I'm watching one of my favorite holiday movies: The Muppet Christmas Carol. It reminded me that Tiny Tim probably had tuberculosis (TB) & rickets. Everything is TB. Several articles have examined the conditions & common ailments in 1800s London. Here's a good one. jamanetwork.com/journals/jam...

Blujepa was approved in March of this year. Contepo was approved in November. Orlynvah was approved in October of 2024, but I threw it in here too. I actually have heard of Blujepa being used in practice, but I haven't heard of anyone seeing Orlynvah yet.

Stay safe on your travels next week. It's a bit too late to get vaccines for next week's travels, but it's a good idea to make sure you're up to date. Keeping your hands clean is a very important way to reduce infection risks, especially while traveling. Happy #USAAW and Happy Thanksgiving!

Even our vets and pets can contribute to antimicrobial resistance. We mentioned livestock yesterday, but today is about how pet owners and veterinarians can help prevent antimicrobial resistance.

We often overlook agriculture and farming when thinking about antimicrobial stewardship, but we're exposed to numerous resistant bacteria from these sources. Most of the recent food recalls are due to agricultural runoff and poor manure management.

Yesterday's post was about the people in direct contact with the patient. Today's #USAAW week post is about the backbone of most of our stewardship programs: the clinical micro lab. We're all in this together. We all have a role.

For our first #USAAW week post, let's look at the 5 Ds of Stewardship. This is one place were providers, pharmacist, and other patient care team members can make a big difference. #WereInItTogether

Mastery Monday: This came up this weekend, so I made an infographic about it. It's a pretty common question that pharmacy gets from providers at all levels. Is your patient allergic or not? Most PCN allergies aren't real, but we want to be cautious with any allergy a patient reports.

I don't know about you, but my nightmares are filled with superbugs and NDMs, not Freddy Krueger and Jason Voorhees. That makes March, Friday the 13th the perfect time to come together to fight and prevent these real monsters. Save the date: more details to come.

Sometimes, the sodium content of antibiotics matters. Just last week, there was a CHF patient with pneumonia who wasn’t improving - It turns out that the culprit wasn’t infection severity; it was likely the sodium load from Zosyn (piperacillin–tazobactam). Check out our "fry scale."

It's Wednesday and I forgot to post our Mastery Monday post on here. Oops! Drug fever is relatively uncommon, with estimates varying but often placing it around 3-5% of drug-related adverse effects or 1-3% of fevers of unknown origin. If you see a persistent fever, it could be worth considering.

Mastery Monday: I wouldn't say Tygacil is a first line for VRE, but it's an option (and it can be a good one for polymicrobial intrabdominal infections associated with VRE). Linezolid is an option even if someone is on an SSRI, depending on the patient.

Mastery Monday: Azithromycin is a fun antibiotic to learn about because it's kind of weird. It's also not as effective as it used to be, which is a global concern due to overprescribing because it is cheap and easily accessible. Who hasn't had an unnecessary Z-Pak? I think most of us have.

Mastery Monday: This week it's oral cephalosporins.The main point is that even though your isolate is susceptible to a ceftriaxone, that doesn't mean the drugs will cover it. We usually use cefazolin as a surrogate.PharmSoHard did a really good podcast about cefdinir data and controversies in 2023.

Mastery Monday: Since it's early in the school year for our new students, residents, and fellows, I thought I'd start doing some "Mastery Monday" posts with some simple, easy to digest facts that will help you all grow into good stewards. If you have an idea for a future topic, let me know.

We have Amanda's CAP guideline summary here, though there is a little controversy with this one!

I've summarized the new cUTI IDSA guidelines (they came out on July 17. A new CAP guideline came out then too but there's some IDSA/ATS drama so I was waiting on the official IDSA letter for that one - who knew ID was so spicy?).

Sunday kicks off Shark Week, and it’s also the 50th Anniversary of Jaws this summer! You might wonder what sharks have to do with stewardship. As apex predators, they face many of the same challenges we do. Stewardship is a team sport and affects the whole ecosystem! #SharkWeek #jaws50

Did you know that today's holiday used to be associated with tetanus? The severity of the disease led some to compare the holiday's death toll to that of major battles for independence.

Check out our latest blog post to join our education committee and find out more about the ADH survey. www.arstewardship.org/post/join-ou...

If you’re like me and couldn’t make it to MAD-ID, you can follow here.

I'm behind on my MMWR, but the March 27th edition had a case study about an Arkansas splash pad and a fatal N. fowleri infection. I'm sure most of us remember the case (it was in 2023) but it's an interesting article with some information about the almost always fatal amoeba.

Happy Medical Laboratory Professionals Week to all the lab peeps. We couldn’t do it without you.

