@juliaiburke.bsky.social
#OTILT In orthopedic hardware infections where hardware isn’t replaced, oral suppressive antibiotics for 3-6 months improve outcomes. And in this study, extending beyond 6 months didn’t show added benefit. @bwdionne.bsky.social @brynnthomas.bsky.social @jeffpears0n.bsky.social
Role of Suppressive Oral Antibiotics in Orthopedic Hardware Infections for Those Not Undergoing Two-Stage Replacement Surgery
Suppressive oral antibiotics for at least three months, but not at least six months, are associated with treatment success at one year post-diagnosis of orthopedic hardware infection. Keywords: deep i...
pmc.ncbi.nlm.nih.gov
June 11, 2025 at 5:41 PM
#OTILT In orthopedic hardware infections where hardware isn’t replaced, oral suppressive antibiotics for 3-6 months improve outcomes. And in this study, extending beyond 6 months didn’t show added benefit. @bwdionne.bsky.social @brynnthomas.bsky.social @jeffpears0n.bsky.social
#OTILT The cefazolin inoculum effect (CzIE) may reduce cefazolin efficacy in MSSA infections with high bacterial load. However, a review of 23 studies found no consistent link between CzIE and worse outcomes, so routine CzIE testing isn’t currently supported. @bwdionne.bsky.social
Clinical significance of cefazolin inoculum effect in serious MSSA infections: a systematic review
AbstractBackground. The cefazolin inoculum effect (CzIE) is a phenomenon whereby some MSSA isolates demonstrate resistance to cefazolin when a high bacteri
academic.oup.com
June 10, 2025 at 4:18 PM
#OTILT The cefazolin inoculum effect (CzIE) may reduce cefazolin efficacy in MSSA infections with high bacterial load. However, a review of 23 studies found no consistent link between CzIE and worse outcomes, so routine CzIE testing isn’t currently supported. @bwdionne.bsky.social
#OTILT Daptomycin isn’t used for pneumonia due to surfactant inactivation but can be used for septic emboli from MRSA bacteremia. However, this case showed treatment failure with dapto and improvement with ceftaroline, so we must still use caution when lungs are involved. @bwdionne.bsky.social
Daptomycin Failure for Treatment of Pulmonary Septic Emboli in Native Tricuspid and Mitral Valve Methicillin-Resistant Staphylococcus aureus Endocarditis
Daptomycin has been used with success for the treatment of right-sided methicillin-resistant Staphylococcus aureus (MRSA) endocarditis. However, its efficacy has not been completely assessed for the t...
pmc.ncbi.nlm.nih.gov
June 9, 2025 at 4:59 PM
#OTILT Daptomycin isn’t used for pneumonia due to surfactant inactivation but can be used for septic emboli from MRSA bacteremia. However, this case showed treatment failure with dapto and improvement with ceftaroline, so we must still use caution when lungs are involved. @bwdionne.bsky.social
#OTILT The urinary antigen test for Legionella mainly detects serogroup 1. A study found over one-third of PCR-confirmed cases were missed, highlighting its limitations in detecting other serogroups. @bwdionne.bsky.social @brynnthomas.bsky.social @jeffpears0n.bsky.social
nejmJW_1L_RGB-b
www.jwatch.org
June 6, 2025 at 4:21 PM
#OTILT The urinary antigen test for Legionella mainly detects serogroup 1. A study found over one-third of PCR-confirmed cases were missed, highlighting its limitations in detecting other serogroups. @bwdionne.bsky.social @brynnthomas.bsky.social @jeffpears0n.bsky.social
#OTILT Horseshoe crab factor G is used in tests to detect (1,3)-beta-D-glucan, a type of sugar found in fungal cell walls. When (1,3)-beta-D-glucan is present, factor G activates and causes a clotting reaction, which helps identify fungal infections in the blood. @bwdionne.bsky.social
Horseshoe crab (1,3)-beta-D-glucan-sensitive coagulation factor G. A serine protease zymogen heterodimer with similarities to beta-glucan-binding proteins - PubMed
Horseshoe crab factor G is an intracellular serine protease zymogen that initiates the (1,3)-beta-D-glucan-sensitive hemolymph clotting pathway. Unlike other known serine protease zymogens, which are ...
