Podcasts about clin infect dis

Diarrhea is one of the more common concerns in emergency medicine worldwide and in the United States, yet we often do not spend enough time understanding the breadth of causes and considerations for this syndrome. Do you know which patients benefit from Zinc? Would you like to review HUS? Can you mixup Oral Rehydration Solution if you needed to? We cover all of this and more in this “code brown” of a chapter! So come, get dirty with Alex and Venk in this truly crappy chapter of Always on EM!   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-e80. doi: 10.1093/cid/cix669. PMID: 29053792; PMCID: PMC5850553. Gore JI, Surawicz C. Severe acute diarrhea. Gastroenterol Clin North Am. 2003 Dec;32(4):1249-67. doi: 10.1016/s0889-8553(03)00100-6. PMID: 14696306; PMCID: PMC7127018. Freedman SB, van de Kar NCAJ, Tarr PI. Shiga Toxin–Producing Escherichia coli and the Hemolytic–Uremic Syndrome. The New England Journal of Medicine. 2023;389(15):1402-1414. doi:10.1056/NEJMra2108739. Logan C, Beadsworth MB, Beeching NJ. HIV and diarrhoea: what is new? Curr Opin Infect Dis. 2016 Oct;29(5):486-94. doi: 10.1097/QCO.0000000000000305. PMID: 27472290. Chassany O, Michaux A, Bergmann JF. Drug-induced diarrhoea. Drug Saf. 2000 Jan;22(1):53-72. doi: 10.2165/00002018-200022010-00005. PMID: 10647976. Schiller LR. Secretory diarrhea. Curr Gastroenterol Rep. 1999 Oct;1(5):389-97. doi: 10.1007/s11894-999-0020-8. PMID: 10980977. Gong Z, Wang Y. Immune Checkpoint Inhibitor-Mediated Diarrhea and Colitis: A Clinical Review. JCO Oncol Pract. 2020 Aug;16(8):453-461. doi: 10.1200/OP.20.00002. Epub 2020 Jun 25. PMID: 32584703. Do C, Evans GJ, DeAguero J, Escobar GP, Lin HC, Wagner B. Dysnatremia in Gastrointestinal Disorders. Front Med (Lausanne). 2022 May 13;9:892265. doi: 10.3389/fmed.2022.892265. PMID: 35646996; PMCID: PMC9136014. Expert Panel on Gastrointestinal Imaging; Chang KJ, Marin D, Kim DH, Fowler KJ, Camacho MA, Cash BD, Garcia EM, Hatten BW, Kambadakone AR, Levy AD, Liu PS, Moreno C, Peterson CM, Pietryga JA, Siegel A, Weinstein S, Carucci LR. ACR Appropriateness Criteria® Suspected Small-Bowel Obstruction. J Am Coll Radiol. 2020 May;17(5S):S305-S314. doi: 10.1016/j.jacr.2020.01.025. PMID: 32370974. Rami Reddy SR, Cappell MS. A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep. 2017 Jun;19(6):28. doi: 10.1007/s11894-017-0566-9. PMID: 28439845. Modahl L, Digumarthy SR, Rhea JT, Conn AK, Saini S, Lee SI. Emergency department abdominal computed tomography for nontraumatic abdominal pain: optimizing utilization. J Am Coll Radiol. 2006 Nov;3(11):860-6. doi: 10.1016/j.jacr.2006.05.011. PMID: 17412185. Scheirey CD, Fowler KJ, Therrien JA, et al. ACR Appropriateness Criteria Acute Nonlocalized Abdominal Pain. Journal of the American College of Radiology : JACR. 2018;15(11S):S217-S231. doi:10.1016/j.jacr.2018.09.010. Atia AN, Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol. 2009 Oct;104(10):2596-604; quiz 2605. doi: 10.1038/ajg.2009.329. Epub 2009 Jun 23. PMID: 19550407. Musekiwa A, Volmink J. Oral rehydration salt solution for treating cholera: ≤ 270 mOsm/L solutions vs ≥ 310 mOsm/L solutions. Cochrane Database Syst Rev. 2011 Dec 7;2011(12):CD003754. doi: 10.1002/14651858.CD003754.pub3. PMID: 22161381; PMCID: PMC6532622. Centers for Disease Control and Prevention (CDC). Scombroid fish poisoning associated with tuna steaks--Louisiana and Tennessee, 2006. MMWR Morb Mortal Wkly Rep. 2007 Aug 17;56(32):817-9. PMID: 17703171. Résière D, Florentin J, Mehdaoui H, Mahi Z, Gueye P, Hommel D, Pujo J, NKontcho F, Portecop P, Nevière R, Kallel H, Mégarbane B. Clinical Characteristics of Ciguatera Poisoning in Martinique, French West Indies-A Case Series. Toxins (Basel). 2022 Aug 3;14(8):535. doi: 10.3390/toxins14080535. PMID: 36006197; PMCID: PMC9415704. Centers for Disease Control and Prevention (CDC). Ciguatera fish poisoning--Texas, 1998, and South Carolina, 2004. MMWR Morb Mortal Wkly Rep. 2006 Sep 1;55(34):935-7. PMID: 16943762. Thyroid Inferno EM Blog: https://emblog.mayo.edu/2014/11/01/thyroid-inferno/  Lazzerini M, Wanzira H. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2016 Dec 20;12(12):CD005436. doi: 10.1002/14651858.CD005436.pub5. PMID: 27996088; PMCID: PMC5450879. Dhingra U, Kisenge R, Sudfeld CR, Dhingra P, Somji S, Dutta A, Bakari M, Deb S, Devi P, Liu E, Chauhan A, Kumar J, Semwal OP, Aboud S, Bahl R, Ashorn P, Simon J, Duggan CP, Sazawal S, Manji K. Lower-Dose Zinc for Childhood Diarrhea - A Randomized, Multicenter Trial. N Engl J Med. 2020 Sep 24;383(13):1231-1241. doi: 10.1056/NEJMoa1915905. PMID: 32966722; PMCID: PMC7466932. Dalfa RA, El Aish KIA, El Raai M, El Gazaly N, Shatat A. Oral zinc supplementation for children with acute diarrhoea: a quasi-experimental study. Lancet. 2018 Feb 21;391 Suppl 2:S36. doi: 10.1016/S0140-6736(18)30402-1. Epub 2018 Feb 21. PMID: 29553435.   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

Drs. Pier Giorgio Cojutti and Navaneeth Narayanan join Dr. Megan Klatt to break down what you need to know about amoxicillin/clavulanate dosing. Tune in to learn more about the PK/PD of amoxicillin and clavulanic acid, how we landed on certain ratios for the treatment of common infections, strategies to optimize dosing for serious infections, and more! References: Oral amoxicillin and amoxicillin-clavulanic acid: properties, indications and usage. Clin Microbiol Infect. 2020 Jul;26(7):871-879. doi: 10.1016/j.cmi.2019.11.028. Epub 2019 Dec 4. PMID: 31811919. New formulations of amoxicillin/clavulanic acid: a pharmacokinetic and pharmacodynamic review. Clin Pharmacokinet. 2005;44(11):1097-115. doi: 10.2165/00003088-200544110-00001. PMID: 16231964. Non-linear absorption pharmacokinetics of amoxicillin: consequences for dosing regimens and clinical breakpoints. J Antimicrob Chemother. 2016 Oct;71(10):2909-17. doi: 10.1093/jac/dkw226. Epub 2016 Jun 20. PMID: 27330071. Augmentin (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infection: a review of the continuing development of an innovative antimicrobial agent. J Antimicrob Chemother. 2004 Jan:53 Suppl 1:i3-20. doi: 10.1093/jac/dkh050. PMID: 14726431. Is the standard dose of amoxicillin-clavulanic acid sufficient? BMC Pharmacol Toxicol. 2014 Jul 21:15:38. doi: 10.1186/2050-6511-15-38. PMID: 25047044. MIC of amoxicillin/clavulanate according to CLSI and EUCAST: discrepancies and clinical impact in patients with bloodstream infections due to Enterobacteriaceae. J Antimicrob Chemother. 2017 May 1;72(5):1478-1487. doi: 10.1093/jac/dkw562. PMID: 28093484. Amoxicillin-Clavulanate Breakpoints Against Enterobacterales: Rationale for Revision by the Clinical and Laboratory Standards Institute. Clin Infect Dis. 2024 Aug 16;79(2):516-523. doi: 10.1093/cid/ciae201. PMID: 38626241. Amoxicillin-Clavulanate Breakpoints Against Haemophilus influenzae: Rationale for Revision by the Clinical and Laboratory Standards Institute. Clin Infect Dis. 2025 Feb 24;80(2):481-482. doi: 10.1093/cid/ciae246. PMID: 38709848. No evidence of difference in mortality with amoxicillin versus co-amoxiclav for hospital treatment of community-acquired pneumonia. J Infect. 2024 Jun;88(6):106161. doi: 10.1016/j.jinf.2024.106161. Epub 2024 Apr 23. PMID: 38663754. Population pharmacokinetics and dosing simulations of amoxicillin in obese adults receiving co-amoxiclav. J Antimicrob Chemother. 2020 Dec 1;75(12):3611-3618. doi: 10.1093/jac/dkaa368. PMID: 32888018. Comprehensive guidance for antibiotic dosing in obese adults: 2022 update. Pharmacotherapy. 2023 Mar;43(3):226-246. doi: 10.1002/phar.2769. Epub 2023 Feb 18. PMID: 36703246.

This StAR episode features the CID State-of-the-Art Review on Ocular Infections.Our guest stars this episode are:Miriam Barshak (Massachusetts General Hospital; Mass Eye and Ear)Akash Gupta (University of Pittsburgh Medical Center)Journal article link: Barshak MB, Durand ML, Gupta A, Mohareb AM, Dohlman TH, Papaliodis GN. State-of-the-Art Review: Ocular Infections. Clin Infect Dis. 2024;79(5):e48-e64. doi:10.1093/cid/ciae433Journal companion article - Executive summary link: https://academic.oup.com/cid/article-abstract/79/5/1125/7906419From Clinical Infectious DiseasesEpisodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.comFebrile is produced with support from the Infectious Diseases Society of America (IDSA)

Un nouvel épisode du Pharmascope est disponible! Dans ce 153e épisode, Nicolas, Isabelle et Olivier discutent de chlamydia et de gonorrhée. Cette deuxième partie est consacrée au traitement de ces infections. Les objectifs pour cet épisode sont les suivants: Discuter de la prise en charge de la chlamydia et de la gonorrhée.  Discuter des traitements antibiotiques de la chlamydia et de la gonorrhée.  Discuter de l'utilisation de la DOXY-PEP. Ressources pertinentes en lien avec l'épisode  Agence de la santé publique du Canada. Chlamydia, gonorrhée et syphilis infectieuse au Canada : Données de surveillance de 2021. INESSS. Guide d'usage optimal : Infection confirmée à Chlamydia trachomatis ou à Neisseria gonorrhoeae. Septembre 2024. INESSS. Guide d'usage optimal : Approche syndromique. Décembre 2024. Portail VIH/sida du Québec : Notification anonyme des partenaires. MSSS. Traitement accéléré des partenaires pour les infections à Chlamydia trachomatis et à Neisseria gonorrhoeae - Aide-mémoire pour les cliniciens. Juillet 2021. MSSS. Traitement accéléré des partenaires pour les infections à Chlamydia trachomatis et à Neisseria gonorrhoeae - Aide-mémoire pour les pharmaciens. Juillet 2021. MSSS. Carte de notification chlamydia/gonorrhée. Juillet 2021. Páez-Canro C et coll. Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non-pregnant women. Cochrane Database Syst Rev. 2019 Jan 25;1(1):CD010871. Lau A et coll. Azithromycin or Doxycycline for Asymptomatic Rectal Chlamydia trachomatis. N Engl J Med. 2021 Jun 24;384(25):2418-2427. Bížová B et coll. Single-dose cefixime 800 mg plus doxycycline 100 mg twice a day for 7 days compared with single-dose ceftriaxone 1 g plus single-dose azithromycin 2 g for treatment of urogenital, rectal, and pharyngeal gonorrhoea: a randomised clinical trial. Clin Microbiol Infect. 2024 Feb;30(2):211-215. Nguyen PTT et coll. Randomized controlled trial of the relative efficacy of high-dose intravenous ceftriaxone and oral cefixime combined with doxycycline for the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae co-infection. BMC Infect Dis. 2022 Jul 9;22(1):607. Yang KJ et coll. Effectiveness of Cefixime for the Treatment of Neisseria gonorrhoeae Infection at 3 Anatomic Sites: A Systematic Review and Meta-Analysis. Sex Transm Dis. 2023 Mar 1;50(3):131-137. Kirkcaldy RD et coll. The efficacy and safety of gentamicin plus azithromycin and gemifloxacin plus azithromycin as treatment of uncomplicated gonorrhea. Clin Infect Dis. 2014 Oct 15;59(8):1083-91. Bachmann LH, Barbee LA, Chan P, et colll. CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. MMWR Recomm Rep. 2024;73(2):1-8.

Drs. Amy Mathers and Julie Ann Justo join Dr. Erin McCreary to talk all things Stenotrophomonas maltophilia, a water-loving organism and frequent colonizer. Hear from the experts on why this organism is so difficult to treat, which agents have in vitro activity, and how to optimize antimicrobial regimens, including the use of combination therapy, in the setting of true infections. This medical education was provided by an unrestricted grant from Shionogi. References: Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Clin Infect Dis. 2024 Aug 7:ciae403. doi: 10.1093/cid/ciae403. PMID: 39108079. Clinical challenges treating Stenotrophomonas maltophilia infections: an update. JAC Antimicrob Resist. 2022 May 5;4(3):dlac040. doi: 10.1093/jacamr/dlac040. PMID: 35529051. Alterations of the Oral Microbiome and Cumulative Carbapenem Exposure Are Associated With Stenotrophomonas maltophilia Infection in Patients With Acute Myeloid Leukemia Receiving Chemotherapy. Clin Infect Dis. 2021 May 4;72(9):1507-1513. doi: 10.1093/cid/ciaa778. PMID: 32544947. An Overview of the Treatment of Less Common Non–Lactose-Fermenting Gram-Negative Bacteria. Pharmacotherapy. 2020 Sep;40(9):936-951. doi: 10.1002/phar.2447. PMID: 32687670.

