Timothy Li
@drtimothyli.bsky.social
ID physician from Hong Kong🇭🇰
Antibiotic stewardship • Penicillin allergy • TB/NTM • WikiGuidelines
Antibiotic stewardship • Penicillin allergy • TB/NTM • WikiGuidelines
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
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
November 16, 2025 at 2:48 PM
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
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
➡️Differential diagnosis
➡️Diagnostic workup
⚠️Escalating antibiotic treatment should not be the default option
doi.org/10.1007/s001...
#IDSky
November 15, 2025 at 3:19 PM
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
➡️Differential diagnosis
➡️Diagnostic workup
⚠️Escalating antibiotic treatment should not be the default option
doi.org/10.1007/s001...
#IDSky
November 11, 2025 at 2:33 PM
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
⚠️All 7 studies included were retrospective and from Asia
⚠️Only 2 studies contained HIV+
doi.org/10.1186/s128...
#IDSky
October 30, 2025 at 3:10 PM
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
⚠️All 7 studies included were retrospective and from Asia
⚠️Only 2 studies contained HIV+
doi.org/10.1186/s128...
#IDSky
Reposted by Timothy Li
🆕🔥🔥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...
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...
October 19, 2025 at 4:34 AM
🆕🔥🔥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...
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
➡️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
October 17, 2025 at 1:05 AM
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
➡️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
🔑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
2025 US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Post-exposure Prophylaxis in Healthcare Settings | Infecti...
2025 US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Post-exposure Prophylaxis in Healthcare Settings
doi.org
October 16, 2025 at 1:16 AM
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
🔑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
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
October 12, 2025 at 1:53 AM
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
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
The patient also had pneumonia, liver and prostate abscesses, and septic shock
doi.org/10.3201/eid3...
#IDSky
October 5, 2025 at 2:30 PM
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
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
doi.org/10.1128/cmr....
#IDSky
September 24, 2025 at 3:26 PM
Recommended treatment regimens for select sexually transmitted enteric pathogens
doi.org/10.1128/cmr....
#IDSky
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
➡️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
September 20, 2025 at 3:09 AM
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
➡️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
doi.org/10.1016/j.ja...
#IDSky
September 13, 2025 at 9:59 AM
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
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
💣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
September 6, 2025 at 3:49 PM
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
💣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
Pathogenesis and commonly affected organs👇🏻
doi.org/10.3389/fimm...
#IDSky
September 1, 2025 at 3:41 PM
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
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
➡️Diagnostic approach
➡️Treatment and follow-up
doi.org/10.1016/S147...
#IDSky
August 19, 2025 at 8:03 AM
A clinical practice guideline for tuberculous meningitis @thelancetinfdis.bsky.social
➡️Diagnostic approach
➡️Treatment and follow-up
doi.org/10.1016/S147...
#IDSky
➡️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
➡️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
August 18, 2025 at 2:48 PM
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
➡️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
➡️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
August 13, 2025 at 1:10 AM
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
➡️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
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
August 6, 2025 at 2:41 PM
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
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
Typical viral load, symptoms, involved immune cells, and antibody titres during different phases of disease are depicted
doi.org/10.1080/2150...
#IDSky
August 4, 2025 at 3:34 PM
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
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
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
July 28, 2025 at 3:24 PM
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
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
July 26, 2025 at 8:58 AM
🔑 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
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
Diagnosis and Management of Community-acquired Pneumonia. An Official American Thoracic Society Clinical Practice Guideline | American Journal of Respiratory and Critical Care Medicine | Articles in P...
doi.org
July 20, 2025 at 8:42 AM
🔑 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
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
doi.org/10.1093/cid/...
#IDSky
July 19, 2025 at 3:11 PM
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
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
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
June 20, 2025 at 1:27 AM
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
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
doi.org/10.1016/j.ji...
#IDSky
June 19, 2025 at 3:46 PM
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
doi.org/10.1016/j.ji...
#IDSky