Christopher Baladad, PharmD, BCIDP

I love chatGPT so much for AI-generated images.

Executive Summary of State-of-the-Art Review: Modern Approach to Nocardiosis—Diagnosis, Management, and Uncertainties Nocardia is a genus of gram-positive, partially acid-fast bacilli that typically infect people with chronic lung disease or immunocompromised states.

Executive Summary of State-of-the-Art Review: Modern Approach to Nocardiosis—Diagnosis, Management, and Uncertainties

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#IDSky

🆕💫 Narrative review in ICM
How to approach a patient hospitalized for pneumonia who is not responding to treatment? #idsky #EMIMCC
link.springer.com/article/10.1...

Been at three different centers now with varying practices for antibiotics and ECMO. It's difficult to steward for sure.

100% agree! Then at discharge we restart the clock for an additional 1-2 weeks of prolonged antimicrobials.

What I wish I had right now, an already made newsletter on "Things We Do For No Reason: 'Continue IV Antibiotics While Inpatient, Then Discharge Home on Oral Antibiotics'" in patients that can otherwise tolerate oral therapy. Fewer lines, shorter stays, same outcomes. #IDSky #PharmSky

For institutions that have sulbactam-durlobactam on formulary.

What are your criteria for use? Do you use it first line for all CRABs? Has it replaced high dose ampicillin-sulbactam?

#IDSky #Pharmsky

Important article for #AMSSky, #TxID, #UTISky, and #IDSky in @cidjournal.bsky.social:

In neutropenic & non-neutropenic cancer patients w/ & w/o catheters, the absence of nitrite/leukocyte esterase or WBC<10 had high NPV for clinically significant bacteriuria

academic.oup.com/cid/advance-...

#IDSky #PharmSky Patient with M. abscessus bacteremia on iHD.

1. How are you dosing amikacin in these patients?
2. Do you have specific peak goals?
3. Do you omit amikacin entirely?

If possible, you're willing to share protocols, that'd be extremely helpful!

🙋‍♂️we have IP submit results. I was not involved in the mapping/ troubleshooting, so probably will not be helpful, but can ask my colleagues that were!

I don't have experience with cefadroxil for UTIs. Though, cefazolin as the surrogate w/ cefadroxil for uUTIs had an accuracy of 91.6%. Just my interpretation is maybe you can get away with TID?

PMID: 883822; PMID: 7073267; PMID: 32659466; PMID: 32349909; PMID: 3501710

Thoughts? #IDSky #PharmSky

Where do we go from here with UTI WikiGuidelines and what do you use?

This study used cephalexin @ variable doses), median txt 10d, and cefazolin MIC of <=16 as susceptible. (CLSI cut-off for uUTI).

Personally, I use cephalexin 1000 mg PO QID x10-14d if cefazolin MIC <=2 for pyelonephritis.

Using posaconazole since theoretically less interactions with rifampin. Some case reports with high dose posconazole 600-800 mg daily + rifampin reached posa troughs >1.

Also thought about rifabutin 150 mg + voriconazole 200-300 mg TID based on another case report.

#IDSky #PharmSky Pt w/ MTB on RIPE w/ rifampin 1200 mg QD (TDM ✅) Smear (+) x3 mo. Now with (+) serum galactomannan (0.5) and worsening O2 status. ID wants to treat for aspergillosis. Would you start posa and continue rifampin or convert to rifabutin and start posa?

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Nice! Our UTI guidance document incorporates a watch and wait approach and a FAQ section with updated EBM to support not treating, but the lack of physician champion from ED and IM may be a reason for low uptake.

The auditing adherence is the hard part that I’m trying to optimize rather than doing manual chart review. My previous Epic had a slicer dicer for outpatient antimicrobial prescribing where I would use it to audit durations of therapy (new Epic hasn’t validated this yet)

Sadly not at my site

Presented on ED abx stewardship to our new ED physician group. Highlighted our ASB treatment rates, educated on our UTI guidelines, and showed our compliance with STI screening with CDC recommendations. How do you engage your ED teams for abx stewardship? #IDsky #Pharmsky #Medsky

Does your ED use Dalbavancin for SSTi? If so, what's your experience like? Is it any different from Linezolid with re: patient experience/admission/readmission/relapse/recurrence? #IDsky

We're evaluating a protocol/workflow now. Prelim last line for patients that failed appropriate abx, CI to linezolid, no complicated infection, and would have been an ED obs/brief inpatient. MUE plans 12 months after rollout.

Hello #PharmSky #IDSky! I’m Chris, an ID pharmacist in San Diego, passionate about antimicrobial stewardship and resistance. Looking forward to connecting and learning with everyone here!

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