Rapid diagnostics may provide faster time to targeted therapy in HAP/VAP infections. Specificity can be as high as 99% with sensitivity to 100% in either BAL or sputum cultures.

@ScottMicek reviews updates to HAP/VAP therapy and the impacts on stewardship #SCCM2023 @SCCM_CPP
Multiple studies have been published with new antibiotics since the most recent HAP/VAP guidelines were published. These antibiotics were shown as non-inferior in their clinical trials which may result in many alternative options listed in the next guideline update #SCCM2023
No additional benefit was observed by adding inhaled aminoglycosides in HAP/VAP infections.
Updates to the Chastre study from the early 2000s failed to show non-inferiority due to recruitment in 8 vs 15 days of treatment for non-fermenter bacterial HAP/VAP infections #SCCM2023

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More from @ohsnapimginger

Jan 24
Cell index and corrected CSF WBC count can be used to generate a score where ≥6 indicates infection. There are challenges with regard to the sensitivity and specificity of this score.

@SarahE_NP provides updates on nosocomial meningitis and ventriculitis (NMV) #SCCM2023
CSF IL-6 and total leukocyte count are sensitivity and specific for ventriculitis in traumatic brain injury patients #SCCM2023
Intraventricular or intrathecal antibiotics should be considered in patients who do not respond to IV antibiotics or when resistant organisms are suspected #SCCM2023
Read 4 tweets
Jan 23
High-dose, long duration beta-lactan therapy remains the mainstay of therapy for infective endocarditis. Gentamicin and rifampin-containing regimens are no longer necessary

#MeganHicks provides updates on endocarditis and cardiovascular infections #SCCM2023
STS RISK-E scoring system may be used to assist with determining surgical risk. Patients with cardiogenic shock or large mobile vegetations at eminent risk of mobilization require more emergent surgery #SCCM2023
Repair of the tricuspid and mitral valves is preferred to replacement as there is potential survival benefit.
Replacement of the aortic valve is preferred #SCCM2023
Read 4 tweets
Mar 18, 2020
Opinion: vancomycin + cefepime + metronidazole (VCM) is superior empiric therapy than vancomycin + piperacillin/tazobactam (VPT) for *most* indications in the emergency department.

There are five reasons why I believe this to be true. #inthisessayiwill
Empiric regimen selection for patients with healthcare-associated risk factors is tough.

Despite my bias, I hope to generate more thought in your next decision rather than simply saying....
1️⃣ VCM is more thoughtful than VPT.

Need anaerobic coverage? Add it! If you don’t, you’re not stuck with broader than necessary therapy.

Don’t need PsAr coverage? Drop to ceftriaxone.

VCM also allows for easier tailoring of therapy later during admission.
Read 9 tweets

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