Timothy Li

Female sex has been identified as a risk factor for mortality in S.aureus BSI. What about other BSI? In this systematic review and meta-analysis, females with GN-BSI were NOT at higher risk of mortality than males after statistical adjustment. doi.org/10.1001/jama... #IDSky

How to approach a patient hospitalized for pneumonia who is not responding to treatment? ➡️Differential diagnosis ➡️Diagnostic workup ⚠️Escalating antibiotic treatment should not be the default option doi.org/10.1007/s001... #IDSky

The spectrum of diagnostic tests available for invasive fungal disease doi.org/10.1016/S147... #IDSky

The combination of echinocandins with TMP/SMX may reduce mortality in HIV-infected patients with pneumocystis pneumonia, but does not appear necessary in non-HIV. ⚠️All 7 studies included were retrospective and from Asia ⚠️Only 2 studies contained HIV+ doi.org/10.1186/s128... #IDSky

🆕🔥🔥CloCeBa RCT Cloxacillin versus cefazolin for MSSA Bacteraemia Cefazolin has a non-inferior efficacy regarding mortality, microbiological or clinical endpoints and was associated with a lower rate of serious adverse events #IDSky www.thelancet.com/journals/lan...

Prevalence of Positive Penicillin Allergy Testing in Hospitalized Adult Patients ➡️SRMA of 46 studies ➡️Pooled prevalence of positive PST: 3.15% ➡️Pooled prevalence of positive DOC: 1.19% 🌟Most penicillin allergy labels can be delabeled (by DOC+/-PST) doi.org/10.1016/j.ja... #IDSky

Update Guidelines on Occupational HIV PEP 🔑Recommendations: -Start PEP ASAP and within 72hrs -Preferred: BIC/FTC/TAF or DTG/XTC/TXF, for 28 days -Final test at week 12 -Shared decision making (forgo PEP or stop early) if source has undetectable HIV RNA doi.org/10.1017/ice.... #IDSky

Colour-COPD RCT from 🇬🇧 Use of sputum colour chart is unlikely to be a useful addition to usual care for guiding antibiotic self-treatment in COPD in primary care Sputum colour did not relate well to bacterial load Caution: severe under-recruitment doi.org/10.1136/bmjr... #IDSky

Radiologic and pathologic findings from a fatal pneumocephalus case caused by hypervirulent Klebsiella pneumoniae in 🇩🇪 The patient also had pneumonia, liver and prostate abscesses, and septic shock doi.org/10.3201/eid3... #IDSky

Recommended treatment regimens for select sexually transmitted enteric pathogens doi.org/10.1128/cmr.... #IDSky

CSF testing for suspected neurosyphilis ➡️isolated ocular or otic features: LP not needed ➡️CSF VDRL: specific but not perfectly sensitive ➡️CSF treponemal test: high negative predictive value, for cases with high suspicion despite negative CSF VDRL doi.org/10.1002/ana.... #IDSky

Direct oral challenges are a safe and effective strategy for delabeling low-risk cephalosporin allergy labels in adults in the outpatient setting. doi.org/10.1016/j.ja... #IDSky

Molecular mechanisms underlying cefiderocol treatment failure in A.baumannii 💣Point mutations in TonB iron receptors 💣Two-component system (TCS)-mediated upregulation of the MacAB-TolC efflux pump 💣β-lactamase-mediated hydrolysis doi.org/10.1128/cmr.... #IDSky

Anti-interferon-γ autoantibodies (AIGAs) syndrome is a rare, adult-onset immunodeficiency characterized by ⬆️susceptibility to various opportunistic infections (E.g. disseminated NTM, talaromyces, salmonella) Pathogenesis and commonly affected organs👇🏻 doi.org/10.3389/fimm... #IDSky

A clinical practice guideline for tuberculous meningitis @thelancetinfdis.bsky.social ➡️Diagnostic approach ➡️Treatment and follow-up doi.org/10.1016/S147... #IDSky

This retrospective cohort from 🇫🇷showed that oral switch is a suitable option for treating IE, even for POET-ineligible patients ➡️treatment failure HR=0.55 favoring oral, 95%CI 0.27-1.17 ➡️more days alive outside 🏥 in oral group (59 vs 47, p=0.001) doi.org/10.1093/cid/... #IDSky

