Gabe 🦊 @IdVilchez
ID doc for fun To Know, to Dare, to Will, to Keep Silence provider.kareo.com/gabriel-vilchez Joined October 2020-
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#IDTwitter @ID_fellows #SIDPharm @TxID_Fellows #TwitteRx @IdVilchez #AMRrounds: called about this microbiology confirmed clinical bloodstream isolate inquiring about AmpC resistance.
#IDTwitter @ID_fellows #SIDPharm @TxID_Fellows #TwitteRx @IdVilchez #IDrounds: oncology patient on trimethoprim-sulfamethoxazole (SXT), acyclovir (ACY), & posaconazole (POS) presents w/ worsening HTN, ⬇️K, ⬆️ Na, & ⬇️ extremity edema. Stable Cr & ⬆️ HCO3. Most likely cause:
@IdVilchez @BradSpellberg @DrToddLee contamination possible but depends on the clinical picture. ncbi.nlm.nih.gov/pmc/articles/P…
Yo. It be like that sometimes #itbelikethatsometimes
Yo. It be like that sometimes #itbelikethatsometimes
@Infected_Terran @BennyFdzLpz @IdVilchez @OncIDPharmd @davidvanduin @PriyaNori @BradSpellberg @wwrighID @JonathanRyderMD @dralicehan @ABsteward @DrToddLee Would check out this Breakpoints podcast! Cefepime more affected by MexXY-oprM and MexCD-oprJ mutations compared to ceftazidime. open.spotify.com/episode/6omdSw…
Quantiferon GOLD / IGRA only confirms LATENT PULMONARY MTB. If miliary or CNS or ACTIVE pulmonary MTB, etc, you need tissue and fluid. Also, negative AFB smears do not rule out MTB. If you’re clinically worried in acutely/severely ill pt, start therapy and work it out. #IDTwitter
Quantiferon GOLD / IGRA only confirms LATENT PULMONARY MTB. If miliary or CNS or ACTIVE pulmonary MTB, etc, you need tissue and fluid. Also, negative AFB smears do not rule out MTB. If you’re clinically worried in acutely/severely ill pt, start therapy and work it out. #IDTwitter
#IDTwitter @ID_fellows #SIDPharm @ASMicrobiology @TxID_Fellows #TwitteRx @IdVilchez #AMRrounds: HIV patient on TAF/FTC/BIC with multiple missed doses and HIV-RNA 5444 copies/mL (3202 copies/mL 3-months prior). Genotype results include M184V and G148H. You would recommend:
#IDtwitter would you trust on ceftazidime for treatment? I don't have the pip tazo MIC @OncIDPharmd @davidvanduin @PriyaNori @BradSpellberg @wwrighID @JonathanRyderMD @dralicehan @ABsteward @DrToddLee
#IDTwitter in general, when you find an Actinomyces in the blood culture, let's say A. israelii, do you usually deemed as a contaminant or you think it could be real until proven otherwise and start a complete work-up to find the occult source? @BradSpellberg @DrToddLee…
Gustave Doré - Charon, ferryman of the dead (1861) Illustration from Dante's Divine Comedy: Inferno, canto III (1320).
*EARLY VIEW* Improvement in insulin sensitivity after switching from an integrase inhibitor‐based regimen to DOR/TDF/3TC in people with significant weight gain onlinelibrary.wiley.com/doi/full/10.11…
Saving 20 minutes for patient would be cool! 🆕️⚡️ @OFIDJournal Counting the Cost of Daptomycin versus Vancomycin in Hospitalized Patients: A Cost Minimalization Analysis #IDXposts academic.oup.com/ofid/article/d…
@DrToddLee @mmPharmD @IdVilchez @BradSpellberg @ABsteward @wwrighID @dralicehan @JGPharmD @CynthiaNixon Here are some articles that I’ve referenced to justify this dosing strategy: 1. pubmed.ncbi.nlm.nih.gov/29992286/#:~:t…. 2. academic.oup.com/ofid/article/9… 3. pure.rug.nl/ws/portalfiles… We haven’t noticed any issues at our 🏥 either as this is our preferred dosing model but 🧠 tox is certainly documented
@DrToddLee @InYourFAECIUM @mmPharmD @IdVilchez @BradSpellberg @wwrighID @dralicehan @JGPharmD @CynthiaNixon Yes, be aware of the neurotoxicity of Ertapenem. We had a couple of cases! x.com/absteward/stat…
@DrToddLee @InYourFAECIUM @mmPharmD @IdVilchez @BradSpellberg @wwrighID @dralicehan @JGPharmD @CynthiaNixon Yes, be aware of the neurotoxicity of Ertapenem. We had a couple of cases! x.com/absteward/stat…
@IdVilchez @BradSpellberg @DrToddLee @ABsteward @wwrighID @dralicehan @JGPharmD @CynthiaNixon Yes. Debate is between 500mg or 1000mg qHD. I go with 1000mg. Some difficulty having HD centers stock it so communication is key.
