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Darcy Wooten she/her

25 Jul, 9 tweets, 2 min read

#IDTwitter

DarcyDoesC.diff

Or #Cdiff pearls

Or how I approach C. diff in light of new guidelines

PCR tests are very sensitive but specificity stinks

Be sure of appropriate clinical context (true diarrhea, diarrhea not due to another cause) before testing.

Initial tx with PO Vanco. Guidelines prefer fidaxomicin but too expensive. Reserve fidax for highest risk (SOT, BMT).

First recurrence: fidax. If high-risk and first recurrence, fidax taper and pulse. Will also try for bezlotoxumab if high-risk pts.

2nd recurrence: fidax pulsed taper and bezlo OR FMT.

3rd recurrence: FMT

Fulminant C.Diff: Vanco 500mg, PR, and IV metronidazole. Talk with Surgery.

There you have it. What’s your approach?

Guidelines here: academic.oup.com/cid/advance-ar…

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More from @Darcy_ID_doc

Darcy Wooten she/her

@Darcy_ID_doc

27 Jul

@erodedbyewaves

#IDDailyPearl quick Tweetorial on ART in the setting of severe renal impairment (GFR <30, not in dialysis). @erodedbyewaves and @ewelford

When CrCl <30, technically should stop TAF and FTC/3TC. TAF can be used down to CrCl 15 not on dialysis (think HBV monoinfection tx data) BUT technically FTC or 3TC should be renally-dosed at these lower CrCl.

I've seen FTC and/or 3TC continued at these lower CrCl levels since risk of lactic acidosis and/or other AE is still low but technically would not be "appropriate"

Read 11 tweets

Darcy Wooten she/her

@Darcy_ID_doc

18 Jul

1/ #IDTwitter #HIVTwitter

Today we will review some of the common types of #HIVDrugResistance tests.

2/ I first break down testing into 2 broad categories of resistance tests:

3/ There are 2 major types of genotype tests that we use to detect #HIVDrugResistance

Read 17 tweets

Darcy Wooten she/her

@Darcy_ID_doc

12 Jul

1/ #IDTwitter #HIVTwitter #HIVDrugResistance

To keep the momentum going, let’s move on to transmitted drug resistance. For those just joining, we previously discussed that #HIVDrugResistance is important yet challenging for learners.

2/ We also reviewed the basic principle that HIV resistance develops when HIV replicates in the setting of subtherapeutic drug levels. Virions containing resistance mutations are selected for in this case.

3/ Today we’ll define transmitted drug resistance (TDR) (vs acquired drug resistance). TDR = acquisition of drug-resistant HIV at the time of new HIV infection. We identify TDR when we do a baseline HIV genotype (recommended for all patients who are newly diagnosed with HIV).

Read 12 tweets

Darcy Wooten she/her

@Darcy_ID_doc

30 Mar

Every ID fellowship should have dedicated training on how to care for and manage infections in patients who inject drugs

This is SO critical given the dramatic increase in deaths associated with substance that we have seen over the past year

A key component is to use de-stigmatizing language. #wordsmatter

Read 9 tweets

Darcy Wooten she/her

@Darcy_ID_doc

25 Mar

@ID_fellows

All @ID_fellows and HIV providers should receive training in trauma-informed care. It is critical for effective and compassionate care of people with HIV.

Many of our patients have experienced adverse childhood experiences, which have significant impact on future physical and mental health.

Women with HIV suffer disproportionately. 30% have PTSD, 55% have experienced recent IPV, 61% have experienced lifetime sexual abuse, and 72% have experienced lifetime physical abuse.

Read 5 tweets

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