Several publications have described wondrous therapeutic effects of faecal microbiota transplant (FMT) on Clostridioides difficile infection. Yet the recent randomised trial assessing FMT in US veterans was terminated early for futility. In this episode, hosts Angela Huttner and Marc Bonten delve into the history, application, and complexities of FMT with experts Maria Vehreschild (Frankfurt University Hospital, Germany) and Dimitri Drekonja (Minneapolis Veteran Affairs Care System and University of Minnesota, US), who led the US trial. From the regulatory challenges and trial nuances to important new research, this conversation sheds light on a potentially revolutionary yet controversial treatment. Episode was edited by Kathryn Hostettler and peer-reviewed by Arjana Zerja (Mother Theresa University Hospital Centre, Tirana, Albania).Other mentions:EurFMTEuropean Directorate for the Quality of Medicines & HealthCare. Guide to the quality and safety of tissues and cells for human application. vol. 5th ed. EDQM Council of Europe; 2022. https://freepub.edqm.eu/publications/17/detail LiteratureDrekonja DM et al (2024) Clin Infect Dis, doi: 10.1093/cid/ciae467

In this episode, Brett, Phil and Martin reflect on the year. We chat about favourite podcasts, papers and conferences in our usual informal manner (well probably even more informal than normal). Papers we mention are listed below. Cimen C, Bathoorn E, Loeve AJ, Fliss M, Berends MS, Nagengast WB, et al. Uncovering the spread of drug-resistant bacteria through next-generation sequencing based surveillance: transmission of extended-spectrum beta-lactamase-producing Enterobacterales by a contaminated duodenoscope. Antimicrob Resist Infect Control 2024;13(1):31. https://doi.org/10.1186/s13756-024-01386-5 Torres-Teran MM, Greentree DH, Varghese MM, Cadnum JL, Pavis RL, Saade EA, et al. Identifying and Remediating Super-splasher Sinks to Reduce Dispersal of Pathogens From Sink Drains. Open Forum Infect Dis 2024;11(7):ofae293. https://doi.org/10.1093/ofid/ofae293 Bush M, Bennett CM, Hutchinson A, Bouchoucha SL. Post implementation quarantine recommendations that support preparedness: A systematic review and quarantine implementation capability framework. Infect Dis Health 2024;29(3):152-71. https://doi.org/10.1016/j.idh.2024.02.004 Dhar S, Jinadatha C, Kilgore PE, Henig O, Divine GW, Todter EN, et al. Lowering the Acquisition of Multidrug-Resistant Organisms (MDROs) With Pulsed-xenon (LAMP) Study: A Cluster-Randomized, Controlled, Double-Blinded, Interventional Crossover Trial. Clin Infect Dis 2024;79(4):1024-30. https://doi.org/10.1093/cid/ciae240 Widmer AF, Atkinson A, Kuster SP, Wolfensberger A, Klimke S, Sommerstein R, et al. Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative Skin Antisepsis: A Randomized Clinical Trial. JAMA 2024;332(7):541-9. https://doi.org/10.1001/jama.2024.8531 Leistner R, Kohlmorgen B, Brodzinski A, Schwab F, Lemke E, Zakonsky G, et al. Environmental cleaning to prevent hospital-acquired infections on non-intensive care units: a pragmatic, single-centre, cluster randomized controlled, crossover trial comparing soap-based, disinfection and probiotic cleaning. EClinicalMedicine 2023;59:101958. https://doi.org/10.1016/j.eclinm.2023.101958 Denkel LA, Voss A, Caselli E, Dancer SJ, Leistner R, Gastmeier P, et al. Can probiotics trigger a paradigm shift for cleaning healthcare environments? A narrative review. Antimicrob Resist Infect Control 2024;13(1):119. https://doi.org/10.1186/s13756-024-01474-6  

In this episode, Brett, Phil and Martin reflect on the year. We chat about favourite podcasts, papers and conferences in our usual informal manner (well probably even more informal than normal). Papers we mention are listed below. Cimen C, Bathoorn E, Loeve AJ, Fliss M, Berends MS, Nagengast WB, et al. Uncovering the spread of drug-resistant bacteria through next-generation sequencing based surveillance: transmission of extended-spectrum beta-lactamase-producing Enterobacterales by a contaminated duodenoscope. Antimicrob Resist Infect Control 2024;13(1):31. https://doi.org/10.1186/s13756-024-01386-5 Torres-Teran MM, Greentree DH, Varghese MM, Cadnum JL, Pavis RL, Saade EA, et al. Identifying and Remediating Super-splasher Sinks to Reduce Dispersal of Pathogens From Sink Drains. Open Forum Infect Dis 2024;11(7):ofae293. https://doi.org/10.1093/ofid/ofae293 Bush M, Bennett CM, Hutchinson A, Bouchoucha SL. Post implementation quarantine recommendations that support preparedness: A systematic review and quarantine implementation capability framework. Infect Dis Health 2024;29(3):152-71. https://doi.org/10.1016/j.idh.2024.02.004 Dhar S, Jinadatha C, Kilgore PE, Henig O, Divine GW, Todter EN, et al. Lowering the Acquisition of Multidrug-Resistant Organisms (MDROs) With Pulsed-xenon (LAMP) Study: A Cluster-Randomized, Controlled, Double-Blinded, Interventional Crossover Trial. Clin Infect Dis 2024;79(4):1024-30. https://doi.org/10.1093/cid/ciae240 Widmer AF, Atkinson A, Kuster SP, Wolfensberger A, Klimke S, Sommerstein R, et al. Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative Skin Antisepsis: A Randomized Clinical Trial. JAMA 2024;332(7):541-9. https://doi.org/10.1001/jama.2024.8531 Leistner R, Kohlmorgen B, Brodzinski A, Schwab F, Lemke E, Zakonsky G, et al. Environmental cleaning to prevent hospital-acquired infections on non-intensive care units: a pragmatic, single-centre, cluster randomized controlled, crossover trial comparing soap-based, disinfection and probiotic cleaning. EClinicalMedicine 2023;59:101958. https://doi.org/10.1016/j.eclinm.2023.101958 Denkel LA, Voss A, Caselli E, Dancer SJ, Leistner R, Gastmeier P, et al. Can probiotics trigger a paradigm shift for cleaning healthcare environments? A narrative review. Antimicrob Resist Infect Control 2024;13(1):119. https://doi.org/10.1186/s13756-024-01474-6  

La recrudescence récente des cas de COVID-19, survenue parallèlement au début de la saison des infections respiratoires saisonnières, suscite plusieurs questions. Quelles sont les recommandations vaccinales actuelles? Les traitements sont-ils toujours efficaces? Qu'en est-il de la COVID-19 longue? Pour répondre à ces questions, Trait pharmacien reçoit Jean-François Tessier, pharmacien au CIUSSS de l'Est-de-l'Île-de-Montréal, président du Regroupement de pharmaciens experts (RPE) en infectiologie et membre du RPE en néphrologie de l'A.P.E.S. Références : Guide d'usage optimal de l'INESSS sur les traitements de la COVID-19 : https://www.inesss.qc.ca/en/publications/publications/publication/usage-optimal-des-traitements-de-la-covid-19.html Recommandations du Protocole d'immunisation du Québec (PIQ) sur la vaccination contre la COVID-19 : https://www.msss.gouv.qc.ca/professionnels/vaccination/piq-vaccins/covid-19-vaccin-a-arn-messager-contre-la-covid-19/ Kaboré JL, Laffont B, Diop M et coll. Real-world effectiveness of nirmatrelvir/ritonavir on Coronavirus disease 2019–associated hospitalization prevention: a population-based cohort study in the province of Quebec, Canada. Clin Infect Dis 2023;77(6):805-15. Lignes directrices canadiennes sur le syndrome post-COVID-19 (CAN-PCC) : https://canpcc.ca/home-francais/

Drs. Cesar Arias (@SuperBugDoc) and Katie Barber join Dr. Julie Ann Justo (@julie_justo) to discuss what is hot-off-the-presses for gram-positive bacterial infections and it's a total party vibe! They review the latest news for recent and ongoing clinical trials (DOTS, DISRUPT, and SNAP trials), discuss hope for novel clinical tests of the cefazolin inoculum effect in staphylococci, and explore the fascinating changes in virulence and potential therapeutic options for the most challenging enterococci. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp References Climate Change and Antimicrobial Resistance. Editors in Conversation Podcast. American Society for Microbiology. Oct 2023. Is More Better? The Role of Combination Therapy for MRSA. Breakpoints Podcast Episode #30. Society of Infectious Diseases Pharmacists. Turner NA, et al. DOTS: Dalbavancin as an Option for Treatment of Staphylococcus aureus Bacteremia. ESCMID Global 2024. April 2024. NCT04775953. Real-world dalbavancin observational cohort: Rebold N, et al. Infect Dis Ther. 2024 Mar;13(3):565-579. doi: 10.1007/s40121-024-00933-2. PMID: 38427289. Exebacase DISRUPT trial : Fowler VG Jr, et al. Clin Infect Dis. 2024 Jun 14;78(6):1473-1481. doi: 10.1093/cid/ciae043. PMID: 38297916. @snap_trial tweet of Breaking News. Aug 2024. Investigator Resources for the SNAP trial. Sept 2024: https://www.snaptrial.com.au/for-investigators#interim Cefazolin inoculum effect on mortality in MSSA bacteremia : Miller WR, et al. Open Forum Infect Dis. 2018 May 23;5(6):ofy123. doi: 10.1093/ofid/ofy123. PMID: 29977970. Prevalence of cefazolin inoculum effect in MSSA and modified rapid nitrocefin test for detection: Carvajal LP, et al. Antimicrob Agents Chemother. 2024 Sep 30:e0089824. doi: 10.1128/aac.00898-24. PMID: 39345182. LiaX as surrogate for cell envelope stress in Enterococus faecium: Axell-House DB, et al. Antimicrob Agents Chemother. 2024 Mar 6;68(3):e0106923. doi: 10.1128/aac.01069-23. PMID: 38289081. Shorter is better for uncomplicated streptococcal bacteremia: Clutter DS, et al. Antimicrob Agents Chemother. 2024 Aug 7;68(8):e0022024. doi: 10.1128/aac.00220-24. PMID: 38975753. Short vs. long antibiotic duration in Streptococcus pneumoniae bacteremia: Crotty M, et al. Open Forum Infect Dis. 2024 Aug 30;11(9):ofae478. doi: 10.1093/ofid/ofae478. PMID: 39257675. This podcast is powered by Pinecast.

Enterococci are commensal microbes, part of the healthy microflora populating the human gut. But they are also opportunistic pathogens and notorious nosocomial agents with intrinsic traits that promote their pathogenesis and make them difficult to kill. In the third instalment of the Nightmare Series, hosts Angela Huttner and Thomas Tängdén are joined by enterococcal experts Kimberly Kline (University of Geneva) and Louis Rice (Brown University) to discuss what make vancomycin-resistant enterococci, or VRE, such a clinical nightmare. Enterococcus faecalis and Enterococcus faecium are the focus. This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Nunzia Esposito of the University of Naples Federico II, Naples, Italy. Literature  Stellfox ME et al. J Antimicrob Chemother 14 Feb 2024. doi: 10.1128/mbio.03396-23  Rogers R & Rice LB. Clin Infect Dis 15 Jan 2024. doi: 10.1093/cid/ciad613 Lebreton F et al. Cell 18 May 2017. doi: 10.1016/j.cell.2017.04.027 Donskey CJ et al. N Engl J Med 28 Dec 2000. doi: 10.1056/NEJM200012283432604

In this episode of Breakpoints' Dosing Consult series, Drs. Chuck Peloquin and Gerry Davies join Dr. Megan Klatt to discuss rifampin dosing for mycobacterial infections. Hear from the experts on if higher doses are really better, toxicity thresholds, and the role of alternative rifamycins for patients with MTB and NTMs. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp References: Efficacy and Safety of High-Dose Rifampin in Pulmonary Tuberculosis. A Randomized Controlled Trial. Am J Respir Crit Care Med. 2018 Sep 1;198(5):657-666. doi: 10.1164/rccm.201712-2524OC. Rifampin vs. rifapentine: what is the preferred rifamycin for tuberculosis? Expert Rev Clin Pharmacol. 2017 Oct;10(10):1027-1036. doi: 10.1080/17512433.2017.1366311. Rifabutin for treating pulmonary tuberculosis. Cochrane Database Syst Rev. 2007 Oct; 2007(4): CD005159. doi: 10.1002/14651858.CD005159.pub2. Implementation of Bedaquiline, Pretomanid, and Linezolid in the United States: Experience Using a Novel All-Oral Treatment Regimen for Treatment of Rifampin-Resistant or Rifampin-Intolerant Tuberculosis Disease. Clin Infect Dis. 2023 Oct 5;77(7):1053-1062. doi: 10.1093/cid/ciad312. This podcast is powered by Pinecast.

This StAR episode features the CID State-of-the-Art Review on use of antimicrobials at the end of life.Our guest stars this episode are:Daniel Karlin (University of California Los Angeles, UCLA)Christine Pham (UCLA)Daisuke Furukawa (Stanford)Journal article link: Karlin D, Pham C, Furukawa D, et al. State-of-the-Art Review: Use of Antimicrobials at the End of Life. Clin Infect Dis. 2024;78(3):e27-e36. doi:10.1093/cid/ciad735Journal companion article - Executive summary link: https://academic.oup.com/cid/article/78/3/493/7596075From Clinical Infectious DiseasesEpisodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.comFebrile is produced with support from the Infectious Diseases Society of America (IDSA)

This StAR episode features the CID State-of-the-Art Review on a comprehensive approach to vascular graft infection.Our guest stars this episode are:Hussam TabajaSupavit “Mac” ChesdachaiDaniel DeSimone(from Mayo Clinic, Rochester, Minnesota)Journal article link: Tabaja H, Chesdachai S, Shah AS, et al. Fostering Collaborative Teamwork-A Comprehensive Approach to Vascular Graft Infection Following Arterial Reconstructive Surgery. Clin Infect Dis. 2024;78(6):e69-e80. doi:10.1093/cid/ciae150Journal companion article - Executive summary link: https://academic.oup.com/cid/article/78/6/1391/7651000From Clinical Infectious DiseasesEpisodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.comFebrile is produced with support from the Infectious Diseases Society of America (IDSA)

This StAR episode features the CID State-of-the-Art Review on Unintended Consequences: Risk of Opportunistic Infections Associated with Long-term Glucocorticoid Therapies in Adults.Our guest stars this episode are:Daniel Chastain (University of Georgia College of Pharmacy)Megan Spradlin (University of Colorado)Hiba Ahmad (University of Colorado)Andrés F Henao-Martínez (University of Colorado)Journal article link: Chastain DB, Spradlin M, Ahmad H, Henao-Martínez AF. Unintended Consequences: Risk of Opportunistic Infections Associated With Long-term Glucocorticoid Therapies in Adults. Clin Infect Dis. 2024;78(4):e37-e56. doi:10.1093/cid/ciad474Journal companion article - Executive summary link: https://academic.oup.com/cid/article/78/4/811/7643625From Clinical Infectious DiseasesEpisodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.comFebrile is produced with support from the Infectious Diseases Society of America (IDSA)

Only known to us since 2008, Candida auris is an emerging fungal pathogen spreading quickly around the world; alarmingly, it is most commonly found in healthcare settings. C. auris sets itself apart from other Candida species with its unique tolerance to high saline and temperature environments and propensity to develop antifungal resistances that promote its survival in hospitals and healthcare facilities. Hosts Emily McDonald and Navaneeth Narayanan are joined by fungal experts Dr. Jeffrey Rybak (St. Jude, Memphis TN) and Dr. Graham Snyder (UPMC, Pittsburgh PA) on their quest to better understand C. auris infections, the clinical challenges and knowledge gaps in C. auris research and discuss measures for prevention and containment on the levels of both the patient and the institution. The recent emergence of C. auris as a multidrug-resistant nosocomial pathogen and its global prevalence has raised more questions than answers. Why now? Why healthcare facilities? Does climate change play a role? Are humans to blame? Tune in to find out what the experts have to say on these questions, and stay to learn about the current therapies available, what is in the antifungal pipeline and how to approach treatment from a stewardship standpoint.This episode was produced by Angela Huttner, edited by Kathryn Hostettler and peer-reviewed by Dr. Claudio Neidhöfer of University Hospital Bonn, Germany.LiteratureSatoh K, Makimura K, Hasumi Y, et al. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol. 2009 Jan;53(1):41-4. doi: 10.1111/j.1348-0421.2008.00083.xLee WG, Shin JH, Uh Y, et al. First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol. 2011 Sep;49(9):3139-42. doi: 10.1128/JCM.00319-11Pfaller MA, Diekema DJ, Turnidge JD, et al. Twenty Years of the SENTRY Antifungal Surveillance Program: Results for Candida Species From 1997–2016. OFID. 2019 March;6(S1): S79–S94. doi: 10.1093/ofid/ofy358Lockhart SR, Etienne KA, Vallabhaneni S, et al. Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses. Clin Infect Dis. 2017 Jan 15;64(2):134-140. doi: 10.1093/cid/ciw691.Clancy CJ, Nguyen MH. Emergence of Candida auris: An International Call to Arms. Clin Infect Dis. 2017 Jan 15;64(2):141-143. doi: 10.1093/cid/ciw696Rybak JM, Cuomo CA, Rogers PD. The molecular and genetic basis of antifungal resistance in the emerging fungal pathogen Candida auris. Curr Opin Microbiol. 2022 Dec;70:102208. doi: 10.1016/j.mib.2022.102208 

