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Jonathan Ryder, MD Profile picture
Jonathan Ryder, MD
@JonathanRyderMD
Assistant Professor @UNMC_ID Find me at: @jonathanrydermd.bsky.social
5 subscribers
Apr 6 • 13 tweets • 4 min read
1/ This week in #IDTwitter @dralicehan asked a great question about meropenem-resistant Strep pneumo.

@UNMC_ID ASP recently had a similar question when looking at our antibiogram.

So I did a mini-lit review in the form of a #Tweetorial

/thread

2/ Locally, our latest antibiogram showed 100% susceptibility of Strep pneumo to ceftriaxone. However, only 94% to penicillin and 80%(!) to meropenem.

This defies the idea that meropenem is a "broader" spectrum agent, especially for CAP & CA-meningitis
Jan 1, 2023 • 9 tweets • 5 min read
A clinical pearl I learned during a recent stent on clinical service is the relationship between influenza & group A streptococcus (GAS, AKA Strep pyogenes).

Thus, let's commence an #IDTwitter #Tweetorial

/thread 1/ CDC & WHO are reporting increases in GAS in children this winter

I suspect this is due in part to GAS's association with viral respiratory illnesses, in particular flu, but this association isn't exclusive to children or flu

emergency.cdc.gov/han/2022/han00…

who.int/emergencies/di…
Jun 5, 2022 • 12 tweets • 7 min read
1/
TIL about BORSA/MODSA, so cue the #IDTwitter #Tweetorial.

Thanks to the many contributors on @DrDidwania_ID's post on a very interesting variation of Staph aureus that phenotypically matches MRSA, but does not carry the correct genotype.

/thread
2/
Methicillin resistance is usually conferred by an altered penicillin-binding protein (PBP2a) via the gene mecA (or sometimes mecC).

MecA is detected by current molecular testing as a marker of methicillin-resistance for Staphylococcal species

link.springer.com/chapter/10.100…
Jan 28, 2022 • 6 tweets • 3 min read
New ACIP recommendations for PCV15 and PCV20 today in @CDCMMWR!

So what do we do for patients who have already received PCV13 or PPSV23?! What combo do we give patients now?

/thread

cdc.gov/mmwr/volumes/7… Both PCV15 and PCV20 were FDA approved in 2021.

Both use a capsular polysaccharide antigen conjugated to a protein carrier as their mechanism (like PCV13).

jamanetwork.com/journals/jama/…
Jun 28, 2021 • 15 tweets • 10 min read
1/ Wow, finishing up my last rotation as a 1st year ID fellow on gen ID has been a whirlwind @UNMC_ID! Had an all-star group of faculty (@Cortes_Penfield, @fadul_nada & @DrJRMarcelin) and an amazing group of residents, students & pharmacists! Time to review a month of learning: 2/ Let's start with an unusual one:
Syphilis can be inoculated via tattoos or manifest with a rash within the tattoo in secondary syphilis. This localization is thought to be due to decreased immune response within the tattoo.
pubmed.ncbi.nlm.nih.gov/30363028/
ijam-web.org/article.asp?is…
Mar 8, 2021 • 8 tweets • 6 min read
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…
Aug 23, 2020 • 13 tweets • 11 min read
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 A fundamental question this week was TB or not TB (sorry, not sorry for the pun @bergmanscott)

ncbi.nlm.nih.gov/pmc/articles/P…
May 24, 2020 • 11 tweets • 4 min read
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?
May 5, 2020 • 22 tweets • 12 min read
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?"

2/ We will start with a poll:

"Does DVT/PE cause fever?"
Feb 1, 2020 • 25 tweets • 11 min read
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 Image 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?! Image
Oct 11, 2019 • 14 tweets • 6 min read
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.