ID Pharmacists play an essential role in health systems. This #IDPharmacistsDay, learn five ways that pharmacists are being #AntibioticsAware via SIDP. For more sharable resources, visit https://sidp.org/AMSToolkit.
Lina Meng, PharmD
@linameng.bsky.social
ID Pharmacist | Antimicrobial Stewardship Team | Stanford Health Care, CA | #MedEd #handshakestewardship I love pugs, 🏐, and travel, but actually spend most of my free time figuring out parenting of young kids🪇
Gut check: This review highlights stewardship opportunities in intra-abdominal infections, focusing on SBP prophylaxis, antibiotic management of biliary infections and appendicitis, and optimizing amoxicillin-clavulanate and metronidazole dosing. doi.org/10.1017/ash....
Gut check: antimicrobial stewardship opportunities in intra-abdominal infections | Antimicrobial Stewardship & Healthcare Epidemiology | Cambridge Core
Gut check: antimicrobial stewardship opportunities in intra-abdominal infections - Volume 6 Issue 1
doi.org
Creating an advanced practice provider-led Complex Outpatient Antimicrobial Therapy program at our institute improved post-discharge follow-up, strengthened outpatient antimicrobial monitoring and supported timely outpatient interventions for patients with complex infection. doi.org/10.1017/ash....
Can implementation of a complex outpatient antimicrobial therapy program reduce readmissions for patients with bone and joint infections? | Antimicrobial Stewardship & Healthcare Epidemiology | Cambridge Core
Can implementation of a complex outpatient antimicrobial therapy program reduce readmissions for patients with bone and joint infections? - Volume 6 Issue 1
doi.org
Feeling the Vibes: An Investigation into Resident Antibiotic Prescribing Practices ✅ Just Accepted 🔗 https://bit.ly/4ablBjg
A warm welcome to our new fellows! We are thrilled to have you on our team, here’s to an exciting journey ahead! Welcome to Stanford ID! #WelcomeFellows #InfectiousDiseases
🩺 Clinically, identifying a lactose fermenting GNR is particularly useful for ruling out Pseudomonas. ⚠️ Many non-lactose fermenters (especially Stenotrophomonas, Burkholderia, and Acinetobacter) can be very challenging to treat. ID consultation should be considered for invasive infections.
Yay! Tara's our awesome ASP track fellow this year - so lucky to get to work with her! @stanfordasp.bsky.social @linameng.bsky.social @dhpharmd.bsky.social @polishmd.bsky.social
Is empiric MRSA and PsA coverage needed for all moderately ICH with pneumonia? A recent study in CID offers a data-driven look. So what to do? Check out our ABX pearl on which ICH patients are best candidates for expanded empiric ABX coverage in CAP. ✅ #amssky #Idsky #medsky #pharmsky
Target Trial Emulation of Empiric Antibiotics on Clinical Outcomes in Moderately Immunocompromised Patients Hospitalized With Pneumonia
Empiric broad-spectrum antibiotic use for moderately immunocompromised patients without risk factors for multidrug-resistant organisms was associated with
academic.oup.com
Stanford Antimicrobial Safety & Sustainability Program@stanfordasp.bsky.social · 11mo ago🌟 ABX Pearl of the Day: ❓ Q: My immunocompromised patient is admitted to the ICU and starting ABX for presumed CAP. Do they need empiric MRSA and Pseudomonas coverage? #IDsky #medsky #meded #pharmsky #skyRX #AMSsky
🔥Finally published🔥 IDSA Guidelines on the Treatment and Management of Complicated Urinary Tract Infections (cUTI) #idsky www.idsociety.org/practice-gui...
Excited to share our newest paper from my PhD: a post-hoc analysis of the BALANCE trial where we explored heterogeneity of treatment effect (HTE) in duration of antibiotic treatment for patients with bloodstream infection. A thread: doi.org/10.1016/j.ec... #IDSky @eclinicalmed.bsky.social
Redirecting
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We're looking for a new Division Chief in Adult ID at Stanford. We have a great ID/Medicine family here and the division has been growing by leaps and bounds. We also have great Pedi ID, Micro, Immunology and Transplant teams. Please share!