This StAR episode features the CID State-of-the-Art Review on ##.Our guest stars this episode are:Arsheena Yassin (Robert Wood Johnson University Hospital)Mariya Huralska (Robert Wood Johnson University Hospital)Journal article link: Yassin A, Huralska M, Pogue JM, Dixit D, Sawyer RG, Kaye KS. State of the Management of Infections Caused by Multidrug-Resistant Gram-Negative Organisms. Clin Infect Dis. 2023;77(9):e46-e56. doi:10.1093/cid/ciad499Journal companion article - Executive summary link: https://academic.oup.com/cid/article/77/9/1223/7408674From Clinical Infectious DiseasesEpisodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.comFebrile is produced with support from the Infectious Diseases Society of America (IDSA)

This StAR episode features the CID State-of-the-Art Review on Staphylococcus aureus bacteremia - controversies in clinical practice.Our guest stars this episode are: Daniel Minter (UCSF)Sarah Doernberg (UCSF)Journal article link: Minter DJ, Appa A, Chambers HF, Doernberg SB. Contemporary Management of Staphylococcus aureus Bacteremia-Controversies in Clinical Practice. Clin Infect Dis. 2023 Nov 30;77(11):e57-e68. doi: 10.1093/cid/ciad500. PMID: 37950887.Journal companion article - Executive summary link: https://academic.oup.com/cid/article/77/11/1489/7453594From Clinical Infectious DiseasesEpisodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.comFebrile is produced with support from the Infectious Diseases Society of America (IDSA)

Episode 173: Acute OsteomyelitisFuture Dr. Tran explains the pathophysiology of osteomyelitis and describes the presentation, diagnosis and management of acute osteomyelitis. Dr. Arreaza provides information about    Written by Di Tran, MSIII, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is osteomyelitis?Osteomyelitis, in simple terms, is an infectious disease that affects both bone and bone marrow and is either acute or chronic.  According to archaeological findings of animal fossils with a bone infection, osteomyelitis was more than likely to be known as a “disease for old individuals”.Our ancestors over the years have used various vocabulary terms to describe this disease until a French surgeon, Dr. Nelaton, came up with the term “Osteomyelitis” in 1844. This is the beauty of medical terms, Latin sounds complicated for some people, but if you break up the term, it makes sense: Osteo = bone, myelo = marrow, itis = inflammation. So, inflammation of the bone marrow.Traditionally, osteomyelitis develops from 3 different sources:First category is the “hematOgenous” spread of the infection within the bloodstream, as in bacteremia. It is more frequent in children and long bones are usually affected. [Arreaza: it means that the infection started somewhere else but it got “planted” in the bones]Second route is “direct inoculation” of bacteria from the contiguous site of infection “without vascular insufficiency”, or trauma, which may occur secondary to fractures or surgery in adults.  In elderly patients, the infection may be related to decubitus ulcers and joint replacements.And the third route is the “contiguous” infection “with vascular insufficiency”, most seen in a patient with a diabetic foot infection.Patients with vascular insufficiency often have compromised blood supply to the lower extremities, and poor circulation impairs healing. In these situations, infection often occurs in small bones of the feet with minimal to no pain due to neuropathy.They can have ulcers, as well as paronychia, cellulitis, or puncture wounds.Thus, the importance of treating onychomycosis in diabetes because the fungus does not cause a lot of problems by itself, but it can cause breaks in the nails that can be a port of entry for bacteria to cause severe infections. Neuropathy is an important risk factor because of the loss of protective sensation. Frequently, patients may step on a foreign object and not feel it until there is swelling, purulent discharge, and redness, and they come to you because it “does not look good.”Acute osteomyelitis often takes place within 2 weeks of onset of the disease, and the main histopathological findings are microorganisms, congested blood vessels, and polymorphonuclear leukocytes, or neutrophilic infiltrates.What are the bugs that cause osteomyelitis?Pathogens in osteomyelitis are heavily depended on the patient's age.  Staph. aureus is the most common culprit of acute hematogenous osteomyelitis in children and adults.  Then comes Group A Strep., Strep. pneumoniae, Pseudomonas, Kingella, and methicillin-resistant Staph. aureus.  In newborns, we have Group B Streptococcal. Less common pathogens are associated with certain clinical presentations, including Aspergillus, Mycobacterium tuberculosis, and Candida in the immunocompromised.Salmonella species can be found in patients with sickle cell disease, Bartonella species in patients with HIV infection, and Pasteurella or Eikenella species from human or animal bites.It is important to gather a complete medical history of the patient, such as disorders that may put them at risk of osteomyelitis, such as diabetes, malnutrition, smoking, peripheral or coronary artery disease, immune deficiencies, IV drug use, prosthetic joints, cancer, and even sickle cell anemia. Those pieces of information can guide your assessment and plan.What is the presentation of osteomyelitis?Acute osteomyelitis may present symptoms over a few days from onset of infection but usually is within a 2-week window period.  Adults will develop local symptoms of erythema, swelling, warmth, and dull pain at the site of infection with or without systemic symptoms of fever or chills.Children will also be present with lethargy or irritability in addition to the symptoms already mentioned.It may be challenging to diagnose osteomyelitis at the early stages of infection, but you must have a high level of suspicion in patients with high risks. A thorough physical examination sometimes will show other significant findings of soft tissue infection, bony tenderness, joint effusion, decreased ROM, and even exposed bone. Diagnosis.As a rule of thumb, the gold standard for the diagnosis of osteomyelitis is bone biopsy with histopathology findings and tissue culture. There is leukocytosis, but then WBC counts can be normal even in the setting of acute osteomyelitis.Inflammatory markers (CRP, ESR) are often elevated although both have very low specificity. Blood cultures should always be obtained whenever osteomyelitis is suspected.  A bone biopsy should also be performed for definitive diagnosis, and specimens should undergo both aerobic and anaerobic cultures.  In cases of osteomyelitis from diabetic foot infection, do the “probe to bone” test. What we do is we use a sterile steel probe to detect bone which is helpful for osteomyelitis confirmation.Something that we can't miss out on is radiographic imaging, which is quite important for the evaluation of osteomyelitis.  Several modalities are useful and can be used for the work-up plan; plain radiographs often are the very first step in the assessment due to their feasibility, low cost, and safety.  Others are bone scintigraphy, CT-scan, and MRI.  In fact, the MRI is widely used and provides better information for early detection of osteomyelitis than other imaging modalities.  It can detect necrotic bone, sinus tracts, and even abscesses. We look for soft tissue swelling, cortical bone loss, active bone resorption and remodeling, and periosteal reaction.  Oftentimes, plain radiography and MRI are used in combination. Treatment:Treatment of osteomyelitis actually is a teamwork effort among various medical professionals, including the primary care provider, the radiologist, the vascular, the pharmacist, the podiatrist, an infectious disease specialist, orthopedic surgeons, and the wound care team.Something to take into consideration, if the patient is hemodynamically stable it is highly recommended to delay empirical antibiotic treatment 48-72 hours until a bone biopsy is obtained.  The reason is that with percutaneous biopsy ideally done before the initiation of antibiotic treatment, “the microbiological yield will be higher”.We'll have a better idea of what particular bugs are causing the problem and guide the treatment appropriately. The choice of antibiotic therapy is strongly determined by susceptibilities results.  The antibiotic given will be narrowed down only for the targeted susceptible organisms.  In the absence of such information, or when a hospitalized patient presents with an increased risk for MRSA infection, empiric antibiotic coverage is then administered while awaiting culture results. It should be broad-spectrum antibiotics and include coverage for MRSA, broad gram-negative and anaerobic bacteria.  For example, vancomycin plus piperacillin-tazobactam, or with broad-spectrum cephalosporin plus clindamycin.  Treatment will typically be given for 4 to 6 weeks.The duration between 4-6 weeks is important for complete healing, but a small study with a small sample showed that an even shorter duration of 3 weeks may be effective, but more research is needed. In certain situations, surgery is necessary to preserve viable tissue and prevent recurrent infection, especially when there are deep abscesses, necrosis, or gangrene, amputation or debridement is deemed appropriate. If the infected bone is completely removed, patients may need a shorter course of antibiotics, even a few days only. Amputation can be very distressing, especially when we need to remove large pieces of infected bone, for example, a below-the-knee amputation. We need to be sensitive to the patient's feelings and make a shared decision about the best treatment for them.In patients with diabetes, additional care must be taken seriously, patient education about the need for compliance with treatment recommendations, with careful wound care, and good glycemic control are all beneficial for the healing and recovery process. Because this is a very common problem in the clinic and at the hospital, we must keep our eyes wide open and carefully assess patients with suspected osteomyelitis to detect it promptly and start appropriate treatment. Adequate and timely treatment is linked to fewer complications and better outcomes._________________________Conclusion: Now we conclude episode number 173, “Acute Osteomyelitis.” Future Dr. Tran explained the pathophysiology, diagnosis, and management of osteomyelitis. A bone biopsy is the ideal method of diagnosis. Delaying antibiotic treatment a few days until you get a biopsy is allowed if the patient is stable, but if the patient is unstable, antibiotics must be started promptly. Dr. Arreaza mentioned the implications of amputation and that we must discuss this treatment empathically with our patients. This week we thank Hector Arreaza and Di Tran. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Bury DC, Rogers TS, Dickman MM. Osteomyelitis: Diagnosis and Treatment. Am Fam Physician. 2021 Oct 1;104(4):395-402. PMID: 34652112.Cunha BA. Osteomyelitis in elderly patients. Clin Infect Dis. 2002 Aug 1;35(3):287-93. doi: 10.1086/341417. Epub 2002 Jul 11. PMID: 12115094.Fritz JM, McDonald JR. Osteomyelitis: approach to diagnosis and treatment. Phys Sportsmed. 2008 Dec;36(1):nihpa116823. doi: 10.3810/psm.2008.12.11. PMID: 19652694; PMCID: PMC2696389.Hatzenbuehler J, Pulling TJ. Diagnosis and management of osteomyelitis. Am Fam Physician. 2011 Nov 1;84(9):1027-33. PMID: 22046943.Hofstee MI, Muthukrishnan G, Atkins GJ, Riool M, Thompson K, Morgenstern M, Stoddart MJ, Richards RG, Zaat SAJ, Moriarty TF. Current Concepts of Osteomyelitis: From Pathologic Mechanisms to Advanced Research Methods. Am J Pathol. 2020 Jun;190(6):1151-1163. doi: 10.1016/j.ajpath.2020.02.007. Epub 2020 Mar 16. PMID: 32194053.Momodu II, Savaliya V. Osteomyelitis. [Updated 2023 May 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532250/Royalty-free music used for this episode: Trap Chiller by Gushito, downloaded on Nov 06, 2023, from https://www.videvo.net 

Hosts Angela Huttner & Erin McCreary welcome Prof. David Paterson (Singapore) and Prof. Josh Davis (Newcastle, Australia) to discuss the design and results of the BLING-3 trial, which compared continuous infusion of beta-lactam antibiotics to standard intermittent dosing in 7000 critically ill patients across 104 intensive-care units. In unadjusted analyses, the trial did not show a statistically significant mortality benefit with continuous infusion. Yet in prespecified adjusted analyses, there was a statistically significant reduction in mortality, and a meta-analysis of randomized trials published simultaneously with the BLING-3 trial showed the same. As the two ID doctors on the BLING team, Profs. Paterson and Davis offer context and insights into what these results mean and how they might affect your clinical practice. Episode peer-reviewed by Dr. Mia Lidén of Charité – Universitätsmedizin Berlin.  LiteratureBLING-1: Dulhunty et al. Continuous infusion of beta-lactam antibiotics in severe sepsis: a multicenter double-blind, randomized controlled trial. Clin Infect Dis. 2013 Jan;56(2):236-44. DOI: 10.1093/cid/cis856BLING-2: Dulhunty et al. A Multicenter Randomized Trial of Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis. Am J Respir Crit Care Med. 2015 Dec 1;192(11):1298-305. DOI: 10.1164/rccm.201505-0857OCBLING-3: Dulhunty et al. Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial. JAMA. 2024 Jun 12:e249779.DOI: 10.1001/jama.2024.9779Meta-analysis: Abdul-Aziz et al. Prolonged vs Intermittent Infusions of β-Lactam Antibiotics in Adults With Sepsis or Septic Shock: A Systematic Review and Meta-Analysis. JAMA. 2024 Jun 12:e249803. DOI: 10.1001/jama.2024.9803

This StAR episode features the CID State-of-the-Art Review on neurosyphilis.Our guest star this episode is Dr. Matthew Hamill (Johns Hopkins University)Journal article link: Hamill MM, Ghanem KG, Tuddenham S. State-of-the-Art Review: Neurosyphilis. Clin Infect Dis. 2024 May 15;78(5):e57-e68. doi: 10.1093/cid/ciad437. PMID: 37593890.Journal companion article - Executive summary link: https://academic.oup.com/cid/article/78/5/1085/7672813From Clinical Infectious DiseasesEpisodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.comFebrile is produced with support from the Infectious Diseases Society of America (IDSA)