Amoxicillin crystalluria (AC) and amoxicillin-induced crystal nephropathy (AICN): a narrative review ➡️pathophysiology ➡️step-by-step diagnosis HDIVA = high dose IV amoxicillin (≥150 mg/kg or ≥8 g per day) doi.org/10.1016/j.ki... #IDSky

Sulfonamide allergy usually involves sulfonamide antimicrobials (e.g. TMPSMX) due to their N1 and N4 side chains Risk of cross-reactivity to non-antimicrobial sulfonamides or non-sulfonamide sulfur drugs is very low because of structural difference doi.org/10.1016/j.ja... #IDSky

Timeline of chikungunya fever Typical viral load, symptoms, involved immune cells, and antibody titres during different phases of disease are depicted doi.org/10.1080/2150... #IDSky

Unlike most drugs, fluconazole dose needs to be INCREASED during CRRT Why? Under normal conditions, >80% of fluconazole is renally excreted as unchanged drug, followed by extensive tubular reabsorption And this process is bypassed during CRRT

Narrative review on fungal diagnostics @cmijournal.bsky.social doi.org/10.1016/j.cm... #IDSky

🔑 for ATS CAP guideline 2025: 1. Lung USG 🆗 for dx 2.Empiric abx suggested for CAP tested +ve for resp virus if in-pt or have comorbidities 3. <5 days abx (min 3 days) if stable, except for in-pt with severe CAP 4. Systemic steroid suggested for in-pt with severe CAP doi.org/10.1164/rccm... #IDSky

In this study from 🇳🇱 involving 400+ patients who underwent hip or knee explanation, the use of sonication fluid culture (vs tissue culture alone) detected additional microorganisms that could impact antibiotic choice in 8% to 20% of PJI cases. doi.org/10.1093/cid/... #IDSky

If discussion on ceilings of care is applicable to resuscitation, ventilatory support, or even blood taking Why shouldn't it be applied to antimicrobial use too? Communication strategies and skills for antimicrobial treatment discussions at end of life⬇️ doi.org/10.1016/S147... #IDSky

Structured linezolid dose reduction (600mg/d➡️300mg/d after 9-13 weeks) had comparable recurrence free cure rates as fixed linezolid 600mg/d when given along with bedaquiline and pretomanid for 26 weeks in PreXDR TB doi.org/10.1016/j.ji... #IDSky

Should secondary SBP prophylaxis (SecSBPPr) still be given in cirrhosis? In 2 US national cohorts (>11000 SBP patients), SecSBPPr⬆️the risk of SBP recurrence in multivariable analysis by 63%–68% vs no prophylaxis. And this trend worsened over time. doi.org/10.14309/ajg... #IDSky

Candida infective endocarditis 🍄🫀🤒 ➡️Suggested management algorithm based on valve type and surgical eligibility ➡️Follow-up recommendations doi.org/10.1016/j.cm... #IDSky

Routine weekly surveillance for MDR-GNB in hematologic patients enables early identification of colonization, often preceding MDR-GNB BSIs. ➡️Rectal swabs positive in 27.5% of patients ➡️BSI occurred in 38.5% colonised vs 12.0% non-colonised patients doi.org/10.1016/j.cm... #IDSky

Among 100 patients with persistent MSSA bacteraemia who were treated with ertapenem combination therapy, those with hypoalbuminemia (<2.5g/dL) had a significantly longer time to negative blood cultures. doi.org/10.1093/jac/... #IDSky

Antimicrobial resistance, antimicrobial tolerance and heteroresistance in Pseudomonas aeruginosa doi.org/10.1038/s415... #IDSky

Pathophysiology and risk factors of ocular candidiasis Systemic treatment: 1st line = fluconazole or voriconazole (Posa: poor penetration Isavu: lack data) Lipo ampho B +/- flucytosine if resistant or refractory Echinocandins: poor penetration doi.org/10.1016/j.cm... #IDSky