pubmed.ncbi.nlm.nih.gov
June 5, 2025 at 4:41 PM
#OTILT Horseshoe crab factor G is used in tests to detect (1,3)-beta-D-glucan, a type of sugar found in fungal cell walls. When (1,3)-beta-D-glucan is present, factor G activates and causes a clotting reaction, which helps identify fungal infections in the blood. @bwdionne.bsky.social
#OTILT Ceftolozane–tazobactam showed better activity than ceftazidime–avibactam against P. aeruginosa, especially with efflux pump or ampC-mediated resistance. Time-kill assays in this study confirmed stronger bactericidal effects at multiple MICs. @bwdionne.bsky.social
Activity of Ceftolozane-Tazobactam against Carbapenem-Resistant, Non-Carbapenemase-Producing Pseudomonas aeruginosa and Associated Resistance Mechanisms
Although carbapenems are effective for treating serious multidrug-resistant Pseudomonas aeruginosa infections, carbapenem-resistant P. aeruginosa (CRPA) is now being reported worldwide. Ceftolozane-ta...
pmc.ncbi.nlm.nih.gov
June 4, 2025 at 5:02 PM
#OTILT Ceftolozane–tazobactam showed better activity than ceftazidime–avibactam against P. aeruginosa, especially with efflux pump or ampC-mediated resistance. Time-kill assays in this study confirmed stronger bactericidal effects at multiple MICs. @bwdionne.bsky.social
#OTILT The higher meropenem dose in meropenem/vaborbactam (2 g q8h) allows for a higher MIC susceptibility breakpoint (≤4 mg/L) compared to meropenem alone (≤1 mg/L with 1 g q8h dosing). This dosing strategy enhances activity against KPC-producing CRE, as shown in this study. @bwdionne.bsky.social
Meropenem-Vaborbactam Activity against U.S. Multidrug-Resistant Enterobacterales Strains, Including Carbapenem-Resistant Isolates
Carbapenems are a common first-line therapy for serious Gram-negative infections, but carbapenem-resistant Enterobacterales (CRE) isolates have become an urgent health concern. Klebsiella pneumoniae s...
pmc.ncbi.nlm.nih.gov
June 3, 2025 at 5:30 PM
#OTILT The higher meropenem dose in meropenem/vaborbactam (2 g q8h) allows for a higher MIC susceptibility breakpoint (≤4 mg/L) compared to meropenem alone (≤1 mg/L with 1 g q8h dosing). This dosing strategy enhances activity against KPC-producing CRE, as shown in this study. @bwdionne.bsky.social
#OTILT Azithromycin can prolong the QTc interval, but this may not always be clinically significant. In this study, QTc increased slightly, but few exceeded 500 ms and no dysrhythmias occurred, showing the importance of individual risk assessment before avoiding azithromycin. @bwdionne.bsky.social
QTc interval prolongation associated with inpatient azithromycin therapy for pneumonia
Context In 2013, the US Food and Drug Administration issued a warning regarding the use of azithromycin and the risk of fatal dysrhythmias after a 14-year retrospective analysis showed increased risk ...
www.degruyterbrill.com
June 2, 2025 at 5:29 PM
#OTILT Azithromycin can prolong the QTc interval, but this may not always be clinically significant. In this study, QTc increased slightly, but few exceeded 500 ms and no dysrhythmias occurred, showing the importance of individual risk assessment before avoiding azithromycin. @bwdionne.bsky.social
#OTILT I learned that ceftaroline, when used for 14 days or more, carries a risk of neutropenia. Regular CBC monitoring is essential, and early discontinuation should be considered if ANC drops. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
Ceftaroline-Associated Neutropenia: Case Series and Literature Review of Incidence, Risk Factors, and Outcomes
Ceftaroline is increasingly prescribed for “off-label” indications involving longer durations and higher doses. There have been postmarketing case reports of neutropenia among patients who have receiv...
