampicillin resistance in Citrobacter koseri.
This intrinsic resistance is due to:
Bla-CKO
23
Bla-SHV-1
25
Bla-TEM-1
31
Efflux (MexAB-OprM)
19
2
2
10
#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
@IdVilchez
#IDrounds
: refractory lymphoma patient presented with fever, cough, rash, & GGO on CT-Chest day 110 after T-cell depletion allo-HST (alemtuzumab conditioning) with GVHD. ALC 200/ul, hepatitis & hematuria.
Likely cause:
Adenovirus
79
BK virus
21
HSV-1
10
VZV
7
1
3
10
#IDTwitter
@ID_fellows
#SIDPharm
@ASMicrobiology
#MedTwitter
@FPMJournal
@IdVilchez
In this
@BMJBestPractice
,
@PaulPauwaert
and I discuss the contemporary evaluation of “classic” fever of unknown origin (
#FUO
) in adults!
@JHMed_ID
@HopkinsMedicine
0
2
9
Further reading:
3
4
10
#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
#TwitteRx
@IdVilchez
#AMRrounds
: called to inquire about which bacteria are intrinsically (i.e., naturally) resistant to polymyxins.
Which of the following would not be expected to be intrinsically resistant to polymyxin E or B?
Burkholderia cepacia
28
Morganella morganii
22
Pseudomonas aeruginosa
104
Serratia marcescens
27
3
3
10
@PaulSaxMD
“study remains an impressive feat of generating clinically relevant evidence on an important topic, and doing so quickly in a way that harmonizes with actual patient care”
Excellent and informative blog as always Paul, particularly the 6 points of conducting a study!
#IDTwitter
1
0
8
@MayoClinicINFD
@ZYetmar
@MatteoPasserin6
@CMIJournal
#TxID
#IDTwitter
Congratulations & well done!
Calculated 19 per 100 (range 9-25) ⬇️ cases w/ SXT-TMP; NNT=2.
Benefits might be overestimated given no K-statistics (reviewers) or Funnel plot (pub bias).
@transplantID
@RazonableMD
@ShohamTxID
@KatesOlivia
@jobadd
@IdVilchez
0
1
10
#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
#TwitteRx
@IdVilchez
#IDrounds
: patient with native vertebral osteomyelitis due MRSA seen in clinic on day 17 of vancomycin (VAN) with now 0.9 ANC (WBC 2.1). ANCA+ Daptomycin started at 8mg/kg/d.
Regarding future use of VAN you:
Rechallenge
50
Do not rechallenge
45
Other
7
2
0
9
#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
#TwitteRx
@IdVilchez
#IDrounds
: Louisianian recently consumed mollusks/crabs seen for occipital HA, N/V, & left vermillion vesicle. WBC 8.2 (Eosinophils 8%). CSF WBC 428, eosinophils 48%, & negative cultures.
Most likely cause:
Angiostrongylus
88
Balyisascaris
15
Gnathostomiasis
50
Herpes simplex
2
5
2
9
#IDTwitter
#ClinMicro
#IDclinicalrounds
called about this finding in 1 bottle (1 set) of BC identified at near 72-hours; only detected by NAT. Clinically asymptomatic, no indwelling CVC, or overlying skin rash at collection site.
@GermHunterMD
@FungalDoc
@IdVilchez
@ClancyNeil
4
2
9
👇😁
Please know that if I invite you to give an academic talk, you’ll leave with baklava!
Dr
@PeterHotez
: from a Greek mom to your home, enjoy!
And taking applications for next speaker 😊
74
47
990
0
2
9
#IDTwitter
#SIDPharm
#ASMClinMicro
#MedTwitter
#MedEd
Going to cozy up to this delicious spectacle of pure sweetness full bodied ale of soft, airy vanilla, and cake notes, that is iced to perfection! Happy Holidays 🎄
2
0
9
#IDTwitter
#SIDPharm
#ASMClinMicro
#MedTwitter
1/
#Biostatistics
&
#Epidemiology
rounds discussion on observational retrospective study regarding T2 Candida testing as antimicrobial and diagnostic stewardship tool among MICU patients with septic shock.