What a great #ARSAS yesterday! Thank you to everyone who attended! We couldn’t do it without your support.

New Mexico has entered the chat... www.koat.com/article/new-...

📝 Here are cliff notes on the new FDA-approved product #Emblaveo www.idstewardship.com/drugs/aztreo... 💠 IV only 💠 Activity vs Ambler Class B metallo-beta-lactamase (MBL) producing gram negative bacteria (e.g., NDM) 💠 Likely will be expensive 💠 Has been approved in Europe since April 2024 #IDsky

Yo, doc. So they say the half-life's long.

Big Data Bayesian Truths: No Vancomycin Trough Concentration Target is Sufficiently Precise for Safety or Efficacy ✅ Just Accepted #IDSky

Our love for stewardship is infectious! Find out more about all the great topics at the stewardship summit on our site: www.arstewardship.org/event-detail...

Are your stewardship interventions love notes or lectures? Learn how to increase your influence with communication strategies at our conference on Feb 28!

I'm excited to post our summit schedule (www.arstewardship.org/summit for the full schedule). I seriously can't decide which of the breakouts I want to see. I want to see them all!

A great feature on one of our board members, Shanda Ferguson, Pharm.D. The featured article underscores her commitment ensuring that residents of Arkansas receive the highest standard of care, even in rural areas.

All this weather made me think of psychrophiles! Most microbes won't survive in these cold temps, but these guys thrive in it. You can read more here: pmc.ncbi.nlm.nih.gov/articles/PMC...

Happy New Year's Eve! Wishing you all a joyful and prosperous new year ahead! The conference is right around the corner. We can't wait to see you there.

Who needs all those birds? What every person interested in ID really wants is to join us in February to learn and share with Infectious Disease specialists throughout the state! Registration is open now. There are discounts for trainees. www.arstewardship.org/event-detail...

On the twelfth day of ID Christmas, in patient histories, 12 normal urines, eleven wounds a weeping, 10 courses completing, 9 pipettes piping, 8 livestock exposures, 7 Vibrio swimming, 6 chest x-raying, 5 golden Staph, 4 shedding birds, 3 gram stains, 2 vials of vanco, and E. coli in a petri.

On the eleventh day of ID Christmas, in patient histories, eleven sounds a weeping, 10 courses completing, 9 pipettes piping, 8 livestock exposures, 7 Vibrio swimming, 6 chest x-raying, 5 golden Staph, 4 shedding birds, 3 gram stains, 2 vials of vanco, and E. coli in a petri.

On the tenth day of ID Christmas, pharmacy gave to me ten courses completing, nine pipettes piping, eight livestock exposures, seven Vibrio swimming, six chest x-raying, five golden Staph, four shedding birds, three gram stains, two vials of vanco, and E. coli in a petri.

On the ninth day of ID Christmas, micro lab gave to me nine pipettes piping, eight livestock exposures (the patient milks cows for a living), seven Vibrio swimming, six chest x-raying, five golden staph, four shedding birds, three gram stains, two vials of vanco, and E. coli in a petri.

On the eighth day of ID Christmas, in patient histories: eight livestock exposures (the patient milks cows for a living), seven Vibrio swimming, six chest x-raying, five golden staph, four shedding birds, three gram stains, two vials of vanco, and E. coli in a petri.

On the seventh day of ID Christmas, micro lab gave to me seven Vibrio swimming, six chest x-rating, five golden staph, four shedding birds, three gram stains, two vials of vanco, and E. coli in a petri.

On the sixth day of ID Christmas, in patient histories: six chest x-rating, five golden staph, four shedding birds, three gram stains, two vials of vanco, and E. coli in a petri.

On the fifth day of ID Christmas, microlab gave to me: five golden staph, four shedding birds, three gram stains, two vials of vanco, and E. coli in a petri. Golden staph is always the gift that keeps on giving (us trouble).

“Just how many birds did the patient get for Christmas? Are they running an aviary? This is going the differential.”

On the third day of ID Christmas, pharmacy gave to me three gram stains, two vials of vanco, and E. coli in a petri.

Our poster session is open for abstract submission. If you're planning to come to the summit and have a fun project to share, submit yours. www.arstewardship.org/submit

On the second day of ID Christmas, pharmacy gave to me two vials of vanco and E. coli in a petri.

Let’s do this. It’s the 12 days of ID Christmas.

The CDC has some good tips about holiday leftovers and thawing and cooking your turkey and other dishes safely! Happy holidays. www.cdc.gov/food-safety/...

We’re at the end of our celebration of antibiotic awareness week! You can continue fighting AMR with us in February at the annual Arkansas Summit for Antimicrobial Stewardship if you’re in Arkansas. Say hi if you’re there! There’s no bad blood with my Bluesky friends!