Discover and read the best of Twitter Threads about #idweek2022
Most recents (24)
Just got done presenting at the 31st Annual Clinical Update in Geriatric Medicine, put on by @AHNtoday and @UPMC. Awesome attendees, as usual!
Was asked to talk about "Controversies in Antimicrobial Therapy"
Figured would share here.
#IDTwitter #MedTwitter
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Was asked to talk about "Controversies in Antimicrobial Therapy"
Figured would share here.
#IDTwitter #MedTwitter
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With a Geriatric audience, had to take the opportunity to focus first on the urine.
But also get into SSTI, Bactrim for Group A strep, if you need IV antibiotics for Lyme, dental prophylaxis for prosthetic joints, and duration of therapy.
First up - does +UA/UCx=UTI?
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But also get into SSTI, Bactrim for Group A strep, if you need IV antibiotics for Lyme, dental prophylaxis for prosthetic joints, and duration of therapy.
First up - does +UA/UCx=UTI?
2/
Emphatic NO on that one.
Need SYMPTOMS to diagnose a UTI.
I tell patients they need to tell us, we can't tell them.
Positive UCx without symptoms = asymptomatic bacteriuria.
3/
Need SYMPTOMS to diagnose a UTI.
I tell patients they need to tell us, we can't tell them.
Positive UCx without symptoms = asymptomatic bacteriuria.
3/
Myth: Bactericidal Agents Are Necessary for the Treatment of BSI at #idweek2022
A nice and easy-to-follow account of bactericidal vs. bacteriostatic agents and activity
@SyamhaninA @fikreeahmad @adammashraff @shaharudeen @andrewchangID @Rasidah @suraya_sudenia @cllau888
A nice and easy-to-follow account of bactericidal vs. bacteriostatic agents and activity
@SyamhaninA @fikreeahmad @adammashraff @shaharudeen @andrewchangID @Rasidah @suraya_sudenia @cllau888
@SyamhaninA @fikreeahmad @adammashraff @shaharudeen @andrewchangID @Rasidah @suraya_sudenia @cllau888 Cidality is NOT an intrinsic property of an antibiotic
e.g., for the same drug (TMP-SMX), we have 2 different properties against 2 different organisms:
1) Static against Steno
2) Cidal against E. coli
e.g., for the same drug (TMP-SMX), we have 2 different properties against 2 different organisms:
1) Static against Steno
2) Cidal against E. coli
What drives physicians refusing ASP recommendations?
We looked into it.
Just got done presenting our #IDWeek2022 oral abstract.
#IDTwitter
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We looked into it.
Just got done presenting our #IDWeek2022 oral abstract.
#IDTwitter
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First, there are a bunch of ways to do TeleASP, but especially the more "intense" models have shown success and can be as good as on-site programs.
Our prior work: academic.oup.com/cid/article/71…
SCORE trial from @E_Stenehjem et al.: academic.oup.com/cid/article/67…
#IDWeek2022
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Our prior work: academic.oup.com/cid/article/71…
SCORE trial from @E_Stenehjem et al.: academic.oup.com/cid/article/67…
#IDWeek2022
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What do we know already about what influences rec acceptance?
Summary of prior work, including great work from @BRxAD - surgeons tend to be less accepting, and recs that reduce antibiotic exposure refused more.
3/
Summary of prior work, including great work from @BRxAD - surgeons tend to be less accepting, and recs that reduce antibiotic exposure refused more.
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Oral Therapy for Bacteremia and Endocarditis
@IDwithNWD giving talk for @BradSpellberg
"No, you're not in the wrong room, and @BradSpellberg did not get younger and more handsome."
#IDWeek2022
#IDTwitter
@IDwithNWD giving talk for @BradSpellberg
"No, you're not in the wrong room, and @BradSpellberg did not get younger and more handsome."
#IDWeek2022
#IDTwitter
Historical lesson first.
Where did the myth that we need IV for IE come from?
Have to go back a ways.
#IDWeek2022
Where did the myth that we need IV for IE come from?
Have to go back a ways.
#IDWeek2022
1/10 Most influential infection prevention papers presented at #IDWeek2022 (non-COVID). 1. In >300 HCP caring for monkeypox patients, only 23% wore all recommended PPE, yet no HCP infections in 21 days. Risk of transmission in health care settings is low. pubmed.ncbi.nlm.nih.gov/36136939/
2/10 Near ZERO viral detection when swabbing nostrils of HCWs exposed to a nebulized virus in a sealed clinical room for 40 mins wearing a fit-tested N95 (that passed) plus HEPA filtration. Wearing a non-fit-tested or failed fit-tested N95 not protective. pubmed.ncbi.nlm.nih.gov/35535021/
3/10 "In patients with symptom resolution of C. difficile infection AFTER treatment with standard-of-care antibiotics [PO Vanco or Fidaxomicin), oral administration of SER-109 was superior to placebo in reducing the risk of recurrent infection." pubmed.ncbi.nlm.nih.gov/35045228/
1/8 Most influential stewardship papers presented at #IDWeek2022. 1. Women in rural settings MORE LIKELY to get antibiotic treatment for uncomplicated UTI for a duration longer than recommended by guidelines, compared with urban settings. pubmed.ncbi.nlm.nih.gov/33622432/
2/8 Why does this matter? "Each day of antibiotic therapy was associated with 4% increased odds of experiencing an adverse event." pubmed.ncbi.nlm.nih.gov/34775072/
3/8 ED specific urine antibiogram, UTI guideline, education, department specific feedback followed by re-education & provider specific feedback -> initial 15% improvement in guideline-concordant abx followed by additional 3% improvement Q2wks during study. pubmed.ncbi.nlm.nih.gov/35100621/
What's better for reducing unnecessary treatment of asymptomatic bacteriuria? Diagnostic stewardship or antibiotic stewardship?