1
2
8
@EB_Hirsch
@IDPharmacometrx
Betsy, I will peer review if you also contribute to my upcoming
@jac_amr
#AMRrounds
section! 😁
#IDTwitter
#SIDPharm
@IdVilchez
@andreaprinzi
@liunezolid
@OncIDPharmd
@richdavisphd
@dralicehan
@danrhoads
@theAMRdoc
@P_A_Bradford
@SimnerLab
@pranita_tamma
@ClancyNeil
@MicroLukas
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@DrNeilStone
Excellent point Neil! Fever patterns also usually have little or no significance in establishing the diagnosis of
#FUO
#IDTwitter
#MedTwitter
#SIDPharm
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@Ashka_TxID
@ErinMcCreary
@JGPharmD
@DavidAl33593759
Thanks for sharing Ashka! Some considerations for beta-lactamase resistance would include be MBL, particularly blaVIM, KPC (ie, KPC-2), and/or class D enzymes (ie, oxa-48 like). Co-resistant mechanisms to include AmpC, OprD loss, and efflux. Did your lab test for carbapenemases?
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#AMRrounds
step 2: Intrinsic resistance
Resistance to amoxicillin, ampicillin, and 1st/2nd cephalosporins is due to chromosomal Amp-C
Intrinsic resistance to tigecycline is due to efflux pump (AcrAB)
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#IDTwitter
#SIDPharm
#ClinMicrobiol
Starting off the 2024 New Year with exciting clinical cases at
@JHMed_ID
@HopkinsMedicine
@OslerResidency
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#IDTwitter
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#ASMClinMicrobiol
💥In this viewpoint, we discuss the recent
@SNM_MI
appropriate use criteria for nuclear medicine in
#FUO
@SanjayJain_Lab
@JHMed_ID
@Rovers_Chantal
@ABetrains
@PaulPauwaert
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@JamesWilsonDO1
@nmoore07
@IDiots_pod
@ABsteward
@ABStewardess
@IdVilchez
TY 4 sharing James! Considerations: 1.) MBL, particularly blaVIM, 2.) KPC w/ omega loop mutations, particularly KPC-2, or 3.) OXA-48 given your carbapenemase screening was positive. Of note Pseudomonas derived cephalosporinase (PDC) w/ omega loop mutations can cause C/T & CZA R.
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#IDTwitter
#MedTwitter
#SIDPharm
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#AMRrounds
Just like a lot of you, we'll be enjoying turkey and touchdowns on Thanksgiving Day with friends and family. Thanksgiving serves as a reminder that despite our differences, we are all members of a larger human family.
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#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
@IdVilchez
#IDrounds
: CLL patient with Richert transformation to diffuse large B-cell NHL & monthly IVIG for CVID planned for R-CHOP. Pre-IVIG HBV serology negative. Recent serology: HBVsAg-, HBVcAB+, HBVsAB+, & HBV-DNA-.
You:
Start HBV vaccine
8
Start tenofovir
35
Repeat serology off IVIG
47
Monthly HBV-DNA testing
18
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#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
#TwitteRx
@IdVilchez
#IDrounds
: when your team knows you well!
@mmPharmD
@EB_Hirsch
@ErinMcCreary
@JRBPharmD
@liunezolid
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#IDTwitter
#MedTwitter
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#ASMClinMicrobiol
We have arrived
@WaltDisneyWorld
for my little beautiful princess to meet all her favorite princesses and
@Disney
@DisneyFrozen
friends!
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@Bornmann_CR
@liunezolid
@dralicehan
@RxIDMo
Epidemiological distribution of wild-type P. mirabilis CZF MICs distributions are significantly higher than for E. coli, in the absence of any resistance mechanism, on which newest breakpoints are primarily based. This same MIC elevation is not seen with AMP against P. mirabilis.