pmc.ncbi.nlm.nih.gov
May 30, 2025 at 4:23 PM
#OTILT I learned that ceftaroline, when used for 14 days or more, carries a risk of neutropenia. Regular CBC monitoring is essential, and early discontinuation should be considered if ANC drops. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT I learned that in the SOLSTICE trial, maribavir was more effective and better tolerated than standard therapies for resistant or refractory CMV in transplant patients. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
Maribavir for Refractory Cytomegalovirus Infections With or Without Resistance Post-Transplant: Results From a Phase 3 Randomized Clinical Trial - PubMed
Maribavir was superior to IAT for cytomegalovirus viremia clearance and viremia clearance plus symptom control maintained post-therapy in transplant recipients with R/R cytomegalovirus. Maribavir had ...
pubmed.ncbi.nlm.nih.gov
May 29, 2025 at 5:04 PM
#OTILT I learned that in the SOLSTICE trial, maribavir was more effective and better tolerated than standard therapies for resistant or refractory CMV in transplant patients. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT I learned that some studies suggest adding gentamicin for staphylococcal prosthetic valve endocarditis may not improve survival. This raises questions about its routine use given the risk of kidney injury. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis - PubMed
The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.
pubmed.ncbi.nlm.nih.gov
May 28, 2025 at 4:05 PM
#OTILT I learned that some studies suggest adding gentamicin for staphylococcal prosthetic valve endocarditis may not improve survival. This raises questions about its routine use given the risk of kidney injury. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT I learned Gram stain scores from 0 to 4+ reflect bacterial density. A 1+ means rare organisms, while 4+ means they appear in nearly every field. This helps guide early empiric antibiotic decisions. @bwdionne.bsky.social @jeffpears0n.bsky.social @brynnthomas.bsky.social
Quantitative Gram Stain Interpretation Criteria Used by Microbiology Laboratories in Alberta, Canada
Microbiology laboratories in Alberta, Canada, were surveyed to determine the quantitative interpretive criteria used to routinely read and report Gram stains. There was a wide variability in the quant...
pmc.ncbi.nlm.nih.gov
May 27, 2025 at 5:50 PM
#OTILT I learned Gram stain scores from 0 to 4+ reflect bacterial density. A 1+ means rare organisms, while 4+ means they appear in nearly every field. This helps guide early empiric antibiotic decisions. @bwdionne.bsky.social @jeffpears0n.bsky.social @brynnthomas.bsky.social
#OTILT HCV antibody tests stay positive for life. This joint IDSA-AASLD/CDC guidance highlights that repeat HCV Ab testing offers no clinical value. Viral load testing should be used to confirm active infection or reinfection. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
Don’t repeat hepatitis C virus (HCV) antibody testing in patients with a previous positive (HCV) test. Instead, order hepatitis C viral load testing for assessment of active versus resolved infection.
There are joint guidelines from the IDSA and the American Association for the Study of Liver Diseases, which are consistent with guidance from the CDC regarding the testing, management, and treatment ...
www.aafp.org
May 23, 2025 at 2:59 PM
#OTILT HCV antibody tests stay positive for life. This joint IDSA-AASLD/CDC guidance highlights that repeat HCV Ab testing offers no clinical value. Viral load testing should be used to confirm active infection or reinfection. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT Antimicrobial lock solutions are known to reduce CLABSI risk! This 2014 meta-analysis supported that, showing a 69% reduction in CLABSI! @brynnthomas.bsky.social @jeffpears0n.bsky.social @bwdionne.bsky.social
Antimicrobial Lock Solutions as a Method to Prevent Central Line–Associated Bloodstream Infections: A Meta-analysis of Randomized Controlled Trials
Antimicrobial lock solutions are effective in preventing catheter-associated bloodstream infections and their effect is additive to standard prevention mea
academic.oup.com
May 22, 2025 at 4:32 PM
#OTILT Antimicrobial lock solutions are known to reduce CLABSI risk! This 2014 meta-analysis supported that, showing a 69% reduction in CLABSI! @brynnthomas.bsky.social @jeffpears0n.bsky.social @bwdionne.bsky.social
#OTILT Stem cell transplant patients are at risk for nocardiosis. This 2022 study found no cases in those on TMP-SMX prophylaxis, supporting its use for prevention. However, treatment may require escalation to other drugs like carbapenems! @jeffpears0n.bsky.social @bwdionne.bsky.social
Risk Factors and Outcomes of Nocardiosis in Hematopoietic Stem Cell Transplant Recipients
Nocardiosis occurs in up to 1.7% of the hematopoietic stem cell transplant (HSCT) population. Risk factors for its development and subsequent outcomes have been incompletely studied. To evaluate risk ...
