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Nate Shively Profile picture
Nate Shively
@NateShivelyMD
ID doc at @AHNtoday. Med. Director, ASP at Allegheny Valley. Husband and father of 3. Prefers being outdoors. Used to be a good bowler. Opinions my own.
Apr 20 • 23 tweets • 12 min read
Getting my own talk from yesterday up late.

Also presented at the Big Beasts session on Community-Acquired Pneumonia.

Focused at stewardship folks but something in here for everyone 👇

#SHEASpring2024

#IDTwitter
#MedTwitter

1/ Image First up, quick definition:
➡️ Since HCAP is now dead, CAP is basically all pneumonia acquired outside of a hospital.

Lots of stuff can cause CAP, but viruses cause a LOT. Any virus that can cause an upper respiratory infection can also cause pneumonia.

#SHEASpring2024

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Apr 19 • 7 tweets • 5 min read
Next up is Dr. Will Allegria to talk about stewardship in Immunocompromised patients.

This is a complicated patient population.

#SHEASpring2024

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Image Many challenges in this patient population, with limited guidelines and data.

Note the specialists (hematology, oncology, transplant) unique to this setting that should be part of the stewardship team. Definitely include transplant ID docs when you have them

#SHEASpring2024

2/

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Apr 18 • 20 tweets • 12 min read
Next up is the Dogmas of stewardship!

Bookmark this thread folks, some great stuff below.

First up is Dr. Jim Lewis.

#SHEASpring2024

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Image First up is busting the "cidal vs static" myth. Jim says he is "quoting Noah to Noah" with @IDwithNWD standing by for the next talk, and an author on this excellent paper with @BradSpellberg.

56 Trials!

#SHEASpring2024

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Apr 16 • 14 tweets • 9 min read
To get my thumbs warmed up for #SHEASpring2024, figured I'd share this talk I forgot to share last month.

Was asked to talk about antibiotic prophylaxis in primary care.

Here's what I came up with:

🧵

#IDTwitter
#MedTwitter

1/ Image First, one that comes up a lot - should we give antibiotic ppx to prevent recurrent UTIs?

Will first cover older adults - important here: is it truly recurrent UTI?

A lot gets called "UTI" that isn't.

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Mar 24, 2023 • 38 tweets • 20 min read
Just got done presenting at the 31st Annual Clinical Update in Geriatric Medicine, put on by @AHNtoday and @UPMC. Awesome attendees, as usual!

Was asked to talk about "Controversies in Antimicrobial Therapy"

Figured would share here.

#IDTwitter #MedTwitter

🧵

1/ With a Geriatric audience, had to take the opportunity to focus first on the urine.

But also get into SSTI, Bactrim for Group A strep, if you need IV antibiotics for Lyme, dental prophylaxis for prosthetic joints, and duration of therapy.

First up - does +UA/UCx=UTI?

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Oct 22, 2022 • 16 tweets • 11 min read
What drives physicians refusing ASP recommendations?

We looked into it.

Just got done presenting our #IDWeek2022 oral abstract.
#IDTwitter

🧵

1/ Image First, there are a bunch of ways to do TeleASP, but especially the more "intense" models have shown success and can be as good as on-site programs.

Our prior work: academic.oup.com/cid/article/71…

SCORE trial from @E_Stenehjem et al.: academic.oup.com/cid/article/67…

#IDWeek2022

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Oct 22, 2022 • 12 tweets • 9 min read
Oral Therapy for Bacteremia and Endocarditis

@IDwithNWD giving talk for @BradSpellberg

"No, you're not in the wrong room, and @BradSpellberg did not get younger and more handsome."

#IDWeek2022
#IDTwitter Historical lesson first.

Where did the myth that we need IV for IE come from?

Have to go back a ways.

#IDWeek2022
Oct 21, 2022 • 8 tweets • 6 min read
What's better for reducing unnecessary treatment of asymptomatic bacteriuria? Diagnostic stewardship or antibiotic stewardship?

@ValerieVaughnMD presenting the @SHEA_Epi featured oral abstract.

#IDWeek2022 ImageImage Pathway to overuse and opportunities to intervene.

#IDWeek2022 Image
Oct 21, 2022 • 4 tweets • 4 min read
Bactrim is fine for most beta-hemolytic strep, folks.

Many of us were taught this one incorrectly because thymidine content in agar unregulated until 2006 so looked resistant in old studies.

Appreciate @SDoernberg clearing this one up in 2nd myth busters talk.

#IDWeek2022 ImageImageImageImage Nice aside - dosing matters.

Most people I'm consulted on who fail oral treatment for true cellulitis are underdosed.

#IDWeek2022 Image
Oct 21, 2022 • 8 tweets • 6 min read
Nice follow up talk from @ValerieVaughnMD - always great stuff from her.

#IDWeek2022 Image Anyone ever seen a patient like this?

(For hospitalists like @ValerieVaughnMD and those of us that review patients with ASP, every day, multiple times per day)

#IDWeek2022 ImageImageImageImage
Oct 21, 2022 • 9 tweets • 6 min read
I don't know anyone that is more excited about urine than @Sonali_Advani.

Some highlights from her great talk this morning ⬇️

#IDWeek2022 Lots of factors go into inappropriate culturing.

Physicians more driven by labs, nurses by appearance/smell.

Education can help.

#IDWeek2022