#IDSky Cefazolin for MSSA meningitis? I am asking because I was criticized by older collegue because I give it to the patient with this infection.

#IDSky Homeless person with scabies and Staphylococcus aureus bacteremia (isolate attached)? How would you explain susceptibility results for cephalosporins (cephalexin) and would you trust cefazolin? @bradspellberg.bsky.social @wwrighid.bsky.social @drtoddlee.bsky.social @dralicehan.bsky.social

#IDSky Patient with transplanted kidney >1 year ago on minimal immunosuppression developed fever. IE was diagnosed by PET-CT. Blood culture grew Corynebacterium sp. S to linezolid and vancomycin. Patient received vancomycin for 5 weeks and linezolid after implantation of prosthetic valve for 2 weeks

#IDSky A 40-years old patient presented with 7 d of high fever, sore throat, and severe neutropenia (0.02). There is a history of psychosis on clozapine, cariprazine, quetiapine and sertraline. Low-risk by MASCC score. What would be appropriate diagnostics and empiric...

@kidneyboy.bsky.social @nephroseeker.medsky.social @nephrosparks.bsky.social @captainchloride.bsky.social Patient 97-years old with sepsis and AKI and probabale colistin effect requiring dialysis for mild volume overload. During dialysis her blood pressure is 180/80 mmHg. How you handle this cases?

#IDSky A 70-year man with AF, presents with bilateral pneumonia w/o respiratroy insufficiency. Seven days previously, patient performed mouth on mouth CPR on plane from Dubai in person who eventually died. What would be appropriate empiric ABx for this patient? Patient reports allergy to penicillin.

#pocus @nephropocus.bsky.social @argaiz.bsky.social Patient with oliguric AKI. No obvious signs of hypervolemia. IVC highly collapsible. How would you interpret this hepatic vein Doppler?

#IDSky Would you trust maximum dose of IV clindamycin for uncomplicated MSSA bacteremia? Do not ask why 😊 @bradspellberg.bsky.social @dralicehan.bsky.social @drtoddlee.bsky.social @idiots-pod.bsky.social @drtimothyli.bsky.social

#IDSky #fungalsky Older patient with known low-grade lymphoma presented with 6 weeks of fever up to 39°C without organ-specific symptoms. CT of abdomen showed focal changes in liver (lymphoma vs. fungal infection). Cryprococcus antigen and 1,3-ß-D-glucan are positive in blood. 👇

#NephSky What is the maximum creatinine clearance in humans? @caulimovirus.bsky.social @edgarvlermamd.bsky.social @kidneyboy.bsky.social @nephroseeker.medsky.social @nephrosparks.bsky.social @captainchloride.bsky.social @nephgirlsketch.bsky.social @hswapnil.medsky.social

#IDSky Does antibiotic with better penetration into abscess cavity have advantage over cefazolin for MSSA bacteremia with multiple small abscesses in m. psoas muscle and possible endocarditis? After 5 days of cefazolin 2 g q6h, patient still febrile on vasopressors. Should other antibiotic... 👇🏽

How would you treat patient with septic shock, septic small joints arthritis and small m. psoas abscesses with this blood isolate? 👇🏽 @dralicehan.bsky.social @abstewardess.bsky.social @bradspellberg.bsky.social @drtoddlee.bsky.social @cosepiid.bsky.social @jonathanrydermd.bsky.social

#IDSky Hospitalized patient with Foley develop fever w/o localizing signs. Empiric meropenem was administered and patient responded well but slowly. Three days later, blood culture grew MSSA and OXA-48 positive K. pneumoniae (same in urine culture). MIC for cef/avi is 4 mg/L.

#IDSky Interesting, real ID case. Seven days of fever, arthralgias and myalgias. Four blood culture bottles are positive. History was positive for diary products consumption.

#IDSky Patient with Listeria meningoencephalitis and <1 cm abscess in pons. Allergic to PEN. Recieved meropenem i TMP-SMX 320/1600 mg q6h and it is better. Would you switch to oral TMP-SMX and in which dose. Patient is 75 kg. @dralicehan.bsky.social @catherineberry.bsky.social

#IDSky I was honored that I can present #UTI #Wikiguidelines on congress about urinary tract infections and urosepsis. Thank you @bradspellberg.bsky.social @drtoddlee.bsky.social @dremilymcd.bsky.social and others about creating such amazing movement.