@ValerieVaughnMD presenting the @SHEA_Epi featured oral abstract.
#IDWeek2022
@ValerieVaughnMD presenting the @SHEA_Epi featured oral abstract.
#IDWeek2022
At #IDWeek2022
Role of follow-up blood cultures for Gram positives
Valeria Fabre
Detection of bacteria depends on:
Volume of blood and number of sets - should aim 40ml in 4 bottles (2 sets)
Role of follow-up blood cultures for Gram positives
Valeria Fabre
Detection of bacteria depends on:
Volume of blood and number of sets - should aim 40ml in 4 bottles (2 sets)
About 20% of GP bactermia are persistent. Mostly S. aureus. Strep not persistent. Wiggers BMC ID 2016
Persistance in SAB may occur in up to 40% of cases
Persistance in SAB may occur in up to 40% of cases
Minejima CID 2020 mentioned again. @BradSpellberg
Risk factors for prolonged SAB - MRSA, endovascular source, ICU
Bacteremia of ≥3 days independent predictor of 30-day mortality
Risk factors for prolonged SAB - MRSA, endovascular source, ICU
Bacteremia of ≥3 days independent predictor of 30-day mortality
Detecting the cefazolin inoculum effect with a rapid test. #IDWeek2022
Sara I. Gomez Villegas, MD; @SuperBugDoc
When S. aureus MIC to cefazolin increases in vitro when inoculum increased
Prevalence 3-15%
Retrospective studies find CzIE associated with poorer outcomes
Sara I. Gomez Villegas, MD; @SuperBugDoc
When S. aureus MIC to cefazolin increases in vitro when inoculum increased
Prevalence 3-15%
Retrospective studies find CzIE associated with poorer outcomes
Looking at dataset from pediatric OM
250 MSSA with 14.4% CzIE+. These were associated with progression from acute to chronic OM
Gold standard for detection is BMD. Cumbersome test. 3 days for test.
250 MSSA with 14.4% CzIE+. These were associated with progression from acute to chronic OM
Gold standard for detection is BMD. Cumbersome test. 3 days for test.
CzIE+ isolates release more BlaZ enzyme. Nitrocefin changes colour in the presence of B-lactamase
Novel 3 hr assay to detect CzIE
Aim: evaluate accuracy of nitrocefin test
Novel 3 hr assay to detect CzIE
Aim: evaluate accuracy of nitrocefin test
Machine learning for identifying patients at risk of severe sepsis. Talk by @suchisaria at #IDWeek2022. Input + Output -> Rules. pubmed.ncbi.nlm.nih.gov/32166234/
This table highlights why we are not going to accurately identify sepsis in real-time without machine learning. pubmed.ncbi.nlm.nih.gov/31939780/ #IDWeek2022 @suchisaria
"Machine learning-based clinical decision support tools for sepsis create opportunities to identify at-risk patients and initiate treatments at early time points." 89% of ~9800 alerts reviewed by physician/APP over 2 yrs -> 2hr less time to 1st abx. pubmed.ncbi.nlm.nih.gov/35864251/
Bactrim is fine for most beta-hemolytic strep, folks.
Many of us were taught this one incorrectly because thymidine content in agar unregulated until 2006 so looked resistant in old studies.
Appreciate @SDoernberg clearing this one up in 2nd myth busters talk.
#IDWeek2022
Many of us were taught this one incorrectly because thymidine content in agar unregulated until 2006 so looked resistant in old studies.
Appreciate @SDoernberg clearing this one up in 2nd myth busters talk.
#IDWeek2022
Nice aside - dosing matters.
Most people I'm consulted on who fail oral treatment for true cellulitis are underdosed.
#IDWeek2022
Most people I'm consulted on who fail oral treatment for true cellulitis are underdosed.
#IDWeek2022
Getting ready for Clinical Controversies in treatment of S. aureus bacteremia. #IDWeek2022
Increasing recognition that 'persistent' bacteremia should probably be earlier rather than later. Each day longer, associated with increased metastatic complications and mortality.
What is best treatment? ASP or cefazolin? Issues of increased toxicity vs cefazolin inoculum effect.
