1/ Happy Opportunistic Monday :) What is the best next step?

1/ Happy Opportunistic Monday #IDtwitter #IDfellows! Sharing another interesting learning case. Written by @johnhannamd and @KrutiYagnikDO 2/ What is the best next therapeutic step?

1/ Happy Opportunistic Monday #IDtwitter #IDfellows; another interesting case and learning opportunity, written by @johnhannamd and @KrutiYagnikDO 2/ Following tissue diagnosis, what is the best next step in management?

1/ Happy Opportunistic Monday #IDtwitter #IDfellows! Here is another interesting learning case for you all. Written by @KrutiYagnikDO and @johnhannamd 2/ While awaiting pending work-up, what is the best next step?

1/ Hello #IDtwitter #IDfellows and Welcome to “Opportunistic Mondays”! For the next few Mondays, @KrutiYagnikDO and @johnhannamd will be presenting interesting OI cases with major teaching points. Enjoy! 2/ What is the drug of choice for his pneumonia?

Thanks to all that participated on last week polls.
Answers (% right):
1 AmpC (75)
2 ESBL (80)
3 KPC (80)
4 NDM (84)
5 OprD-mediated (80)

Let’s talk about commonly encountered resistance phenotypes.

#IDMedEd #IDTwitter #IDFellows There are a four major types of gram-negative resistance mechanisms:
1.Enzymatic degradation
2.Change in binding site (e.g. MecA)
3.Loss of porin channels
4.Efflux pumps.

We will review here 1 and 3.

Hi #IDfellows #IDtwitter

We have a series of short cases & questions (5) on resistant phenotypes of gram-negative bacteria. Tweetorials to follow

Authors: @LeMiguelChavez & @InfectiousDan

Make sure to participate here or on Instagram (@ID_fellows) #IDmicro #IDinsta #IDMedEd Female patient presents with clinical symptoms consistent with pyelonephritis and her urine culture grows the following:

Hi #IDFellows and #IDTwitter, back with another case: 63F h/o ESRD on HD p/w fever. Blood cx positive for MSSA x 4 days. Blood cx clear on day 5 with Rx Cefazolin. TTE on HD2 without vegetations. What is the best next step? 1/ Let’s talk about when to get a TEE for Staph aureus bacteremia (SAB) to identify infective endocarditis (IE)!

This is a #IDControversy for #IDFellows & #IDTwitter. Let's examine the evidence.

#IDTwitter, #IDFellows and #MedTwitter, You asked, and we listened!

https://twitter.com/ID_fellows/status/1369719330661949445

The #IDFellowsCup will now be open to non-ID fellows. Welcome to the bleacher section!

@IDFellowsCup We welcome Rookies (Anyone Pre-ID fellowship), Legends (those post-ID fellowship), and everything in between!

#IDTwitter #IDFellows
Introducing our new series: “IDFN top 10 articles every fellow should read”🔖

#1: SAB management
by @mmcclean1 @LeMiguelChavez
Reviewers @KaBourgi, @IgeGeorgeMD, @Courtcita, @MDdreamchaser

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.

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?

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?

1/
Thanks to all that participated in our 1st live #IDFellowCase yest! Here is a wrap-up review tweetorial for reference + those who missed it.

Special thanks to @MDdreamchaser!

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?

1/
72F with CML had persistent fever ~102F, cough. CT chest with focal consolidation in LLL. Sputum cx: Klebsiella pneumoniae. Serum BDG, GM negative.

Was on Vanc/Cefepime/LAmB, now narrowed to Cefepime + afebrile 24h

Duration of Cefepime?
#IDTwitter #IDMedEd #IDFellows Today’s #tweetorial is on fever + neutropenia!

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

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:

https://twitter.com/nejm/status/1109141522413428737?lang=en

1/
Thank you all for the enthusiasm! #WeAreID #IDTwitter #IDfellows

#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

What is your approach? 2/
Many approaches possible.

Check out this amazing tweetorial by @BoggildLab

https://twitter.com/BoggildLab/status/1226586319901659137?s=20

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)

1/
First #IDtweetorial

65M w/persistent MRSA bacteremia on day 4 of Vancomycin. Last Vanc trough 18.7. MRSA is Vanco Susc.
Primary team asking to change therapy.

What would you do? (Poll)

Let’s review some of the evidence to guide our decision
#IDTwitter #IDfellows 2/
First, what is considered persistent bacteremia?
In a frequently cited study, bacteremia in pts w/MRSA IE lasted a median of 7d w/Vanco, w/ no unusual complications
This led to believe that slow clearance was usual for some cases of MRSA IE
bit.ly/2PDQ4wl