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Steven Tong Profile picture
Steven Tong
@syctong
Infectious diseases physician, clinical researcher with interests in genomics and Indigenous health, follower of Jesus
Oct 21, 2022 • 5 tweets • 1 min read
Follow-up BC in GN BSI
Majdi N. Al-Hasan

Gianella CMI 2020. Lower mortality in those who had follow-up BC done -> 2 fold reduction.

Maskarinec CMI 2020. 1702 patients. FUBC in 68%. 20% FUBC persistently positive. Higher mortality if no FUBC. If done, FUBC+ higher mortality I haven't read the studies, but do wonder about both immortal time bias and bias by indication in these studies. Is there something systematically different in those who do get FUBC?
Oct 21, 2022 • 9 tweets • 2 min read
At #IDWeek2022

Role of follow-up blood cultures for Gram positives
Valeria Fabre

Detection of bacteria depends on:
Volume of blood and number of sets - should aim 40ml in 4 bottles (2 sets) About 20% of GP bactermia are persistent. Mostly S. aureus. Strep not persistent. Wiggers BMC ID 2016

Persistance in SAB may occur in up to 40% of cases
Oct 21, 2022 • 6 tweets • 2 min read
Detecting the cefazolin inoculum effect with a rapid test. #IDWeek2022

Sara I. Gomez Villegas, MD; @SuperBugDoc

When S. aureus MIC to cefazolin increases in vitro when inoculum increased

Prevalence 3-15%

Retrospective studies find CzIE associated with poorer outcomes Looking at dataset from pediatric OM
250 MSSA with 14.4% CzIE+. These were associated with progression from acute to chronic OM

Gold standard for detection is BMD. Cumbersome test. 3 days for test.
Oct 21, 2022 • 4 tweets • 1 min read
ACTIV-1 infliximab, abatacept and cenicriviroc (CVC) as immunomodulators in COVID-19. Emily Ko

#IDWeek22

COVID-19 with pneumonitis / hypoxia

Primary endpoint - time to recovery

Ages 55, 60% male, BMI 32, 50% obese

Receiving remdesivir and steroids, <10% IMV Infliximab - about 500 in active and placebo arms; no diff in time to recovery. 41% lower odds of day 28 mortality, 32% higher odds of clinical status at day 14.
No diff in adverse events
Oct 21, 2022 • 23 tweets • 6 min read
Getting ready for Clinical Controversies in treatment of S. aureus bacteremia. #IDWeek2022 Image Increasing recognition that 'persistent' bacteremia should probably be earlier rather than later. Each day longer, associated with increased metastatic complications and mortality.
Oct 21, 2022 • 4 tweets • 2 min read
Debating role of vancomycin for MRSA at #IDWeek2022.

Dr Wagner argues that increasing duration of MRSA bacteraemia associated with poorer outcomes (mortality).

I accept this.

BUT, therapeutically reducing duration of bacteraemia has not been associated with improved mortality. Duration of bacteremia is a SURROGATE. Although logical and biologically plausible that reducing duration of bacteremia with a particular antibiotic (vs another) should improve the outcome we care about (mortality), this has not yet been demonstrated.
Oct 20, 2022 • 4 tweets • 1 min read
Oral abstract at #IDWeek2022 from Ryan Khodadadi, @MayoClinicINFD

Ceftriaxone as definitive therapy for MSSA (compared to ASP / cefazolin)

Multi-centre in Mayo Clinic campuses, and Florida, and Arizona. 2018-2019 Inclusion - receipt of ≥7 days outpatient therapy

Primary outcome - 90 day treatment failure (mortality or recurrence)

223 patients; 186 with ASP/cefazolin (mostly cefazolin) and 37 ceftriaxone

More uncomplicated patients for ceftriaxone
Oct 20, 2022 • 7 tweets • 2 min read
Viral studies now. #IDWeek2022 with @annieluet #1 ANCHOR study (Palefsky NEJM 2022). PLHIV. With high grade squamous cell intra-epithelial lesion (HSIL). Intervention - office based electrocautery ablation vs Control (observation). 4450 randomised. Anal cancer rate: 1.8% --> 0.9%. 57% lower with treatment. Well tolerated
Oct 20, 2022 • 13 tweets • 2 min read
Clinical trials for bacterial infections with @julie_justo at #IDWeek2022 GRACE-VAP (Yoshimura JAMA NO 2022): VAP in Japan; 12 ICUs; non-inferiority (20% margin); randomised to anti-MRSA + anti-pseudomonal vs Gram stain guided restrictive therapy. All were endo-tracheal aspirates.
Apr 25, 2022 • 9 tweets • 3 min read
@AchimKaasch about to present SABATO results at #ECCMID2022! Image SABATO has been going on for quite a while now!

Question: is switching to oral therapy for low risk SAB possible?

Low risk: negative follow-up BC, no mestatistic infection, intravascular catheters removed, no prosthetic vascular material, not immunosuppressed
Sep 16, 2021 • 13 tweets • 3 min read
So it was busy last night. On call for COVID calls @theRMH. Between 9pm and 6am, accepted 10 new COVID admissions.

On call for COVID means I’m at home. The emergency department and sometimes other hospitals call me about COVID patients for hospital admission. We discuss the patient and make a management plan. Then the patient goes to the COVID wards for further assessment and admission by the on-site junior medical staff who are on all night for these wards (heroes).
Sep 12, 2021 • 14 tweets • 3 min read
Been working on one of the COVID wards @TheRMH last few days. Some reflections (thread):

It’s busy. We now have 3 wards for patients. Plus 2 ‘pods’ in intensive care. Patients continuing to arrive for care. It’s calm on these wards. Less fear and anxiety for staff compared to last year.
It’s clear that staff safety is a priority. Everyone in N95 masks and face shields. Air scrubbers to ‘clear’ the air, strategically placed in high-risk areas (PPE room in photo).