Cosmina Gingaras, MD, MPH
@cosepiid.bsky.social
Infectious Diseases MD. I enjoy complex, multidisciplinary cases & rare diseases. When the world gets overwhelming, I find refuge in the arts and in nature. Also formerly trained as an epidemiologist at UTSPH and did some basic science in virology at BCM
Oxa and linezolid, esp.initially. Once the patient stabilizes and I see clinical, biological and radiologic improvement, usually at least 10 days into treatment, I try to switch to oral, probably two agents, not one (tmp-smx and rifa for example). Total duration is a minimum of one month
June 26, 2025 at 2:36 PM
Oxa and linezolid, esp.initially. Once the patient stabilizes and I see clinical, biological and radiologic improvement, usually at least 10 days into treatment, I try to switch to oral, probably two agents, not one (tmp-smx and rifa for example). Total duration is a minimum of one month
Right, I'm interested in the protocols you use.
April 21, 2025 at 11:05 AM
Right, I'm interested in the protocols you use.
Do you have any use for rectal swabs?
April 20, 2025 at 4:32 AM
Do you have any use for rectal swabs?
Interesting. Do you use rectal swabs for anything?
April 20, 2025 at 4:32 AM
Interesting. Do you use rectal swabs for anything?
Very interesting.
March 14, 2025 at 11:21 PM
Very interesting.
Blood cultures. If CRP and procalcitonin are raised, then start empiric cefazolin plus/minus vancomycin. If not raised, continue monitoring for recurrent fever and repeat above process.
March 14, 2025 at 11:17 PM
Blood cultures. If CRP and procalcitonin are raised, then start empiric cefazolin plus/minus vancomycin. If not raised, continue monitoring for recurrent fever and repeat above process.
Reposted by Cosmina Gingaras, MD, MPH
Back in 1975 I was taught to first check a urine Na and K. If the urine K was greater than Na - start spironalactone at 100 and recheck. Until the urine Na was greater than the urine K, increase the spironalactone. Once urine Na > K, then start 40 mg furosemide each day. I still use this model.
March 3, 2025 at 11:42 AM
Back in 1975 I was taught to first check a urine Na and K. If the urine K was greater than Na - start spironalactone at 100 and recheck. Until the urine Na was greater than the urine K, increase the spironalactone. Once urine Na > K, then start 40 mg furosemide each day. I still use this model.
Reposted by Cosmina Gingaras, MD, MPH
Please give it a go advance mode . Here the 🔗 and it’s still working in safari & google chrome 🇬🇧
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
PubMed
PubMed® comprises more than 37 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central a...
pubmed.ncbi.nlm.nih.gov
March 2, 2025 at 11:48 AM
Please give it a go advance mode . Here the 🔗 and it’s still working in safari & google chrome 🇬🇧
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
Reposted by Cosmina Gingaras, MD, MPH
EuropePMC relies on a feed (feeds ?) from PubMed.
As I understand, it can run on its own, but I do not know how it will get updated and synchronised with PubMed. Though it does collect some data separately.
I hope EuropePMC had prepared as much as they could for this predictable event.
As I understand, it can run on its own, but I do not know how it will get updated and synchronised with PubMed. Though it does collect some data separately.
I hope EuropePMC had prepared as much as they could for this predictable event.
March 2, 2025 at 9:55 AM
EuropePMC relies on a feed (feeds ?) from PubMed.
As I understand, it can run on its own, but I do not know how it will get updated and synchronised with PubMed. Though it does collect some data separately.
I hope EuropePMC had prepared as much as they could for this predictable event.
As I understand, it can run on its own, but I do not know how it will get updated and synchronised with PubMed. Though it does collect some data separately.
I hope EuropePMC had prepared as much as they could for this predictable event.
Oncology is pretty reserved with antibiotherapy compared to hematology. Possibly because infections tend to be more common and more problematic in hematological patients, given that immune cells are principally and more profoundly affected
March 1, 2025 at 4:45 PM
Oncology is pretty reserved with antibiotherapy compared to hematology. Possibly because infections tend to be more common and more problematic in hematological patients, given that immune cells are principally and more profoundly affected
Sure, I agree. I'm an ID doctor, so I know our side of the story. I'm trying to see the other side and whether there are some gaps in knowledge or experience that I may fill :) of course, again, culture data depends heavily on lab capabilities (and also sampling procedures)
March 1, 2025 at 3:25 PM
Sure, I agree. I'm an ID doctor, so I know our side of the story. I'm trying to see the other side and whether there are some gaps in knowledge or experience that I may fill :) of course, again, culture data depends heavily on lab capabilities (and also sampling procedures)
I think this frequent and compulsive check of inflammatory biomarkers reflects a continuous preparation for the start of chemo and evaluation during chemo. An increase in CRP is a cue to escalate ABs, even if no infection is clinically apparent. A decreasing CRP=continue current broad spectrum ABs:)
March 1, 2025 at 2:18 PM
I think this frequent and compulsive check of inflammatory biomarkers reflects a continuous preparation for the start of chemo and evaluation during chemo. An increase in CRP is a cue to escalate ABs, even if no infection is clinically apparent. A decreasing CRP=continue current broad spectrum ABs:)
Most often I see MDR/XDR BGN infections (beginning with upper airway colonizations, possibly selected for by empirical antibiotics given for just high CRPs), and whether those coexist with viral or fungal infections is more difficult to ascertain based on our hospital's diagnostic capabilities.
March 1, 2025 at 12:19 PM
Most often I see MDR/XDR BGN infections (beginning with upper airway colonizations, possibly selected for by empirical antibiotics given for just high CRPs), and whether those coexist with viral or fungal infections is more difficult to ascertain based on our hospital's diagnostic capabilities.
The other issue is that we do not have complete susceptibility data for the rectal swab screenings. So, we get results like species and main resistance mech, ESBL or CRE or VRE or MDR A baumannii. So, it can be tricky to start an empiric drug regimen based on these data
March 1, 2025 at 11:45 AM
The other issue is that we do not have complete susceptibility data for the rectal swab screenings. So, we get results like species and main resistance mech, ESBL or CRE or VRE or MDR A baumannii. So, it can be tricky to start an empiric drug regimen based on these data
Thank you for these references. I noticed that indeed these patients develop life-threatening infections soon into their chemo and that the rising CRP has predictive value for infection (CRPs are usually tens when we are first consulted and increase rapidly without any localizing sign of infection)
March 1, 2025 at 11:43 AM
Thank you for these references. I noticed that indeed these patients develop life-threatening infections soon into their chemo and that the rising CRP has predictive value for infection (CRPs are usually tens when we are first consulted and increase rapidly without any localizing sign of infection)