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Jonathan Ryder, MD

8 Mar, 8 tweets, 6 min read

@UNMC_ID

1/ Haven't done this in awhile, but want to share some great literature we discussed this week while on the @UNMC_ID general ID service! So happy to have a big multidisciplinary team led by @DrJRMarcelin along with our pharmacists @Molly_M_Miller & @bergmanscott!

2/ Will start with my favorite article on carbapenem-resistant gram-negative infections from Doi et al with my own adaptation of their super useful table

academic.oup.com/cid/article/69…

@UNMC_ID

3/ We continue to #RespectTheStaph learning of an unusual manifestation of Staph aureus prostatic abscess from a future @UNMC_ID fellow's paper & another lit review.
academic.oup.com/ofid/article/6…
ncbi.nlm.nih.gov/pmc/articles/P…

4/ Key risk factors for Staph aureus prostatic abscess (PA) include SSTI, hx of GU disease or instrumentation, IVDU, DM, immunodeficiencies & hepatitis C

Most present with GU symptoms & concomitant bacteremia is common

Think of PA when dysuria & Staph aureus bacteremia co-exist

5/ I've previously heard of VISA & VRSA, but there is also a phenomenon of VISA in patients with MSSA that I was unfamiliar. This is not due to VanA acquisition, but rather increased cell wall thickness & altered PBPs.

aac.asm.org/content/61/7/e…
academic.oup.com/cid/article/49…

6/ Do you have to treat all patients with findings of candidiasis on EGD?

Well, not if the patient is asymptomatic & immunocompetent. Treatment does not change the natural history for these cases.

pubmed.ncbi.nlm.nih.gov/29702297
pubmed.ncbi.nlm.nih.gov/26083902
ncbi.nlm.nih.gov/pmc/articles/P…

7/ I've officially stored the CIED guideline algorithms to my phone now, these flowcharts are clutch for #IDFellows

hrsonline.org/guidance/clini…

8/ Lastly, a quick review of antibiotics that are safe in pregnancy (Category B):
👌Beta-lactams
👌Vancomycin
👌Azithromycin
👌Clindamycin
👌Daptomycin
👌Metronidazole
👌Nitrofurantoin
👌Fosfomycin

🚫Avoid: FLQs, Tetracyclines, AGs & TMP-SMX

pubmed.ncbi.nlm.nih.gov/26598097

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More from @JonathanRyderMD

Jonathan Ryder, MD

@JonathanRyderMD

23 Aug 20

@UNMC_ID

My 3rd week of general ID @UNMC_ID has come to a close with #PasteurellasFellas, led by the wonderful @KellyCawcuttMD! Really appreciate her critical care insight on ID. We had some fascinating discussions this week. Time for another recap! #IDTwitter #IDPearls

@bergmanscott

A fundamental question this week was TB or not TB (sorry, not sorry for the pun @bergmanscott)

ncbi.nlm.nih.gov/pmc/articles/P…

We discussed the differential diagnosis of miliary nodules on imaging. TB leads the list, but dimorphic fungi (histo, blasto, cocci) can be just as common in endemic areas. Malignancy as well.

atsjournals.org/doi/pdf/10.151…
ncbi.nlm.nih.gov/pmc/articles/P…

Read 13 tweets

Jonathan Ryder, MD

@JonathanRyderMD

24 May 20

1/ While on my current GI rotation, I've been reading about Clostridioides difficile because, you know, #IDNerd. I ran across something I had not learned about before:

A Hypervirulent Strain of CDiff!

So naturally, I had to look into this.

/thread #Tweetorial #CDiff #IDTwitter

2/
What is the name of the strain of hypervirulent CDiff?

3/
The hypervirulent strain of CDiff is known as NAP1/B1/027, which stands for North American pulsed-field gel electrophoresis type 1, restriction endonuclease analysis type B1, PCR ribotype O27.

That's a mouthful.

So what's the big deal about this strain?

Read 11 tweets

Jonathan Ryder, MD

@JonathanRyderMD

5 May 20

@DxRxEdu

1/ "Does DVT/PE cause fever?" 🌡️🤒🌡️🤒🌡️

This #Tweetorial was inspired by a recent @DxRxEdu thread. So I did a deep dive into the evidence behind this dogma and also asked, "if so, how?"

https://twitter.com/DxRxEdu/status/1254054132031336448

2/ We will start with a poll:

"Does DVT/PE cause fever?"

3/ Dating back to 1959, Israel & Goldstein found fever to be the most common sign in patients with PE (78.9%), 10% with temp >39.5C. They admit infection to be an underlying cause. Additionally, PE made based on CXR & EKG findings & autopsy.

annals.org/aim/article-ab…

Read 22 tweets

Jonathan Ryder, MD

@JonathanRyderMD

1 Feb 20

1/ Let's differentiate pyogenic from amebic liver abscess in a #Tweetorial today. We will examine DDx, risk factors, microbiology, clinical features, diagnostics, and treatment. This came from my most recent morning report. #IDTwitter #LiverTwitter #MedEd

@CPSolvers

2/ Differential diagnosis for liver abscess:
Infectious etiologies predominate. Most are pyogenic (bacterial). Amebic (Entamoeba histolytica) and hydatid cyst (Echinococcus) important. Differentiate these from HCC or liver mets. @CPSolvers what am I missing?!

3/ Pathogenesis of pyogenic liver abscess (PLA):
- Biliary obstruction (GB, cancer) most commonly
- Surgical complication, trauma
- Portal vein pyemia from intra-abdominal infection (e.g. appendicitis)
- Hematogenous seeding (endocarditis)
- Cancer tx complication (RFA, TACE)

Read 27 tweets

Jonathan Ryder, MD

@JonathanRyderMD

11 Oct 19

Today I'm going to do a #Tweetorial on non-resolving pneumonia (NRP)! These are a series of pearls on a prior #MorningReport case that I gave earlier this year. We are going to cover definitions, differential diagnosis/schema & workup of NRP #IDTwitter #PulmTwitter

So first off, what is non-resolving pneumonia (NRP)?

It is a bit vague, but it's a lack of resolution of symptoms or radiographic findings over an expected time period despite appropriate antibiotic treatment.

Let's separate this term from "recurrent PNA", which consists of multiple episodes with symptom free intervals & radiologic clearance (e.g. aspiration PNA).

We will avoid the topic of "what is a pneumonia anyway?"

Read 14 tweets

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