Infected Terran
@infectedterran.bsky.social
ID doc in Philly. Lover of all things infectious, medical education, ethics and Starcraft.
Oh absolutely. That is very true. I was trying to keep the numbers "clean" but your point is very well taken. I would love to do that study at our institution.
November 7, 2025 at 2:16 PM
Oh absolutely. That is very true. I was trying to keep the numbers "clean" but your point is very well taken. I would love to do that study at our institution.
Yes,I meant 9 percent of all meningitis (purulent and non purulent. It's 72 percent of the 13 percent of those that are bacterial.
November 7, 2025 at 1:53 AM
Yes,I meant 9 percent of all meningitis (purulent and non purulent. It's 72 percent of the 13 percent of those that are bacterial.
There is a treatment threshold formula that could help. sk.sagepub.com/ency/edvol/m...
Calculated as Risk/Benefit+Risk. We compare that number to say, the mortality of meningitis absent vanco. Its a bit more complicated but for anyone trying to really math this one out.
Calculated as Risk/Benefit+Risk. We compare that number to say, the mortality of meningitis absent vanco. Its a bit more complicated but for anyone trying to really math this one out.
Sage Reference - Encyclopedia of Medical Decision Making - Test-Treatment Threshold
<p>Decision making is a critical element in the field of medicine that can lead to life-or-death outcomes, yet it is an element fraught with complex and conflic
sk.sagepub.com
November 6, 2025 at 6:32 PM
There is a treatment threshold formula that could help. sk.sagepub.com/ency/edvol/m...
Calculated as Risk/Benefit+Risk. We compare that number to say, the mortality of meningitis absent vanco. Its a bit more complicated but for anyone trying to really math this one out.
Calculated as Risk/Benefit+Risk. We compare that number to say, the mortality of meningitis absent vanco. Its a bit more complicated but for anyone trying to really math this one out.
Pardon the typos. New keyboard.
November 6, 2025 at 6:28 PM
Pardon the typos. New keyboard.
So we would need to calculate harm from Vanco in those 3 scenarios but, intuitively, we should forego vanco until we know at least that its a purulent (poss bacterial) meningitis. Thoughts? @bradspellberg.bsky.social @jgpharmd.bsky.social @jonathanrydermd.bsky.social
November 6, 2025 at 6:27 PM
So we would need to calculate harm from Vanco in those 3 scenarios but, intuitively, we should forego vanco until we know at least that its a purulent (poss bacterial) meningitis. Thoughts? @bradspellberg.bsky.social @jgpharmd.bsky.social @jonathanrydermd.bsky.social
If I did my math right, if we give vanco to every LP that has "meningitis), we need about 1100 doses to catch 1 CRO resitance. For second scenario, we need about 130. For confirme Strep pneumo 1 in 100.
November 6, 2025 at 6:25 PM
If I did my math right, if we give vanco to every LP that has "meningitis), we need about 1100 doses to catch 1 CRO resitance. For second scenario, we need about 130. For confirme Strep pneumo 1 in 100.
If we run that just for bacterial meningitis (72% of that 13% of ALL comers with meningitis, call it you get pus on a tap), that means that 0.72% of bacterial meningitis will have CRO resistant Strep pneumo. And again, for all Strep pneumo, 1% will be resistant.
November 6, 2025 at 6:23 PM
If we run that just for bacterial meningitis (72% of that 13% of ALL comers with meningitis, call it you get pus on a tap), that means that 0.72% of bacterial meningitis will have CRO resistant Strep pneumo. And again, for all Strep pneumo, 1% will be resistant.
If we assume that 1% of all Strep pneumo cases (9.3% of all meningitis) will be CRO resistant (check your local data if you can), that means that of all comers with any meningitis, CRO resistant Strep pneumo is roughly 0.093%.
November 6, 2025 at 6:16 PM
If we assume that 1% of all Strep pneumo cases (9.3% of all meningitis) will be CRO resistant (check your local data if you can), that means that of all comers with any meningitis, CRO resistant Strep pneumo is roughly 0.093%.
The data I mostly got from this article and that is where we will start. Bacterial meningitis represents about 13% of all meningoencephalitis in the US. Of those, 72% (or 9.3% of the totality of cases) will be Strep pneumo
jamanetwork.com/journals/jam...
jamanetwork.com/journals/jam...
Progress and Challenges in Bacterial Meningitis
This review summarizes current evidence on the epidemiology, diagnosis, and treatment of bacterial meningitis.
jamanetwork.com
November 6, 2025 at 6:11 PM
The data I mostly got from this article and that is where we will start. Bacterial meningitis represents about 13% of all meningoencephalitis in the US. Of those, 72% (or 9.3% of the totality of cases) will be Strep pneumo
jamanetwork.com/journals/jam...
jamanetwork.com/journals/jam...
I'm crunching some numbers to put out a spicy thread tomorrow. Stay tuned.
November 5, 2025 at 8:05 PM
I'm crunching some numbers to put out a spicy thread tomorrow. Stay tuned.
And a quick google search got me this FWIW (10 patients, 5 each group)
pubmed.ncbi.nlm.nih.gov/8067771/
pubmed.ncbi.nlm.nih.gov/8067771/
Antibiotic therapy and acute outcome of meningitis due to Streptococcus pneumoniae considered intermediately susceptible to broad-spectrum cephalosporins - PubMed
Children with meningitis due to Streptococcus pneumoniae isolates that are relatively or fully resistant to penicillin and have decreased susceptibility to broad-spectrum cephalosporins (MIC, > or = 2.0 micrograms/ml) who have failed treatment with broad-spectrum cephalosporins have been reported …
pubmed.ncbi.nlm.nih.gov
November 5, 2025 at 4:59 PM
And a quick google search got me this FWIW (10 patients, 5 each group)
pubmed.ncbi.nlm.nih.gov/8067771/
pubmed.ncbi.nlm.nih.gov/8067771/
This sounds like an awesome project here in Philly. Does DOH have these numbers or would we have to run hospital by hospital?
November 5, 2025 at 4:57 PM
This sounds like an awesome project here in Philly. Does DOH have these numbers or would we have to run hospital by hospital?
This is gold. Thank you!!
November 5, 2025 at 4:35 PM
This is gold. Thank you!!
October 31, 2025 at 12:47 PM
I mean drug induced neutropenia can also be bad even without the concomitant mucositis. I have to quickly google but this sis scratching something in my brain. It sounds like a board question.
October 31, 2025 at 12:46 PM
I mean drug induced neutropenia can also be bad even without the concomitant mucositis. I have to quickly google but this sis scratching something in my brain. It sounds like a board question.
Actually I realize you didn't actually call it that, so I'm a snob and also cant read lol
October 31, 2025 at 12:39 PM
Actually I realize you didn't actually call it that, so I'm a snob and also cant read lol
I'm gonna be a bit of a snob here and say this is not neutropenic fever in the sense people think of it (guideline is neutropenic fever in patients with cancer which implies chemo with mucositis and marrow suppresion). However, neutropenia from antipsych is bad
October 31, 2025 at 12:12 PM
I'm gonna be a bit of a snob here and say this is not neutropenic fever in the sense people think of it (guideline is neutropenic fever in patients with cancer which implies chemo with mucositis and marrow suppresion). However, neutropenia from antipsych is bad
Oh man thats awesome. I just finished giving the talk but definitely will incorporate for next time
October 29, 2025 at 5:26 PM
Oh man thats awesome. I just finished giving the talk but definitely will incorporate for next time