Where all your ID needs are met! Sort of.
I think we can all agree that resistance is inevitable, despite what the quote says, in the world of infectious diseases. More and more, the use of broad spectrum antibiotics (looking at you, vanco-zosyn!) brings upon more resistant organisms, with beta-lactamases being one of the key methods of resistance in many gram negative bacteria. As
Look, I know I have talked a lot about staphylococcus but there is a ton of details that go into the therapeutic aspects of it. When it comes to staphylococcus aureus bacteremia, specifically MRSA, vancomycin is the first line therapy per the IDSA guidelines (1). I have discussed the issues with vancomycin dosing, and how
I discussed C. auris in my last post and pointed out that, due to the relative novelty of the organism, there are no “defined” breakpoints when it comes to drug-bug combinations. While I did say that fluconazole, in many instances, was considered “resistant”, the truth is I cannot say that with 100% confidence as there
The use of rifampin for staphylococcal infections is a bit controversial. The recommendation seems to be its use on infections involving prosthetic material, such as prosthetic valve endocarditis or prosthetic joint infections. For instance, the AHA infective endocarditis (1) guidelines recommends the addition of rifampin to a regimen consisting of vancomycin to infectious caused by
What do we want? More nec fasc! When do we want it? Now! Perhaps not a lot of people really want necrotizing fasciitis (see here), though to be fair, this post is not entirely about necrotizing fasciitis. In fact, this deals more with the “super saiyan” antigens, those toxins that group A strep and some
Hyperbaric oxygen therapy involves breathing 100% oxygen at a higher atmospheric pressure (usually 2.5-3 atm) and it has recently been widely used for multiple diseases. Recall Boyle’s law: Increasing pressure decreases the volume, so pressurizing the human body causes a decrease in volume of gas-filled spaces (1). As such, it has clinical uses in arterial
I’ve previously discussed how much more difficult Enterococcal infections are to treat when compared to other bacteria such as streptococci. This stems from the fact these bacteria have tend to be more resistant to beta-lactam antibiotics, with synergy being the name of the game for serious infections with these bacteria (in general, ampicillin/ceftriaxone). This is
Depending on where you practice, I think it is safe to assume there is a “nickname” for the combination of vancomycin/piperacillin-tazobactam (VAN/PTZ). “Guerilla-cillin,” “Parkla-mycin” or just “the big guns” this is a very common combination that is thrown up front for sepsis or health-care acquired infections (the debate of whether this is an appropriate approach
A 72yo male with history of hypertension, kidney stones, and recent diagnosis of acute prostatitis presents with malaise and myalgias. According to the patient, he has been feeling unwell for the past month. He had a recent outpatient visit for dysuria, the UA was positive for leukocyte esterase. A DRE revealed acute prostatitis and he
I have a confession to make. I like fluroquinolones. I know. They’re broad spectrum, especially levofloxacin and moxifloxacin. They have pretty good bioavailability (almost 100%), and they cover pseudomonas (ciprofloxacin and levofloxacin) making them good PO stepdown therapy for severe pseudomonas bacteremia. Having said that, if you have spent any time in the internet you
Dr. Germophile 