Granulicatella adiacens endocarditis outpatient treatment. Ceftriaxone? Ceftriaxone ampicillin? Vancomycin? Something else? #idxposts

While some may view ARISE-FLUIDS RCT (NEJM) as the final blow to the 30 mL/kg recommendation, a new cohort study just published in JAMA of 25,481 patients found that initial administration of ≥30 mL/kg was associated with lower 30-day mortality among patients with hypoperfusion or intermediate lactate elevation without severe cardiac or kidney comorbidities. The story of 30 mL/kg is far from over. #idxposts jamanetwork.com/journals/jam…

Excellent review📜on the diagnosis 🔬, management 💊and emerging trends in encephalitis🧠🦠 🔗thelancet.com/journals/lance… 🔗10min⏰ podcast🎙️ summary: open.spotify.com/episode/0Dt… #IDXposts

🆕💥🔴Multicenter retrospective study of ICU patients with pneumonia BIOFIRE® PN Panel implementation was associated with improved early antimicrobial de-escalation and appropriate therapy, with the greatest benefit in hospitals with comprehensive antimicrobial stewardship infrastructure #idxposts academic.oup.com/cid/article…

🆕💥🟢Getting It Right the Second Time: How Can we Optimize First-Generation Cephalosporin (cephalexin and cefadroxil) Dosing for Skin and Soft Tissue Infections in the 21st Century 🔺The authors summarize clinical and PK/PD data that compare dosing strategies for SSTIs. 🔺Conduct population PK target attainment simulations for varying doses of cephalexin and cefadroxil for Staphylococcus aureus and Group A Streptococcus 🔺Given potential risks of underdosing due to obesity, non-adherence with frequently dosed regimens, and inadequate PTA in higher MIC organisms (e.g., MSSA), the authors favor using higher-dosed regimens such as cephalexin 1000 mg three times daily or cefadroxil 1000 mg two times daily for moderate–severe SSTIs #idxposts accpjournals.onlinelibrary.w…

🆕💥🟢Multicenter prospective study shows that quantitative PCR on oral wash has a better positive predictive value than PCR on bronchoalveolar lavage for the diagnosis of Pneumocystis pneumonia in HIV-negative immunocompromised patients #idxposts academic.oup.com/cid/article…

🆕🔥The ARISE FLUIDS RCT Among adults with septic shock, the use of restricted fluids and early vasopressors did not result in more days alive and out of the hospital through day 90 than the use of liberal fluids and later vasopressors Pulmonary edema (0.6% in the vasopressor group vs. 5.0% in the fluids group; P<0.001). #idxposts

This is an excellent review, I would recommend it for my residents and interns #idxposts #MedEd #mustread #bookmark

Culture-negative endocarditis remains a diagnostic challenge, as standard microbiological techniques frequently fail to detect the responsible organisms. Plasma microbial cell-free DNA metagenomic next-generation sequencing (mcfDNA-mNGS) may improve pathogen identification and increase diagnostic yield in these cases. #idxposts

🆕💥 🟢 Systematic review and meta-analysis 16 studies (9,819 patients) Of these, one (6%) was a multi-center, open-label RCT Efficacy of a transition to oral antimicrobial therapy for gram-negative bacilli bloodstream infection #idxposts cambridge.org/core/journals/…

🆕💥🟢 Narrative review Treatment duration of community-acquired pneumonia due to Legionella pneumophila: where do we stand? #idxposts sciencedirect.com/science/ar…

Shortened duration of treatments may be sufficient even among immune compromised patients #idxposts

Important #HIV work by @SimonettiFR and team. Here's a post by Dr Simonetti on LinkedIn👇 #IDXposts ________________________________________ 🦀Time to celebrate🦀. Our study on #HIV non-suppressible viremia despite effective ART has been published in Nature Portfolio (Nat Comm). We studied ~50 PWH on ART with detectable viremia despite no drug resistance and optimal adherence to investigate the frequency of defective proviruses contributing to HIV in plasma. Three take home messages: ➡️NSV during long-term ART is most likely caused by 5'Leader defective virus released from infected clones, extending previous work from our group and others. ➡️We developed a digital PCR assay allowing to easily Capture 5'Leader Anomalies Without Sequencing (🦀CLAWS🦀). CLAWS is a "drop-off" dPCR assay that can distinguish intact from mutated or deleted Major Splicing Donor (MSD) sequences, where 5'Leader defects converge. ➡️We observed a progressive increase in 5'L-defective RNA in plasma from 1 month on ART (~1%) to long-term ART (~95%), suggesting differential selective pressure for 5'L-defective proviruses. You can find the paper here rdcu.be/fm8lU We hope this study will improve the care of people with HIV with detectable viremia on ART and provide a new tool to study HIV persistence. This was an incredible collaboration between Johns Hopkins Division of Infectious Diseases, University of Toronto, NIH, and Aarhus University. Thanks to the Hopkins CFAR, the Ontario HIV Treatment Network and the W.W. Smith Charitable Trust for funding this study.