This episode is sponsored by Medtronic.Painful diabetic peripheral neuropathy (DPN) can significantly impact a person with diabetes and their quality of life. Nalani Hunsaker PA-C, MCMSc, BC-ADM, a paid consultant for Medtronic, joins The Huddle to talk about Medtronic's spinal cord stimulation therapy option, how the procedure works, and its success in relieving pain from DPN. Please reach out to http://www.medtronic.com/dpnconnect to connect with a Medtronic representative today. If you would like to share more information with your patients check out http://www.medtronic.com/dpnpain References:1. de Vos CC, Meier K, Zaalberg PB, et al. Spinal cord stimulation in patients with painful diabetic neuropathy: A multicentre randomized clinical trial. Pain. 2014;155(11):2426–2431. doi:10.1016/j.pain.2014.08.031 2. Slangen R, Schaper NC, Faber CG, et al. Spinal cord stimulation and pain relief in painful diabetic peripheral neuropathy: A prospective two-center randomized controlled trial. Diabetes Care. 2014;37(11):3016–3024. doi:10.2337/dc14-0684 3. Medtronic Pain Therapy Clinical Summary M221494A016 Rev B. United States; 2022. 4. van Beek M, Geurts JW, Slangen R, et al. Severity of neuropathy is associated with long-term spinal cord stimulation outcome in painful diabetic peripheral neuropathy: Five-year follow-up of a prospective two-center clinical trial. Diabetes Care. 2018;41(1):32–38. doi:10.2337/dc17-0983 5. Zuidema X et al. Long-term Evaluation of Spinal Cord Stimulation in Patients With Painful Diabetic Polyneuropathy: An Eight-to-Ten-Year Prospective Cohort Study. Neuromodulation. 2022 Dec 30:S1094-7159(22)01403-9. 6. Tarakji KG, Mittal S, Kennergren C, et al. Antibacterial Envelope to Prevent Cardiac Implantable Device Infection. N Engl J Med. 2019;380(20):1895-19057. Desai MJ, Hargens LM, Breitenfeldt MD, Doth AH, Ryan MP, Gunnarsson C, Safriel Y. The rate of magnetic resonance imaging in patients with spinal cord stimulation. Spine (Phila Pa 1976). 2015 1;40(9):E531-7.8. Mullins CF, Harris S, Pang D. A retrospective review of elevated lead impedances in impedance-dependent magnetic resonance-conditional spinal cord stimulation devices. Pain Pract. 2023;00:1–8 https://creativecommons.org/licenses/by/4.0/.9. Temel Y, Ackermans L, Celik H, et al. Management of hardware infections following deep brain stimulation. Acta Neurochir (Wien). April 2004;146(4):355-361.10. Pepper J. Zrinzo L, Mirza B, Foltynie T, Limousin P, Hariz M. The risk of hardware infection in deep brain stimulation surgery is greater at impulse generator replacement than at the primary procedure. Stereotact Funct Neurosurg. 2013;91(1):56-65.11. Tolleson C, Stroh J, Ehrenfeld J, Neimat J, Konrad P, Phibbs F. The factors involved in deep brain stimulation infection: a large case series. Stereotact Funct Neurosurg. 2014;92(4): 227-233.12. Thrane JF, Sunde NA, Bergholt B, Rosendal F. Increasing infection rate in multiple implanted pulse generator changes in movement disorder patients treated with deep brain stimulation. Stereotact Funct Neurosurg. 2014;92(6):360-364.13. Deer TR, Provenzano DA, Hanes M, et al. The Neurostimulation Appropriateness Consensus Committee (NACC) Recommendations for Infection Prevention and Management [published correction appears in Neuromodulation. July 2017;20(5):516]. Neuromodulation. January 2017;20(1):31-50.14. Mekhail NA, Mathews M, Nageeb F, Guirguis M, Mekhail MN, Cheng J. Retrospective review of 707 cases of spinal cord stimulation: indications and complications. Pain Pract. March-April 2011;11(2):148-153.15. Falowski SM, Provenzano DA, XIa Y, Doth AH. Spinal Cord Stimulation Infection Rate and Risk Factors: Results From a United States Payer Database. Neuromodulation. February 2019;22(2):179-189.16. Clifton M, Quirouet A, Pizarro-Berdichevsky J, et al. Infection rate after sacral neuromodulation surgery: a review of 1033 InterStim procedures. J Urol. April 2016;195(4S):851.17. Bjerknes S, Skogseid IM, Sæhle T, Dietrichs E, Toft M. Surgical site infections after deep brain stimulation surgery: frequency, characteristics and management in a 10-year period. PLoS One. August 14, 2014;9(8):e105288.18. Piacentino M, Pilleri M, Luigi Bartolomei L. Hardware-related infections after deep brain stimulation surgery: review of incidence, severity and management in 212 single-center procedures in the first year after implantation. Acta Neurochir (Wien). December 2011; 153(12):2337-2341.19. Hamani C, Lozano AM. Hardware-related complications of deep brain stimulation: a review of the published literature. Stereotact Funct Neurosurg. 2006;84(5-6):248-251.20. Hayek SM, Veizi E, Hanes M. Treatment-Limiting Complications of Percutaneous Spinal Cord Stimulator Implants: A Review of Eight Years of Experience From an Academic Center Database. Neuromodulation. October 2015;18(7):603-608. 21. Bendel MA, O'Brien T, Hoelzer BC, et al. Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants. Neuromodulation. August 2017;20(6):553-557. 22. Wexner SD, Hull T, Edden Y, et al. Infection rates in a large investigational trial of sacral nerve stimulation for fecal incontinence. J Gastrointest Surg. July 2010;14(7):1081-1089.15 23. Chen T, Mirzadeh Z, Lambert M, et al. Cost of Deep Brain Stimulation Infection Resulting in Explantation. Stereotact Funct Neurosurg. 2017;95(2):117-124.24. Provenzano DA, Falowski SM, Xia Y, Doth AH. Spinal Cord Stimulation Infection Rate and Incremental Annual Expenditures: Results From a United States Payer Database. Neuromodulation. April 2019;22(3):302-310.25. Medtronic data on file: Economic Impact of Infection Related to Neuro-Stimulator Implant. Study report prepared for Medtronic prepared by Optum, 2018/01/03.26. Garrigos ZE, Farid S, Bendel MA, Sohail MR. Spinal Cord Stimulator Infection: Approach to Diagnosis, Management, and Prevention. Clin Infect Dis. June 10, 2020;70(12):2727-2735. 27. Tarakji KG, Mittal S, Kennergren C, et al. Antibacterial Envelope to Prevent Cardiac Implantable Device Infection. N Engl J Med. May 16, 2019;380(20):1895-190528. Garrigos ZE, Farid S, Bendel MA, Sohail MR. Spinal Cord Stimulator Infection: Approach to Diagnosis, Management, and Prevention. Clin Infect Dis. June 10, 2020;70(12):2727-273529. Petersen EA, Stauss TG, Scowcroft JA, et al. Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial. JAMA Neurol. April 2021. doi:10.1001/jamaneurol.2021.0538 Spinal Cord Stimulation Brief Summary INDICATIONS Spinal cord stimulation (SCS) is indicated as an aid in the management of chronic, intractable pain of the trunk and/or limbs-including unilateral or bilateral pain. CONTRAINDICATIONS Diathermy - Energy from diathermy can be transferred through the implanted system and cause tissue damage resulting in severe injury or death. WARNINGS Sources of electromagnetic interference (e.g., defibrillation, electrocautery, MRI, RF ablation, and therapeutic ultrasound) can interact with the system, resulting in unexpected changes in stimulation, serious patient injury or death. An implanted cardiac device (e.g., pacemaker, defibrillator) may damage a neurostimulator, and electrical pulses from the neurostimulator may cause inappropriate response of the cardiac device. Patients with diabetes may have more frequent and severe complications with surgery. A preoperative assessment is advised for some patients with diabetes to confirm they are appropriate candidates for surgery. PRECAUTIONS Safety and effectiveness has not been established for pediatric use, pregnancy, unborn fetus, or delivery. Avoid activities that put stress on the implanted neurostimulation system components. Recharging a rechargeable neurostimulator may result in skin irritation or redness near the implant site. ADVERSE EVENTS May include: undesirable change in stimulation (uncomfortable, jolting or shocking); hematoma, epidural hemorrhage, paralysis, seroma, infection, erosion, device malfunction or migration, pain at implant site, loss of pain relief, and other surgical risks. Adverse events may result in fluctuations in blood glucose in patients with diabetes. Refer to www. medtronic.com for product manuals for complete indications, contraindications, warnings, precautions and potential adverse events. Rx only. Rev 0422 TYRX™ Neuro Absorbable Antibacterial Envelope Brief Statement The TYRX™ Neuro Absorbable Antibacterial Envelope is intended to hold a vagus nerve stimulator, a spinal cord neuromodulator, a deep brain stimulator or a sacral nerve stimulator securely in order to create a stable environment when implanted in the body. The Neuro Antibacterial Envelope contains the antimicrobial agents Minocycline and Rifampin which, have been shown to reduce infection in an in vivo model of bacterial challenge following surgical implantation of a pulse generator. The Neuro Antibacterial Envelope is NOT indicated for use in patients who have an allergy or history of allergies to tetracyclines, Rifampin, or absorbable sutures. The Neuro Antibacterial Envelope is also NOT indicated for use in patients with contaminated or infected wounds, or Systemic Lupus Erythematosus (SLE). This device is intended to be used in conjunction with vagus nerve stimulators or deep brain stimulators implanted in the infraclavicular fossa, or in conjunction with spinal cord neuromodulators or sacral nerve stimulators implanted laterally to the body midline and slightly superior to the gluteal region. The use of this product in patients with compromised hepatic and renal function, or in the presence of hepatotoxic or renal toxic medications, should be considered carefully, because Minocycline and Rifampin can cause additional stress on the hepatic and renal systems. Patients who receive the Neuro Antibacterial Envelope and who are also taking methoxyflurane should be monitored carefully for signs of renal toxicity. Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.Learn more about ADCES and the many benefits of membership at adces.org/join.

Les infections microbiennes sont souvent synonymes d'infections bactériennes ou virales, comme la pneumonie ou l'influenza. Mais qu'en est-il des infections fongiques? En fait, elles ne sont pas à négliger : les infections fongiques graves, qui affectent surtout les patients plus vulnérables, sont associées à près de deux millions de décès chaque année. Pour cet épisode, Trait pharmacien reçoit Alexandre Rivard et François Bourdeau, pharmaciens au Centre universitaire de santé McGill, pour discuter des antifongiques et des particularités de leur suivi. François est également membre du Regroupement de pharmaciens experts en infectiologie de l'A.P.E.S. et récipiendaire du Prix d'excellence pour la relève 2024. Références : Lignes directrices du programme d'antibiogouvernance du Centre universitaire de santé McGill : https://www.muhcasp.com/ Pappas PG, Kauffman CA, Andes DR et coll. Clinical practice guideline for the management of candidiasis: 2016 update by the IDSA. Clin Infect Dis 2016;62(4):e1-50. Patterson TF, Thompson GR III, Denning DW et coll. Clinical practice guideline for the diagnosis and management of aspergillosis: 2016 update by the IDSA. Clin Infect Dis 2016;63(4):e1-60. Cornely OA, Alastruey-Izquierdo A, Arenz D et coll. Global guideline for the diagnosis and management of mucormycosis: An initiative of the ECMM in cooperation with the MSGERC. Lancet Infect Dis 2016;19(12):e405-21. Laverdiere M, Bow EJ, Rotstein C et coll. Therapeutic drug monitoring for triazoles: A needs assessment review and recommendations from a Canadian perspective. Can J Infect Dis Med Microbiol 2014;25(6):327-43.

This StAR episode features the CID State-of-the-Art Review on acute encephalitis.Our guest stars this episode are: Karen Bloch (Adult ID physician at Vanderbilt University Medical Center)Carol Glaser (Pediatric ID physician at California Department of Public Health)David Gaston (Adult ID physician and clinical microbiologist at Vanderbilt University Medical Center)Arun Venkatesan (Neurologist at Johns Hopkins University)Journal article link: Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. Clin Infect Dis. 2023;77(5):e14-e33. doi:10.1093/cid/ciad306Journal companion article - Executive summary link: https://academic.oup.com/cid/article/77/5/669/7269079From Clinical Infectious DiseasesEpisodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.comFebrile is produced with support from the Infectious Diseases Society of America (IDSA)

This StAR episode features the CID State-of-the-Art Review on periprosthetic joint infections.Our guest stars this episode are: Sandra Nelson (ID physician at Massachusetts General Hospital)Jodian Pinkney (ID physician at Massachusetts General Hospital)Antonia Chen (Orthopedic surgeon at Brigham and Women's Hospital)Aaron Tande (ID physician at Mayo Clinic)Journal article link: Nelson SB, Pinkney JA, Chen AF, Tande AJ. Periprosthetic Joint Infection: Current Clinical Challenges. Clin Infect Dis. 2023;77(7):e34-e45. doi:10.1093/cid/ciad360Journal companion article - Executive summary link: https://academic.oup.com/cid/article/77/7/939/7289507From Clinical Infectious DiseasesEpisodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.comFebrile is produced with support from the Infectious Diseases Society of America (IDSA)

This StAR episode features the CID State-of-the-Art Review: Frame Shift – Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized with Infections.Our guest stars this episode are: Dr. Kinna Thakarar (ID and Addiction Medicine physician at MaineHealth/Tufts University School of Medicine)Dr. Ayesha Appa (ID and Addiction Medicine physician at University of California San Francisco, UCSF)Chastity Tuell (Harm reductionist and Washington County Program Director for Maine Access Points)Journal article link: Thakarar K, Appa A, Abdul Mutakabbir JC, Goff A, Brown J 3rd, Tuell C, Fairfield K, Wurcel A. Frame Shift: Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections. Clin Infect Dis. 2024 Feb 17;78(2):e12-e26. doi: 10.1093/cid/ciad664. PMID: 38018174.Journal companion article - Executive summary link: https://academic.oup.com/cid/article/78/2/233/7453720From Clinical Infectious DiseasesEpisodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.comFebrile is produced with support from the Infectious Diseases Society of America (IDSA)

In this episode, Drs. Helen Boucher (@hboucher3), Ramy Elshaboury, and Mike Dudley (@MikeMNDudley) join host, Megan Klatt (@MeganKlatt3), to discuss barriers to antimicrobial drug development, potential incentives and legislation to promote market growth, and what we can do to ensure the antimicrobial pipeline doesn't run dry. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp References An analysis of antibacterial drug development trends in the United States, 1980-2019: Dheman N, et al. Clin Infect Dis. 2021 Dec 6;73(11):e4444-e4450. doi:10.1093/cid/ciaa859. PMID: 32584952. Antibacterial R&D at a crossroads: we've pushed as hard as we can…now we need to start pulling!: Rex JH, Outterson K. Clin Infect Dis. 2021 Dec 6;73(11):e4451-4453. doi:10.1093/cid/ciaa852. PMID: 32584949. No Patient Left Behind (website): https://www.nopatientleftbehind.org/ (many useful explainers of how the investment, innovation cycle, and drug pricing work) ISPOR special task force report on defining elements of value in health care – a health economics approach: Lakdawalla DN, et al. Value Health. 2018 2018 Feb;21(2):131-139. doi: 10.1016/j.jval.2017.12.007. PMID: 29477390. Generalized cost-effectiveness analysis to assess treatment value in hepatitis C: Chou JW, et al. Am J Manag Care. 2023 Dec;29(12):696-703. doi: 10.37765/ajmc.2023.89468. PMID: 38170486.

