#IDSky You thought that you saw everything? Look this abomination in three blood culture bottles, ICU patient... @stanfordasp.bsky.social @dralicehan.bsky.social @abstewardess.bsky.social @bradspellberg.bsky.social @cortes-penfield.bsky.social @drneilstone.bsky.social @freichert666.bsky.social

#IDSky Blood culture from the febrile patient in ICU. Proteus miralbilis is isolated (susceptibility below). How would you treat? @dralicehan.bsky.social @antibioticdoc.bsky.social @bradspellberg.bsky.social @idiots-pod.bsky.social @wwrighid.bsky.social @cortes-penfield.bsky.social

@pulmcrit.bsky.social Can you explain principles of amiodarone dosing as boluses? How to decide to repeat bolus and in which time during treatment? I do not quite understand from the IBCC article below 👇🏼

#IDSky What would be appropriate empiric antibiotic therapy for community-acquired renal abscess? @bradspellberg.bsky.social @drtoddlee.bsky.social

#IDSky A patient with decompensated cirrhosis of the liver was found to have SBP. Isolate from ascites is shown below. How would you treat and for how long? @fungaldoc.bsky.social @germhuntermd.bsky.social @fungalspore.bsky.social @drneilstone.bsky.social

#IDSky Cefazolin for MSSA meningitis? I am asking because I was criticized by older collegue because I give it to the patient with this infection.

#IDSky Homeless person with scabies and Staphylococcus aureus bacteremia (isolate attached)? How would you explain susceptibility results for cephalosporins (cephalexin) and would you trust cefazolin? @bradspellberg.bsky.social @wwrighid.bsky.social @drtoddlee.bsky.social @dralicehan.bsky.social

#IDSky Patient with transplanted kidney >1 year ago on minimal immunosuppression developed fever. IE was diagnosed by PET-CT. Blood culture grew Corynebacterium sp. S to linezolid and vancomycin. Patient received vancomycin for 5 weeks and linezolid after implantation of prosthetic valve for 2 weeks

#IDSky A 40-years old patient presented with 7 d of high fever, sore throat, and severe neutropenia (0.02). There is a history of psychosis on clozapine, cariprazine, quetiapine and sertraline. Low-risk by MASCC score. What would be appropriate diagnostics and empiric...

@kidneyboy.bsky.social @nephroseeker.medsky.social @nephrosparks.bsky.social @captainchloride.bsky.social Patient 97-years old with sepsis and AKI and probabale colistin effect requiring dialysis for mild volume overload. During dialysis her blood pressure is 180/80 mmHg. How you handle this cases?

#IDSky A 70-year man with AF, presents with bilateral pneumonia w/o respiratroy insufficiency. Seven days previously, patient performed mouth on mouth CPR on plane from Dubai in person who eventually died. What would be appropriate empiric ABx for this patient? Patient reports allergy to penicillin.

#pocus @nephropocus.bsky.social @argaiz.bsky.social Patient with oliguric AKI. No obvious signs of hypervolemia. IVC highly collapsible. How would you interpret this hepatic vein Doppler?

#IDSky Would you trust maximum dose of IV clindamycin for uncomplicated MSSA bacteremia? Do not ask why 😊 @bradspellberg.bsky.social @dralicehan.bsky.social @drtoddlee.bsky.social @idiots-pod.bsky.social @drtimothyli.bsky.social

#IDSky #fungalsky Older patient with known low-grade lymphoma presented with 6 weeks of fever up to 39°C without organ-specific symptoms. CT of abdomen showed focal changes in liver (lymphoma vs. fungal infection). Cryprococcus antigen and 1,3-ß-D-glucan are positive in blood. 👇

#NephSky What is the maximum creatinine clearance in humans? @caulimovirus.bsky.social @edgarvlermamd.bsky.social @kidneyboy.bsky.social @nephroseeker.medsky.social @nephrosparks.bsky.social @captainchloride.bsky.social @nephgirlsketch.bsky.social @hswapnil.medsky.social

#IDSky Does antibiotic with better penetration into abscess cavity have advantage over cefazolin for MSSA bacteremia with multiple small abscesses in m. psoas muscle and possible endocarditis? After 5 days of cefazolin 2 g q6h, patient still febrile on vasopressors. Should other antibiotic... 👇🏽

