@brynnthomas.bsky.social
#OTILT One common mechanism of carbapenem-resistance in Pseudomonas aeruginosa is the loss of the porin channel OprD. Secondary efflux mutations may select more for meropenem than imipenem or ER-35786. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
June 11, 2025 at 5:52 PM
#OTILT One common mechanism of carbapenem-resistance in Pseudomonas aeruginosa is the loss of the porin channel OprD. Secondary efflux mutations may select more for meropenem than imipenem or ER-35786. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT CSF-VDRL is the preferred test for neurosyphilis diagnosis, but due to its limited sensitivity, negative results do not rule out disease. Positive results should be confirmed with CSF treponemal tests such as FTA-ABS. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
June 10, 2025 at 4:52 PM
#OTILT CSF-VDRL is the preferred test for neurosyphilis diagnosis, but due to its limited sensitivity, negative results do not rule out disease. Positive results should be confirmed with CSF treponemal tests such as FTA-ABS. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT Cefazolin and ertapenem may be used synergistically for persistant MSSA bacteremia (limited data). Ertapenem may decrease the drug exposure required for cefazolin to have bactericidal activity within biofilms. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
June 9, 2025 at 4:49 PM
#OTILT Cefazolin and ertapenem may be used synergistically for persistant MSSA bacteremia (limited data). Ertapenem may decrease the drug exposure required for cefazolin to have bactericidal activity within biofilms. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT Ceftolazone/Tazobactam is a newer agent used for resistant pseudomonal infections, however tazobactam is not as active against AmpC-producing organisms. Ceftazoline/Avibactem retains activity againts AmpC enzymes. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
June 6, 2025 at 4:31 PM
#OTILT Ceftolazone/Tazobactam is a newer agent used for resistant pseudomonal infections, however tazobactam is not as active against AmpC-producing organisms. Ceftazoline/Avibactem retains activity againts AmpC enzymes. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT Vowst is a novel oral therapy taken prophylactically after completion of C. difficile therapy to prevent recurrent iinfection. This capsule contains live fecal microbiota spores and works to reestablish a healthy gut microbiome. @bwdionne.bsky.social @jeffpears0n.bsky.social
June 5, 2025 at 7:37 PM
#OTILT Vowst is a novel oral therapy taken prophylactically after completion of C. difficile therapy to prevent recurrent iinfection. This capsule contains live fecal microbiota spores and works to reestablish a healthy gut microbiome. @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT The only patients to be cured from HIV had CCR5-tropic viruses. They were treated with stem cell transplants with a CCR5/Delta32 mutation that makes the coreceptor CCR5 nonfunctional; however, this mutation is linked to increased mortality. @bwdionne.bsky.social
June 4, 2025 at 8:45 PM
#OTILT The only patients to be cured from HIV had CCR5-tropic viruses. They were treated with stem cell transplants with a CCR5/Delta32 mutation that makes the coreceptor CCR5 nonfunctional; however, this mutation is linked to increased mortality. @bwdionne.bsky.social
#OTILT Carbapenem-resistance in Klebsiella species is increasing, however treatment guidance is still limited. High dose meropenem or mero/vaborbactam can be used in some cases or cephalosporins+BLIs or colistin combo therapy. @bwdionne.bsky.social @juliaiburke.bsky.social @jeffpears0n.bsky.social
June 3, 2025 at 7:35 PM
#OTILT Carbapenem-resistance in Klebsiella species is increasing, however treatment guidance is still limited. High dose meropenem or mero/vaborbactam can be used in some cases or cephalosporins+BLIs or colistin combo therapy. @bwdionne.bsky.social @juliaiburke.bsky.social @jeffpears0n.bsky.social
#OTILT Ampicillin susceptibilitiy testing can be used to infer imipenem susceptibility to E. faecalis; However, you can't reliably infer resistance if isolates are penicillin-resistant and ampicillin-susceptible. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
June 2, 2025 at 3:13 PM