Dr. Casey Clements spent two hours breaking down the history and influences in sepsis care over the past three decades and going through the best practices in today's emergency medicine. Do you know how Sepsis is defined currently? What is the difference between SEP - 1 and surviving sepsis campaign? What is the role of steroids or vitamin C? Can you resuscitate these patients with albumin? These and so many more questions will be answered in this two part series. So join Venk like vancomycin, and Alex (aka Zosyn) and Casey "not-cidal" Clements in these amazing episodes.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS SOFA Score: Vincent JL, MOreno R, Takala J, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction / failure. On Behalf of the working group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996 Jul;22(7):707-10 Vincent JL, de Mendonca A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunction / failure in intensive care units: results of a multicenter, prospective study. Working group on ‘sepsis-related problems' of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793-1800 Ferreira FL, Bota DP, Bross A, Merlot C, Vincent JL. Serial evaluation of the SOFA score to predict outcomes in critically ill patients. JAMA. 2001 Oct 10;286(14):1754-8 Cardenas-Turanzas M, Ensor J, Wakefield C, Zhang K, Wallace SK, Price KJ, Nates JL. Cross-validation of a sequential organ failure assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. J Crit Care. 2012 Dec;27(6):673-80 qSOFA score Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):762-774 Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and SEptic Shock (Sepsis-3). JAMA. 2016;315(8):775-787 Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of Sepsis-3 Criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA. 2017;317(3):301-308 Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317(3):290-300 Comparing Prognostic scores Henning DJ, Puskarich MA, Self WH, Howell MD, Donnino MW, Yealy DM, Jones AE, Shapiro NI. An Emergency Department validation of the SEP-3 Sepsis and Septic Shock definitions and comparison with 1992 consensus definitions. Ann Emerg Med. 2017 Oct;70(4):544-552 IDSA concern Rhee C, Chiotos K, Cosgrove SE, Heil EL, Kadri SS, Kalil AC, Gilbert DN, Masur H, Septimus EJ, Sweeney DA, Strich JR, Winslow DL, Klompas M. Infectious diseases society of america position paper: Recommended revisions to the National Severe Sepsis and Septic Shock early management bundle (SEP-1) Sepsis Quality Measure. Clin Infect Dis. 2021 Feb 16;72(4):541-552 About Barcelona Declaration Slade E, Tamber PS, Vincent JL. The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care. 2003;7:1-2 1- hour surviving sepsis bundle guidance Freund Y, Khoury A, Mockel M, et al. European Society of Emergency Medicine position paper on the 1-hour sepsis bundle of the Surviving Sepsis Campaign: expression of concern. Eur J Emerg Med. 2019 Aug;26(4):232-233 Early Goal Directed Therapy Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. NEJM. 2001 Nov 8;345(19):1368-77 SEP - 1 Quality Measure National Quality Forum Measure submission and evaluation worksheet 5.0 for NQF #0500 Severe Sepsis and Septic Shock: Management Bundle, last updated Date: Oct 05, 2012. Website link Accessed 01-31-2024: https://www.qualityforum.org/Projects/i-m/Infectious_Disease_Endorsement_Maintenance_2012/0500.aspx  National Quality Forum: NQF Revises Sepsis Measure. Website link accessed 01-31-2024: https://www.qualityforum.org/NQF_Revises_Sepsis_Measure.aspx  Faust JS, Weingart SD. The Past, Present, and Future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1 - the early management bundle for severe sepsis / septic shock. Emerg Med Clin N Am. 2017; 35:219-231 Affordable care act Patient Protection and Affordable Care Act, Public Law 148, U.S. Statutes at Large 124 (2010):119-1024. Website link accessed 01-31-2024: https://www.govinfo.gov/app/details/STATUTE-124/STATUTE-124-Pg119/summary.  Fluids for sepsis in concerning populations Pence M, Tran QK, Shesser R, Payette C, Pourmand A. Outcomes of CMS-mandated fluid administration among fluid-overloaded patients with sepsis: A systematic review and meta-analysis. Am J Emerg Med. 2022 May:55:157-166 Zadeh AV, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis. Am J Emerg Med. 2023 Nov:73:34-39   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs  

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 This Thanksgiving, amidst all the turkey, the stuffing, the cranberry sauce, the ham, and the cornucopia of dessert options, you may be inclined to let the food coma sink in. But for those interested in the science behind this fanciful feast, listen to what Dr. Jason Maley has to say about the neurologic complications of some of the common dishes served at your holiday spread. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. REFERENCES Caruana M, Cauchi R, Vassallo N. Putative role of red wine polyphenols against brain pathology in Alzheimer's and Parkinson's disease. Front Nutr 2016;3:31. PMID 27570766Clauss HE, Lorber B. Central nervous system infection with Listeria monocytogenes. Curr Infect Dis Rep 2008;10(4):300-6. PMID 18765103Garcia HH, Del Brutto OH; Cysticercosis Working Group in Peru. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol 2005;4(10):653-61. PMID 16168934Hillbom M, Saloheimo P, Fujioka S, Wszolek ZK, Juvela S, Leone MA. Diagnosis and management of Marchiafava-Bignami disease: a review of CT/MRI confirmed cases. J Neurol Neurosurg Psychiatry 2014;85(2):168-73. PMID 23978380Richard DM, Dawes MA, Mathias CW, Acheson A, Hill-Kapturczak N, Dougherty DM. L-tryptophan: basic metabolic functions, behavioral research and therapeutic indications. Int J Tryptophan Res 2009;2:45-60. PMID 20651948Sobel J. Botulism. Clin Infect Dis 2005;41(8):1167-73. PMID 16163636Williams ES. Chronic wasting disease. Vet Pathol 2005;42(5):530-49. PMID 16145200 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Invitado: Dr.José Luis Lázaro Martínez Director Clínico de la Clínica Universitaria de Podología y jefe de la unidad de Pie Diabético de la Universidad Complutense de Madrid (UCM). En este episodio discutimos sobre el pie diabético y el manejo de infecciones de hueso. Anfitriones: Dr. Rodrigo Garza Dra. Davinia Samano Lectura recomendada: Three Weeks Versus Six Weeks of Antibiotic Therapy for Diabetic Foot Osteomyelitis: A Prospective, Randomized, Noninferiority Pilot Trial. Gariani et al., Clin Infect Dis. 2021 Oct 5;73(7):e1539-e1545. doi: 10.1093/cid/ciaa1758.

Welcome to Episode 30 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 30 of “The 2 View” – oral phenylephrine, visual diagnosis plans, and NSVT. Oral Phenylephrine Myers Z. FDA panel: Many oral allergy meds don't work. WTTV CBS4Indy. Published October 15, 2023. Accessed October 17, 2023. https://cbs4indy.com/news/fda-panel-many-oral-allergy-meds-dont-work/ Neurosyphilis Review Hamill MM, Ghanem KG, Tuddenham S. State of the art review: neurosyphilis. Clin Infect Dis. Published August 18, 2023. Accessed November 1, 2023. doi: 10.1093/cid/ciad437 Visual Diagnosis - Behcet's Disease Behcet's Disease. Vasculitis Foundation. Published July 18, 2012. Accessed October 17, 2023. https://www.vasculitisfoundation.org/education/behcets-disease/ ACEP Clinical Policy on Ischemic Stroke Clinical Policies – Acute Ischemic Stroke. ACEP. Published May 2023. Accessed November 2, 2023. https://www.acep.org/patient-care/clinical-policies/acute-ischemic-stroke The VAN Assessment to Identify Large Vessel Occlusion Strokes. Core EM. Published May 17, 2018. Accessed November 2, 2023. https://coreem.net/journal-reviews/the-van-assessment/ Los Angeles Motor Scale (LAMS). MDCalc. Accessed November 2, 2023. https://www.mdcalc.com/calc/3959/los-angeles-motor-scale-lams Rapid Arterial oCclusion Evaluation (RACE) Scale for Stroke. MDCalc. Accessed November 2, 2023. https://www.mdcalc.com/calc/3941/rapid-arterial-occlusion-evaluation-race-scale-stroke NSVT: Non-Sustained Ventricular Tachycardia Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. Published August 1, 2018. Accessed October 17, 2023. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549 Farzam K, Tivakaran VS. QT Prolonging Drugs. StatPearls Publishing; 2023. Accessed October 17, 2023. https://www.ncbi.nlm.nih.gov/books/NBK534864/ Foth C, Gangwani MK, Ahmed I, Alvey H. Ventricular Tachycardia. StatPearls Publishing; 2023. Accessed October 17, 2023. https://www.ncbi.nlm.nih.gov/books/NBK532954/ Ep 1 Lady G and Courage Under Fire. Burnt. Published January 27, 2021. Accessed November 2, 2023. https://podcasts.apple.com/us/podcast/ep-1-lady-g-and-courage-under-fire/id1551194920?i=1000506903956 Glaucomflecken. Will and Kristin's Cardiac Arrest Story with Paramedic Lieutenant Aaron Gregg. Published August 22, 2023. Accessed October 17, 2023. https://www.youtube.com/watch?v=CQtYoKPNsrM Laslett DB, Cooper JM, Greenberg RM, et al. Electrolyte Abnormalities in Patients Presenting With Ventricular Arrhythmia (from the LYTE-VT Study). Am J Cardiol. PubMed. NIH: National Library of Medicine: National Center for Biotechnology Information. Published August 15, 2020. Accessed October 17, 2023. https://pubmed.ncbi.nlm.nih.gov/32565090/ Nonsustained ventricular tachycardias. Bmj.com. BMJ Best Practice. Accessed October 25, 2023. https://bestpractice.bmj.com/topics/en-us/831 PVCs and Nonsustained VT: When to Worry? How to Treat? - Penn Physician VideoLink.; 2015. Published January 7, 2015. Accessed October 17, 2023. https://videolink.pennmedicine.org/videos/pvcs-and-nonsustained-vt-when-to-worry-how-to-treat TualatinValleyFire. Dr. Will Flanary - Cardiac Arrest Survivor. Published February 16, 2021. Accessed October 17, 2023. https://www.youtube.com/watch?v=wu9uAwnSrJU Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 Prions are perhaps some of the most terrifying infectious particles known to man. But did you know that patients with some prion diseases actually shed these contagious proteins in their urine? These and other facts about prion diseases are discussed in this week's episode of BrainWaves. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. REFERENCES Zabel MD, Reid C. A brief history of prions. Pathog Dis 2015;73(9):ftv087. PMID 26449713Rutala WA, Weber DJ. Creutzfeldt-Jakob disease: recommendations for disinfection and sterilization. Clin Infect Dis 2001;32(9):1348-56. PMID 11303271Glatzel M, Abela E, Maissen M, Aguzzi A. Extraneural pathologic prion protein in sporadic Creutzfeldt-Jakob disease. N Engl J Med 2003;349(19):1812-20. PMID 14602879Moda F, Gambetti P, Notari S, et al. Prions in the urine of patients with variant Creutzfeldt-Jakob disease. N Engl J Med 2014;371(6):530-9. PMID 25099577Wieser HG, Schindler K, Zumsteg D. EEG in Creutzfeldt-Jakob disease. Clin Neurophysiol 2006;117(5):935-51. PMID 16442343Lapergue B, Demeret S, Denys V, et al. Sporadic Creutzfeldt-Jakob disease mimicking nonconvulsive status epilepticus. Neurology 2010;74(24):1995-9. PMID 20445151Siegler JE, Jacobs DA, Amado D, Adams JL, Berger JR. Rapidly progressive dementia with hypoglycorrhachia. J Clin Neurosci 2015;22(10):1685-7. PMID 26094562Geschwind MD. Prion diseases. Continuum (Minneap Minn) 2015;21:1612-38. PMID 26633779  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers HIV/AIDS psychiatry with special guests from two international settings to provide complementary perspectives on HIV psychiatry. Dr. Adriana Carvalhal, HIV Psychiatrist and Staff Psychiatrist at Scarborough Health Network in Canada and Dr. Leigh Van Den Heuvel, Psychiatrist and Associate Professor in the Department of Psychiatry, at Stellenbosch University in South Africa. The learning objectives for this episode are as follows:  By the end of this episode, you should be able to… Understand the unique mental health needs of people living with HIV and the bidirectional relationship between HIV and mental health Identify HIV-specific mental health disorders and how to screen for these conditions Outline the overall approach to treatment for HIV patients with mental health disorders Guests: Dr. Adriana Carvalhal and Dr Leigh Van Den Heuvel Produced by: Saja Jaberi (MD), Kate Braithwaite (MD) and Gaurav Sharma (PGY5) Hosts: Kate Braithwaite (MD) and Gaurav Sharma (PGY5) Audio editing by: Gaurav Sharma (PGY5) Show notes by: Saja Jaberi (MD) and Gaurav Sharma (PGY5) Conflicts of Interest: Neither of our guests nor hosts have declared any conflicts of interest related to this topic. Generic names are used for all medications referenced. Contents: Introduction - 0:19 Learning objectives - 3:52 The bidirectional relationship between HIV and psychiatric illness - 4:24 Prevalence of psychiatric illness in HIV - 9:56 Screening for psychiatric illness in HIV populations - 12:11 HIV Associated Neurocognitive Disorder (HAND) - 19:27 Diagnostic Criteria - 20:19 Clinical Presentation & Etiology - 23:03 Risk Factors - 26:56 Screening Tools - 32:06 Treatment - 36:59 HIV Psychiatry case example - 39:48 Navigating the differential diagnosis - 41:44 Initial management & addressing comorbidities - 44:30 Drug-drug interactions between antiretroviral and psychiatric medications - 48:04 Review of learning objectives & final thoughts - 52:04 Outro - 55:55   Resources: Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada (occguidelines.com) Estimates of HIV incidence, prevalence and Canada's progress on meeting the 90-90-90 HIV targets, 2020 - Canada.ca   HIV and Clinical Depression  https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-Anxiety-2012.pdf  https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-CognitiveDisorder-2012.pdf  International HIV Dementia Scale (IHDS) - Mental Health Screening - National HIV Curriculum (uw.edu)/ Liverpool HIV Interactions (hiv-druginteractions.org) References: Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843. Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843. Awori V, Mativo P, Yonga G, Shah R. The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus. South Afr J HIV Med. 2018 Apr 12;19(1):674. doi: 10.4102/sajhivmed.v19i1.674. PMID: 29707383; PMCID: PMC5913780. Bloch M, Kamminga J, Jayewardene A, Bailey M, Carberry A, Vincent T, Quan D, Maruff P, Brew B, Cysique LA. A Screening Strategy for HIV-Associated Neurocognitive Disorders That Accurately Identifies Patients Requiring Neurological Review. Clin Infect Dis. 2016 Sep 1;63(5):687-693. doi: 10.1093/cid/ciw399. Epub 2016 Jun 19. PMID: 27325690; PMCID: PMC4981762. Clinical Care Guidelines for Adults and Adolescents living with HIV in Ontario, Canada. Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada (occguidelines.com) Core Concepts - Screening for Mental Health Conditions - Basic HIV Primary Care - National HIV Curriculum (uw.edu) Cysique LA, Casaletto KB, Heaton RK. Reliably Measuring Cognitive Change in the Era of Chronic HIV Infection and Chronic HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci. 2021;50:271-298. doi: 10.1007/7854_2019_116. PMID: 31559600. EACS Guidelines version 11.1, October 2022. Joska JA, Witten J, Thomas KG, Robertson C, Casson-Crook M, Roosa H et al. A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa. AIDS and behavior. 2016 Aug 1;20(8):1621-1631. doi: 10.1007/s10461-016-1316-y Kolakowska A, Maresca AF, Collins IJ, Cailhol J. Update on Adverse Effects of HIV Integrase Inhibitors. Curr Treat Options Infect Dis. 2019;11(4):372-387. doi: 10.1007/s40506-019-00203-7. Epub 2019 Nov 16. PMID: 33380904; PMCID: PMC7758219. Robbins RN, Scott TM, Gouse H, Marcotte TD, Rourke SB. Screening for HIV-Associated Neurocognitive Disorders: Sensitivity and Specificity. Curr Top Behav Neurosci. 2021;50:429-478. doi: 10.1007/7854_2019_117. PMID: 32677005. Rubin LH, Maki PM. Neurocognitive Complications of HIV Infection in Women: Insights from the WIHS Cohort. Curr Top Behav Neurosci. 2021;50:175-191. doi: 10.1007/7854_2019_101. PMID: 31396894. Southern African HIV Clinicians Society. Management of mental health disorders in HIV-positive patients. S Afr J HIV Med 2013; 14(4): 155 - 165  Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021 Dec 6;73(11):e3572-e3605. doi: 10.1093/cid/ciaa1391. Erratum in: Clin Infect Dis. 2021 Dec 08;: Erratum in: Clin Infect Dis. 2022 Nov 30;75(11):2052. PMID: 33225349. Turjanski, N., & Lloyd, G. (2005). Psychiatric side-effects of medications: Recent developments. Advances in Psychiatric Treatment, 11(1), 58-70. doi:10.1192/apt.11.1.58 Wang Y, Liu M, Lu Q, Farrell M, Lappin JM, Shi J, Lu L, Bao Y. Global prevalence and burden of HIV-associated neurocognitive disorder: A meta-analysis. Neurology. 2020 Nov 10;95(19):e2610-e2621. doi: 10.1212/WNL.0000000000010752. Epub 2020 Sep 4. PMID: 32887786.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Time to "idiot proof" the myth of bactericidal being better than bacteriostatic agents onthis collaborative episode with the ID_IOTS podcast.About our Guest: Jame and Callum are the hosts of the ID_IOTS podcast, an Infectious Disease podcast. You can find them through https://idiotspodcasting.buzzsprout.com/share wherever you get your podcasts and also on Twitter as @IDiots_pod References from this episode: https://idiotspodcasting.buzzsprout.com/1782416/12537247-44-the-basics-of-beta-lactamase-inhibitorsWald-Dickler N, Holtom P, Spellberg B. Busting the Myth of ‘Static vs Cidal': A Systemic Literature Review. Clin Infect Dis. 2018 17;66(9):1470–4.Use of bacteriostatic agents in Neutropenic fever: DOI: 10.1586/eri.09.11. Jaksic B, Martinelli G, Oteyza JP, Hartman CS, Leonard LB, Tack KJ. Efficacy and Safety of Linezolid Compared with Vancomycin in a Randomized, Double-Blind Study of Febrile Neutropenic Patients with Cancer.Clinical Infectious Diseases. 2006 Mar 1;42(5):597–607https://www.bradspellberg.com/shorter-is-better Visit the Microbe Mail website to sign up for updates E-mail: mail.microbe@gmail.comYouTube: Microbe MailInstagram: Microbe_Mail

