Intéressant... Jamais vu encore en vrai.. Gentil rappel de toujours examiner les patients complètement, même si un diagnostic de choc sur pneumonie ou tableau abdominal semblant évident

hvKP is a life-& vision-threatening pathogen that should be promptly recognized The triad of liver abscess + bacteremia + endophthalmitis should prompt immediate suspicion Endophthalmitis is a medical emergency in septic patients with visual symptoms Delays kill eyes and sometimes patients #microsky

Hypervirulent Klebsiella pneumoniae (hvKP ) is a life-threatening pathogen that requires prompt clinical recognition! 🆕💫Tips for intinsvists: Hypervirulent Klebsiella pneumoniae Delays kill eyes - and sometimes patients! #IDsky #EMIMCC link.springer.com/article/10.1...

Cryptococcus neoformans and C. gattii represent encapsulated yeasts which have become increasingly common CNS pathogens during the enlarging age of the immunocompromised host 🆕💫 Review: Pain is in the Brain with the Sugar-Coated Killer #idsky academic.oup.com/jid/article/...

🚨WHO global surveillance (19–22) shows 🔼 gonococcal AMR: 🔴Ceftriaxone 39%↓susceptibility/resistance 🔴Cefixime 50% R 🔴Azithro 88% R 🔴Cipro 99% R ⚠️ Gonorrhoea could become untreatable due to high AMR levels New hope: oral zoliflodacin & gepotidacin #idsky www.thelancet.com/journals/lan...

📢WHO emphasizes there is currently no conclusive scientific evidence confirming a possible link between autism & use of acetaminophen (aka paracetamol) during pregnancy A robust,extensive evidence base exists showing childhood vaccines do not cause autism #idsky www.who.int/news/item/24...

Oh finally blue sky added a bookmark function #idsky

🆕💫Navigating the Muddled Middle: A Case-Based Exploration of Oral β-Lactams for Systemic Gram-Negative Infections The authors explore the utility of oral β-lactams for treatment of systemic GN infections through 3 hypothetical case scenarios #idsky #EMIMCC academic.oup.com/ofid/article...

Rapid diagnostic tests combined with individualised decision-making improve the selection of antibiotic therapy. Rapid de-escalation to narrow-spectrum monotherapy and shortening of the duration of therapy should be the rule. #IDsky #EMIMCC

🆕🔥State of art review with many🌟s + Prof. Jason Roberts Antibiotic therapy for severe bacterial infections 🟢When to start and not to start antibiotics? 🟢Mon vs combo Abx 🟢PK/PD principles 🟢Drug–drug inx A #mustread article for ID professional #idsky link.springer.com/article/10.1...

Klebsiella pneumoniae remains a notorious bug that keeps challenging us in clinical practice—its resistance mechanisms are complex and relentless. This article offers valuable insights. A must-read for the ID community—please share. #idsky

Recent years have seen a dramatic rise in carbapenem-resistant K. pneumoniae which is now recognized as one of the most formidable MDR pathogens worldwide. 🆕🔥The mechanisms of antibiotic resistance & drug resistance transmission of Klebsiella pneumoniae #idsky www.nature.com/articles/s41...

nice!! I need to read the study but it’s consistent with PROPHY-VAP which supports its validity. https://emcrit.org/pulmcrit/prophy-vap/

🆕💫PROTECT RCT Ceftriaxone to prevent early-onset pneumonia in comatose patients after out-of-hospital cardiac arrest: a pilot randomized controlled trial and resistome assessment (PROTECT) #IDsky #EMIMCC @pulmcrit.bsky.social journal.chestnet.org/article/S001...

🆕💫Systematic review and meta-analysis of RCTs with 🌟 Professor Roberts Continuous or extended vs intermittent infusions of beta-lactam antibiotics in ICU patients with pneumonia #IDsky #EMIMCC journals.asm.org/doi/10.1128/...

