General Infectious Disease&nbsp;&nbsp;&nbsp;

How would you manage a patient with Crohn's disease on a biologic and presents with non-bloody diarrhea, normal-appearing mucosa on sigmoidoscopy but severe colitis on biopsy with a positive CMV stain?

Would you send a CMV DNA PCR in blood, and if you elect to treat with anti-CMV medication, how long would you treat and what parameters would you use,...

What specific criteria or patient conditions would make you hesitant to use fluoroquinolones early in the treatment course for managing MSSA joint infections with oral antibiotics?

For example, baseline QT prolongation, elderly age group, or underlying heart disease?

What duration of antibiotics do you use in patients with Actinomyces osteomyelitis, i.e., do you stop after 6 weeks or do you give a longer oral antibiotic course?

How do you decide between ceftolozane/tazobactam and ceftazidime/avibactam for empiric treatment of an infection due to difficult-to-treat Pseudomonas aeruginosa while awaiting additional susceptibilities?

Which biomarkers or diagnostic tools do you prioritize to support the decision to start antifungal treatment in septic patients with no clear source of infection but at high risk for fungal infections?

Do you add adjunctive gentamicin and/or rifampin for treatment of prosthetic valve Staphylococcus aureus endocarditis?

Do you routinely treat patients with neurosyphilis with IM penicillin for 1-3 weeks after completing a full treatment course of IV penicillin?

https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm

Do you routinely consider FDG PET/CT imaging for workup of fever of unknown origin?

What are your top takeaways from ID Week 2024?

Do you consider the use of tocilizumab in patients with COVID pneumonia who have had an improvement in supplemental O2 requirements but have significantly elevated inflammatory markers after day two of remdesivir and dexamethasone?

When would you initiate exchange transfusion in babesiosis and significant hemolysis?

Is parasitemia >10% and severe hemolysis with Hb less than 7 enough to initiate this?

Do you take into consideration a patient's serum albumin level in your decision to use ertapenem?

Do you routinely recommend a lumbar puncture for patients with suspected ocular or otic syphilis in the absence of additional CNS symptoms?

Do you routinely treat chronic sacral osteomyelitis when there is no plan for debridement or flap?

What is your approach to recurrent asymptomatic bacteriuria in pregnancy for patients without personal history of recurrent UTIs or pyelonephritis?

Assuming patient already received an initial course of antibiotic treatment in response to a positive urine culture during routine screening early in ...

How do you decide on the timing and number of blood cultures for suspected endocarditis given the differences in recommendations between the ESC guidelines and the Duke Criteria?

The ESC guidelines recommend obtaining at least three sets of blood cultures at 30-minute intervals before starting antibiotic therapy, each with 10 m...

Do you add gentamicin when treating prosthetic valve endocarditis secondary to viridans group Streptococcus with a penicillin-intermediate isolate (MIC >0.125 - <0.5)?

How often do you see bony erosions in patients with Lyme arthritis?

How do you integrate next-generation sequencing with traditional culture methods to improve the identification of fungal pathogens, especially in cases where routine cultures are negative when evaluating suspected prosthetic joint infections?

Do you routinely perform echocardiography in patients with Staphylococcus aureus bacteremia deemed low risk for metastatic infection, or do you selectively omit it based on specific clinical criteria?

Hendriks, et al., PMID 38576380

Under what circumstances do you consider valacyclovir for the management of VZV disease of the CNS?

Is there a role for suppressive antibiotic therapy when it comes to chronic femoral/tibial osteomyelitis?

In patients with possible Bartonella henselae infection and elevated IgG titer, what is the best way to confirm the diagnosis: tissue biopsy with Warthin-Starry staining, tissue sent for Bartonella henselae PCR, or tissue sent for culture?

What agent and for how long would you treat a patient with asymptomatic azole-resistant C auris candiduria who is planning to undergo a urological procedure?

Do you routinely recommend IV systemic antibiotic therapy in additional to intravitreal antibiotic therapy for exogenous bacterial endophthalmitis?