Lucca Cirilo e Frederico Amorim trouxeram tudo que você precisa saber sobre vacinação pra dengue: quais os tipos, quais as indicações e contraindicações e qual as coisas novas que ainda vão surgir! Referências Referências episódio: 1. https://sbim.org.br/images/files/notas-tecnicas/nota-tecnica-sbim-sbi-sbmt-qdenga-v4.pdf 2. Patel SS, Rauscher M, Kudela M, Pang H. Clinical Safety Experience of TAK-003 for Dengue Fever: A New Tetravalent Live Attenuated Vaccine Candidate. Clin Infect Dis. 2023 Feb 8;76(3):e1350-e1359. doi: 10.1093/cid/ciac418. PMID: 35639602; PMCID: PMC9907483. 3. Biswal S, Borja-Tabora C, Martinez Vargas L, Velásquez H, Theresa Alera M, Sierra V, Johana Rodriguez-Arenales E, Yu D, Wickramasinghe VP, Duarte Moreira E Jr, Fernando AD, Gunasekera D, Kosalaraksa P, Espinoza F, López-Medina E, Bravo L, Tuboi S, Hutagalung Y, Garbes P, Escudero I, Rauscher M, Bizjajeva S, LeFevre I, Borkowski A, Saez-Llorens X, Wallace D; TIDES study group. Efficacy of a tetravalent dengue vaccine in healthy children aged 4-16 years: a randomised, placebo-controlled, phase 3 trial. Lancet. 2020 May 2;395(10234):1423-1433. doi: 10.1016/S0140-6736(20)30414-1. Epub 2020 Mar 17. Erratum in: Lancet. 2020 Apr 4;395(10230):1114. PMID: 32197105. 4. Patel SS, Rauscher M, Kudela M, Pang H. Clinical Safety Experience of TAK-003 for Dengue Fever: A New Tetravalent Live Attenuated Vaccine Candidate. Clin Infect Dis. 2023 Feb 8;76(3):e1350-e1359. doi: 10.1093/cid/ciac418. PMID: 35639602; PMCID: PMC9907483.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: September 19, 2019In this week's clinical case, Dr. Mike Bradshaw (Chicago Medical School and Billings Clinic) walks us through the case of a young woman with HSV encephalitis. With a twist. SPOILER ALERT: If you don't want to know the answer, DON'T LOOK AT THE SHOWNOTES!Produced by James E Siegler and Mike Bradshaw. Music courtesy of Yan Terrien, Unheard Music Concepts, Steve Combs, and Montplaisir. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.REFERENCESArmangue T, Leypoldt F, Dalmau J. Autoimmune encephalitis as differential diagnosis of infectious encephalitis. Curr Opin Neurol 2014;27(3):361-8. PMID 24792345Armangue T, Leypoldt F, Málaga I, et al. Herpes simplex virus encephalitis is a trigger of brain autoimmunity. Ann Neurol 2014;75(2):317-23. PMID 24318406Armangue T, Spatola M, Vlagea A, et al. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis. Lancet Neurol 2018;17(9):760-72. PMID 30049614Bacon TH, Boon RJ, Schultz M, Hodges-Savola C. Surveillance for antiviral-agent-resistant herpes simplex virus in the general population with recurrent herpes labialis. Antimicrob Agents Chemother 2002;46(9):3042-4. PMID 12183267Dubey D, Pittock SJ, Kelly CR, et al. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Ann Neurol 2018;83(1):166-77. PMID 29293273Gable MS, Sheriff H, Dalmau J, Tilley DH, Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project. Clin Infect Dis 2012;54(7):899-904. PMID 22281844Granerod J, Ambrose HE, Davies NW, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis 2010;10(12):835-44. PMID 20952256Linnoila JJ, Binnicker MJ, Majed M, Klein CJ, McKeon A. CSF herpes virus and autoantibody profiles in the evaluation of encephalitis. Neurol Neuroimmunol Neuroinflamm 2016;3(4):e245. PMID 27308306Prüss H, Finke C, Höltje M, et al. N-methyl-D-aspartate receptor antibodies in herpes simplex encephalitis. Ann Neurol 2012;72(6):902-11. PMID 23280840Steiner I, Budka H, Chaudhuri A, et al. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 2010;17(8):999-e57. PMID 20236175Venkatesan A, Benavides DR. Autoimmune encephalitis and its relation to infection. Curr Neurol Neurosci Rep 2015;15(3):3. PMID 25637289We belie

The complexity behind recurrent UTI management often leaves both patients and clinicians with questions on the optimal management strategy. Should they be treated as an uncomplicated UTI? Are there special considerations or prevention measures? Are there unforeseen or unknown factors contributing to disease incidence? In this second episode, we take a deep dive into the treatment and management of recurrent UTI and explore the impact that this disease has on patients. Disclaimers: This presentation is sponsored by GSK. The speakers are GSK paid healthcare providers. The content is intended to support disease state education and is considered nonpromotional. The content and views expressed therein do not necessarily reflect the views, policies, or position of Pri-Med. This program is limited to Health Care Professionals (HCPs) only. GSK complies with all state and federal laws including transparent reporting and disclosure of payments and transfers of value to HCPs.   References: Anger J, Lee U, Ackerman AL, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. J Urol. 2019;202(2):282-289. doi: 10.1097/JU.00000000000002963.  Foxman B, Brown P. Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs. Infect Dis Clin North Am. 2003;17(2):227-241. doi: 10.1016/s0891-5520(03)00005-9 Foxman B, Gillespie B, Koopman J, et al. Risk factors for second urinary tract infection among college women. Am J Epidemiol 2000; 151:1194. Ikäheimo R, Siitonen A, Heiskanen T, et al. Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis 1996; 22:91. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103. Markowitz MA, Wood LN, Raz S, Miller LG, Haake DA, Kim JH. Lack of uniformity among United States recommendations for diagnosis and management of acute, uncomplicated cystitis. Int Urogynecol J. 2019;30(7):1187-1194. doi:10.1007/s00192-018-3750-z. Labcorp Report – Antibiotic Resistance in Bladder Infections (2019). https://www.labcorp.com/organizations/data/insights[1]analysis#InsightAnalytics-Antibiotic. Accessed December 1, 2022. Langford BJ, Brown KA, Diong C, et al. The Benefits and Harms of Antibiotic Prophylaxis for Urinary Tract Infection in Older Adults. Clin Infect Dis. 2021;73(3):e782-e791. doi:10.1093/cid/ciab116 Harding C, Mossop H, Homer T, et al. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ. 2022;376:e068229. Published 2022 Mar 9. doi:10.1136/bmj-2021-0068229

The controversy surrounding whether to collect urine cultures and which empiric treatment to prescribe in patients with uncomplicated UTI has left many clinicians unsure of the right approach. In this the first episode of a podcast series, we'll discuss the definition of clinical cure and dive into the evidence behind grey areas in the diagnosis and management of uncomplicated UTI. Disclaimers: This presentation is sponsored by GSK. The speakers are GSK paid healthcare providers. The content is intended to support disease state education and is considered nonpromotional. The content and views expressed therein do not necessarily reflect the views, policies, or position of Pri-Med. This program is limited to Health Care Professionals (HCPs) only. GSK complies with all state and federal laws including transparent reporting and disclosure of payments and transfers of value to HCPs.   References: Gupta K, Hooton TM, Naber KG, et al.; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103- e120. doi: 10.1093/cid/ciq2572. Anger J, Lee U, Ackerman AL, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. J Urol. 2019;202(2):282-289. doi: 10.1097/JU.00000000000002963 Houlbar M, Meng L. SHC Clinical Pathway: Inpatient Management of Urinary Tract Infections – Adult Patients. Stanford Antimicrobial Safety and Sustainability Program. November 2017. https://med.stanford.edu/content/dam/sm/bugsanddrugs/documents/c linicalpathways/SHC-UTI-Inpatient-Guideline.pdf. Accessed November 30, 2022. Hooton TM, Gupta K. Acute simple cystitis in women. UpToDate. Updated March 15, 2021. Accessed November 9, 2022. https://www.uptodate.com/contents/acute-simple-cystitis-in-women Colgan R, Williams M. Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician. 2011;84(7):771-776. Shafrin J, Marijam A, Joshi AV, et al. Impact of suboptimal or inappropriate treatment on healthcare resource use and cost among patients with uncomplicated urinary tract infection: an analysis of integrated delivery network electronic health records. Antimicrob Resist Infect Control. 2022;11(1):133. Published 2022 Nov 4. doi:10.1186/s13756-022-01170-3 Daneman N, Chateau D, Dahl M, et al. Fluoroquinolone use for uncomplicated urinary tract infections in women: a retrospective cohort study. Clin Microbiol Infect. 2020;26(5):613-618. doi:10.1016/j.cmi.2019.10.016 Bratsman A, Mathias K, Laubscher R, Grigoryan L, Rose S. Outpatient fluoroquinolone prescribing patterns before and after US FDA boxed warning. Pharmacoepidemiol Drug Saf. 2020;29(6):701-707. doi:10.1002/pds.5018 FDA Drug Safety Communication. FDA. 2019. Accessed October 10, 2022 https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns[1]about-increased-risk-ruptures-or-tears-aorta-blood-vessel[1]fluoroquinolone-antibiotics Nicolle LE; AMMI Canada Guidelines Committee*. Complicated urinary tract infection in adults. Can J Infect Dis Med Microbiol. 2005;16(6):349- 360. doi:10.1155/2005/385768

Uncomplicated UTIs (Urinary Tract Infections) can have a detrimental impact on emotional wellbeing. Patients may feel ignored by their clinicians, who face a diverse set of challenges when managing uncomplicated UTIs, all of which are important to address when keeping the plan patient-centered. In this podcast, we will discuss patient-clinician communication barriers and the importance of patient[1]centered outcomes in managing uncomplicated UTIs. Disclaimers: This presentation is sponsored by GSK. The speakers are GSK paid healthcare providers. The content is intended to support disease state education and is considered nonpromotional. The content and views expressed therein do not necessarily reflect the views, policies, or position of Pri-Med. This program is limited to Health Care Professionals (HCPs) only. GSK complies with all state and federal laws including transparent reporting and disclosure of payments and transfers of value to HCPs.   References: Hilt EE, McKinley K, Pearce MM, et al. Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder. J Clin Microbiol. 2014;52(3):871-876. doi:10.1128/JCM.02876-13 Lindsay LE, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis 68, no. 10 (May 2, 2019): e83–110. https://doi.org/10.1093/cid/ciy1121 Advani SD, Polage CR, Fakih MG. Deconstructing the urinalysis: A novel approach to diagnostic and antimicrobial stewardship. Antimicrob Steward Healthc Epidemiol. 2021;1(1):e6. doi: 10.1017/ash.2021.167. Epub 2021 Jun 28. PMID: 34604864; PMCID: PMC8486290 FDA Drug Safety Communication. FDA. 2016. Accessed October 10, 2022 https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety[1]communication-fda-advises-restricting-fluoroquinolone-antibiotic-use-certain Anger J, Lee U, Ackerman AL, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. J Urol. 2019;202(2):282-289. doi: 10.1097/JU.00000000000002963 Thompson J, Marijam A, Mitrani-Gold FS, Wright J, Joshi AV. Activity impairment and health-related emotional wellbeing associated with an uncomplicated urinary tract infection among US females. Oral presentation at: IDWeek 2021; September 29-October 3, 2021; Virtual Conference. Session: UTIs; presentation 196 7.Colgan R, Keating K, Dougouih M. Survey of symptom burden in women with uncomplicated urinary tract infections. Clin Drug Investig. 2004;24(1):55-60. doi: 10.2165/00044011-200424010-00007 Thompson J, Marijam A, Mitrani-Gold FS, Wright J, Joshi AV. A survey study of healthcare resource use, and direct and indirect costs, among females with an uncomplicated urinary tract infection in the United States. Poster presented at: IDWeek 2021; September 29-October 3, 2021. Poster 1227 Grigoryan L, Mulgirigama A, Powell M, Schmiemann G. The emotional impact of urinary tract infections in women: a qualitative analysis. BMC Womens Health. 2022;22(1):182. doi: 10.1186/s12905-022-01757-3 Scott VC, Thum LW, Sadun T, et al. Fear and frustration among women with recurrent urinary tract infections: findings from patient focus groups. J Urol. 2021;206(3):688-695. doi: 10.1097/JU.0000000000001843 Lecky DM, Howdle J, Butler CC, McNulty CA. Optimising management of UTIs in primary care: a qualitative study of patient and GP perspectives to inform the development of an evidence-based, shared decision-making resource. Br J Gen Pract. 2020;70(694):e330-e338. doi: 10.3399/bjgp20X708173 Chwa A, Kavanagh K, Linnebur SA, Fixen DR. Evaluation of methenamine for urinary tract infection prevention in older adults: a review of the evidence. Ther Adv Drug Saf. 2019;10:2042098619876749. Published 2019 Sep 23. doi:10.1177/2042098619876749 Harding C, Mossop H, Homer T, etal. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ 2022;376:e068229. doi: 10.1136/bmj-2021-0068229 Wade C, et al. Methenamine Prophylaxis for Recurrent Urinary Tract Infections in a Tertiary Referral Center. Urol Pract 2021;8(8):699-704 Hoffmann TC. Methenamine hippurate for recurrent urinary tract infections. BMJ 2022; 376 De Paepe H, Hoebeke P, Renson C, et al. Pelvic-floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding. Br J Urol. 1998;81 Suppl 3:109-113. doi:10.1046/j.1464-410x.1998.00021.x Hooton TM, Vecchio M, Iroz A et al. Effect of increased daily water intake in premenopausal women with recurrent urinary tract infections. JAMA Intern Med 2018; 178: 1509 Gupta K, Hooton TM, Naber KG, et al.; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120. doi: 10.1093/cid/ciq257

