Your intestinal microbiome predicts your risk of SSI following abdominal surgery. So, can probiotics prevent SSI? academic.oup.com/ofid/advance...

Next time you think to yourself, I miss paper charting, tell me if you read: 1. Frequent vs. Pregnant, 2. Positive vs. Routine, 3. Heparin 1000 units vs. 10000, 4. Hypertension vs. Hypotension, 5. Negative vs. Hepatitis

Bonding capital is what you do within a community to create more affinity between people. Bridging capital is when you reach across communities to groups that are not part of your own. We need both to create stronger organizations and stronger societies. www.ihi.org/insights/how...

What about patient care will AI not replace: 1. Human connection at the bedside 2. Someone who truly cares and is worried about the outcome AI will challenge us to define what it means to be a human being.

Heard @theihi.bsky.social Leadership Alliance: 1. “Safety is a process of proactive risk mitigation” 2. “We need to understand work as it happens every day, not just when an event occurs” 3. “Let’s not buy new technology for a year and spend that money on optimizing technology that we have”

1/4 At the end of 2025, several tax provisions from the 2017 Tax Cuts and Jobs Act (TCJA) expire. Extending TCJA will add >$4 trillion to U.S. deficit over 10 years. TCJA disproportionately advantages those with more wealth. bipartisanpolicy.org/blog/the-new..., taxpolicycenter.org/taxvox/unpac...

We have an exciting opportunity to join @dartmouthhealth.bsky.social as the Chief of Infectious Diseases. Please message me if you have questions. This is a wonderful opportunity to lead an incredible team in a beautiful part of the country. dhcareers.org/job/section-...

“Leaders move along a continuum from inspiring to infuriating, and where they land at any given time depends on how well they play 3 key roles. … Visionaries give us meaning & purpose; exemplars provide us with passion & protection; and mentors bring us belonging & status.” hbr.org/2025/03/what...

When trying to diagnose Jamestown Canyon virus disease, it is worth noting the high seroprevalence (prior exposure) in endemic states such as Massachusetts, Minnesota, and Wisconsin. I suspect that this is also true in Northern New England. academic.oup.com/cid/advance-...

Routine use of rifampin in not recommended for staphylococcal native valve endocarditis. But what if patient undergoes valvular surgical intervention? The answer is still no. Not only does rifampin combination therapy not help, it may cause harm. academic.oup.com/ofid/advance...

Sharing two quotes from Edgar Schein’s “Humble Inquiry” that I finished this weekend; they seem even more relevant in our current era.

1/4 Vit A supplementation for treating measles: This is based on studies showing an association between prevalence of Vit A deficiency and measles mortality; however, evidence in support of Vit A supplementation has not reached statistical significance. pmc.ncbi.nlm.nih.gov/articles/PMC...

I am getting a lot of questions about measles. Here are some thoughts on measles vaccination, as a number of people are asking about boosters.

Fascinating paper showing missed diagnoses identified on autopsy. Speaks to the need for better pleuropulmonary and CNS diagnostic testing. A fair bit of TB was missed, but this may not reflect US experience (paper from Iran). Regardless, message holds. academic.oup.com/ofid/advance...

Nice discussion about “a more efficient and effective quality measurement enterprise that contributes to clinician well-being while enhancing the quality impact of performance measurement.” qualitysafety.bmj.com/content/earl...

Thoughtful discussion on a path forward focussed on the following 4 tenets to “transform diversity backlash”: Fairness, Access, Inclusion, Representation. hbr.org/2025/01/what...

Across ~750k inpatients in 928 U.S. hospitals, starting with empiric narrow-spectrum antibiotics escalated to broad-spectrum antibiotics based on cultures was NOT associated with worse outcomes compared with empirically starting broad (done close to 90% of the time). academic.oup.com/cid/advance-...

Thoughtful challenge to 30 yrs of clinical practice. FQ ppx to prevent SBP in pts w/ cirrhosis based on low quality evidence and a/w ⬆️ resistant bacteria, longer hospitalizations, C diff, ⬆️ gut translocation due to microbiome disruption, and ⬆️ rates of recurrent SBP. academic.oup.com/cid/advance-...

Thoughts for a Wednesday.

“QI is a humanistic response to solving problems. It is personal in both [how we] engage humans in change and the outcomes that matter to us enough to make these efforts.” “Leaders must be strong but humble, curious yet compassionate, inspiring and predictable.” qualitysafety.bmj.com/content/earl...

Urgent care centers have been reported to have higher rates of inappropriate antibiotic prescribing. Study demonstrated that active participation in 3 PDSA cycles successfully reduced inappropriate antibiotic prescribing, although some racial disparities persisted. www.cambridge.org/core/journal...

“When done right, team rituals provide certainty, connection, & space for employees to engage with each other & connect to the purpose of their work. In this way, rituals become a stabilizing force that helps unite & shepherd employees through whatever storms come their way.” hbr.org/2025/01/the-...

“Leaders of the 20th century were question answerers, setting the vision and strategy from above. … Leaders in the 21st century are question askers. They seek feedback and new perspectives, and they ask curious questions about themselves, their teams, and their environment.” hbr.org/2024/10/6-es...

A negative urinalysis (- LE, - nitrite, <10 WBCs/hpf) has a negative predictive value of 98% in urine collected from neutropenic patients. These patients don’t need to be excluded from lab reflex protocols. academic.oup.com/cid/advance-...

Interesting study showing that antibodies in saliva are a better correlate of protection than antibodies in serum when it comes to protection against symptomatic #COVID19. Highlights the importance of robust induction of mucosal immune responses. academic.oup.com/ofid/advance...

