#IDWeek2020 #PedsID
Session: Mano a Mano
Should we tx + tracheal cultures?
Con: @asicksamuels
3 Reasons not to treat:
1. Positive cxs do not equal infection
2. Trach cxs are unreliable
3. Treated positive trach cxs do not equal improved outcomes
+
Risk patient harm from over-tx
Session: Mano a Mano
Should we tx + tracheal cultures?
Con: @asicksamuels
3 Reasons not to treat:
1. Positive cxs do not equal infection
2. Trach cxs are unreliable
3. Treated positive trach cxs do not equal improved outcomes
+
Risk patient harm from over-tx
#IDWeek2020 #PedsID
Session: Mano a Mano
Should we tx + tracheal cultures?
Pro:
VAT assoc'd w/⬆️duration of mech vent, ICU LOS, mortality
Tx of VAT can prevent progression to VAP and perhaps mortality
Treating VAT w/impaired oxygenation is really tx'ing VAP, which is warranted
Session: Mano a Mano
Should we tx + tracheal cultures?
Pro:
VAT assoc'd w/⬆️duration of mech vent, ICU LOS, mortality
Tx of VAT can prevent progression to VAP and perhaps mortality
Treating VAT w/impaired oxygenation is really tx'ing VAP, which is warranted
#IDWeek2020 #PedsID
Session: Mano a Mano
Should we treat positive tracheal cultures?
Classic #PedsID consult question!
Final consensus:
Session: Mano a Mano
Should we treat positive tracheal cultures?
Classic #PedsID consult question!
Final consensus:
#IDWeek2020 #PedsID
Session: Mano a mano
Vanc for invasive staph
PRO:
Vanc still good empiric choice
We have hx, experience to ask about risk factors for nephrotox
Monitoring might not be needed if only using 48h
Can use AUC/MIC:⬇️toxicity, don't have to use $$ Bayesian software
Session: Mano a mano
Vanc for invasive staph
PRO:
Vanc still good empiric choice
We have hx, experience to ask about risk factors for nephrotox
Monitoring might not be needed if only using 48h
Can use AUC/MIC:⬇️toxicity, don't have to use $$ Bayesian software
#IDWeek2020 #PedsID
Session: Mano a mano
Vanc for invasive staph
CON:
Abandon vanc
We do not really know how to dose or monitor vanc for efficacy against MRSA in sick kids
There is harm: toxicity, delays in "therapeutic" levels
Less toxic alternatives
Session: Mano a mano
Vanc for invasive staph
CON:
Abandon vanc
We do not really know how to dose or monitor vanc for efficacy against MRSA in sick kids
There is harm: toxicity, delays in "therapeutic" levels
Less toxic alternatives
#IDWeek2020 #PedsID #TxID
Session: Mano a mano
Do you tx child with parent who refuses to vaccinate?
Excited to see @tanviboston @BCHPedsID !
Defer/Con:
VPI in kids after SOT: pubmed.ncbi.nlm.nih.gov/30640369/
No natl policy requiring completion of vacc, so left to casebycase/indl ctrs
Session: Mano a mano
Do you tx child with parent who refuses to vaccinate?
Excited to see @tanviboston @BCHPedsID !
Defer/Con:
VPI in kids after SOT: pubmed.ncbi.nlm.nih.gov/30640369/
No natl policy requiring completion of vacc, so left to casebycase/indl ctrs
#IDWeek2020 #PedsID #TxID
Session: Mano a mano
Do you tx child with parent who refuses to vaccinate?
List/Pro:
If not listed➡️death
At some pt, does risk of dialysis/underlying dz outweigh risk of VPI?
Is it fair to deny child waiting time due to parent decision
Session: Mano a mano
Do you tx child with parent who refuses to vaccinate?
List/Pro:
If not listed➡️death
At some pt, does risk of dialysis/underlying dz outweigh risk of VPI?
Is it fair to deny child waiting time due to parent decision
#IDWeek2020 #PedsID #TxID
Session: Mano a mano
Do you tx child with parent who refuses to vaccinate?
No rebuttals - a very difficult topic with excellent discussion. Needs careful education and medical/ethical considerations + joint decision making with parents/patients
Session: Mano a mano
Do you tx child with parent who refuses to vaccinate?
No rebuttals - a very difficult topic with excellent discussion. Needs careful education and medical/ethical considerations + joint decision making with parents/patients
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