Tidal Volume is a podcast from ATS Peds focusing on core concepts of pediatric pulmonology. The goal is to bring in depth focus on these core concepts for residents, fellows, early career pulmonologists or even senior faculty looking for a refresher.In episode 7, Ryan Thomas MD from Michigan State University discusses tracheobronchitis in children with tracheostomy tubes with Dan Craven MD and Moshe Prero MD from Case Western Reserve University/Rainbow Babies and Children's Hospital and Alexander Gipsman MD from Children's Hospital  of Philadelphia. We discuss their review article Tracheobronchitis in children with tracheostomy tubes: Overview of a challenging problem and why they decided to write on this topic.  We also discuss the importance of tracheobronchitis in this patient population, the risk factors for infection, the microbiology of the airway,  and the diagnosis and treatment of tracheobronchitis in children with tracheostomy tubes.  Guests:  Daniel Craven, MD, Case Western Reserve UniversityMoshe Prero, MD, Case Western Reserve UniversityAlexander Gipsman, MD, Children's Hospital of Philadelphia Host:  Ryan Thomas, MD,  Michigan State University ReviewersChristina Barreda, MD, University of Wisconsin Elizabeth Fiorino, MD, Hofstra University Production/EditingRyan Thomas, MD,  Michigan State University Contact Information:TidalVolumeATSPeds@gmail.com Twitter Accounts:Ryan Thomas, MD@MSUPedsPulm@ATSPeds References  Gipsman A, Prero M, Toltzis P, Craven D. Tracheobronchitis in children with tracheostomy tubes: Overview of a challenging problem. Pediatr Pulmonol. 2022 Apr;57(4):814-821. Akangire G, Manimtim W, Nyp M, et al. Factors leading to rehospitalization for tracheostomized and ventilator-dependent infants through 2 years of age. J Perinatol. 2017;37(7):857-863. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-332.  Griese M, Felber J, Reiter K, et al. Airway inflammation in children with tracheostomy. Pediatr Pulmonol. 2004;37(4):356-361.  Willson DF, Conaway M, Kelly R, Hendley JO. The lack of specificity of tracheal aspirates in the diagnosis of pulmonary infection in intubated children. Pediatr Crit Care Med. 2014;15(4):299-305.  Cline JM, Woods CR, Ervin SE, Rubin BK, Kirse DJ. Surveillance tracheal aspirate cultures do not reliably predict bacteria cultured at the time of an acute respiratory infection in children with tracheostomy tubes. Chest. 2012;141(3):625-631.  Rusakow LS, Guarín M, Wegner CB, Rice TB, Mischler EH. Suspected respiratory tract infection in the tracheostomized child: the pediatric pulmonologist's approach. Chest. 1998;113(6):1549-1554.  Goldstein I, Wallet F, Nicolas-Robin A, Ferrari F, Marquette CH, Rouby JJ. Lung deposition and efficiency of nebulized amikacin during escherichia coli pneumonia in ventilated piglets. Am J Respir Crit Care Med. 2002;166(10):1375-1381.  Herrmann G, Yang L, Wu H, et al. Colistin-tobramycin combinations are superior to monotherapy concerning the killing of biofilm Pseudomonas aeruginosa. J Infect Dis. 2010;202(10):1585-1592.  Tamma PD, Turnbull AE, Milstone AM, Lehmann CU, Sydnor ER, Cosgrove SE. Ventilator-associated tracheitis in children: does antibiotic duration matter? Clin Infect Dis. 2011;52(11):1324-1331.  Chastre J, Wolff M, Fagon JY, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290(19):2588-2598.  Silva RC, Ojano-Dirain CP, Antonelli PJ. Effectiveness of pediatric tracheostomy tube cleaning. Arch Otolaryngol Head Neck Surg. 2012;138(3):251-256.  Morrison JM, Hassan A, Kysh L, Dudas RA, Russell CJ. Diagnosis, management, and outcomes of pediatric tracheostomy-associated infections: A scoping review. Pediatr Pulmonol. 2022 May;57(5):1145-1156.  Jutras C, Autmizguine J, Chomton M, et al. Inhaled antibiotics for the prevention of respiratory tract infections in children with a tracheostomy. Front Pediatr. 2021;9:633039.

Lyme disease is the most common tick-borne disease in the US that can present in three different stages. Diagnosis is through a combination of a thorough history, review of systems, physical exam, as well as a two-tier serologic testing. Former Pediatric resident, Dr. James Davis, joins Associate Professor of Pediatrics, Dr. Susan Goldberg, to discuss the evaluation and management of Lyme Disease in the pediatric population. After listening to this podcast, learners should be able to: Recognize common presenting signs and symptoms of Early Localized, Early Disseminated, and Late Lyme disease from a patient history and physical examination Determine whether a patient meets clinical diagnostic criteria and, if not, which lab tests are appropriate for diagnosis of Lyme disease Appropriately prescribe the correct antibiotic choice and duration for patients, depending on variation of Lyme disease and accompanying symptoms Accurately and effectively instruct patients in prevention strategies for tick bites and Lyme disease Special thanks to Dr. Ingrid Camelo, Dr. Rebecca Yang and Dr. Jacob Eichenberger who peer reviewed today's episode. FREE CME Credit (requires free sign-up): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=11411  References: Rodino KG, Theel ES, Pritt BS. Tick-Borne Diseases in the United States. Clin Chem. 2020 Apr 1;66(4):537-548. doi: 10.1093/clinchem/hvaa040. PMID: 32232463. Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis. 2021 Jan 23;72(1):e1-e48. doi: 10.1093/cid/ciaa1215. PMID: 33417672. Eddens T, Kaplan DJ, Anderson AJM, Nowalk AJ, Campfield BT. Insights From the Geographic Spread of the Lyme Disease Epidemic. Clin Infect Dis. 2019 Jan 18;68(3):426-434. doi: 10.1093/cid/ciy510. PMID: 29920580; PMCID: PMC6336907. Sundheim KM, Levas MN, Balamuth F, Thompson AD, Neville DN, Garro AC, Kharbanda AB, Monuteaux MC, Nigrovic LE. Seasonality of Acute Lyme Disease in Children. Trop Med Infect Dis. 2021 Nov 9;6(4):196. doi: 10.3390/tropicalmed6040196. PMID: 34842846; PMCID: PMC8628899. 2021. "Lyme Disease (Lyme Borreliosis, Borrelia burgdorferi sensu lato Infection)", Red Book: 2021–2024 Report of the Committee on Infectious Diseases, Committee on Infectious Diseases, American Academy of Pediatrics, David W. Kimberlin, MD, FAAP, Elizabeth D. Barnett, MD, FAAP, Ruth Lynfield, MD, FAAP, Mark H. Sawyer, MD, FAAP Bax CE, Clark AK, Oboite M, Treat JR. A case of disseminated Lyme disease in a child with skin of color. Pediatr Dermatol. 2021 Nov;38 Suppl 2:140-141. doi: 10.1111/pde.14770. Epub 2021 Sep 13. PMID: 34515362. Lipsett SC, Nigrovic LE. Diagnosis of Lyme disease in the pediatric acute care setting. Curr Opin Pediatr. 2016 Jun;28(3):287-93. doi: 10.1097/MOP.0000000000000339. PMID: 27138805. Shapiro ED. Borrelia burgdorferi (Lyme disease). Pediatr Rev. 2014 Dec;35(12):500-9. doi: 10.1542/pir.35-12-500. PMID: 25452659; PMCID: PMC5029759. Meissner HC, Steere AC. Management of Pediatric Lyme Disease: Updates From 2020 Lyme Guidelines. Pediatrics. 2022 Mar 1;149(3):e2021054980. doi: 10.1542/peds.2021-054980. PMID: 35229121. Bolourchi M, Silver ES, Liberman L. Advanced Heart Block in Children with Lyme Disease. Pediatr Cardiol. 2019 Mar;40(3):513-517. doi: 10.1007/s00246-018-2003-8. Epub 2018 Oct 31. PMID: 30377753. Chason ME, Monaghan M, Wang J, Cheng Y, DeBiasi RL. Symptom Resolution in Pediatric Patients With Lyme Disease. J Pediatric Infect Dis Soc. 2019 May 11;8(2):170-173. doi: 10.1093/jpids/piy067. PMID: 30060012. 2021. "Prevention of Mosquitoborne and Tickborne Infection", Red Book: 2021–2024 Report of the Committee on Infectious Diseases, Committee on Infectious Diseases, American Academy of Pediatrics, David W. Kimberlin, MD, FAAP, Elizabeth D. Barnett, MD, FAAP, Ruth Lynfield, MD, FAAP, Mark H. Sawyer, MD, FAAP Centers for Disease Control and Prevention. Preventing Tick Bites on People [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; Sept 2019 [cited 2022 March 30]. Available from: https://www.cdc.gov/lyme/prev/on_people.html

Dr. Kimberly Blumenthal (@KimberlyBlumen1), Dr. Meghan Jeffres (@PharmerMeg), and Dr. Eric Macy (@EricMacyMD) join Dr. Julie Ann Justo (@julie_justo) to summarize the history of cephalosporin avoidance in penicillin allergies, evidence-based pros and cons of giving cephalosporins in penicillin allergy, how to leverage technology to improve treatment of patients with penicillin allergies, and much more! Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ References Macy E. Why Was There Ever a Warning Not to Use Cephalosporins in the Setting of a Penicillin "Allergy"? J Allergy Clin Immunol Pract. 2021 Nov;9(11):3929-3933. doi: 10.1016/j.jaip.2021.06.059. PMID: 34303019. Liang EH, et al. Adverse Reactions Associated with Penicillins, Carbapenems, Monobactams, and Clindamycin: A Retrospective Population-based Study. J Allergy Clin Immunol Pract. 2020 Apr;8(4):1302-1313.e2. doi: 10.1016/j.jaip.2019.11.035. PMID: 31821919. Macy E, Contreras R. Adverse reactions associated with oral and parenteral use of cephalosporins: A retrospective population-based analysis. J Allergy Clin Immunol. 2015 Mar;135(3):745-52.e5. doi: 10.1016/j.jaci.2014.07.062. PMID: 25262461. Macy E, et al. Population-Based Incidence of New Ampicillin, Cephalexin, Cefaclor, and Sulfonamide Antibiotic "Allergies" in Exposed Individuals with and without Preexisting Ampicillin, Cephalexin, or Cefaclor "Allergies". J Allergy Clin Immunol Pract. 2022 Feb;10(2):550-555. doi: 10.1016/j.jaip.2021.10.043. PMID: 34757066. Picard M, et al. Cross-Reactivity to Cephalosporins and Carbapenems in Penicillin-Allergic Patients: Two Systematic Reviews and Meta-Analyses. J Allergy Clin Immunol Pract. 2019 Nov-Dec;7(8):2722-2738.e5. doi: 10.1016/j.jaip.2019.05.038. PMID: 31170539. Romano A, et al. Cross-reactivity and tolerability of aztreonam and cephalosporins in subjects with a T cell-mediated hypersensitivity to penicillins. J Allergy Clin Immunol. 2016 Jul;138(1):179-186. doi: 10.1016/j.jaci.2016.01.025. PMID: 27016799. Romano A, et al. Cross-Reactivity and Tolerability of Cephalosporins in Patients with IgE-Mediated Hypersensitivity to Penicillins. J Allergy Clin Immunol Pract. 2018 Sep-Oct;6(5):1662-1672. doi: 10.1016/j.jaip.2018.01.020. PMID: 29408440. Blumenthal KG, et al. The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk. Clin Infect Dis. 2018 Jan 18;66(3):329-336. doi: 10.1093/cid/cix794. PMID: 29361015. Blumenthal KG, et al. Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study. BMJ. 2018 Jun 27;361:k2400. doi: 10.1136/bmj.k2400. PMID: 29950489. Blumenthal KG, et al. Recorded Penicillin Allergy and Risk of Mortality: a Population-Based Matched Cohort Study. J Gen Intern Med. 2019 Sep;34(9):1685-1687. doi: 10.1007/s11606-019-04991-y. PMID: 31011962. Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin "allergy" in hospitalized patients: A cohort study. J Allergy Clin Immunol. 2014 Mar;133(3):790-6. doi: 10.1016/j.jaci.2013.09.021. PMID: 24188976. AAAI. Choosing Wisely. 2014 Mar 3. https://www.choosingwisely.org/clinician-lists/american-academy-allergy-asthma-immunlogy-non-beta-lactam-antibiotics-penicillin-allergy/ Jeffres MN, et al. Systematic review of professional liability when prescribing β-lactams for patients with a known penicillin allergy. Ann Allergy Asthma Immunol. 2018 Nov;121(5):530-536. doi: 10.1016/j.anai.2018.03.010. PMID: 29551402. Macy E, et al. Association Between Removal of a Warning Against Cephalosporin Use in Patients With Penicillin Allergy and Antibiotic Prescribing. JAMA Netw Open. 2021 Apr 1;4(4):e218367. doi: 10.1001/jamanetworkopen.2021.8367. PMID: 33914051. Blumenthal KG, et al. Addressing Inpatient Beta-Lactam Allergies: A Multihospital Implementation. J Allergy Clin Immunol Pract. 2017 May-Jun;5(3):616-625.e7. doi: 10.1016/j.jaip.2017.02.019. PMID: 28483315. Jeffres M. Penicillin and/or Beta-Lactam Allergy Tip Sheet & Cross-reactivity Table. https://drive.google.com/file/d/1cokYXnSDlO3vk8ke1LaalPz4iavuNSV8/view?usp=share_link Khan DA, et al. Drug allergy: A 2022 practice parameter update. J Allergy Clin Immunol. 2022 Sep 17:S0091-6749(22)01186-1. doi: 10.1016/j.jaci.2022.08.028. Epub ahead of print. PMID: 36122788. Guyer AC, et al. Allergy Electronic Health Record Documentation: A 2022 Work Group Report of the AAAAI Adverse Reactions to Drugs, Biologicals, and Latex Committee. J Allergy Clin Immunol Pract. 2022 Nov;10(11):2854-2867. doi: 10.1016/j.jaip.2022.08.020. PMID: 36151034. Iammatteo M, et al. Safety and Outcomes of Oral Graded Challenges to Amoxicillin without Prior Skin Testing. J Allergy Clin Immunol Pract. 2019 Jan;7(1):236-243. doi: 10.1016/j.jaip.2018.05.008. PMID: 29802906. Bavbek S, et al. Determinants of nocebo effect during oral drug provocation tests. Allergol Immunopathol (Madr). 2015 Jul-Aug;43(4):339-45. doi: 10.1016/j.aller.2014.04.008. PMID: 25088674. DePestel DD, et al. Cephalosporin use in treatment of patients with penicillin allergies. J Am Pharm Assoc (2003). 2008 Jul-Aug;48(4):530-40. doi: 10.1331/JAPhA.2008.07006. PMID: 18653431. Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints. Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Contributor: Travis Barlock, MD Educational Pearls: Catheter related blood infections were thought to be caused by skin flora seeding the catheter. Thus, significant effort is applied to sterility and skin preparation.   However, studies have shown that bacteria growing on the tip of the catheter is not consistent with growth on cultures of skin.   Staphylococcus epidermidis is commonly found on cultures of catheter sites. It has also been found in the gut flora of >50% of ICU patients. Rates of catheter related blood infections have been decreased through oral decontamination and early feeding.  These findings suggest enteral bacterial translation as a major source of blood stream infection. References O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-e193. doi:10.1093/cid/cir257 von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med. 2001;344(1):11-16. doi:10.1056/NEJM200101043440102 ALTEMEIER WA, HUMMEL RP, HILL EO. Staphylococcal enterocolitis following antibiotic therapy. Ann Surg. 1963;157(6):847-858. doi:10.1097/00000658-196306000-00003 Marshall JC, Christou NV, Horn R, Meakins JL. The microbiology of multiple organ failure. The proximal gastrointestinal tract as an occult reservoir of pathogens. Arch Surg. 1988;123(3):309-315. doi:10.1001/archsurg.1988.01400270043006 Mrozek N, Lautrette A, Aumeran C, et al. Bloodstream infection after positive catheter cultures: what are the risks in the intensive care unit when catheters are routinely cultured on removal?. Crit Care Med. 2011;39(6):1301-1305. doi:10.1097/CCM.0b013e3182120190 Atela I, Coll P, Rello J, et al. Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research. J Clin Microbiol. 1997;35(7):1784-1790. doi:10.1128/jcm.35.7.1784-1790.1997 Tani T, Hanasawa K, Endo Y, et al. Bacterial translocation as a cause of septic shock in humans: a report of two cases. Surg Today. 1997;27(5):447-449. doi:10.1007/BF02385710   Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MS4 & Erik Verzemnieks, MD In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/ Donate to EMM today!

