@jonathanrydermd.bsky.social: A CNS infection case is used as a framework for discussion of advanced CNS diagnostics, including diagnostic stewardship of multiplex PCR meningitis panels, plasma mcfDNA, and CSF mNGS.

A new summary of an old article from our group published in Journal of Infection (doi: 10.1016/j.jinf.2014.12.010) #sepsis #IDsky #infection

Officially open! Very honoured to be asked to cut the ribbon to unveil the new Haematology and Oncology ward at Heartlands Hospital in Birmingham. Thank you to every fan who bought a ticket for the guitar raffle, it really means a lot. Tony 🖤 Footage: BBC Midland News

🔥Just published🔥 SSC 2026 Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026 : Critical Care Medicine #IDsky #EMIMCC @pulmcrit.bsky.social share.google/NbagT9xMBTgk...

This is a great case for trainees to review, highlighting how to approach a complex patient who may not be responding to treatment as expected. The answer is not always "escalate antimicrobial therapy". #AMSSky doi.org/10.1093/cid/...

Another Reason to De-escalate. Check out this week’s KASIC pearl to learn about β-lactam/β-lactamase Inhibitors for MSSA kymdro.org/kasic/?p=8807 #IDsky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs

Abundant

Excited to share our latest publication about SEP-1 metrics during the BCx shortage in the setting of enhanced BCx stewardship efforts @kcawcutt.bsky.social @ichejournal.bsky.social #IDSky www.cambridge.org/core/journal...

In contrast to what ATS guidelines insist, antibiotics don't work for viral CAP... #IDSky

#idboardreview 5 wks post kidney transplant (deceased donor) pt had tremors, lower extremity weakness, confusion, urinary incontinence. 6 wks post transplant: fever, hydrophobia, dysphagia, autonomic instability & died 7wks postT #idsky #idmeded #meded

In the latest episode of The SHEA Podcast, Dr. Jonathan Ryder hosts a pro/con debate on procalcitonin with experts Dr. Michael Mansour and Dr. Sheetal Kandiah. They dig into where PCT adds value (or doesn’t) in antimicrobial stewardship and diagnostic decision-making. bit.ly/4pts2mW

It’s all in formalin?

Could re-title the article “The US could learn a lot from Nebraska”.

RIP Ozzie

Long C-19 is a plethora of pathways... No easy fix, because it's many routes to 🤬☠️ link.springer.com/article/10.1...

I bring here an old article from our group classifying the immunological alterations in sepsis into ten major immunophenotypes. Still useful in my view. #IDsky #immunoSky www.journalofinfection.com/article/S016... www.journalofinfection.com/article/S016...

#Elephants with jobs: Life guard

☝️A Bank of Sand Dollars !

Ran into a colleague, he asked me how I was doing. I said with enthusiasm I was on my way to “make a sweet diagnosis”. He said “what, diabetes?” I had a quick laugh but I don’t think he heard a word I said after that because he couldn’t stop laughing for the rest of the time we talked. Good 4 him.

Thank you CDC for calling me back after hours on a Friday. You helped me provide world class care to a patient with a rare and difficult to treat infection. You are an absolute global treasure! #IDSky

I loaded an antibiogram into google sheets, data on over 100k isolates. Gemini, the AI assistant, offered, without me asking for it, if I wanted it to analyze the data. I thought sure why not, let’s see what it can do. I asked it a few simple questions and guess what? It’s terrible. #IDSky

Real-World HIV RNA And Antigen/Antibody Testing Among People Who Use Long-Acting Injectable PrEP - academic.oup.com/cid/advance-...

I canceled Netflix.

Only now is it suggested that evidence based medicine be used as evidence in medical malpractice. There’s a lot of weak evidence out there and “custom” often masquerades as weak evidence. Hate to think someone has lost previously because “custom” trumped evidence.

🆕 from Ilges et al: Real-word utility of procalcitonin (PCT) in patients hospitalized with community-acquired pneumonia: A matched cohort study ▶️ Authors find PCT testing not associated w/ reduced antimicrobial utilization, LOS, or 30-day all-cause mortality #IDSky 📄: doi.org/10.1017/ice....

There it is, mostly young, ~50% unvaccinated, 50% pending determination. www.dshs.texas.gov/news-alerts/...

Looking for data on vaccination status and age of those infected to inform wider population risk. www.nytimes.com/2025/03/04/u...