pmc.ncbi.nlm.nih.gov
May 21, 2025 at 3:32 PM
#OTILT Stem cell transplant patients are at risk for nocardiosis. This 2022 study found no cases in those on TMP-SMX prophylaxis, supporting its use for prevention. However, treatment may require escalation to other drugs like carbapenems! @jeffpears0n.bsky.social @bwdionne.bsky.social
#OTILT I learned that ciprofloxacin was found to be more effective than cefpodoxime for uncomplicated UTIs in this 2013 RCT. However, the cefpodoxime dose and duration were lower than what is recommended in Brigham’s guidelines, which may have impacted its effectiveness. @jeffpears0n.bsky.social
Cefpodoxime vs Ciprofloxacin for Short-Course Treatment of Acute Uncomplicated Cystitis: A Randomized Trial
Although fluoroquinolones remain the most reliable urinary antimicrobial, resistance rates have increased and effective fluoroquinolone-sparing antimicrobials are needed. To determine whether cefpodox...
pmc.ncbi.nlm.nih.gov
May 20, 2025 at 4:50 PM
#OTILT I learned that ciprofloxacin was found to be more effective than cefpodoxime for uncomplicated UTIs in this 2013 RCT. However, the cefpodoxime dose and duration were lower than what is recommended in Brigham’s guidelines, which may have impacted its effectiveness. @jeffpears0n.bsky.social
#OTILT I learned that oral antibiotics can be as effective as IV therapy for osteomyelitis. The OVIVA trial showed non-inferiority of oral step-down therapy, supporting early transition from IV in appropriate patients. @brynnthomas.bsky.social @jeffpears0n.bsky.social @bwdionne.bsky.social
Oral versus Intravenous Antibiotics for Bone and Joint Infection | NEJM
The management of complex orthopedic infections usually includes a prolonged course of intravenous antibiotic agents. We investigated whether oral antibiotic therapy is noninferior to intravenous a...
www.nejm.org
May 19, 2025 at 7:37 PM
#OTILT I learned that oral antibiotics can be as effective as IV therapy for osteomyelitis. The OVIVA trial showed non-inferiority of oral step-down therapy, supporting early transition from IV in appropriate patients. @brynnthomas.bsky.social @jeffpears0n.bsky.social @bwdionne.bsky.social
#OTILT I learned that for VRE infections where Enterococcus is reported as SDD to daptomycin, higher dosing (8–12 mg/kg) is needed. SDD reporting improved appropriate dosing, highlighting the value of ID involvement. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
Understanding and Application of Daptomycin-Susceptible Dose-Dependent Category for Enterococcus: A Mixed-Methods Study
In 2018, the Clinical Microbiology Laboratory at our institution adopted updated daptomycin Enterococcus–susceptible dose-dependent breakpoints. While the introduction of susceptible dose-dependent (S...