Childhood deaths before age 5 in the U.S. have dropped from 40-50% (1800s) to <1% thanks to closed sewers, pasteurization, federal regulations preventing the addition of harmful chemicals to food, vaccines, and antibiotics. theconversation.com/infectious-d...

In a prospective trial of a passive diversion device in an ED setting, blood culture contamination rate decreased 60%. academic.oup.com/ofid/advance...

“On their own, conflict, climate change, and the resurgence of disease would each present a serious risk to the world’s health. The US must prioritize all of them, or else we risk having them boil over into global health catastrophes.” www.healthaffairs.org/doi/10.1377/...

Following the relaxing of #COVID19 restrictions, we have seen surges in flu, RSV, and Group A Strep infections. There was a waning of immunity to these infections as fewer people were exposed due to masking and social distancing. academic.oup.com/jid/advance-...

Editorial: Evidence that universal gloving, contact precautions, cohorting & environmental decontamination ⬇️ MDRO transmission is low. Evidence for patient decolonization is moderate. ‘The world is covered with a thin patina of feces.’ Call for paradigm shift. qualitysafety.bmj.com/content/earl...

“Leaders will never have time on their hands. … Leaders shouldn’t spend their scarce time on activities simply because they are very important. They should do only the things that nobody else in the organization can do nearly as well—if at all.“ hbr.org/2025/01/lead...

Choosing Wisely: You are called about giving abx prophy to a close contact of someone who had invasive Group A Strep infection. Evidence suggests no ⬇️ in GAS infection in those who get prophylaxis, but there is a THREE FOLD ⬆️ incidence of adverse drug rxn. Say no. academic.oup.com/cid/advance-...

Of ~125k pts w/ suspected sepsis across 236 U.S. hospitals, only 1 in 5 had broad-spectrum abx (anti-MRSA, anti-PsA) de-escalated by day 4 when no resistant organisms identified. After propensity matching, de-escalation a/w ⬇️ AKI, ICU days, and inpatient mortality. academic.oup.com/cid/advance-...

Cool tool for estimating risk of TB within first 5 years of immigration to a low incidence country. tb-migrate.shinyapps.io/website/ (Validation here: academic.oup.com/cid/advance-...)

Got sepsis? Want to give a beta-lactam and vancomycin empirically while figuring things out? Give the beta-lactam first. Goes in quick, unlike the vanco. Makes a difference. Meaning: fewer patients die. academic.oup.com/cid/advance-...

I feel I must say…please don’t use bat guano to fertilize your cannabis. Two fatal cases of Histoplasmosis in Rochester, NY. #TheMoreYouKnow academic.oup.com/ofid/advance...

“Hopeful people…believe that things might turn out well — but they also believe that in that context of uncertainty, actions matter. Being hopeful…involves willpower (a desire to bring about hoped for outcomes), and waypower (the charting of a clear path to achieve them).” hbr.org/2024/12/the-...

When reliability is high, observed scores better reflect true performance (higher signal:noise). “Reliability needs to reach at least 0.7 for 50% of flagged organisations to be correctly flagged and 0.9 to nearly eliminate incorrectly flagging organizations.” qualitysafety.bmj.com/content/earl...

“Leaders who successfully carried out their sponsorship role went beyond transactional behaviours and the removal of implementation barriers. … [A leader must] build a common vision and engage in two-way relationship building and interactive problem solving.” qualitysafety.bmj.com/content/earl...

As we think about how we continue to serve as agents of change, is important that we delineate our values, weave these values into everything that we do, be aggressively authentic, and then find common ground to drive improvement.

Celebrating and supporting Men’s Health @dartmouthhealth.bsky.social. Focus on prostate cancer, testicular cancer, mental health, and suicide prevention. Please consider supporting: cancer.dartmouth.edu/donate/frien....

1 out of every 7-8 Americans says they don’t have a regular source of healthcare, and 1 out of 12-13 Americans don’t have any health insurance. Americans spend an average of 7.3% of their annual income on healthcare. As a country, we are not upholding the Hippocratic oath. hbr.org/2024/11/why-...

About 1/3 of surveyed providers do not regularly examine patients before ordering fever work-up. 66% always or often order “full fever work-up,” 77% when instructed to do so in handoff instructions. www.cambridge.org/core/journal...

In a study of patients meeting NHSN criteria for CAUTI, 18% met clinical definition, 42% were indeterminate, and 40% were catheter-associated asymptomatic bacteriuria. www.cambridge.org/core/journal...

Across 14 studies with ~21k patients, PICC lines had a two-fold higher risk of bloodstream infection than midlines, but midlines had higher rates of superficial vein thrombosis, infiltrations, and leaks. PICCs are higher cost and have higher patient dissatisfaction. www.cambridge.org/core/journal...

Study showed that increasing the percentage of patients with a bone and joint infection (including PJI) discharged on an oral antibiotic had no negative impact on 90 day failure rates, while decreasing LOS (and PICC adverse events). academic.oup.com/ofid/advance...

“Right now, many of us feel suspended between what once was and what is yet to come.” Ask: 1. What do you value?, 2. Where do we stand?, 3. How can we move ahead? Make sure you: 1. Step back and take stock, 2. Strengthen the ties that bind, 3. “Hold fast and stay true.” hbr.org/2024/11/how-...

1/8 As an introduction, I am reposting a series of podcast that we created delving into topics that impact healthcare quality and safety. Our first podcast addressed burnout (creators.spotify.com/pod/show/the...).

I am new to Bluesky, drawn by a hope that this is where the intelligent scientific discourse migrated following the demise of Twitter. Please reach out to let me know you are here. I like to post on infectious diseases, infection prevention, antibiotic stewardship, quality, safety, and leadership.