🆕🔥Streptococcal endocarditis: a meta-analysis of species dependant risk by 🌟s @drtoddlee.bsky.social 🌟Updated figure 🌟Infective endocarditis prevalence of streptococcal species vs. proportion of streptococcal species bacteraemia #idsky #EMIMCC www.sciencedirect.com/science/arti...

🆕🔥Prospective,multinational PK study by 🌟 Prof. Roberts Meropenem & pip/tazo optimised dosing regimens for critically ill patients receiving RRT Dosing nomograms developed to inform dosing for different RRT settings, urine outputs & target conc #idsky link.springer.com/article/10.1...

Finally published 🆕🔥DOTS RCT Among participants with complicated S aureus bacteremia who achieved blood culture clearance, dalbavancin was not superior to standard therapy for achieving a more desirable outcome at day 70 #idsky jamanetwork.com/journals/jam...

#5/5 You have not actually prevented any infections. You simply suppressed colonization growth from non-sterile sites. We are clear in our Discussion that the studies found a statistical reduction in infections that was likely not a true reduction in infections. The trials were poorly designed.

#4/5 When you randomized pts to receive abx or not, and then take cultures from non sterile sites, you will OBVIOUSLY grow more bacteria from the patients randomized to NOT receive abx. You are suppressing colonization with abx. This makes it appear that an infection was prevented. But...

#3/4 The #2 infection type was "pneumonia". Again, numerous studies over the last 20 years have shown that a high percentage of "pneumonias" diagnosed in hospital are not actually pneumonias. Which brings us the fundamental error in the design of all of these trials...

#2/4 The #1 "infection" type in these RCTs was "UTI" based on positive urine culture, with no description of symptoms being present. Since we know that >50% of "UTIs" in hospitals are not UTIs, but asymptomatic bacteriuria, the majority of infections were not actually infections.

#1/5 The problem is even worse than that. It's not simply a trade off of preventing infections vs. worsening resistance & adverse effects. Indeed, it is not at all clear that infections were actually prevented at all in these RCTs. As we discuss, the definition of infection was highly problematic.

The findings of this study re-open the discussion surrounding the long standing and firmly-held belief that antibiotic prophylaxis has a mortality benefit in patients with cirrhosis presenting with upper gastrointestinal bleeds #idsky #EMIMCC

International guidelines recommend 5 to 7 days of antibiotic prophylaxis for patients with cirrhosis & upper GI bleeding. 🆕🔥Systematic Review ( 14 RCTs, N=1322) & Bayesian Meta-Analysis challenged this universally held dogma #idsky jamanetwork.com/journals/jam...

⭐️ 📄 ⭐️ Recently @pharmermeg.bsky.social updated this open-access post. Originally published in 2017, the new version has a complete overhaul & provides a downloadable document. This is an article that has been read by by tens thousands of people 🌎🌍🌏. www.idstewardship.com/cross-reacti... #IDsky

Preach 🙌

This always seemed a weird concept

the distinction between “bactericidal” vs “bacterostatic” antibiotics is some irrelevant BS. this is fantastic, because there are plenty of other complex considerations when it comes to selecting an antibiotic. #EMIMCC

We implore authors, peer reviewers,and journal editors to stop perpetuating the concept of static and cidal antibiotics, given the aforementioned evidence demonstrating it is a myth. In a clinical context, these terms are not complex. Rather,they are simply incorrect journals.asm.org/doi/10.1128/...

Highlights: steroids for severe CAP (which I think most are already doing) and shorter duration of abx for some patients (3-5d).

(I'm not talking about CIMA [Chinese industry ofmeta-analyses} - look at sCAP corticosteroids >> meta-analyses in PubMed, for a laugh...I counted 9 in 2 years...). Problem 1: “grey” literature. All the unpublished studies because they were negative, and therefore never included in the MA...