Among hospitalized patients, electronic sepsis screening compared with no screening resulted in significantly lower in-hospital 90-day mortality. ja.ma/3XqAyr9 #MedSky

Cannot thank @drandrekalil.bsky.social enough for inviting me to write this commentary on the BALANCE trial for ACP Journal Club in @annalsofim.bsky.social this month! #ShorterIsBetter #IDSky @unmc-id.bsky.social www.acpjournals.org/doi/10.7326/...

I indiscriminately cancel procalcitonin when I see it ordered.

Study finds no link between CMS sepsis bundle, fewer deaths A systematic review and meta-analysis found no high- or moderate-level evidence that compliance with SEP-1 was associated with a mortality benefit. www.cidrap.umn.edu/a...

Heard this on NPR posting like an article I didn’t want to lose. “To fixate too much on the word God, I think, is to miss out the fact that prayer arises naturally in the human heart, whether or not anybody has a relationship to formal religion” - Padraig O’Tuama

Taking a history today, asked the patient if they had any metal or plastic in their body. Patient replied “No, nothing recyclable” #IDSky

meridian.allenpress.com/jgme/article... Will see if I can get this to work in Cerner.

Is the CDC/IDSA Avian flu call still on? Date & Time Jan 23, 2025 04:00 PM Eastern Time (US and Canada) Webinar ID 948 4482 2767 Description Date: Thursday, January 23 (4:00 p.m. - 5:15 p.m. ET) (U.S. and Canada) #IDSky

We finally succeeded in visualizing influenza viruses in droplets! Jin Pan found that virions hung around with mucin, which helped keep them intact and preserved infectivity. pubs.acs.org/doi/full/10.... Free preprint at drive.google.com/file/d/1tMgc... /1

#idsky Anyone have experience with IM Tobramycin for outpatient treatment of MDR P. aeruginosa UTI? The 2023 CLSI Update suggests aminoglycosides may be “suitable” for UTI but gentamicin was removed as a treatment option for P. aeruginosa. Trying to reconcile IM Tobramycin vs Gent for my clinic.

🆕💫Systematic review and meta-analysis Diagnostic accuracy of Xpert MTB/RIF Ultra for detecting pulmonary tuberculosis and rifampicin resistance #idsky #tbsky link.springer.com/article/10.1...

For Maths fans, 2025 is a square. 45² = 45 x 45 = 2025 Also, 9² x 5² = 2025 40² + 20² + 5² = 2025 My favourite? 1³+2³+3³+4³+5³+6³+7³+8³+9³ = 2025 #Mathematics #teaching #education

Staphylococcus aureus Tetracycline Resistance and Co-resistance in a Doxy-PEP-Eligible Population ✅ Just Accepted #IDSky

This review article provides an overview of the "basics" in leveraging ambulatory antimicrobial stewardship measures to build a sustainable program. #IDsky bit.ly/3DbzU9r

🦠We call a lot of things “sepsis” 🔎Our #AnnalsofIM study examined how broad this grab bag really is ⚠️Among ~75,000 patients with sepsis, we found remarkably wide spectrum of presentations & outcomes across infection source & organ dysfunction patterns Thread ⬇️ #medsky #emimcc #idsky #pharmsky

Mid 50s patient presents to the hospital with fever, chills, headache. HOD 2 the primary service can’t find an infection so they call ID. The patient is visible distressed, but able to provide some history, just having gotten back from visiting a hot springs. 1/ www.statnews.com/2024/12/16/c...

Interesting post, & one I have some sympathy with. Sepsis is a useful pathophysiological concept, but hard to pin down in clinical reality. The closer we get to an effective, universal diagnostic for pathogen ID & host response (I.e. the hallmark of infection) the closer we will be to squaring this.

8 yo boy out fishing with his dad. The boy scales over a ledge to get close to the river, on his descent, something flies out of the darkness, hits the boy in the palm and flys off. It flew oddly, unlike a bird, and the suspicion was for a bat. No skin is broken on the boys palm. PEP or not? 🤔

Sepsis and Septic Shock www.nejm.org/doi/full/10.... "... we lack a precise definition of the dysregulated host response [to infection] and a diagnostic test to confirm its presence. Moreover, we have limited ability to confirm or characterize infection in real time." #IDSky #PedsIDSky #Sepsis

📸Random image The Frequency of Dual Allergy to Penicillins and Cefazolin #idsky #medsky #AMSsky

Dear incoming ID Fellows, you are truly entering a fellowship in every sense of the word. You will always have a home among your peers and those that came before you, having shared the same struggles and successes as you continue, as we do, to try to make the world a better place.