HIV and ID Observations

May 28th, 2014

Some ID Stuff We’re Talking About on Rounds

Just finished two weeks on the inpatient general medical service — hence the radio silence — giving me a chance to work with residents, interns, and medical students. Here’s a smattering of the ID topics we discussed, along with a comment or two: “Common” causes of gram negative soft tissue infection (at least for board exam purposes), and […]

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January 30th, 2014

Unanswerable Questions in Infectious Diseases: Persistent MRSA Bacteremia

Ok, here’s a favorite of adult ID specialists everywhere — a real tough one. The case goes something like this: Older person, many medical problems. Probably is on hemodialysis, with the vascular surgeons having some difficulty with access. There’s diabetes, of course, and cardiovascular disease, and oh yeah, a mechanical aortic valve that’s around 10 years […]

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January 21st, 2014

Unanswerable Questions in Infectious Diseases: The Positive Cultures for Candida in an ICU Patient

OK, gang. You did such a bang-up job on Question #1 that I can’t resist getting another consult. Here’s the case:  Patient in intensive care, has been there for some time — at least a week, probably weeks. Perhaps he/she had surgery (especially abdominal surgery) that didn’t go well, or has severe cardiovascular disease, or multiple […]

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January 15th, 2014

Unanswerable Questions in Infectious Diseases: The Abdominal Collection and Duration of Antibiotic Therapy

Each time I attend on the inpatient service, the number of questions for which we just don’t have a definitive answer continues to amaze me. And here’s the most remarkable part — many of them come up all the time! In that spirit, I will post a series of these quandaries, and you, the brilliant readers, […]

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December 24th, 2013

Brush with Greatness: John G. Bartlett

At the IDSA meeting in 2012, John Bartlett gave a lecture called, “Infectious Diseases Update for the HIV Provider” — what a great title — which was, as usual, information-packed, practical, well-referenced, and just plain fun. It also occurred to me at the time that there is probably no other person on the planet who […]

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September 27th, 2013

Yes! An Economic Justification for ID Specialists

We’re currently in the middle of fellowship interview season, and I overheard the following conversation between two of my colleagues as they contemplated their upcoming interviewees: ID Doctor #1:  He seems like a great candidate — wants to study hospital and community epidemiology of highly drug-resistant bacterial infections, and has already made major contributions to his […]

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August 1st, 2013

Poll: Will There Be A Shortage of HIV Providers?

Over on NEJM Journal Watch — love that new name — I reviewed a paper on the demographics of people living with AIDS in San Francisco. Bottom line — more than half are now older than 50. Implication — that’s so old! First, it really isn’t, unless you compare it to the dismal era 20+ years ago, when […]

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July 3rd, 2013

First Year ID Fellows — What Do They Learn, and What Do They Hate?

In the weird calendar of academic medical centers, July 1 is the “official” first day of school. In our ID program, however, we shifted it to July 5 a few years ago to avoid the interruption of the July 4 holiday at the beginning of the year. On July 3 — today — our incoming first-year […]

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June 6th, 2013

ID Learning Unit — Aminoglycosides

You young whippersnappers out there may not believe it, but we once used aminoglycosides all the time — literally every day on inpatient medical and surgical services, especially in the ICUs. They were an inevitable part of “triples” (e.g., amp/gent/clinda), a broad-spectrum combination given to almost every critically ill patient way back when — think right around […]

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February 17th, 2013

An Adherence Intervention That Works — But There’s a Catch

In a previous post, we reviewed the various flavors of medication non-adherence, and concluded with this tantalizing line: Next up:  An Adherence Intervention that Actually Works — But There’s a Catch Well here it is, just published online in JAMA Internal Medicine. Dr. Robert Gross (a long-time HIV adherence researcher from U Penn) and colleagues enrolled 180 patients […]

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