We know is subjective & expect feedback/future improvements 👇
1. Clinical management of Staphylococcus aureus bacteremia: a review. pubmed.ncbi.nlm.nih.gov/25268440/
👉 A must read written by Holland et al. where they review the evidence of the management of SAB.
2. Impact of Infectious Disease Consultation on Quality of Care, Mortality, and Length of Stay in Staphylococcus aureus Bacteremia: Results From a Large Multicenter Cohort Study. pubmed.ncbi.nlm.nih.gov/25701854/
👉ID consult associated with reduced inpatient mortality.
3. Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT): Scoring System to Guide Use of Echocardiography in the Management of Staphylococcus aureus Bacteremia pubmed.ncbi.nlm.nih.gov/25810284/
👉Predictive risk factors for infective endocarditis, and thus the need for TEE.
4. The Cefazolin Inoculum Effect Is Associated With Increased Mortality in Methicillin-Susceptible Staphylococcus aureus Bacteremia. pubmed.ncbi.nlm.nih.gov/29977970/
👉Presence of cefazolin inoculum effect in the infecting isolate was associated with an increase 30-day mortality.
5. Cefazolin versus anti-staphylococcal penicillins for treatment of methicillin-susceptible Staphylococcus aureus bacteraemia: a narrative review. pubmed.ncbi.nlm.nih.gov/28698037/
👉Similar outcomes for treatment of MSSA but more side effects with the anti-staphylococcal penicillins.
6. Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis-dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia. pubmed.ncbi.nlm.nih.gov/17173215/
👉Vancomycin had higher risk of treatment failure compared to cefazolin in MSSA BSI.
7. Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. pubmed.ncbi.nlm.nih.gov/16914701/
👉RCT: dapto noninferior to SOC (B-lactams or vanco + gentamicin). Dapto resistance can emerge on treatment and more renal dysfunction in the SOC arm.
8. Adjunctive rifampicin for Staphylococcus aureus bacteremia (ARREST): a multicenter, randomized, double-blind, placebo-controlled trial. pubmed.ncbi.nlm.nih.gov/29249276/
👉 Rifampin addition not different to standard therapy in failure, recurrence or death.
9. Effect of Vancomycin or Daptomycin With vs Without an Antistaphylococcal β-Lactam on Mortality, Bacteremia, Relapse, or Treatment Failure in Patients With MRSA Bacteremia: A Randomized Clinical Trial. (CAMERA-2) pubmed.ncbi.nlm.nih.gov/32044943/
👉more AKI with combination w/o benefit.
10. A Narrative Review of Early Oral Stepdown Therapy for the Treatment of Uncomplicated Staphylococcus aureus Bacteremia: Yay or Nay? pubmed.ncbi.nlm.nih.gov/32523971/
👉 Oral step-down therapy can be an alternative in some select patients without complicated SAB.
1/ #IDTwitter and #IDFellows, here is another #IDboardreview question: 20F p/w pharyngitis w/fever. There is no cough. Exam: Cervical adenopathy; tonsillar exudate. Rapid Strep antigen test pos. You start to prescribe her Amoxicillin but there is an allergy alert.
2/ She reports an allergic reaction to penicillin around age 8 or 9. She had a rash but no other symptoms. It resolved following discontinuation of med. She did not receive any treatment. Which of the following would you do next?
3/ Today we are going to talk about everyone’s favorite – #penicillin#allergy!
1/ Follow up for our #IDFellows and #IDTwitter on an #IDCase - 25 year old female with behcet's disease and chronic pain who presents for positive T Spot done for screening. Started on Rifampin for latent TB Infection. She calls 3 days later with diffuse pain.
2/ Great job, #IDTwitter, honing in on the issue! This was intentionally vague to stimulate discussion. As you alluded to, the key lies in what else she was taking. But first, what might we worry about as adverse effects Rifampin?
3/ Allergic reactions to rifampin are relatively rare though they have been described. However, patients may experience flushing, rash and itching that is unrelated to hypersensitivity. Rifampin can often be continued in these patients. PMID: 10575418
If you have feedback OR want to sign up to do a future case, use this form:forms.gle/cV4bRezYUCp6VR…
2/ A case of 70F with ring-enhancing brain/lung lesions was presented. Here is how @MDdreamchaser walked thru the case:
1⃣Define pt risk of infection (e.g. splenectomy, steroid use)
2⃣Take presenting clinical syndrome
3⃣Tempo of illness: abrupt? gradual?
3/ In this case, co-occurrence of brain-lung nodules was helpful clue
Background:
Up to 50% pts with solid tumors & >80% pts with hem malignancy will develop fever during chemo cycle assoc’d with neutropenia
Only 20-30% of these identify clinical infection
Only 10-25% bacteremia
3/ The very basics:
🔹Here is the classic article from 1966 that demonstrated ⬆️susc to infection as neutrophils<500
🔹Freq and severity of infection inversely proportional to neutrophil count
🔹Risk of severe infection and BSI greatest at ANC <100 pubmed.ncbi.nlm.nih.gov/5216294/
1/ Hey #IDFellows, here is a new #IDTwitter Tweetorial: 24F w/1 wk hx pharyngitis + 1d cough & SOB. VS T 39.3C, RR 23, SpO2 92%, HR 112. Exam with tonsillar swelling & erythema; L neck pain and swelling on palpation. CXR w/peripheral nodular opacities. Best empiric abx?
2/ Lemierre’s syndrome = #eponym for suppurative thrombophlebitis of the jugular vein. Often preceded by pharyngitis +/- neck swelling. Commonly associated with pulmonary septic emboli. Check these #NEJM Clinical Images:
3/ Most common organisms include Fusobacterium necrophorum >>> other fusobacterium > anaerobic streptococci. Fusobacterium necrophorum, an anaerobic gram-negative rod, seems to be distinctively adept at causing septic thrombophlebitis.
#IDTweetorial
36F w/ fever for 6 days after the day of returning from Manzini, Eswatini. Stayed there 15 days, visited rural fields. Also, weakness, myalgia, night sweats, sore throat
1⃣ Common things being common: In addition to RTI, gastroenteritis, SSTI, UTI/STI, DO NOT want to miss: MDRT (malaria, dengue, rickettsial infections, typhoid fever)