How would you treat patient with septic shock, septic small joints arthritis and small m. psoas abscesses with this blood isolate? 👇🏽 @dralicehan.bsky.social @abstewardess.bsky.social @bradspellberg.bsky.social @drtoddlee.bsky.social @cosepiid.bsky.social @jonathanrydermd.bsky.social

#IDSky Hospitalized patient with Foley develop fever w/o localizing signs. Empiric meropenem was administered and patient responded well but slowly. Three days later, blood culture grew MSSA and OXA-48 positive K. pneumoniae (same in urine culture). MIC for cef/avi is 4 mg/L.

#IDSky Interesting, real ID case. Seven days of fever, arthralgias and myalgias. Four blood culture bottles are positive. History was positive for diary products consumption.

#IDSky Patient with Listeria meningoencephalitis and <1 cm abscess in pons. Allergic to PEN. Recieved meropenem i TMP-SMX 320/1600 mg q6h and it is better. Would you switch to oral TMP-SMX and in which dose. Patient is 75 kg. @dralicehan.bsky.social @catherineberry.bsky.social

#IDSky I was honored that I can present #UTI #Wikiguidelines on congress about urinary tract infections and urosepsis. Thank you @bradspellberg.bsky.social @drtoddlee.bsky.social @dremilymcd.bsky.social and others about creating such amazing movement.

#IDSky Older patient with septic shock. Started on meropenem and vancomycin. Blood culture grew isolate shown below. What would be your antibiotic of choice, what would you use for oral switch, and how long would you treat? @dralicehan.bsky.social @empiricgame.bsky.social @bradspellberg.bsky.social

#NephSky #PharmSky Should we BSA adjusted eGFR (non-indexed eGFR, mL/min) instead Cockroft-Gault Equation for antibiotic dosing? @idstewardship.bsky.social @kidneyboy.bsky.social @edgarvlermamd.bsky.social @captainchloride.bsky.social @drtoddlee.bsky.social @caulimovirus.bsky.social

#NephSky How acetazolamide works in case of nephrogenic DI? What is the mechanism? @kidneyboy.bsky.social @caulimovirus.bsky.social @edgarvlermamd.bsky.social @hswapnil.medsky.social @nephrosparks.bsky.social @juancarlosqvelez.bsky.social @renaltubules.bsky.social @captainchloride.bsky.social

#CriticalCare #NephSky Can standard simple therapy CVC be used instead HD-CVC for RRT in critical care if HD-CVC for some reason cannot be placed? Did anyone tried this? @christosargyrop.bsky.social @pulmcrit.bsky.social @kidneyboy.bsky.social @hswapnil.medsky.social @captainchloride.bsky.social

#NephSky If patient presents with severe non-acute hyponatremia (Na <125 mmol/L) and hypokalemia (K <3.0 mmol/L), how this should be treated to prevent osmotic demyelination syndrome? Should we include K correction rate in Na correction rate, not to pass the 8-12 mmol/L/24 h correction threshold?

#NephSky How to measure dialysis adequacy in patients with AKI? Is there a method equivalent to ESKD patients on HD? Can I use Kt/V and URR, and if yes, what would be the cut-offs? @kidneyboy.bsky.social @nephroseeker.medsky.social @captainchloride.bsky.social @edgarvlermamd.bsky.social

#CriticalCare Pt was found at home, unresponsive + shock. History + well controled HIV and HBV cirrhosis on Biktarvy and DM type 2 on insulin. ABG from admission in #ICU 👇. Patient needs fluid resuscitation. What fluid woud you prescribe based on pH-resuscitation guidelines? @pulmcrit.bsky.social

For my collegues from Canada, from the Park of Friendship in Belgrade, Serbia. 😊 @drtoddlee.bsky.social @dremilymcd.bsky.social

#IDSky What would be your empiric antibiotic therapy in patients with suspected secondary bacterial pneumonia in patient with Influenza virus infection? Would you trust cefazolin as cover for MSSA in this scenario? @dralicehan.bsky.social @bradspellberg.bsky.social @mav-rust.bsky.social