Nico Cortés-Penfield MD

Nah. Decision-making for these infections is so highly individualized - there will always be an abundance of patients whose scenarios don't slot comfortably into clinical trial data, and a job for someone to trying to figure out what to do about it.

Writing this was a ton of fun (and TBH a great excuse to get Erin and Julie in my co-author pokedex of ID rockstars). Particularly want to highlight the modern MSK infection RTCs table, which points to how much early PO switch has become standard among the people who do run Ortho ID clinical trials.

I think the data is more limited in this situation; has been several years now since I sat with the tet gene literature (Breakpoints has a deep dive on this) but IIRC mino is still reliable in this situation. Our default susceptibilities only report tet and luckily are usually sensitive.

I use quite a bit of doxy in ortho infections given its good tolerability and few DDIs! Tetracyclines were used in RTCs by Li & Benkabouche w outcomes similar to other drugs. We published a small case series of doxy/mino for staph PJI, which has worked well for us: pubmed.ncbi.nlm.nih.gov/38826885/

Props to Darth Maul for making sure Qui-Gon Jinn never got to be appointed head of the galactic HHS

Manning et al 2022 from Josh Davis’s group looked at 2 vs 6 weeks IV for PJI.

I would argue that the even better match for your question is Lora-Tamayo 2018 (8 vs 6-12wk FQ/rif for Staph PJI after DAIR) since most of those pts had early switch, but PO switch wasn’t what was being randomized there

This is the worst take I’ve seen from you Michael. Calypso is unproblematic.

Stripe is, unfortunately, who you are looking for.

The new expression of academic collegiality is when you start a zoom call with your Canadian/European peers and make pained/apologetic noises while they kindly inquire about your plans to leave the country.

👀 In a large national VA cohort, oral antibiotic prophylaxis following 2-stage for PJI not only was not associated with fewer reinfections, but led to those recurrent infections being caused by more resistant pathogens (ie with more limited suppression options)

pubmed.ncbi.nlm.nih.gov/40051754/

It’s a fantastic start, but where’s our GII.4 and GII.17 vaccines??? That’s were the money/vomitus is.

Have been fiddling with EuropePMC all morning and seems like a suitable replacement for PubMed- actually casts a wider net, including preprints and abstracts by default. Would love to see even an ID journal letter to the editor published with some quantitative comparisons (assuming PubMed survives)

Balance!

Cefuroxime

The Microbiome is fascinating and also has been a largely fruitless money pit for the past ~15 years IMO

you could also do your ID fellowship abroad and then practice ID abroad….

Zero clue. I don’t know of any trials on duration in spine implant infection, so wherever it came from, the data can’t be that solid.

Ending the work of USAID and PEPFAR amounts to a mass killing. Just morally depraved. I don’t understand how you could value human life and do this thing.

Well, don’t try to remove thy foley unless thou hast been instructed on the proper technique

So @asm.org if I publish in one of your journals (like AAC or CMR) do you reserve the right the change the publish text of my peer-reviewed work at any time without telling me?

Let us know

No clue, just that it’s down for a redesign

It’s a planned downtime to renovate the site- know this because one of my committees had a hard deadline to get something done beforehand.

Real shitty timing though! Also doesn’t explain the town hall delay.

As someone who is very familiar with both the US and Canadian systems, I can confirm that PHAC is a great source of info, especially regarding guidance and easy to access facts. It doesn’t replace American data lost at CDC in the great purge but it does provide reliable health & medical information.

@germhuntermd.bsky.social cyberbullying the IDSA into saying dismantling the CDC might be bad

That’s great, I always hope it’s gonna be useful like that! Haven’t been so lucky.

So basically the idea that Karius is higher yield in IC hosts is bunk, and even the factors associated with a positive Karius are only very modestly associated (i.e. even for those folks it’s mostly negative).

Fits my experience- order Karius 1-2x a year, nearly always feel I have wasted $$$ after

I miss complaining about the Jedi on the secret healthcare group chat. Maybe the only good memory I have of the pandemic.

(AJAB, now and forever)

I usually use pip-tazo and linezolid, the former for GNRs and the latter for MRSA and toxin inhibition for invasive beta-hemolytic strep. I like linezolid over vancomycin+clinda for this indication mostly to avoid AKI risk (or TDM concerns) in septic patients.

Such a fun episode to make with old & new friends! As always, we get nerdy 🤓 this time about biofilms 🧫

The innovative non-pharmacologic agents in the PJI space are fascinating. It’s much more than 🦴 cement!

@cortes-penfield.bsky.social @sidpharm.bsky.social #Breakpoints #IDSky #AMSSky #PharmSky

I would use bactrim, probably for 4wk; staph is probably the main pathogen here and covering both is a nice bonus.

“HAL, stop prescribing gentamicin bladder instillations. This patient has a suprapubic catheter, he will have pyuria and bacteruria until the day he dies.”

“I’m sorry Dave, I can’t do that.”