>>> we need to test in a clinical trial
If still BC+ at 5 days?
No routine role for combination antibiotics - no benefit with rifampin, daptomycin, aminoglycosides in trials
>>> we need to test in a clinical trial
If still BC+ at 5 days?
No routine role for combination antibiotics - no benefit with rifampin, daptomycin, aminoglycosides in trials
Anyone ever seen a patient like this?
(For hospitalists like @ValerieVaughnMD and those of us that review patients with ASP, every day, multiple times per day)
#IDWeek2022
(For hospitalists like @ValerieVaughnMD and those of us that review patients with ASP, every day, multiple times per day)
#IDWeek2022
A note that what we call overdiagnosis for infections, others may call inappropriate diagnosis.
#IDWeek2022
#IDWeek2022
Debating role of vancomycin for MRSA at #IDWeek2022.
Dr Wagner argues that increasing duration of MRSA bacteraemia associated with poorer outcomes (mortality).
I accept this.
BUT, therapeutically reducing duration of bacteraemia has not been associated with improved mortality.
Dr Wagner argues that increasing duration of MRSA bacteraemia associated with poorer outcomes (mortality).
I accept this.
BUT, therapeutically reducing duration of bacteraemia has not been associated with improved mortality.
Duration of bacteremia is a SURROGATE. Although logical and biologically plausible that reducing duration of bacteremia with a particular antibiotic (vs another) should improve the outcome we care about (mortality), this has not yet been demonstrated.
Cites 43% of patients with trough-based dosing develop AKI.
We didn't find this in CAMERA2. Almost all on vanc and trough-based dosing. In control arm only 6% developed AKI. jamanetwork.com/journals/jama/…
Yes, that was in the context of a clinical trial. But 6% is far from 43%
We didn't find this in CAMERA2. Almost all on vanc and trough-based dosing. In control arm only 6% developed AKI. jamanetwork.com/journals/jama/…
Yes, that was in the context of a clinical trial. But 6% is far from 43%
I don't know anyone that is more excited about urine than @Sonali_Advani.
Some highlights from her great talk this morning ⬇️
#IDWeek2022
Some highlights from her great talk this morning ⬇️
#IDWeek2022
Lots of factors go into inappropriate culturing.
Physicians more driven by labs, nurses by appearance/smell.
Education can help.
#IDWeek2022
Physicians more driven by labs, nurses by appearance/smell.
Education can help.
#IDWeek2022
#idweek2022 #womeninID breakfast how to tackle gender equity
-transparency in pay #heforshe
-negotiate salary self-advocacy
-administrators should have access to form where everyone’s salary is listed which anyone can look at
-need leadership opportunity equity
-transparency in pay #heforshe
-negotiate salary self-advocacy
-administrators should have access to form where everyone’s salary is listed which anyone can look at
-need leadership opportunity equity
#idweek2022 #womeninID breakfast
-even at same academic level: not the same job: keep data of your exact workload: what revenue you are bringing and what is your impact local, regional and nationally
-document everything you do @DrJRMarcelin
-even at same academic level: not the same job: keep data of your exact workload: what revenue you are bringing and what is your impact local, regional and nationally
-document everything you do @DrJRMarcelin
#idweek2022 #womeninID
-new task force gender disparity
-will do gap analysis
-how to quantify your work and assign value to it
-understand FTE
-are you exceeding your FTE role
-if adding work: add support or compensation
-avoid stacking don’t do same role in same time
-new task force gender disparity
-will do gap analysis
-how to quantify your work and assign value to it
-understand FTE
-are you exceeding your FTE role
-if adding work: add support or compensation
-avoid stacking don’t do same role in same time
Clinical trials in bacterial diseases that may change your practice. #IDWeek2022 1. De-escalation of antibiotics for VAP based on Gram stain was non-inferior to waiting for culture. pubmed.ncbi.nlm.nih.gov/35394515/
2. Obtaining follow-up blood cultures in patients with Gram negative bacteremia associated with decreased mortality. pubmed.ncbi.nlm.nih.gov/36136334/
3. SABATO trial presented at ECCMID 2022. Oral switch to Bactrim 1 DS PO BID (or clindamycin 600mg PO Q8hr or linezolid 600mg PO BID) non-inferior to IV course for Staph aureus bacteremia secondary to venous catheter or skin and soft tissue infection. clinicaltrials.gov/ct2/show/NCT01…
At #IDWeek2022, @hboucher3 presented data that ~1.3 million deaths were directly attributable to antimicrobial resistance in 2019. pubmed.ncbi.nlm.nih.gov/35065702/
Although @IDSAInfo 10 by ‘20 initiative resulted in 14 new ID drugs coming to market, “the majority…have been modifications of existing chemical classes of antibiotics [and] larger pharmaceutical companies continue to abandon the field.” Nobody’s buying. pubmed.ncbi.nlm.nih.gov/30715222/
“The antibiotic market is broken and won’t fix itself,” says @hboucher3 at #IDWeek2022.
