I was wondering what kind of physician in the world could be responsible for such a heinous idea, which led me to this article. So terrible.

www.rollingstone.com/politics/pol...

Wow, that’s terrible. I don’t know. I feel like it has to be a MBL, so maybe aztreonam-avibactam? Or maybe if it’s an oxa-48, cefidericol? Or maybe it’s one of those monster NDM with the pbp3 mutations?

I am going to call a friend @jgpharmd.bsky.social @juliejusto.bsky.social

We are genotyping and phenotyping as many of the isolates as we can get hold of (will be most). So the analysis of blaZ and cefazolin inoculum effect will follow once done. Can't wait to see what this shows!
Altogether there were 1341 participants in SNAP, so much larger than CloCeBa.

I suspect the issue is with who is drawing samples. Phlebotomists can be reeducated on technique based off of contamination rates and reeducation works well, but PIV’s are typically placed by nurses who are tasked with innumerable other responsibilities. Watch one episode of the PITT and it’s 🤯

Agree, but I usually look back at old cxs to help decide. I have rarely seen a renal abscess that wasn’t “partially” treated as an outpt and then ended up being more complicated

Wow!

There are a fair share of appropriate lawsuits as well, but as a person in the the general public, it’s challenging to know what is the standard of care. I think the tips provided in this article are very helpful reminders on how to provide good care in general

Would recommend vaccinating partner and waiting several weeks assuming male pt is not immunocompromised

I think this is a very difficult organism to treat and high chance of relapsed infection with prosthesis, likely biofilm

Omg. 😱

I would ask how in the world does this ever happen, but I do remember ordering takeout once years ago and finding a huge cooked roach in the food.

It was horrifying. These are the kinds of cases that give you delusional parasitosis.

Pt relapsed twice. Has a deep seated infection until proven otherwise and now has a prosthetic valve so would suppress indefinitely

🤣

I got a different antibiotic this time! I am now moxifloxacin! I don’t know what that means about me. I feel like I was penicillin before

I would repeat TEE to make sure there isn’t a perivalvular abscess and consider imaging of spine as well. Would consider linezolid, tedizolid (not sure if it’s available anymore) or dalvance suppression after repeat treatment course

I blame p traps

I would start empiric cefepime for neutropenic fever pending workup and then try to figure out if the neutropenia is drug related or a newly diagnosed heme malignancy

I appreciate that the bluejay puts wing hygiene first