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#IDTwitter
#SIDPharm
#MedEd
#MedTwitter
1/
#Biostatistics
&
#Epidemiology
rounds discussion on observational study regarding risk of ventricular arrhythmia or cardiac arrest w/ Ceftriaxone & Lansoprazole. Specific questions were outcomes probabilities & estimated 95% CI.
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@docxusofficial
New development of corkscrew hairs (due to hair growth from a plugged follicle) on a background of perifollicular hemorrhages is considered pathognomonic (i.e., sufficiently high PPV) for scurvy!
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@dralicehan
@SBtotheDub
@JGPharmD
@ErinMcCreary
@OncIDPharmd
@drtimothyli
Against MBL+ PsA (most likely VIM followed by KPC as NDM is unusual in PsA) isolates in 👇 report ATM+AVI MIC only 1-2 dilutions ⬇️ than ATM alone.
Recommend testing prior to use given potential for omega loop mutations with PsA PDC’s causing CZA-R.
doi: 10.1128/AAC.00472-17
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@PaulSaxMD
@BrighamWomens
The impact Sidney Farber, MD had on children of his time, children of these children, parents, students, & beyond with DFCI’s contributions of nearly 47% recent FDA approved cancer treatments as well as federally funded AIDS & cancer research breakthroughs is hard to imagine!
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Hint:
1. Convert new probability to odds: 0.331/0.669 = 0.4948
2. Multiply odds X LR: 0.4948 x 4.2 = 2.078
3. Then convert to probability: 2.078/3.078 = 0.675 or 67.5%
A positive UA ⬆️ the probability of UTI to 67.5% in this patient! Answer: D
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#IDTwitter
@ID_fellows
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@TxID_Fellows
#TwitteRx
@IdVilchez
#IDrounds
: teenager with lower extremity pyoderma & AKI improving on PCN-G 1 MU IV q6. UA with hematuria, dysmorphic RBC, & proteinuria.
Which of the following could be useful in determining the etiology?
ASO titer
42
Anti-DNase B
23
Pharyngeal culture
18
Urine culture
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#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
#TwitteRx
@IdVilchez
#AMRrounds
#IDrounds
#MedTwitter
#Olympics2024
and
@reeses
with new peanut butter cup shapes.
Poll: What is your favorite Reese’s peanut butter cup shape and why? (Please reply)
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#IDTwitter
#SIDPharm
#ASMClinMicro
Going to try a new fermented malt beverage, full-bodied,and with strong flavour peanut butter 🥜 and of marshmallows! 😁
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#IDTwitter
@ID_fellows
#SIDPharm
@ASMicrobiology
@TxID_Fellows
@IdVilchez
@jobadd
@ShohamTxID
@AndrewKaraba
#CraftBeer
night trying the newest microbial fermentation beverage that is surprisingly smooth for a stout and very creamy flavor.
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#IDTwitter
@ID_fellows
#SIDPharm
@TxID_Fellows
#TwitteRx
@IdVilchez
#FUOrounds
: Indochinese immigrant w/ 4-week fevers, cough, & hemoptysis not responding to antibiotics. CXR RLL effusion. WBC 14.2 (22% eosinophils). Sputum/AFB negative. Pickled crayfish exposure.
Most likely:
Anisakis species
8
Echinococcus species
4
Paragonimus species
70
Schistosoma species
5
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#IDTwitter
@ID_fellows
#SIDPharm
@ASMicrobiology
@TxID_Fellows
#TwitteRx
@IdVilchez
#IDrounds
: fisherman w/ EtOH use disorder seen w/ MAP 40-50, WBC 35 & bilateral lower extremity hemorrhage bullous lesions. Records report history of raw oyster ingestion.
Most likely cause:
Aeromonas species
17
Clostridium species
1
Streptococcus species
0
Vibrio species
114
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#IDTwitter
#MedTwitter
#SIDPharm
#ASMClinMicro
Tremendous feeling to now have the first full draft of two (2)
#FUO
research manuscripts ready for the co-authors to review!
The internal peer-review process is just as equally important as the external peer review process!
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