Congratulations to Steve Tong, Josh Davis and the huge SNAP team (including Monash Health). Clear outcome that cefazolin is less nephrotoxic than flucloxacillin for MSSA, and pencillin is better for PSSA. @steventong.bsky.social @gurujosh.bsky.social
Cool paper from Florian Kramer & colleagues about a novel feature of circulating H5N1 clade 2.3.4.4. These viruses have a longer stalk in their neuraminidase (NA) enzyme, a key viral protein. This was not seen in past H5N1 strains (2002-2019)
Why does it matter?🧪
journals.asm.org/doi/10.1128/...
Looks like PubMed is down - not sure if this is a temporary outage or something more sinister. Europe PMC is an alternative search engine for medical literature that is publicly accessible. europepmc.org
Great list @absteward.bsky.social! Mine is coming soon (limited to 10)
Paul Sax's "oh wow" moments in HIV: AZT during pregnancy reduces vertical transmission; triple ARVs improve survival; integrase inhibitors as effective salvage therapy; PrEP is very effective; undetectable = untransmissible and now 6 monthly lenacapravir PReP is 100% effective
Not my area of expertise, but I understand there are restrictions on the use of the Individual Healthcare Identifier so that it can't be used in linkage. But I could be wrong - others might know.
Very annoying when you’re writing a manuscript - can’t easily find/replace to change full stops to interpuncts. I understand it’s a historical anachronism, like the New Yorker using diaereses (coöperation”) en.m.wikipedia.org/wiki/Interpu...
Five years ago (1 Dec 2019), the first person became unwell in a case cluster of a new infection that we now know as COVID-19. pmc.ncbi.nlm.nih.gov/articles/PMC...
My father's family were originally rice farmers in China, and I ended up doing my PhD on melioidosis, a disease of rice farmers, partly based in Thailand where many of his siblings moved to (and where my cousin is an infectious diseases physician).
C is the Schrödinger's result - simultaneously inferior and non-inferior.
I've been off social media mostly for almost three years, was enticed back by Tony Korman, and tentitively wading back in!
Supports routinely using 7 days of treatment in bacteraemia (other than S aureus, fungaemia, and if there is a definite indication for longer eg endocarditis)
90 day mortality was *lower* in 7 day group (14.5%) vs 14 day group (16.1%); met non-inferiority criteria
There were no major differences between shorter/longer groups in subgroups, i8ncluding ICU, APACHE-II >25, by site or pathogen.
Broad variety of infection sites but majority gram neg (71%); clear separation in duration between shorter group (median 8 days) vs longer duration group (median 14 days)
It included ICU patients (55% of enrolled patients) but notably excluded immunocompromised, S aureus, candida, deep infection (eg endocarditis).
This was a large trial (n=3608) at 74 hospitals in 7 countries. (COI: The Australian arm was co-ordinated from Monash by Ben Rogers). It was a non inferiority, 7 vs 14 days of treatment; primary outcome 90 day mortality.
Congratulations to the BALANCE group on the trial published in NEJM today. This trial tested 7 vs 14 days of antibiotics for bloodstream infection. #IDSky www.nejm.org/doi/full/10....
Lessons from practice for immunocompromised hosts by Dr Ai Li Yeo and A/Prof Claire Dendle
#ForbesWeek #IDSky
1. There can be more than two pathologies in immunocompromised patients
Thanks for coming to Melbourne! It's been an honour to have you join our ID community here and benefit from your expertise.
28. In community-acquired infection, resistant organisms do not cause more severe illness than their sensitive counterparts. The only reason for using broader than usual therapy is when you (and the patient) cannot afford to be wrong.
27. When you suspect bacteraemia, do not wait for the patient’s temperature to go up before doing blood cultures.
26. In patients with unexplained neurological features, think of the five great infective mimics: HIV, syphilis, tuberculosis, Lyme disease (with epidemiological history), Whipple’s disease.
25. Bacterial aortitis needs to be excluded in a patient who develops abdominal pain or back pain within weeks of an episode of diarrhoea.
24. Remember that Listeria monocytogenes meningoencephalitis can masquerade clinically as herpes simplex encephalitis.
23. Avoid the term “atypical pneumonia” in children, adults over the age of 50 years, the immunocompromised, the severely ill, or patients with diffuse bilateral interstitial pulmonary infiltrates.
22. Not everyone with aseptic meningitis has viral meningitis; unless confirmed by PCR, viral meningitis is a diagnosis made after the patient has recovered.
21. Specific IgM antibodies are a useful but unreliable marker of primary infections in pregnancy, thus clinical decisions should not be based solely on a positive IgM.
20. Consider common bacterial infections, and not just opportunistic infections in febrile patients with HIV.
19. Think of vertebral osteomyelitis and epidural abscess in a patient with fever and back pain.
18. Infection in the diabetic patient will flourish until the diabetes is controlled.