#OTILT Ampicillin susceptibilitiy testing can be used to infer imipenem susceptibility to E. faecalis; However, you can't reliably infer resistance if isolates are penicillin-resistant and ampicillin-susceptible. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT Fostemsavir is HIV1 attachment inhibitor, a relatively new class of antiretrovirals, for multidrug-resistant HIV1. It doesn't show cross-resistance with other antiretrovirals and can be added onto optimized background therapy for patients with limited options. @bwdionne.bsky.social
May 30, 2025 at 4:47 PM
#OTILT Fostemsavir is HIV1 attachment inhibitor, a relatively new class of antiretrovirals, for multidrug-resistant HIV1. It doesn't show cross-resistance with other antiretrovirals and can be added onto optimized background therapy for patients with limited options. @bwdionne.bsky.social
#OTILT The main Cytomegalovirus (CMV) mutations we worry about with antiviral resistance are UL97 and UL54. Resistance testing can help direct antiviral therapy when CMV viral loads are increasing with standard therapy. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
May 29, 2025 at 5:03 PM
#OTILT The main Cytomegalovirus (CMV) mutations we worry about with antiviral resistance are UL97 and UL54. Resistance testing can help direct antiviral therapy when CMV viral loads are increasing with standard therapy. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT Time-to-event analyses and logistic regressions are both used in analyzing event data (ex. deaths/mortality), but a time-to-event analysis allows you to see when an event happened within the time range. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
May 28, 2025 at 4:26 PM
#OTILT Time-to-event analyses and logistic regressions are both used in analyzing event data (ex. deaths/mortality), but a time-to-event analysis allows you to see when an event happened within the time range. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT Although it's not a typical organism of the GI tract, Strep. pneumoniae can cause spontanous bacterial peritonitis (SBP). Cirrhosis of the liver can cause splenomegaly, impairing the spleen's ability to clear encapsulated bacteria like Strep. pneumoniae. @bwdionne.bsky.social
May 27, 2025 at 8:17 PM
#OTILT Although it's not a typical organism of the GI tract, Strep. pneumoniae can cause spontanous bacterial peritonitis (SBP). Cirrhosis of the liver can cause splenomegaly, impairing the spleen's ability to clear encapsulated bacteria like Strep. pneumoniae. @bwdionne.bsky.social
#OTILT Hepatitis D infection requires previous or co-infection with HepB to replicate and coinfection may result in more rapid liver cirrhossis and disease progression. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
May 23, 2025 at 8:04 PM
#OTILT Hepatitis D infection requires previous or co-infection with HepB to replicate and coinfection may result in more rapid liver cirrhossis and disease progression. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT Although leukocytosis is a hallmark of infection, people can have elevated WBCs for a variety of reasons that aren't infective - surgery/trauma, steroids, autoimmune disorders, etc.. Newborns and pregnant women also have a higher normal range. @jeffpears0n.bsky.social @bwdionne.bsky.social
May 22, 2025 at 4:47 PM
#OTILT Although leukocytosis is a hallmark of infection, people can have elevated WBCs for a variety of reasons that aren't infective - surgery/trauma, steroids, autoimmune disorders, etc.. Newborns and pregnant women also have a higher normal range. @jeffpears0n.bsky.social @bwdionne.bsky.social
#OTILT Carbapenems can cause a rapid decline in valproate serum concentrations after a single administration. A retrospective analysis showed nearly half individuals on valproate for seizure control had a seizure with carbapenem administration. @bwdionne.bsky.social @jeffpears0n.bsky.social
May 21, 2025 at 3:19 PM
#OTILT Carbapenems can cause a rapid decline in valproate serum concentrations after a single administration. A retrospective analysis showed nearly half individuals on valproate for seizure control had a seizure with carbapenem administration. @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT Piperacillin/Tazobactam can't always be trusted for ESBL E. coli or K. pneumoniae bacteremia even when it shows as susceptable on susceptibility testing. The MERINO trial showed increased mortality from treatment with pip/tazo compared to treatment with meropenem. @jeffpears0n.bsky.social
May 20, 2025 at 7:39 PM
#OTILT Piperacillin/Tazobactam can't always be trusted for ESBL E. coli or K. pneumoniae bacteremia even when it shows as susceptable on susceptibility testing. The MERINO trial showed increased mortality from treatment with pip/tazo compared to treatment with meropenem. @jeffpears0n.bsky.social
