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Sep 28, 2020 11 tweets 5 min read Read on X
1/#ManuscriptMonday #IDTwitter #Tweetorial

​Does oral vanco ppx during systemic abx therapy prevent healthcare facility-onset C. diff infection in high-risk patients? ​

@MannyGuajardoMD recently reviewed a study on this very topic at our virtual JC.​

pubmed.ncbi.nlm.nih.gov/31560051
2/Healthcare facility-onset C diff infection (HCFO-CDI) is ️💰🤒☠️​

What can we do to prevent HCFO-CDI?​

✅Inf prevention strategies​
#AntimicrobialStewardship
❓Probiotics​
❓OVP Image
3/Downsides to OVP:​

​💊Affects GI microflora​
💊VRE overgrowth 📈​
💊Increased risk for C. diff colonization​
💊Not always tolerated​
💊Cost effective?​

pubmed.ncbi.nlm.nih.gov/31560048/
4/This open-label, randomized, prospective study at a single US center identified admitted patients at high-risk for CDI via a computer-based risk-prediction model.​

pubmed.ncbi.nlm.nih.gov/30318399/

High-risk:​
👴>60yo​
🏥Hosp ≤30d prior ​
💊Got systemic abx during prior admit
5/Inclusion criteria:​

✅High risk for CDI​
✅Currently on systemic abx​
✅Admitted >72h​

Exclusion criteria:​
❌Active CDI​
❌On probiotics​
❌On metronidazole​
❌Unable to take oral vanco
6/Treatment arms:​

💊OVP while on systemic abx + 5d after (vanc 125mg daily)​
💊No prophylaxis (NP)​

60% of OVP had VRE swabs at baseline & discharge.
7/Primary endpoint = ​incidence of HCFO-CDI​

Results? ​
💊OVP = 0/50 ​
💊NP = 6/50 (p=0.03) ​

Average duration of OVP = 12d​

NNT to prevent 1 episode of HCFO-CDI in these high-risk patients = 9
8/Other findings:​

​💊 OVP was tolerated ➡️ 1 person with mild GI upset​
💊 No new VRE colonization with OVP​
💊 OVP is cost-effective ➡️ $26/patient
9/Also, the OVP arm may have been at a higher risk for HCFO-CDI ➡️ received more high-risk antibiotics during prior and index hospitalizations​

👇 refresher on which antibiotics are more "Cdiff-genic" Image
10/Overall, this is a positive study with some limitations (small, incomplete follow-up).​

Will you be using #OVP for #Cdiff prevention in hospitalized patients receiving systemic antibiotics who are at high-risk for CDI?​

@ID_fellows @IDSAMedEdCOP @SHEA_Epi
11/️Check out some other papers for a deeper dive into this topic ⬇️​

DOI: 10.1093/jac/dkw383
​DOI: 10.1093/cid/ciz966​
DOI: 10.1017/ice.2020.277​

And a must read for #IDFellows... tinyurl.com/yyzu6xsl

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More from @BCMIDFellowship

Oct 14, 2020
1/38YOF recovered from mild #COVID19 two weeks ago.

Last week, she developed new fevers, headache, photophobia, dyspnea, nausea, vomiting, polyarthralgias, lip peeling, conjunctival injection, and the following pruritic rash:

#IDTwitter #IDFellows #MedTwitter
2/She was admitted to the hospital.

Labs were notable for elevation of ESR, CRP, D-dimer, BNP, and LFTs. COVID-19 NAAT was positive.

CT showed hepatosplenomegaly.

What organism likely triggered her disease process?
3/This is a case of Multisystem Inflammatory Syndrome in Adults (MIS-A).

MIS-C was first recognized in children in COVID-19 hotspots in March 2020 (kids >12y, mortality rate 2%). Most return to baseline health.
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Oct 2, 2020
2/Today, we'll focus on superficial fungal infections, pathogens, and treatments, specifically:

💠 Dermatophytes
💠 Tinea versicolor
3/Dermatophytes👉a label given to 3 genera that cause skin disease in humans & animals:

🔹 Trichophyton
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📷@DocWoc71 Image
Read 19 tweets
Sep 30, 2020
1/@HoustonAETC lunch & learns are 🔥! ​

@MelanieGoebelMD gave a fantastic talk on primary manifestations of skin diseases in PWH (people with HIV)​

Let's review rapid-fire style...​

#IDFellows #IDTwitter #DermTwitter #MedTwitter@idfellows @MedTweetorials
2/​
30YOM with well-controlled HIV and several months of this itchy red rash with silvery scales: Image
3/What is the most likely diagnosis?
Read 27 tweets
Sep 11, 2020
1/Welcome #IDFellows #IDTwitter #MedTwitter to another #IDFungiFriday

🍄 For the next few tweetorials @A_Spallonii @BCMIDFellowship is presenting a refresher in Med Mycology
🍄 Today’s tweet will focus on basic terminology, 🔬 morphology, and intro to mycoses
2/Goals for these tweets

✅Make you more comfortable with med mycology
✅Learn something you didn’t know before about fungi (🍄)
✅Convince you that 🍄 are fundamental to life on 🌎 Image
3/So let’s start with a question 👉 What are 🍄?

Fungi are organisms that ___
Read 15 tweets
Sep 9, 2020
2/You're seeing a 52YO man with new diagnosis of HIV in clinic, no co-morbidities. Risk factors include multiple unprotected sexual encounters (♂️♀️). Thorough review of systems and exam are unrevealing.

What lab and imaging tests would you order at this visit?
3/Start with some basic labs:

✔️CD4 cell count and %
✔️HIV viral load
✔️CBC w/diff
✔️CMP
✔️Urinalysis
Read 14 tweets
Sep 2, 2020
1/Welcome to this week’s #IDBoardReview #Tweetorial presented by @bacteri_al

75 YOM w/ DM, CHF, NAFLD p/w fever, swelling & pain of left leg x48h. Gram stain from BCx pictured below 👇

#IDTwitter #IDMedEd @ID_Fellows @IDSAMedEdCOP
2/What epidemiological exposure do you suspect?
3/Gram stain shows a curved GNR (oxidase +)

Diagnosis: Vibrio vulnificus necrotizing skin/soft tissue infection (SSTI)

Pt reports recent fishing 🎣 in "brackish water"
Read 18 tweets

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