#IDSky Older patient with septic shock. Started on meropenem and vancomycin. Blood culture grew isolate shown below. What would be your antibiotic of choice, what would you use for oral switch, and how long would you treat? @dralicehan.bsky.social @empiricgame.bsky.social @bradspellberg.bsky.social

#NephSky #PharmSky Should we BSA adjusted eGFR (non-indexed eGFR, mL/min) instead Cockroft-Gault Equation for antibiotic dosing? @idstewardship.bsky.social @kidneyboy.bsky.social @edgarvlermamd.bsky.social @captainchloride.bsky.social @drtoddlee.bsky.social @caulimovirus.bsky.social

#NephSky How acetazolamide works in case of nephrogenic DI? What is the mechanism? @kidneyboy.bsky.social @caulimovirus.bsky.social @edgarvlermamd.bsky.social @hswapnil.medsky.social @nephrosparks.bsky.social @juancarlosqvelez.bsky.social @renaltubules.bsky.social @captainchloride.bsky.social

#CriticalCare #NephSky Can standard simple therapy CVC be used instead HD-CVC for RRT in critical care if HD-CVC for some reason cannot be placed? Did anyone tried this? @christosargyrop.bsky.social @pulmcrit.bsky.social @kidneyboy.bsky.social @hswapnil.medsky.social @captainchloride.bsky.social

#NephSky If patient presents with severe non-acute hyponatremia (Na <125 mmol/L) and hypokalemia (K <3.0 mmol/L), how this should be treated to prevent osmotic demyelination syndrome? Should we include K correction rate in Na correction rate, not to pass the 8-12 mmol/L/24 h correction threshold?

#NephSky How to measure dialysis adequacy in patients with AKI? Is there a method equivalent to ESKD patients on HD? Can I use Kt/V and URR, and if yes, what would be the cut-offs? @kidneyboy.bsky.social @nephroseeker.medsky.social @captainchloride.bsky.social @edgarvlermamd.bsky.social

#CriticalCare Pt was found at home, unresponsive + shock. History + well controled HIV and HBV cirrhosis on Biktarvy and DM type 2 on insulin. ABG from admission in #ICU 👇. Patient needs fluid resuscitation. What fluid woud you prescribe based on pH-resuscitation guidelines? @pulmcrit.bsky.social

For my collegues from Canada, from the Park of Friendship in Belgrade, Serbia. 😊 @drtoddlee.bsky.social @dremilymcd.bsky.social

#IDSky What would be your empiric antibiotic therapy in patients with suspected secondary bacterial pneumonia in patient with Influenza virus infection? Would you trust cefazolin as cover for MSSA in this scenario? @dralicehan.bsky.social @bradspellberg.bsky.social @mav-rust.bsky.social

#IDSky #UTI #WikiGuidelines Using tap water for treatment of CAUTI and decrease use of antibiotics. pubmed.ncbi.nlm.nih.gov/39414620/ Update for UTI Guidelines? @bradspellberg.bsky.social @drtoddlee.bsky.social @dremilymcd.bsky.social @dralicehan.bsky.social @mav-rust.bsky.social

#IDSky What is you approach to fever without other specific symptoms which appear after coronary (or other) stent placement procedure? @dralicehan.bsky.social @catherineberry.bsky.social @bradspellberg.bsky.social @drtoddlee.bsky.social @cosepiid.bsky.social @dremilymcd.bsky.social

#NephSky Did you (ever) use electrolyte free water clearance for DDAVP dose optimisation in patients with central DI? I have a patient with history of central DI on desmopressin (0.2 mg BID) who developed hypernatremia during acute illness due to poor water intake. After inital partial correction 👇

@pulmcrit.bsky.social I found this typo in your blog about hypomagnesemia. In text you state that hypophosphatemia can be cause of hypomagnesemia (image 1), but in diagram (image 2) there is hyperphosphatemia as a cause.

@kidneyboy.bsky.social I found your old blog post. Sorry for asking, but I am not sure how much fluid and what type was prescribed for replacement in this patient at the end. Can you explain the specifics? pbfluids.com/2009/07/thin...

#IDSky Three days of mildly sore throat and malaise and I am again COVID-19 positive. No other symptoms. Should I try Paxlovid® again? Two years ago all symptoms vanished after only two doses of Paxlovid® but the altered taste wasquite annoying.

#MedSky #NephSky How do you dose furosemide for ascites in decompensated cirrhosis? Once daily or multiple times per day, when higher doses (>40 mg/day) are used? @nephroseeker.medsky.social @kidneyboy.bsky.social @hswapnil.medsky.social @captainchloride.bsky.social @rmcentor.bsky.social

#IDSky For those interested, an UPDATE: cefazolin 2 g, IV, loading dose, and then 8 g/24 h as continuous infusion was prescribed. Patient was responded quite well both clinically and biochemically judging by inflammatory markers. Thank you all.

#IDSky I updated all-in-one table for #ShorterIsBetter approach based on @bradspellberg.bsky.social original work. All references of mentioned studies in the table are available on: www.bradspellberg.com/shorter-is-b... PDF document is availabe on demand (send me DM).