Drs. Antonio Oliver (@aoliverp73) and Maggie Monogue (@MaggieMonogue) join Dr. Erin McCreary (@Erin McCreary) to discuss all things Pseudomonas aeruginosa. Tune in to learn from some of the best about the complexities of P. aeruginosa resistance, the role of various antibiotics in the management of DTR isolates, and much more! LinkedIn: https://www.linkedin.com/company/sidp/ Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx References Shields RK, et al. Clin Infect Dis. 2022;ciac097. doi: 10.1093/cid/ciac097. Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Drs. Brian Werth (@bdubrx), Zack Nelson (@zacroBID) and Amy Brotherton (@AmyBrother10) join Dr. Jillian Hayes (@thejillianhayes) to discuss updates in the management of sexually transmitted infections. Listen in for guidance on how doses are selected, practical implementation of guideline changes, and how to discuss these changes with patients. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ References St. Cyr S, et al. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–1916. doi: http://dx.doi.org/10.15585/mmwr.mm6950a6.  STI treatment guidelines. Centers for Disease Control and Prevention. https://www.cdc.gov/std/treatment-guidelines/default.htm. Published 2021. Accessed May 12, 2022.  National overview – sexually transmitted Disease SURVEILLANCE, 2019. Centers for Disease Control and Prevention. https://www.cdc.gov/std/statistics/2019/overview.htm. Published April 13, 2021. Accessed May 12, 2022. Doan T, et al. N Engl J Med. 2020 Nov 12;383(20):1941-1950. doi: 10.1056/NEJMoa2002606. PMID: 33176084.  Doan T, et al. N Engl J Med. 2019 Jun 6;380(23):2271-2273. doi: 10.1056/NEJMc1901535. PMID: 33167060. Kong FYS, et al. Clin Infect Dis. 2014 Jul 15;59(2):193-205. doi: 10.1093/cid/ciu220. PMID: 24729507.  Dombrowski JC, et al. Clin Infect Dis. 2021 Sep 7;73(5):842-831. doi: 10.1093/cid/ciab153. PMID: 33606009.  Connolly KL, et al. Antimicrob Agents Chemother. 2019 Feb 26;63(3):e01644-18. doi: 10.1128/AAC.01644-18. PMID: 30642924.  Páez-Canro C, et al. Cochrane Database Syst Rev. 2019 Jan 25;1(1):CD010871. doi: 10.1002/14651858.CD010871.pub2. PMID: 30682211.  Dukeres-Muijrers NHTM, et al. Sex Transm Infect. 2021 Mar;97(2):147-151. doi: 10.1136/sextrans-2020-054558. Epub 2020 Jul 31. PMID: 32737209. Manavi K, et al. Int J STD AIDS. 2016 Dec;27(14):1303-1308. doi: 10.1177/0956462415614723. Epub 2015 Oct 27. PMID: 26511655.  Chisholm SA, et al. J Antimicrob Chemother. 2010 Oct;65(10):2141-8. doi: 10.1093/jac/dkq289. Epub 2010 Aug 6. PMID: 20693173.  Kastner U, et al. Infection. 2001 Oct;29(5):251-6. doi: 10.1007/s15010-001-1072-3. PMID: 11688901. Dellamonica P. J Antimicrob Chemother. 2002 Oct;50(4):614-5. doi: 10.1093/jac/dkf166. PMID: 12356813. Davidson RJ. Infect Drug Resist. 2019 Mar 8;12:585-596. doi: 10.2147/IDR.S187226. PMID: 30881064. Burr LD, et al. Antimicrob Agents Chemother. 2022 Apr 19;66(4):e0224621. doi: 10.1128/aac.02246-21. PMID: 35293783. Hepatitis C State of Medicaid Access: https://stateofhepc.org Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Drs. Kate DeSear (@IDPharmD_Kate) and Frank Tverdek (@FTverdek) join Dr. Julie Ann Justo (@julie_justo) to discuss the practice of empiric escalation in this episode of our gram-negative resistance series. Listen in for encouragement on following your intuition and tips on how, when, and why to practice this other side of antimicrobial stewardship. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ References Clinical and Laboratory Standards Institute. Access Our Free Resources: M100 and M60. Accessed at https://clsi.org/standards/products/free-resources/access-our-free-resources/ Gallagher JC, et al. Open Forum Infect Dis. 2018 Oct 31;5(11):ofy280. doi: 10.1093/ofid/ofy280. PMID: 30488041. Castan B, et al. Infect Dis Now. 2021 Sep;51(6):532-539. doi: 10.1016/j.idnow.2021.05.003. Epub 2021 May 17. PMID: 34015539. Cultrera R, et al. Antibiotics (Basel). 2020 Sep 24;9(10):640. doi: 10.3390/antibiotics9100640. PMID: 32987821. Strich JR, et al. Clin Infect Dis. 2021 Feb 16;72(4):611-621. doi: 10.1093/cid/ciaa061. PMID: 32107536. Montravers P, Bassetti M. Curr Opin Infect Dis. 2018 Dec;31(6):587-593. doi: 10.1097/QCO.0000000000000490. PMID: 30299359. Strich JR, Heil EL, Masur H. J Infect Dis. 2020 Jul 21;222(Suppl 2):S119-S131. doi: 10.1093/infdis/jiaa221. PMID: 32691833. Kumar A, et al. Crit Care Med. 2006 Jun;34(6):1589-96. doi: 10.1097/01.CCM.0000217961.75225.E9. PMID: 16625125. Hibbard ML, et al. Surg Infect (Larchmt). 2010 Oct;11(5):427-32. doi: 10.1089/sur.2009.046. PMID: 20818984. Rosa RG, Goldani LZ, dos Santos RP. BMC Infect Dis. 2014 May 23;14:286. doi: 10.1186/1471-2334-14-286. PMID: 24884397. Benanti GE, et al. Antimicrob Agents Chemother. 2019 Jan 29;63(2):e01813-18. doi: 10.1128/AAC.01813-18. PMID: 30509935.

Dr. Ben Weaver and Dr. Elisa Walsh (@elisacwalsh) from Massachusetts General Hospital join the show to discuss the literature around the infectious risk of arterial catheters and the role of barrier precautions. This is the first episode produced from a new podcast elective that's available to MGH anesthesia residents. Special thanks to Dr. Saddawi-Konefka for supporting the initiative. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Cohen DM, Carino GP, Heffernan DS, et al. Arterial catheter use in the ICU: A national survey of antiseptic technique and perceived infectious risk. Crit Care Med. 2015;43(11):2346-2353. doi:10.1097/CCM.0000000000001250 Koh DBC, Gowardman JR, Rickard CM. Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters (Critical Care Medicine (2008) 36, (397-402)). Crit Care Med. 2008;36(4):1394. doi:10.1097/CCM.0b013e31816e6d16 Lucet JC, Bouadma L, Zahar JR, et al. Infectious risk associated with arterial catheters compared with central venous catheters. Crit Care Med. 2010;38(4):1030-1035. doi:10.1097/CCM.0b013e3181d4502e O'Horo JC, Maki DG, Krupp AE, Safdar N. Arterial catheters as a source of bloodstream infection: A systematic review and meta-analysis. Crit Care Med. 2014;42(6):1334-1339. doi:10.1097/CCM.0000000000000166 Raad II, Hohn DC, Gilbreath BJ, et al. Prevention of Central Venous Catheter-Related Infections by Using Maximal Sterile Barrier Precautions during Insertion Srr PREVENTION OF CENTRAL VENOUS CATHETER-RELATED INFECTIONS BY USING MAXIMAL STERILE BARRIER. 1994;15(4). Rijnders BJA, Van Wijngaerden E, Wilmer A, Peetermans WE. Use of full sterile barrier precautions during insertion of arterial catheters: A randomized trial. Clin Infect Dis. 2003;36(6):743-748. doi:10.1086/367936 Rijnders BJA, Wijngaerden E Van, Peetermans WE. Catheter-Tip Colonization as a Surrogate End Point in Clinical Studies on Catheter-Related Bloodstream Infection : How Strong Is the Evidence ? 2002;35:1053-1058.

Welcome to Episode 14 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 14 of “The 2 View” – Urticaria, Foreign Bodies, and a Special Interview Urticaria Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. Published 2014. Accessed February 11, 2022. https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/Urticaria-2014.pdf Radecki RP, MS. Does New IV Urticaria Medication Offer Benefits Over Current Treatments? ACEP Now. Published June 15, 2021. Accessed February 11, 2022. https://www.acepnow.com/article/does-new-iv-urticaria-medication-offer-benefits-over-current-treatments/ Safety of use of high dose antihistamines in difficult-to-control chronic urticaria patients. J Am Acad Dermatol. Published May 1, 2015. Accessed February 11, 2022. https://www.jaad.org/article/S0190-9622(15)00371-0/fulltext Sarti L, Barni S, Giovannini M, Liccioli G, Novembre E, Mori F. Efficacy and tolerability of the updosing of second-generation non-sedating H1 antihistamines in children with chronic spontaneous urticaria. Pediatr Allergy Immunol. Wiley Online Library. Published August 3, 2020. Accessed February 11, 2022. https://onlinelibrary.wiley.com/doi/10.1111/pai.13325 Schaefer P. Acute and Chronic Urticaria: Evaluation and Treatment. Am Fam Physician. Published June 2017. Accessed February 11, 2022. https://www.aafp.org/afp/2017/0601/p717.html Winters M. Clinical Practice Guideline: Initial Evaluation and Management of Patients Presenting with Acute Urticaria or Angioedema. AAEM - American Academy of Emergency Medicine. Published July 10, 2006. Accessed February 11, 2022. https://www.aaem.org/resources/statements/position/clinical-practice-guideline-initial-evaluation-and-management-of-patients-presenting-with-acute-urticaria-or-angioedema Foreign Bodies & Toxic Shock Syndrome Cone LA, Woodard DR, Byrd RG, Schulz K, Kopp SM, Schlievert PM. A recalcitrant, erythematous, desquamating disorder associated with toxin-producing staphylococci in patients with AIDS. J Infect Dis. NIH. PubMed.gov. Published April 1992. Accessed February 11, 2022. https://pubmed.ncbi.nlm.nih.gov/1552193/ Contou D, Colin G, Travert B, et al. Menstrual Toxic Shock Syndrome: A French Nationwide Multicenter Retrospective Study. Clin Infect Dis. Oxford Academic. Published January 15, 2022. Accessed February 11, 2022. https://academic.oup.com/cid/article-abstract/74/2/246/6255963 Parsonnet J, Hansmann MA, Delaney ML, et al. Prevalence of Toxic Shock Syndrome Toxin 1-Producing Staphylococcus aureus and the Presence of Antibodies to This Superantigen in Menstruating Women. J Clin Microbiol. NCBI. Published September 2005. Accessed February 11, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234102/ Shands KN, Schmid GP, Dan BB, et al. Toxic-Shock Syndrome in Menstruating Women: Association with Tampon Use and Staphylococcus aureus and Clinical Features in 52 cases. N Engl J Med. Published December 18, 1980. Accessed February 11, 2022. https://www.nejm.org/doi/full/10.1056/nejm198012183032502?casa_token=GVNPVVA8uB4AAAAA:LQTf1B8PlxwffYbLmuOeWnteCLdkKtwEydZDKn2lYW-NoNe8953D58cgSMnWVnwbN136BWtd23zr Streptococcal Toxic Shock Syndrome: All You Need to Know. Cdc.gov. Published November 23, 2021. Accessed February 11, 2022. https://www.cdc.gov/groupastrep/diseases-public/streptococcal-toxic-shock-syndrome.html Toxic Shock Syndrome (Other Than Streptococcal) (TSS) 2011 case definition. Cdc.gov. Reviewed April 16, 2021. Accessed February 11, 2022. https://ndc.services.cdc.gov/case-definitions/toxic-shock-syndrome-2011/ Foreign Bodies Continued - Management Coskun A, Erkan N, Yakan S, Yıldirim M, Cengiz F. Management of rectal foreign bodies. World J Emerg Surg. Published March 13, 2013. Accessed February 11, 2022. https://wjes.biomedcentral.com/articles/10.1186/1749-7922-8-11 O'Malley G, O'Malley R. Body Packing and Body Stuffing. Merck Manuals Professional Edition. Reviewed/Revised May 2020. Accessed February 11, 2022. https://www.merckmanuals.com/professional/special-subjects/recreational-drugs-and-intoxicants/body-packing-and-body-stuffing Guest Interview: Kenny Walks Across America Facebook. Facebook.com. Accessed February 11, 2022. https://www.facebook.com/KennywalksacrossAmerica Kenny Walks Across America. Kenny Walks Across America. Accessed February 11, 2022. http://www.kennywalksacrossamerica.com Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

CDC: Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings. Mullins et al. Coronavirus in pregnancy and delivery; rapid review.  Accepted article. https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.22014 [Internet]. 2020.   Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women : a retrospective review of medical records. 2020;6736(20):1–7. Wang X, Zhou Z, Jianping Z, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis. 2020 Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. 2020;9(1):51–60 Rasmussen et al. Coronavirus Disease 2019 (COVID-19) and Pregnancy: What obstetricians need to know. AJOG 2020 https://www.ajog.org/action/showPdf?pii=S0002-9378%2820%2930197-6 Wu et al. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020. Published online. https://jamanetwork.com/journals/jama/fullarticle/2762130

CDC: Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings. Mullins et al. Coronavirus in pregnancy and delivery; rapid review.  Accepted article. https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.22014 [Internet]. 2020.   Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women : a retrospective review of medical records. 2020;6736(20):1–7. Wang X, Zhou Z, Jianping Z, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis. 2020 Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. 2020;9(1):51–60 Rasmussen et al. Coronavirus Disease 2019 (COVID-19) and Pregnancy: What obstetricians need to know. AJOG 2020 https://www.ajog.org/action/showPdf?pii=S0002-9378%2820%2930197-6 Wu et al. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020. Published online. https://jamanetwork.com/journals/jama/fullarticle/2762130