Timothy Li @drtimothyli
ID physician @CUHKMedicine • #abxstewardship • #penicillinallergy • Certificate in Travel Health® Hong Kong Joined October 2019-
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Severe gastritis with yellowish exudates after taking an antibiotic Guess what's the culprit?
Echinocandins for urinary tract infections Your thoughts? @GermHunterMD @DrNeilStone @FungalDoc
Degradation pattern for each type of β-lactamase doi.org/10.3390%2Fanti…
This is a case of NDM E.coli The 💊 of choice is a combo of the apparently R ceftazidime-avibactam + aztreonam (if synergy confirmed) Tigecycline, despite S, is not a good choice by itself due to the low serum level It can be used in high dose as an adjunct though
This is a case of NDM E.coli The 💊 of choice is a combo of the apparently R ceftazidime-avibactam + aztreonam (if synergy confirmed) Tigecycline, despite S, is not a good choice by itself due to the low serum level It can be used in high dose as an adjunct though
We need to stop getting to this point … If you think we can manage with Tigecycline & Colistin. It’s hard. They are reserve drugs and comes with a lot of drawbacks. Tigecycline has increased mortality rate when compared to other antibiotics. Colistin is hard on kidneys.…
Getting my own talk from yesterday up late. Also presented at the Big Beasts session on Community-Acquired Pneumonia. Focused at stewardship folks but something in here for everyone 👇 #SHEASpring2024 #IDTwitter #MedTwitter 1/
⭐SGLT2i is associated with an ⬆️ risk of genital mycotic infections but not UTI or necrotizing fasciitis of the perineum (Fournier’s gangrene). ⭐In most cases, patients developing mild-moderate or stable severe GU infections can continue SGLT2i (benefits > risks).
Saw this on a referral letter Is this a new magic potion?
Next up is the Dogmas of stewardship! Bookmark this thread folks, some great stuff below. First up is Dr. Jim Lewis. #SHEASpring2024 1/
Does anyone routinely perform a TOE/TEE before oral switch when treating IE?🤔 Can we afford to do so in real life (as in the POET trial)? Is it really necessary for patients who are responding to treatment well (to the extent that discharge from hospital can be considered)?
Does anyone routinely perform a TOE/TEE before oral switch when treating IE?🤔 Can we afford to do so in real life (as in the POET trial)? Is it really necessary for patients who are responding to treatment well (to the extent that discharge from hospital can be considered)?
Compared to allergists, evaluation of low-risk penicillin allergy by non-allergists can be comparably effective, safe, and impactful on quality-of-life. Proud to be part of this doi.org/10.1016/j.jaip…
Catheter removal based on a defined schedule potentially ⬇️phlebitis/thrombophlebitis according to this systematic review and meta-analysis just published in @CIDJournal No difference on CRBSI or local infections though doi.org/10.1093/cid/ci…
Catheter removal based on a defined schedule potentially ⬇️phlebitis/thrombophlebitis according to this systematic review and meta-analysis just published in @CIDJournal No difference on CRBSI or local infections though doi.org/10.1093/cid/ci… https://t.co/f6InemPskY
Classify Rx 📱 @simplify_drugs
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Cynthia Cooper, MD @DrCindyCooper
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𝗡𝗶𝗵𝗮𝗿 .. @nihardesai7
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Brad Spellberg @BradSpellberg
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Ilan Schwartz MD PhD @GermHunterMD
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Bug Pharmacist 💊�.. @IDstewardship
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Gabe 🦊 @IdVilchez
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The Wolf of College S.. @AdiG1993
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1-min ID consult @1min_idconsult
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AMR Now @AMRNowKe
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Classify Rx 📱 @simplify_drugs
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Adi @IDdocAdi
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𝗡𝗶𝗵𝗮𝗿 .. @nihardesai7
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Paul Sax @PaulSaxMD
58K Followers 2K Following Harvard/Brigham Infectious Diseases doctor, writer, @CIDJournal editor, educator. Prefer baseball to football, pizza to sushi, dogs to cats, Beatles to Stones.