In brief... I consider only large RCTs, grading them according to their quality and risk of bias... Meta-analyses are NOT the highest level of evidence available This has been elegantly conceptualized by the BMJ's “new” pyramid of evidence. The problems with meta-analyses are many.

Systemic corticosteroids for CAP 🟢For adult inpatients with non-severe CAP, we recommend NOT administering systemic corticosteroids (strong recommendation, low-quality evidence) 🟢For adult inpatients with severe CAP we suggest systemic corticosteroids #idsky

nice to see steroid recommended for severe CAP, its quite overdue (see issue #12 from this blog on the last IDSA guidelines https://emcrit.org/pulmcrit/idsa-cap-guidelines/#12 but these guidelines are incredibly limited in their scope, I believe there are new IDSA CAP guidelines coming out soon?

For adults with suspected CAP, we suggest lung ultrasound is an acceptable diagnostic alternative to chest x-ray in medical centers where appropriate clinical expertise exists(conditional recommendation, low-quality evidence). #idsky 🤔

For adult inpatients with severe CAP who reach clinical stability, we suggest 5 or more days of antibiotics, rather than less than 5 days of antibiotics (strong recommendation,low-quality evidence). #idsky

For adult outpatients with CAP who reach clinical stability, we suggest less than 5 days of antibiotics (minimum of 3 days duration), rather than five or more days of antibiotics(conditional recommendation, low-quality evidence) #idsky

For adult outpatients with co-morbidities who have clinical & imaging evidence of CAP & who test positive for a respiratory virus, we suggest prescribing empiric antibiotics due to concern for bacterial-viral co-infection (conditional recommendation,v low-quality) #idsky

For adult inpatients with clinical & imaging evidence of non-severe CAP who test positive for a respiratory virus,we suggest prescribing empiric antibiotics due to concern for bacterial-viral co-infection conditional recommendation,v low-quality evidence) 🤔 #idsky

Interesting update for Rx CAP from the USA: -USS can be used for Dx rather than CXR if ppl are experienced enough -ABx: 5d or less for nonsevere, 5+ for severe -Steroids for Severe CAP. Shorter Is Better continues to spread!

🔥🔥Just published 🔥🔥 ATS CAP guidelines 2025 Diagnosis and Management of Community-acquired Pneumonia. An Official American Thoracic Society Clinical Practice Guideline Free access pdf #IDsky#EMIMCC www.atsjournals.org/doi/10.1164/...

🔥Finally published🔥 IDSA Guidelines on the Treatment and Management of Complicated Urinary Tract Infections (cUTI) #idsky www.idsociety.org/practice-gui...

🧬 Dear taxonomists: Are we losing Candida? • Candida auris → Candidozyma auris • Candida krusei → Pichia kudriavzevii • Candida glabrata → Nakaseomyces glabrata • Candida lusitaniae → Clavispora lusitaniae • Candida kefyr → Kluyveromyces marxianus #idsky

Taxonomy shift 🚨 Candida auris has been reclassified as Candidozyma auris (C auris ) to reflect its distinct genetic profile from other Candida species. #IDSky #microsky

Many physicians prescribe antibiotics for security amid uncertainty, following the “just in case” mindset: lab monitoring handles cytopenia and hepatotoxicity, C. difficile is treatable, and—why worry about resistance decades later when there’s a patient to care for now ? #idsky

As ID physicians, when asked about the importance of ASP, many of us may share the same answers How do we know that today's carbapenem use will lead to a superbug tomorrow? Why worry about resistance decades later, when I have a patient to worry about now. #IDSky academic.oup.com/cid/article/...

💬 Describe antibiotic stewardship — in at least two words. #IDSky

LOUDER to the people at the back. #IDSky

The clinical value of in vitro data favoring adjunctive therapy for IE or bacteremia is dubious. Adjunctive AGs, once used in S. aureus native valve IE based on observational data, showed no mortality benefit in RCTs—meta-analyses even found increased mortality with adj AGs. #idsky