#IDSky @bradspellberg.bsky.social Can we conclude from this data that for the first row 8 weeks would be equal to 12 weeks?

#IDSky Patient with proven meticillin-sensitive Staphylococcus aureus (👇) bacteremia and sepsis, but there is also high suspicion of endocarditis and concomitant meningitis. How would you treat? What do you think about high-dose cefazolin (8-10 g/day, continuous IV or 2 g, q6h, IV) as monotherapy 👇

#IDSky Does cellulitis on chronically lymphedematous limb requires longer course of antibiotics than "simple" celullitis? @dralicehan.bsky.social @abstewardess.bsky.social @bradspellberg.bsky.social @drtoddlee.bsky.social @cosepiid.bsky.social @jonathanrydermd.bsky.social @mav-rust.bsky.social

#MedSky #NephSky #ICUSky Is it possible clinically to make distinction between peripheral edema due volume overload and edema from capillary leak from sepsis or other cause? Any tricks and perils? @argaiz.bsky.social @edgarvlermamd.bsky.social @pulmcrit.bsky.social @kidneyboy.bsky.social

#NephSky Can you treat fluid overload in anuric patient due tu AKI in low-resource settings by causing diarrhea? @pulmcrit.bsky.social @kidneyboy.bsky.social @nephroseeker.medsky.social @juancarlosqvelez.bsky.social @emcrit.bsky.social @captainchloride.bsky.social @hswapnil.medsky.social

#IDSky Does anyone has an access to this article in full? pubmed.ncbi.nlm.nih.gov/34666060/ @absteward.bsky.social @mav-rust.bsky.social @dralicehan.bsky.social @jameswilsondo.bsky.social

#IDSky Would you ever treat asymptomatic chronic non-typhoidal Salmonella carrier state? If yes, which antibiotic would you use and for how long? @dralicehan.bsky.social @abstewardess.bsky.social @bradspellberg.bsky.social @catherineberry.bsky.social @drtoddlee.bsky.social @mav-rust.bsky.social

#IDSky Beautiful isolate from 🩸-culture in patient with CAUTI and septic shock? Do we really need empiric meropenem for severely ill patients coming from home? Choice of antibiotic people? @bradspellberg.bsky.social @dralicehan.bsky.social @idiots-pod.bsky.social @mav-rust.bsky.social

#IDSky How would you treat artificial knee joint infection caused by Staphylococcus lugdunensis (susceptibility report 👇🏼). @cortes-penfield.bsky.social @dralicehan.bsky.social @bradspellberg.bsky.social @drtoddlee.bsky.social @idvilchez.bsky.social @mav-rust.bsky.social @catherineberry.bsky.social

#IDSky Patient was proven to be CNS aspergilosis by examination of tissue by microbiologist. Liposomal amphotericin B and voriconazole were prescribed and patient responded well based on imaging. During therapy patoent developed transitory leukopaenia and anemia which corrected on transfusion. 👇🏼

#NephSky Pt with disseminated pancreatic malignancy presented with few days of intractable vomiting and volume depletion. Those are ABG values: pH 7.763 PCO₂ 7.54 kPa PO₂ 5.44 kPa SpO₂ 79.7% K 2.3 Na 143 Ca 0.75 mmol/L Cl low (below machine treshold) glucose 12.8 mmol/L lactate 3.0 HCO₃ 68.8 mmol/L

But it was nice to finally have some clinical data too. This is the one I quote when I have to convince surgeons, icu, etc. doi.org/10.1093/ofid...

#IDSky What do you use as an empiric therapy for necrotizing soft tissue infections (fasciitis)? Please elaborate why. @empiricgame.bsky.social @dralicehan.bsky.social @absteward.bsky.social @abstewardess.bsky.social @antibioticdoc.bsky.social @bradspellberg.bsky.social

1️⃣ #IDSky Middle-aged patient with history of bone-marrow transplantation 4 years ago for ALL in remission, and surgery for leiomiosarcoma of the colon 3 years ago, presented with clinical signs of unilateral pneumonia. Chest CT showed diffuse tree-in-bud pattern, 👇🏼

Cat bites (punctures) are typically worse than dog bites (tears) for Pasteurella multocida and other pathogens since they lead to a deeper inoculation belied by surface appearance Worst animal to be bitten by in terms of infectious risk however: ANOTHER HUMAN Now a 🧵/ Top 10 exotic bite infections

#CriticalCare #NephSky Guidelines state that we should give albumin for hepatorenal syndrome? Does this apply to all patients, or only those with some level of hypoalbuminemia? Recently I saw a patitent with HRS and albumin of 32 g/L. What is the practice? @pulmcrit.bsky.social @emcrit.bsky.social