pmc.ncbi.nlm.nih.gov
May 16, 2025 at 7:58 PM
#OTILT I learned that for VRE infections where Enterococcus is reported as SDD to daptomycin, higher dosing (8–12 mg/kg) is needed. SDD reporting improved appropriate dosing, highlighting the value of ID involvement. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT I learned that ciprofloxacin is commonly used as prophylaxis after leech therapy for Aeromonas, a freshwater bacterium that can cause SSTIs! However, this article highlights emerging resistance and the need to consider alternatives. pubmed.ncbi.nlm.nih.gov/24495623/ @bwdionne.bsky.social
Ciprofloxacin-resistant Aeromonas infection following leech therapy for digit replantation: report of 2 cases - PubMed
Medicinal leeches are commonly used after finger replantation to treat surgically unsalvageable venous congestion. Infection from Aeromonas hydrophila is a recognized complication of leech therapy tha...
pubmed.ncbi.nlm.nih.gov
May 15, 2025 at 4:47 PM
#OTILT I learned that ciprofloxacin is commonly used as prophylaxis after leech therapy for Aeromonas, a freshwater bacterium that can cause SSTIs! However, this article highlights emerging resistance and the need to consider alternatives. pubmed.ncbi.nlm.nih.gov/24495623/ @bwdionne.bsky.social
#OTILT Doxycycline is not used for bacteremia due to its high volume of distribution. This leads to low serum concentrations and may result in inadequate treatment of bloodstream infections! academic.oup.com/cid/article/... @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
May 14, 2025 at 7:00 PM
#OTILT Doxycycline is not used for bacteremia due to its high volume of distribution. This leads to low serum concentrations and may result in inadequate treatment of bloodstream infections! academic.oup.com/cid/article/... @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT Cranberries contain proanthocyanidins (PACs), which inhibit the adherence of fimbriated Escherichia coli to urothelial cells and help prevent recurrent UTIs in women and children! www.cochrane.org/CD001321/REN.... @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
May 13, 2025 at 8:46 PM
#OTILT Cranberries contain proanthocyanidins (PACs), which inhibit the adherence of fimbriated Escherichia coli to urothelial cells and help prevent recurrent UTIs in women and children! www.cochrane.org/CD001321/REN.... @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT QT varies with heart rate, so QTc is the corrected version. A 2023 study found automatic QTc readings can differ by over 100 ms from manual ones, especially in LQTS! academic.oup.com/europace/art... @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
Manual vs. automatic assessment of the QT-interval and corrected QT
AbstractAims. Sudden cardiac death (SCD) is challenging to predict. Electrocardiogram (ECG)-derived heart rate-corrected QT-interval (QTc) is used for SCD-
academic.oup.com
May 12, 2025 at 6:35 PM
#OTILT QT varies with heart rate, so QTc is the corrected version. A 2023 study found automatic QTc readings can differ by over 100 ms from manual ones, especially in LQTS! academic.oup.com/europace/art... @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT Today I learned that MALDI-TOF is a mass spectrometry-based proteomics tool that allows for rapid and highly specific species identification and is now used for most identification testing at Brigham! @bwdionne.bsky.social @jeffpears0n.bsky.social @brynnthomas.bsky.social
May 9, 2025 at 7:14 PM
#OTILT Today I learned that MALDI-TOF is a mass spectrometry-based proteomics tool that allows for rapid and highly specific species identification and is now used for most identification testing at Brigham! @bwdionne.bsky.social @jeffpears0n.bsky.social @brynnthomas.bsky.social
#OTILT I learned that elastomeric devices make it possible for patients to receive IV antibiotics like vancomycin at home, allowing for continued treatment outside the hospital through a small, portable infusion pump! @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
May 8, 2025 at 4:59 PM
#OTILT I learned that elastomeric devices make it possible for patients to receive IV antibiotics like vancomycin at home, allowing for continued treatment outside the hospital through a small, portable infusion pump! @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
#OTILT is what Karius testing is! It’s a plasma test that detects microbial DNA to identify infections. It is a last-ditch option when other tests come up short, but it is really expensive so we reserve it for tough cases. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social
May 7, 2025 at 7:50 PM
#OTILT is what Karius testing is! It’s a plasma test that detects microbial DNA to identify infections. It is a last-ditch option when other tests come up short, but it is really expensive so we reserve it for tough cases. @brynnthomas.bsky.social @bwdionne.bsky.social @jeffpears0n.bsky.social