#OTILT While Coag-neg Staph. are often considered contaminants, Staph. lugdunensis is more virulent and can cause serious infections. Luckily this staph. spp. is typically oxacillin-susceptible. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
May 19, 2025 at 7:40 PM
#OTILT While Coag-neg Staph. are often considered contaminants, Staph. lugdunensis is more virulent and can cause serious infections. Luckily this staph. spp. is typically oxacillin-susceptible. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT Vibrio vulnificus is a rare cause of SSTIs that originates from marine environments and shellfish (like oysters). Mortality from Vibrio skin infections is high (~25%), especially in patients with hepatic disease (~50). @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
May 15, 2025 at 4:15 PM
#OTILT Vibrio vulnificus is a rare cause of SSTIs that originates from marine environments and shellfish (like oysters). Mortality from Vibrio skin infections is high (~25%), especially in patients with hepatic disease (~50). @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT Gram positive bacilli are often not true pathogens and are typically contaminants. Factors such as malignancy, immunosuppression, h/o PUD, and ^SOFA score increase odds of GPBs being pathogenic @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
May 14, 2025 at 4:58 PM
#OTILT Gram positive bacilli are often not true pathogens and are typically contaminants. Factors such as malignancy, immunosuppression, h/o PUD, and ^SOFA score increase odds of GPBs being pathogenic @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT Coadministration of QT-prolonging drugs is complex! We don't fully understand why some drugs have an additive effect on QT. They may affect 1 or more ion channel(s) and single drug classification systems are insufficient to predict addative effects. @bwdionne.bsky.social
May 14, 2025 at 12:13 AM
#OTILT Coadministration of QT-prolonging drugs is complex! We don't fully understand why some drugs have an additive effect on QT. They may affect 1 or more ion channel(s) and single drug classification systems are insufficient to predict addative effects. @bwdionne.bsky.social
Today I looked into autoimmune encephalitis, when the immune system attacks neuronal proteins, and its typical treatment with IV corticosteroids, immunoglobulin, +/- plasmapheresis. #OTILT @juliaiburke.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
May 12, 2025 at 6:59 PM
Today I looked into autoimmune encephalitis, when the immune system attacks neuronal proteins, and its typical treatment with IV corticosteroids, immunoglobulin, +/- plasmapheresis. #OTILT @juliaiburke.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
Today I learned more about antibiotic susceptibility testing and the 90-60 Rule where antibiotics produce favorable outcomes around 90% or 60% of the time for susceptible or resistant isolates. #OTILT @bwdionne.bsky.social @juliaiburke.bsky.social @jeffpears0n.bsky.social
May 10, 2025 at 12:14 AM
Today I learned more about antibiotic susceptibility testing and the 90-60 Rule where antibiotics produce favorable outcomes around 90% or 60% of the time for susceptible or resistant isolates. #OTILT @bwdionne.bsky.social @juliaiburke.bsky.social @jeffpears0n.bsky.social
Today I learned about GART (Genotypic Antiretroviral Resistance Test) that tests drug-resistance mutations in HIV genes for appropriate HIV drug selection. #OTILT @juliaiburke.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
May 8, 2025 at 4:53 PM
Today I learned about GART (Genotypic Antiretroviral Resistance Test) that tests drug-resistance mutations in HIV genes for appropriate HIV drug selection. #OTILT @juliaiburke.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT is that serum creatinine (SCr) levels can lag behind renal function during recovery from AKI or changes in renal function. Using SCr to calculate CrCl for renal dose adjustments may lead to under-dosing renally cleared medications. @bwdionne.bsky.social @jeffpears0n.bsky.social
May 7, 2025 at 8:09 PM
#OTILT is that serum creatinine (SCr) levels can lag behind renal function during recovery from AKI or changes in renal function. Using SCr to calculate CrCl for renal dose adjustments may lead to under-dosing renally cleared medications. @bwdionne.bsky.social @jeffpears0n.bsky.social