#IDDailyPearl: When do we need to think about empiric coverage for drug-resistant Shigella?

A 🧵 2/

XDR Shigella is defined as being resistant to azithro, cipro, ceftriaxone, TMP-SMX, and amp.

5% of cases reported to CDC were classified as XDR in 2022

emergency.cdc.gov/han/2023/han00…

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Great conversation with @IAS_USA panelists on the new guidelines!

For those with tuberculous meningitis, high-dose steroids should be initiated along with tuberculosis treatment and ART should be initiated within 2 weeks after starting tuberculosis treatment and steroids ✅TAF and rifampin OK
✅Do DTG bid if using rifampin
✅DTG daily OK if using rifabutin
🚫BIC with rifamycins

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A poem for medical graduates and trainees: 2/
Curiosity is an itchy state of mind
Lying West of wonder and East of ecstacy
Not well localized in a brain bound by murmuring limbics
Not with its own bump in the phrenology of CT and PET
A defiantly defining feature of being human and alive

#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.

#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.

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:

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.

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

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.