Do you preferentially avoid use of piperacillin-tazobactam for empiric anti-pseudomonal coverage in hospitalized patients due to risk of nephrotoxicity?

ACORN Randomized Clinical Trial

Do you routinely check cefepime levels in patient's with suspected cefepime-induced neurotoxicity?

How would you approach treatment duration for patients with persistent candida species fungemia with a history of a prosthetic heart valve but negative TEE/CT PET and no other identifiable source of infection?

Do you treat prosthetic joint infections after a two-stage revision arthroplasty with oral antibiotics for the full duration of therapy, assuming a susceptible oral option is available?

What is your approach to management of CIED in a patient with community-acquired Staph aureus bacteremia who clears blood cultures quickly with negative follow up blood cultures within 72 hours of antimicrobial therapy and negative TEE?

Would you still routinely ask for CIED removal, or would you pursue PET/CT for further evaluation and consider keeping CIED if PET/CT negative?

What is your approach to monitoring of inflammatory markers during treatment of native vertebral osteomyelitis?

Do you give additional pneumococcal vaccines after a dose of PCV20 in patients with asplenia?

Do you find HZV titers useful in diagnosing shingles sine herpete?

Do you use combination antibiotic therapy for treatment of bacterial endocarditis due to gram-negative bacilli?

Do you use combination therapy for persistent MSSA bacteremia?

If yes, which combination(s)?

Under what circumstances would you recommend the maternal RSV vaccine for a pregnant patient if nirsevimab will also be available for the infant after birth?

Under what circumstances would you recommend early fecal microbiota transplantation over antibiotic treatment or bezlotoxumab in a patient with recurrent C. difficile infection?

Have you used Karius to aid in the diagnosis of a non-resolving pneumonia, with negative bronchoscopy, biopsy, and other infectious work up in an immunocompetent patient?

Do you routinely ask for removal of a indwelling central line (PICC or tunneled catheter) in a patient with pseudomonal bacteremia from known source with otherwise appropriate clinical improvement on anti-pseudomonal antibiotic therapy?

How exhaustive (especially considering cost) should an immunological workup be for patients with extensive, recurrent, or deep seated Staph aureus infections without obvious immunocompromise (e.g. cancer, diabetes, steroids) or recurrent breaks in skin integrity?

Do you transition to oral antibiotics to treat uncomplicated Staphylococcus aureus bacteremia after patients have improved with intravenous antibiotic therapy?

4 Answers available

Have you incorporated the use of linezolid in lieu of vancomycin plus clindamycin for empiric treatment of necrotizing fasciitis?

Do you recommend lifelong antibiotic prophylaxis, or do you prefer a more selective approach based on risk factors in asplenic patients without a history of severe infections?

How long would you treat an upper urinary tract infection in a patient with acute obstructive pyelonephritis due to a kidney stone status-post urinary stenting without yet removal of the stone?

4 Answers available

Do you recommend routine ophthalmologic exam for all patients with hypervirulent Klebsiella pneumoniae bacteremia?

Do you choose an antibiotic with CSF penetration, such as nafcillin over cefazolin, in the setting of MSSA endocarditis with septic emboli to the brain (assuming no concomitant meningitis or brain abscess)?

Is there any utility to trending Histoplasma serology titers to guide duration of therapy or treatment response for pulmonary histoplasmosis with negative urine antigen?

What is your approach to duration of fidaxomicin in a patient receiving treatment for first C difficile infection while also receiving concurrent antibiotics for an infection?

Do you extend the course of fidaxomicin past initial 10 days to at least 3-7 days after completion of antibiotics?

Do you adhere to the standard 5-day minimum treatment duration for community-acquired pneumonia, or have you used shorter courses for certain low-risk patients?

What is your approach to treatment of patients with fulminant C difficile infection who required ileostomy creation or colectomy?

Is there a role for oral vancomycin in these patients, or is oral vancomycin redundant if other routes of administration are being used (i.e intracolo...