Brad Spellberg @BradSpellberg
23K Followers 191 Following CMO Los Angeles General Medical Center, hospitalist, infectious diseases expert, researcher
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Ilan Schwartz MD PhD @GermHunterMD
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Bug Pharmacist 💊�.. @IDstewardship
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Gabe 🦊 @IdVilchez
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The Wolf of College S.. @AdiG1993
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Mayo Clinic Infectiou.. @MayoClinicINFD
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13K Followers 378 Following Clinician-scientist at McGill Fellow of the Infectious Diseases Society of America. Co-inventor of https://t.co/IlHagSloQ3 Immortal-time Lord. Legacy verified.
1-min ID consult @1min_idconsult
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2K Followers 2K Following stage mom, abx steward, ortho-ID & emerging infx doc, comedy/hip hop obsessive. Assoc Prof @MontefioreID, deputy editor @ASHE_journal, @CID photo quiz co-editor
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682 Followers 541 Following KASIC was established to innovate and expand antimicrobial stewardship across the Commonwealth of Kentucky. All resources can be found here: https://t.co/S3fLuyiAA6
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554 Followers 563 Following ID doctor from Singapore and joint PhD candidate at @ihpmeuoft and @UniMelbMDHS. Working on novel approaches in clinical trial design in bloodstream infections.
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@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc It depends- if it is true UTI- Azole R- I have used micafungin - most of times it has worked.
@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc There is literature evidence for micafungin efficacy against UTI with fluconazole resistant Candida pubmed.ncbi.nlm.nih.gov/27424599/
@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc Echinocandins do not achieve significant concentration in urine. The urinary concentration of caspofungin, micafungin and anidulafungin is only 1.4%, 0.7% and <0.1% of their plasma concentration, respectively. dig.pharmacy.uic.edu/faqs/2019-2/au…
Interesting to see the use of echinocandins in UTI, reflecting v limited options actually available for this. Antifungal pipeline doesn't look great for candida UTI either (big problem where I am!) Anyone use nitroxaline? Has C.auris activity but limited data 🤔
Echinocandins for urinary tract infections Your thoughts? @GermHunterMD @DrNeilStone @FungalDoc
@DrNitinShinde5 @drtimothyli @GermHunterMD @DrNeilStone I would say myth is too strong of a word. As we learn more, we find out why things that shouldn't work do indeed work sometimes.
@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc It's very effective. Once again proves that lot of concepts and ideas in ID are sometimes turned out to be myths
@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc As a last option when fluconazole/flucytosine/Non-liposomal Ampho B can’t be used for some clinical reasons. It works in my case although not sure it is effective or clear by immune system itself or ???
@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc Have seen it with C auris… didn’t end well, (pt then developed fungemia ) Wonder what should have been used for C auris from urine? Susceptibility results takes over a week so by then it’s usually too late
@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc Not for cystitis, but can be used for renal parenchymal infections, like abscess or pyelonephritis
@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc Despite the lack of data, we often use it a lot. Surprisingly, it's effective 😅
@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc For fluco-R Candida, after making sure we are dealing with a ‘true’ infection, and with high doses, I think they can work.
@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc Double dose for Caspofungin maybe the only echinocandin to use in that case? 🤔
@drtimothyli @GermHunterMD @DrNeilStone Can work. But that's often a more difficult issue.
@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc Have used in horrendous cystitis (flucon R) and renal function too poor for Amph D. So last ditch salvage. It worked. Suspect good tissue penetration into bladder wall.
@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc Have used them successfully for Candidemia 2/2 pyelo or nephrostomy tube infection. Haven’t for cystitis. They have a low fraction of urine penetration compared to blood, but possibly enough to surpass MIC of Candida anyway.
@FungalDoc @drtimothyli @GermHunterMD @DrNeilStone For cystitis probably they're not good due to poor urinary concentration, for pyelonephritis they may be ok
@drtimothyli @GermHunterMD @DrNeilStone Depends. Often all you need to do is clear the tissue and the urine is irrelevant. So they often work.
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