@IdVilchez @BradSpellberg @DrToddLee @wwrighID @dralicehan @mmPharmD @JGPharmD @CynthiaNixon Yes , we do. Check this out x.com/absteward/stat…
Antibiotic Steward Ba.. @ABsteward
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Another day, another stasis dermatitis not responding to antibiotics.
@IdVilchez @BradSpellberg @DrToddLee What was considered a diphtheroids (contamination)in the blood culture is now is identified as actinomyces by the malditoff
@IdVilchez @OncIDPharmd @davidvanduin @PriyaNori @BradSpellberg @wwrighID @JonathanRyderMD @dralicehan @ABsteward @DrToddLee This is peculiar. With ceftaz/cefepime discordance either there is an error or a non-beta-lactamase mechanism (e.g. porin or pump) or you have two colonies accidentally used to do the testing with heterozygous phenotypes. Would test pip, ceftol if desired.
@IdVilchez @OncIDPharmd @davidvanduin @PriyaNori @BradSpellberg @JonathanRyderMD @dralicehan @ABsteward @DrToddLee Underlying mechanism might include class D enzyme doi.org/10.1128/AAC.45… rather than derepressed PDC or over-expressed MexAB-OprM efflux to explain FEP-R and CAZ-S. Single dose AGS might be useful if urine isolate without systemic infection. doi: 10.1128/AAC.02165-18
@IdVilchez @OncIDPharmd @davidvanduin @PriyaNori @BradSpellberg @wwrighID @JonathanRyderMD @dralicehan @ABsteward @DrToddLee The higher MIC to cefepime than to ceftazidime could indicate the presence of an OXA-1. Better not to prescribe piperacillin/tazobactam!
#IDTwitter @ID_fellows #SIDPharm @TxID_Fellows #TwitteRx @IdVilchez #IDrounds: oncology patient on trimethoprim-sulfamethoxazole (SXT), acyclovir (ACY), & posaconazole (POS) presents w/ worsening HTN, ⬇️K, ⬆️ Na, & ⬇️ extremity edema. Stable Cr & ⬆️ HCO3. Most likely cause:
@IDiots_pod @dralicehan @IdVilchez @OncIDPharmd @davidvanduin @PriyaNori @BradSpellberg @wwrighID @JonathanRyderMD @ABsteward @DrToddLee Probably makes no difference but I typically choose tobra for pseudo
Now if DaVita would only carry those…
I like this article 🤩 @Contagion_Live @drgabx @BWDionne Proposed post-dialytic antibiotic dosing regimens following intermittent, thrice weekly hemodialysis 🌟 Table 🌟 #IDTwitter #medtwitter #TwitteRx contagionlive.com/view/antibioti…
Everyone who's treating MRSA Bacteremia should read this article now! An excellent review by @VanceFowler5 et Al @CIDJournal Persistent MRSA Bacteremia: Resetting the Clock for Optimal Management 🌟Excellent figures 🌟 @snap_trial Thoughts 🤔 #IDTwitter academic.oup.com/cid/article-ab…
Let’s organize an #IDTwitter Tweetup in Barcelona Any suggestions for a date (Sat or Sun) and venue?
So who from here am I gonna meet in Barcelona next week? #eccmid2024 @ESCMID
@dralicehan @IdVilchez @OncIDPharmd @davidvanduin @PriyaNori @BradSpellberg @wwrighID @JonathanRyderMD @ABsteward @DrToddLee The one remaining use for aminoglycosides! You found it!
@IdVilchez @BradSpellberg @DrToddLee contamination possible but depends on the clinical picture. ncbi.nlm.nih.gov/pmc/articles/P…
@IdVilchez How is a guy supposed to row AND keep the loin cloth from falling off?
Yo. It be like that sometimes #itbelikethatsometimes
@TBrnaughtTB Agree and I’ll go a step further. @LAGenHospMed @LAGeneral_ID we teach that IGRA is an outpatient test for latent tb. Not an inpatient test. It has no role in the diagnosis of active tb.
@Infected_Terran @BennyFdzLpz @IdVilchez @OncIDPharmd @davidvanduin @PriyaNori @BradSpellberg @wwrighID @JonathanRyderMD @dralicehan @ABsteward @DrToddLee Would check out this Breakpoints podcast! Cefepime more affected by MexXY-oprM and MexCD-oprJ mutations compared to ceftazidime. open.spotify.com/episode/6omdSw…
Quantiferon GOLD / IGRA only confirms LATENT PULMONARY MTB. If miliary or CNS or ACTIVE pulmonary MTB, etc, you need tissue and fluid. Also, negative AFB smears do not rule out MTB. If you’re clinically worried in acutely/severely ill pt, start therapy and work it out. #IDTwitter
i would addend this to say: please do not rely on a negative IGRA to “rule out” TB disease in cases of moderate PreTP, a positive IGRA can increase your suspicion to pursue further workup there is nothing binary or crisp about TB diagnostics—it’s all probability titration