Category: ID Guide

The Semi-Procalcitonin in Bacteremia

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

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The Trojan Horse of Antibiotics

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

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Straight from the Horse’s Lung: Rhodococcus Equi

Originally described as a pathogen in 1923, Corynebacterium equi was isolated from the lungs of ten foals (aka a young horse) who had pneumonia (1). Its name was later changed to rhodococcus (aka red coccus), and can be mistaken for mycobacterium spp due to its sometimes acid-fast appearance (2). It is known to infect horses,

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TB or not TB: A Journey Through Chemotherapy

This is quite a corny and overtold joke. I have discussed some new drugs for multidrug resistant tuberculosis (MDR-TB), which is defined as resistance to both rifampin and isoniazid, however I felt like going back to the basics of TB therapy. Indeed, we all learn in STEP 1 and med school about “RIPE-ing it up”

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Lines on lines on lines: CLABSI, CRBSI, and Line Infections

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

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Basics of Pulmonary Valley Fever

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,

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Ahorita-que? The New Gram Positive Antibiotic, Oritavancin

Vancomycin is the work-horse antibiotic every person reaches for. It is a glycopeptide that covers a wide range of gram positive bacteria, with its niche being in its coverage of methicillin-resistant staphylococcus aureus and Enterococcus spp. It is bacteriostatic, with dosing issues and highly nephrotoxic, however it is ubiquitous throughout any hospital in the United

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One PET, Two PET – Endocarditis and Positron Emission Tomography

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

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The Microbiology of Diabetic Foot Infections – What I Didn’t Know

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

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Neutropenic Fever – I Need The Vancz

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

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