What is your approach to antiviral treatment of HSV acute retinal necrosis?

Is there a role for oral antiviral therapy alone (as opposed to induction with IV) and for what duration? And is there a role for ongoing suppressive ...

What is your approach to use of D-mannose for prevention of recurrent uncomplicated cystitis?

Especially in light of the results of the randomized clinical trial published on 8/2024 in Jama Internal Medicine by Hayward et al., PMID 38587819.

Do you use oral fosfomycin as a treatment option for uncomplicated cystitis due to ESBL producing E coli?

For which patients could you consider direct oral amoxicillin challenge as opposed to skin testing for penicillin allergy de-labeling?

For how long would you treat Klebsiella aerogenes folliculitis of the face manifesting as a cystic lesion?

Would you combine antibiotics with isotretinoin?

Do you recommend antibiotic prophylaxis for an ESKD patient with a tunneled dialysis catheter who is planned for a dental procedure?

What is your approach to counseling patients regarding re-initiation of anti-TNF therapy after completion of treatment for non-disseminated pulmonary histoplasmosis?

Would it be safe to resume and if so, when?

Do you prescribe linezolid to patients who are concomitantly on an SSRI?

7 Answers available

How long would you treat a patient with recent history of TAVR presenting with E faecalis bacteremia with unclear source with TEE showing thickened valves but no obvious vegetation?

How long do you treat an isolated bacterial liver abscess which has either undergone percutaneous drainage or for which an indwelling drain is placed?

What is your approach to the use of Paxlovid for patients with risk factors for severe Covid-19 infection but who have received SARS-CoV-2 vaccines in light of the EPIC-SR trial findings?

EPIC-SR Trial

What is your approach to duration of systemic antibiotics for treatment of isolated bacterial endophthalmitis in the absence of bacteremia or other deep-seated metastatic foci of infection?

What is your approach to a patient with undetectable MMR titers checked prior to or during immunosuppression and a history of MMR vaccination in childhood?

Is there a role for booster vaccination and if so, how do you approach the timing when a patient is already on a biologic for immunosuppression?

How do you treat a patient with a gram-negative infection with resistance to imipenem but sensitivity to meropenem and negative for Carbapenem resistant organism by xpert Carba-R-assay?

Have you incorporated the use of steroids for patients with severe community-acquired pneumonia?

In light of published data from the CAPE COD trial...

Is there a role for repeat surveillance blood cultures in patients with prosthetic valve endocarditis without associated cardiac abscess after a 6 week course of antibiotic treatment without surgical intervention?

Is there a role for chronic suppressive oral or inhaled therapy for recurrent Burkholderia cepacia pneumonia causing frequent hospitalizations in a patient with severe bronchiectasis with or without underlying cystic fibrosis?

In addition to ampicillin, is there any benefit to the addition of either gentamicin or bactrim when treating a patient with listeria meningitis?

Have you applied the POET trial to clinical practice?

How long do you continue antibiotics after cholecystostomy tube placement for acute cholecystitis?

Since the COVID-19 pandemic, increasingly we see management of acute cholecystitis with cholecystostomy tubes as opposed to surgery, even amongst pati...

What duration of therapy do you use for treatment of Legionella pneumonia in an immunocompetent host without associated empyema or extrapulmonary infection?

Is there a role for beta-lactams as step-down oral therapy for uncomplicated gram-negative bacteremia?

If so, what antibiotic regimens do you use?

6 Answers available

For how long do you treat an early spinal hardware infection secondary to MSSA after operative washout and retention of hardware?

Do you treat Stenotrophomonas maltophilia bacteremia with combination therapy and if so, what is your preferred combination of antibacterials?

For how long do you treat uncomplicated CRE bacteremia in an immunocompetent patient?

Would you consider stepping down from an echinocandin to azole therapy prior to the end of an initial six-week course for fluconazole-susceptible Candida albicans endocarditis in the absence of valve surgery?