Ongoing UCx stewardship efforts at Stanford 🤝 in partnership with infection control, CAUTI taskforce, micro lab, RNs ✔️ 2017: switch to UA with reflex only of wbc>10 ✔️2024: a creation of UCx order panel. 🚧 remove UA/UCx orders from surgery pre-op ordersets? #IDsky #AMSsky
Stanford Antimicrobial Safety & Sustainability Program@stanfordasp.bsky.social · last yr.🔍 Key Points: -Borderline urine WBC counts (6–10 cells/mL) may reflect dehydration and should be expected in patients with oliguria or anuria. -Low urine WBC (WBC < 10) almost always excludes the diagnosis of UTI.
#idsky #amssky Anyone using Tamiflu after IV peramivir in ICU patients that gain enteral access? Do people trust IV peramivir efficacy in severe/hospitalized flu? pubmed.ncbi.nlm.nih.gov/39181595/
Antivirals for treatment of severe influenza: a systematic review and network meta-analysis of randomised controlled trials - PubMed
World Health Organization.
pubmed.ncbi.nlm.nih.gov
Stanford Antimicrobial Safety & Sustainability Program@stanfordasp.bsky.social · 2y ago🌟 ABX Pearl of the Day: Treatment Options for Influenza in ICU Patients 💊 📋 Q: My patient is admitted to the ICU with influenza. What are treatment options? #IDsky #medsky #meded #pharmsky #skyRX
I learned about this meropenem/VPA drug interaction the hard way as a new practitioner after unsuccessfully dose titrating VPA for days (and wasting 💰). Fortunately VPA indication was for alcohol withdrawal (non benzo ICU protocol at Stanford), not seizures! See useful tidbits on this interaction👇
Stanford Antimicrobial Safety & Sustainability Program@stanfordasp.bsky.social · 2y ago🌟 ABX Pearl of the Day: drug interaction carbapenems + valproic acid 💡 Q: I’d like to start meropenem for an ESBL E. coli infection in my patient who is also on valproic acid (VPA). What should I be aware of? #IDsky #Medsky #MedEd #PharmSky #SkyRX
For ceftriaxone-R Enterobacterales from blood, our micro report shows MIC but no interpretation. Instead, displays cautionary comment. Chance for ASP-micro lab collab! 🤝
Stanford Antimicrobial Safety & Sustainability Program@stanfordasp.bsky.social · 2y ago🌟 ABX Pearl of the Day: AmpC or ESBL? 📋 Q: How can I quickly spot the difference in AmpC and ESBL resistance patterns? 🤔 🩺 A: Step 1: Look at the organism. Step 2: Check ceftriaxone susceptibility. Here’s a quick & handy decision tree to inform ABX Rx 👇 #IDsky #MedSky #PharmSky 🔗 IDSA AMR Guidance
Study shared by esteemed👇 on pyuria cutoff (in elderly♀️)"At a cutoff of 264 leuk/µL, sensitivity and specificity of microscopy were 88% (positive and negative likelihood ratio: 7.2 and 0.1, respectively). The commonly used cutoff of 10 leuk/µL had a poor specificity (36%) and a sensitivity of 100%."
Angela Huttner @angelahuttner.bsky.social · 2y agoMeant to share this study by @merellambregts.bsky.social's team @cjcrnich.bsky.social 😊 when you & I were on #Breakpoints we were asked whether there was a pyuria cutoff to help differentiate btw infection & colonization Here may be one (in elderly ♀️ at least) #IDSky academic.oup.com/cid/article/...