Suggested investigation of suspected immunosuppression* *Also: recurrent deep abscesses, chronic diarrhoea with weight loss, recurring infections, infection requiring prolonged antibiotic therapy, persistent rash (particularly without recent antibiotic use). doi.org/10.1016/S221... #IDSky

In this study that included 42067 adults in 🇺🇸, long-acting lipoglycopeptides (laLGPs) were effective as step-down treatment of serious gram +ve bacterial infections, offering comparable outcomes (readmission/ED visit/90d inpatient☠️) vs SOC antibiotics doi.org/10.1001/jama... #IDSky

A large cohort study with target trial emulation including >500k patients found no benefit associated with antibiotic treatment for 🏥 patients with nonsevere COVID-19 Routine use of antibiotics for these patients should be avoided given the known harms doi.org/10.1001/jama... #IDSky

Radiologic algorithmic approach to immunocompromised patients without HIV with masses and nodules doi.org/10.1016/j.ch... #IDSky

Hematology thin smears (HS) perform equally to parasitology thick and thin blood smears (PS) for the diagnosis of Plasmodium and Babesia infections in a low prevalence setting 93.3% sensitivity 99.8% specificity 97.7% PPV 99.4% NPV 100% concordance with PS (for new cases) doi.org/10.1128/jcm....

Suggested strategies for treatment of resistant/refractory CMV disease for transplant recipients doi.org/10.1016/j.ij... #IDSky

🆕💫The MEFIER Score - A Risk Score to Stratify Infective Endocarditis in Patients with Enterococcus faecalis bacteremia based on an 11-year territory-wide cohort AUROC of 0.79 (95%CI 0.72-0.88), and a NPV of 0.98 (95%CI 0.97-0.99) #idsky #IEWiki academic.oup.com/ofid/advance...

Meta-analysis on mNGS for infectious meningoencephalitis ➡️ 23 studies, n = 1660 ➡️Pooled sensitivity = 0.70 and specificity = 0.93 (for TB: 0.67 and 0.97) Further research is needed: ➡️ for which patients? ➡️ at what point in the diagnostic process? doi.org/10.1093/ofid... #IDSky

In moderate to low quality observational data, cefazolin was non-inferior for mortality and potentially superior for safety as compared to anti-staphylococcal penicillins overall and across most individual comparisons doi.org/10.1016/j.cm...

Figure showing evidence for detection of 27 viruses in the semen, their viability in the semen, sexual transmission, and detection in other parts of the male reproductive tract doi.org/10.1016/j.la... #IDSky

Estimated per-act probability of acquiring HIV from an infected source, by exposure act dx.doi.org/10.15585/mmw... #IDSky

Urinary catheters should only be used when needed and removed as soon as they are no longer necessary. Here are some complications of urinary catheters and mechanisms for prevention doi.org/10.1001/jama... #IDSky

Urinary nitrite testing introduces diagnostic confusion without adding value with regard to the decision to treat False +ve: asymptomatic bacteriuria, contamination False -ve: UTI due to non nitrate–reducing bacteria (e.g. Enterococcus, Acinetobacter species) doi.org/10.1001/jama... #IDSky

Transmission and clinical manifestations of leptospirosis in humans doi.org/10.1038/s415... #IDSky

Comparative effect of different corticosteroids in severe community-acquired pneumonia: a network meta-analysis ⭐11 RCT, 2042 participants ⭐Only hydrocortisone was significantly more effective at ⬇️mortality than placebo. It also ⬇️the need for MV. doi.org/10.1186/s128... #IDSky

State-of-the-Art Review: Modern Approach to Nocardiosis ⭐The duration of antibiotic treatment is understudied and based on few data ➡️ can be shortened if harms begin to outweigh potential benefits ⭐~5% develop recurrence ➡️ close monitoring needed doi.org/10.1093/cid/... #IDSky

Multicentric cohort study from 🇫🇷 In patients with PVE rejected from surgery despite indication, suppressive antimicrobial therapy (SAT) is associated with ⬇️composite of 1 year all-cause ☠️ and PVE-related 🏥 when compared with conventional therapy doi.org/10.1016/j.ij... #IDSky