HIV and ID Observations

September 3rd, 2014

How to Choose a Case for ID Case Conference

As August becomes September, ID fellows across the land are becoming increasingly skilled, heading rapidly upwards on that steep learning curve that is the first year of fellowship. With one-sixth of the year already in the books, it’s a wonderful thing to see. One potential downside to this accumulating knowledge, however, is that they start to become […]

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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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