Thrilled to see @conanmacdougall.bsky.social join! 🌟 Your insights are always spot-on. This graph on new ABX approval is spot on. 😂 So true about the emotional rollercoaster—though here, prescribers don't pay attention to drug cost unless formulary restricted. #IDsky #AMSsky #pharmsky #skyrx
Conan MacDougall@conanmacdougall.bsky.social · 2y ago
Love our peds ASP colleagues and their amazing tools! ♥️ One of our ED's go-to favorites is their pediatric Amox-Clav Dosing Guide—because seriously, who can keep track of all those doses and formulations/ratios? Welcome to Blue Sky! 🌟 #AMSsky #IDsky #pharmsky #skyRX #medsky
Guidelines & Protocols
stanfordchildrens.org
Stanford Antimicrobial Safety & Sustainability Program@stanfordasp.bsky.social · 2y agoHurray! Our Peds ID/ASP colleagues are here!! @stanfordpedsasp.bsky.social
The look I get from SICU when I tell them they can stop ABX 24 hours after early GI perf repair 👀👽 #IDsky #pharmsky #AMSsky
Stanford Antimicrobial Safety & Sustainability Program@stanfordasp.bsky.social · 2y ago🌟 ABX Pearl of the Day: Duration of treatment in intra-abdominal infections (IAI)! 💊 💡 Q: How long should I treat IAI after source control? 🔍 A: While STOP-IT trial calls for 4 days post-source control, there are notable exceptions. See infographic for details 👇 #IDsky #AMSsky #MedSky #Pharmsky
I sense a debate or update brewing for ID Week 2025/SIDP: team FQ vs b-lactam for uncomplicated GNR bacteremia? 🎙️👥 @idsainfo.bsky.social @sidpharm.bsky.social #IDsky
Stanford Antimicrobial Safety & Sustainability Program@stanfordasp.bsky.social · 2y ago🌟 ABX Pearl of the Day: Best practices for Tx of uncomplicated GNR bacteremia💊 📋 Q: My patient presented with septic shock from a urinary source, blood cultures positive for E. coli. What is the duration of therapy, and must I use IV to complete the course for Enterobacterales bacteremia? 🤔 #IDsky
ID team Q: recs on amoxicillin PO dose for stepdown for uncomplicated strep bacteremia on day 5? Me: Pick anything. You're just about done with treatment! ...1g q8h #IDsky #medsky #pharmsky #RXsky
Antibiotic Steward 🅱️C🆔🅿️🌟@absteward.bsky.social · 2y ago🔥BALANCE RCT🔥 74 hospitals in 7 countries 3,608 patients A 7-day course of antibiotics for hospitalized patients with bloodstream infections was non inferior to 14d within a 4% prespecified margin for mortality at 90 days #idsky www.nejm.org/doi/full/10....
Congratulations to @nischalr3.bsky.social and his team for their paper being selected as the @thetxidjournal.bsky.social 2024 Bob Rubin Clinical Impact Awardee - this award selects the paper felt to have the biggest impact on clinical care in #TxID! #IDSky onlinelibrary.wiley.com/doi/10.1111/...
Evaluating antimicrobial duration for Gram‐negative bacteremia in patients with neutropenia due to hematologic malignancy or hematopoietic stem cell transplantation
In the management of immunocompromised patients with neutropenia and Gram-negative bloodstream infection, short antimicrobial courses (≤10 days) had comparable propensity score-adjusted 90-day outcom...
onlinelibrary.wiley.com
Back to ASP work on Monday, and it feels like everyone has aspirated over the weekend and is on ABX. 🫠 Perfect timing for this ABX pearl on distinguishing aspiration pneumonitis from pneumonia. 🔑 Hyperacute resolution? Skip the ABX. Check it out! 👇 #USAAW24 #AMSsky #IDsky #pharmsky #MedEd
Stanford Antimicrobial Safety & Sustainability Program@stanfordasp.bsky.social · 2y ago🌟 ABX Pearl of the Day: Distinguishing aspiration pneumonitis from aspiration pneumonia 📋 Q: Patient with aspiration event and new onset fever & hypoxia started on empiric ABX for suspected aspiration pna. Fever and hypoxia resolve within 12 hours. Should we continue ABX? 🤔 #IDsky #MedSky #PharmSky
Shout out to our amazing ASP team members @dhpharmd.bsky.social and @marisa-holubar.bsky.social for this fun idea! 🦠💜 Loving the micro nerd energy at Stanford for #USAAW24. 🙌 What’s everyone else doing this week? #IDsky #Medsky #pharmsky #amssky
Stanford Antimicrobial Safety & Sustainability Program@stanfordasp.bsky.social · 2y agoHappy 🟪 Antibiotic Awareness Week 🟪 Along with presentations, we will be raffling off microbe pins, keychains, and gift cards! What are you doing for #USAAW24? #IDSky #MedSky
Need help! 🙏 #IDsky #Medsky #AMSsky @joshparkpharmd.bsky.social—looking for ideas/must-haves to build a simple ED dashboard 📊 for tracking ABX use & outcomes. We’re on Epic and keeping it basic for the first go. CC: @dhpharmd.bsky.social