Infected Terran, MD @Infected_Terran
Infectious disease doc in Philadelphia, educator and clinical ethicist. Son of #UCV #ID #MedEd #Ethics and #Starcraft2 Same name in the hairy elephant Philadelphia, PA Joined January 2009-
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"Once there was only dark. If you ask me, the light's winning". Re-watched season 1 of True Detective and by, I don't think there has ever been any show that comes close to that first season. Impeccable. Flawless. Wish I could mind wipe myself and see it again for the first time.
Sustained bacteremia with a typical endocarditis pathogen. TTE normal. Bacteremia clears. No HF, emboli, no heart block. No other source. DO you need a TEE? How good is physician Gestalt vs TEE at predicting findings needing surgery? @BradSpellberg @Cortes_Penfield #IDtwitter
ESRD on HD with very likely E.faecalis endocarditis. Trying to avoid a line at all costs. Would you do a POET type regimen PO adjusted for GFR? Vanco plus AG with HD? Other? @BradSpellberg @DrToddLee @GA
Occam and Bayes are my shepherds. I shall not want.
"Never has our future been more unpredictable, never have we depended so much on political forces that cannot be trusted to follow the rules of common sense and self-interest—forces that look like sheer insanity." — Hannah Arendt, 1951, The Origins of Totalitarianism
ABIM wont even let me do their LKA questions without completing their survery. The LOLS keep coming...
Bacteriuria with pyuria in a demented patient presenting with delirium/AMS without fever or systemic toxicity should be treated or not treated? Please comment below. #idtwitter @febrilepodcast
I know invasive GAS is going gangbusters but, is there something different about these strains that are making it so aggressive?? #idtwitter
You are not your MMR. You are not your Aligulac score. You are the all singing, all dancing crap of the ladder.
Remember kids to never confuse knowledge with wisdom. They sound similar but they're very different things. The world is full of grey areas. Ars longa vita brevis.
@BradSpellberg @toscamarina @IdVilchez @DrToddLee @DrEmilyMcD @dralicehan @AntibioticDoc @JamesWilsonDO1 @BJegorovic @Infected_Terran @wwrighID In fact, IV causes more cdiff than oral, according to this study IV antibiotic therapy administered to ED patients before discharge was associated with higher rates of antibiotic associated diarrhea and with 2 cases of CDI ncbi.nlm.nih.gov/pmc/articles/P…
"Let me never fall into the vulgar mistake of dreaming that I am persecuted whenever I am contradicted." ― Ralph Waldo Emerson
The answer to all life's problems is not vanc and Zosyn.
Estimados, estoy buscando trabajos de analista político o de «creador de contenido» (i.e. escritor). Si saben de algo, incluso en otros campos, por favor no duden en avisarme.
To the dad (Vlad I think?) I saw at Repo records buying Interpol's "Turn on the bright lights" and Neutral Milk Hotel's "In the aeroplane over the sea" to his kids (who they picked themselves), you have won at parenting.
How often do you encounter meaningful ART resistance and HIV treatment failure in your practice? If possible, comment what your practice is like and where geographically you are @PaulSaxMD #IDtwitter
Is there an idiom in English that's the equivalent of "He arado en el mar"? @IdVilchez
Ilan Schwartz MD PhD @GermHunterMD
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1K Followers 1K Following Physician scientist engaged in biomaterials, immunoengineering, and device-related infection. ID fellow at MGH/BWH. Post-doc at the Wyss Institute.@dr_michaelmarks The UK should join our enterococcal platform grant submission this fall. For enterococcus faecalis IE: Amp vs amp gent vs amp ctx with response adaptive randomization.
How did everyone feel about all the gentamicin recommendations?
@Infected_Terran @PaulSaxMD A nice pharmacist would tell the pt that their insurance will not cover or require a PA, but offer a #GoodRx coupon or their own low cost program on the spot. @costplusdrugs also has fantastic prices on holly grail PAs like #albendazole #voriconazole and #posaconazole
ID is the most interesting field of medicine. Yet, due to antiquated payment structures, we are one of the most underpaid specialties, limiting recruitment. @IDSAInfo and @IDSAFoundation have been working to change that. Can you help them: idsociety.quorum.us/campaign/59199/
@DrToddLee @BradSpellberg @Infected_Terran @GA My understanding was oto/vestibulotoxicity were associated with duration >5-7d, and irreversible, whereas the AKI was almost always reversible and dose dependent; hence Scotland’s “72h Gent, then phone micro for advice” policy. V little Ototox seen north of the border…
@BradSpellberg @Infected_Terran @GA Unpredictable but rare before 5 days. Risk with Gent > tobramycin last I checked
@JonathanRyderMD @Infected_Terran @BradSpellberg @Cortes_Penfield Staph aureus is our bread and butter so absolutely matches our experience
@Infected_Terran @BradSpellberg @GA As someone who has lost hearing in one ear due to sensorineural hearing loss, it scares me a lot.
@Infected_Terran @namarschalk @BradSpellberg @GA It's all about how people will treat you if therapy fails... You're pushing people's comfort zone. I tend to match poet with respect to regimens for this reason.
@DrNeilStone Adrenaline: from the Latin "ad renal", the location of the gland. But there was already a trademarked extract called Adrenalin in the US, so American doctors translated it to Greek ("epi nephros") to get epinephrine
@DrToddLee @TorontoIDDoc @edenhelmi @Infected_Terran @Cortes_Penfield It is a brilliant discussion my friend. Really aspirational, frankly. i wish all guidelines had this kind of thoughtful consideration rather than from the mountain-top stone tablet thou-shalts.
@BradSpellberg @TorontoIDDoc @edenhelmi @Infected_Terran @Cortes_Penfield This is another discussion section of the wiki guidelines full supplement that I am proud of.
@Infected_Terran @TempleID1 @BradSpellberg @Cortes_Penfield One of those studies above cites a sensitivity of TTE for cardiac abscess of 28%. Staph aureus also way more likely to be etiology of abscess pubmed.ncbi.nlm.nih.gov/1997851/
@BradSpellberg @edenhelmi @Infected_Terran @Cortes_Penfield Yes agree. And that is the key: maximizing the number of TEEs done, where it changes the path of management.
@TorontoIDDoc @BradSpellberg @edenhelmi @Infected_Terran @Cortes_Penfield In the situation described, I would say it doesn’t change management. Hence I wouldn’t get a TEE in this case. Shouldn’t do an invasive test, or any test for that matter, if it doesn’t change your management.
@Infected_Terran @BradSpellberg @Cortes_Penfield Patient didn't need surgery. But we did end up treating for 4-6 weeks, and not 2 weeks as originally planned. The only uncomplicated SAB is one where the cause for SAB is obvious as daylight (such as a central venous catheter or necrotizing pneumonia following influenza).
@BradSpellberg @TorontoIDDoc @Infected_Terran @Cortes_Penfield There isn’t one, I would NOT get a TEE. It’s an invasive test, I’ve seen esophageal perforation from this. In this situation, it won’t change my management hence would not get one.
@Infected_Terran @TorontoIDDoc @BradSpellberg @Cortes_Penfield Unlikely. So I don’t need a TEE.