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Trying to figure out if a febrile patient showing up to the ED is having a bacterial infection is a conundrum. The main concern is bacteremia, since it confers higher mortality depending on the type of bacteremia a patient has. Inflammatory markers such as CRP and the neutrophil-to-lymphocyte ratio are relatively useful surrogates that may
I reckon it’s time to write about new antibiotics. I do not like beta-lactamases. Mostly due to their ability to confuse clinicians, however also because it makes it difficult to pick an antibiotic for certain infections. I have written extensively about these, so look at this post. In general, carabepenemases and cephalosporinases within class A
Central lines are cool, for the most part. Except for when they’re infected. The pathophysiology behind these is explained in this diagram (1): Microorganisms gain access to the extraluminal or intraluminal surface of the device. Both skin and hub may be the important entry point of organisms, with the development of biofilm contributing to their
The cephalosporins are a class of beta-lactam antibiotics that is generally classified based on “generations.” These denote the spectrum of bacteria they target, with each successive generation having more gram negative coverage. I am convinced most people only know about ceftriaxone, the prototype third-generation cephalosporin aka an “extended-spectrum beta lactam” along with cefepime, which is
Coccidioides (from now on, called Cocci) is an endemic fungi that exists in two forms, yeast and mold, that is endemic to the southeastern United States (1). It is related to both Histoplasma and Blastomyces with two species known to infect humans. C. immitis and C. posadasii. Arthroconidia can be transported in soil or fomites,
Skin and soft tissue infections are fairly common infectious presentations almost all physicians have experience with. In general, gram positive organisms tend to predominate in community-acquired cellulitis, usually skin organisms, which manage to get access to the soft tissues through a break in the skin itself. Exposure to water can change the microbiology of skin
PETs. We all love them. I have two of those, if the pictures in my “about me” page are any indication as well as the main pic of this post. This post will not cover our beloved (and sometimes only) friends. No, we will be talking about positron emission tomography, an imaging modality we usually
This and (likely) the next post are a product of questions I got asked. For instance, do you need anaerobic coverage for diabetic foot infections? Depends, but see later. What organisms do you need to cover for cellulitis in those who have had water exposure? Cephalexin and quinolones, with some exceptions. We will talk about
Neutropenic fever, defined as a single temperature 38.3C (101F) OR 38.0C (100.4F) for one hour in patients whose granulocyte count are <500 cells OR <1000 cells with an expected decline to <500 over the next 48 hours. This is actually a fairly frequent occurrence in those who undergo intensive chemotherapy, especially in hematological malignancies, which
HIV therapy has undergone many iterations. Long gone are the days of AZT and semi-literal drug cocktails and we have entered into an era where HIV treatment is as easy as just getting one pill per day with Triumeq, Biktarvy, and Atripla which include three-active components. Newcomer, Cabotegravir, may change the game going forward as
Dr. Germophile 