July 15th, 2018

On-Service Digest, July 2018 — with Special Section Just for Staph aureus

“Hey, medicine is fun!” she said, high-fiving enthusiastically with one of her co-interns.

I’m currently on-service for the inpatient ID consult team, and this is July.

At a teaching hospital. 

Here’s where some would play scary music. After all, the interns and fellows have just started! YIKES!

But no scary music for me I love working with the July newbies.

Because whatever they lack in experience or efficiency, they more than make up for it with enthusiasm and motivation. They’re on that steep upward slope in the learning curve, and it’s fun to experience this firsthand.

Plus, there’s plenty of extra help around, and this year we hit the jackpot. In addition to an excellent first-year ID fellow, our team also has a resident with a distinguished ID pedigree and a medical student who has done ID research. If that weren’t enough, we also have a terrific ID PharmD who has his own keen residents.

Yes, we almost have enough people on rounds to field a decent softball team. We make quite the sight entering and leaving the elevator.

So what have we learned so far? Here are few items, ranging from obvious to obscure, inspired by a similar roundup last December.

Special Staph aureus section — hey, this is inpatient ID, remember?

Hey, this list of medical/surgical specialties and classic rock songs left off Infectious Diseases!


Here’s the obvious answer (with apologies to Peggy Lee and her very different song of the same name):


12 Responses to “On-Service Digest, July 2018 — with Special Section Just for Staph aureus

  1. William O Hahn says:


    Really appreciated your journal watch breakdown.

    Minor quibble: probably would not pick daptomycin for destination therapy in device associated Corynebacterium striatum infections. Our group (https://www-ncbi-nlm-nih-gov.offcampus.lib.washington.edu/pubmed/26544621) and others (https://www-ncbi-nlm-nih-gov.offcampus.lib.washington.edu/pubmed/24973133) have reported rapid emergence of resistance in isolates that tested “susceptible” with resulting clinical failures.

    Will Hahn

    • Paul Sax says:

      Very interesting! What do you think of linezolid as a non-vancomycin alternative?
      thank you,

  2. Music in hospitals!

  3. Loretta S says:

    As soon as I saw the clinical trial name SABATO, “Mr. Roboto” by Styx popped into my head and now I can’t get rid of it! Argh! An earworm! Well, there are worse earworms to have. None of which I will list, as earworms are infectious, as we all know. Merely hearing the name of an earworm is enough to become infected. Any progress on treatment options for earworms? 🙂

    But seriously, Paul. Thanks so much for these summaries, as always. I learn so much from them. And doxy is a favorite among us primary care folks, too.

    Apologies to anyone who now has Mr. Roboto running through their head. Domo.

  4. William O Hahn says:

    Thanks for kind words.

    We have used linezolid during acute periods without failure and in our single-institution case series (https://www.ncbi.nlm.nih.gov/pubmed/27767926), no isolates tested “resistant.” This is similar to other institutions (https://www.ncbi.nlm.nih.gov/pubmed/29339389).

    Linezolid should work but, as the old saying goes, “clinical experience is limited.” Our experience is that linezolid is relatively poorly tolerated over extended periods of time required for hardware associated infections. With LVAD infections (in particular) this can be quite problematic.

  5. Jared says:

    Appreciate the blog as always but I object to the absence of family medicine in the setlist

  6. Sarah Williams says:

    What’s the link between your resident and Dr. Nagami’s book? I haven’t read the book but just ordered it, looking forward to some fun reading.

  7. Federico Tomasella MD says:

    Many thanks for this insightful On-Service Digest, Dr. Sax
    Here are some personal addition to the above:

    1) TMP/SMX is likely fine for treatment of HIV-related cerebral toxoplasmosis.
    I have been treating Cerebral Toxo with TMP/SMX for around 3 years now because of two reasons: first, many presentations are unable to take oral meds due to concomitant oral thrush and/or esophagitis and seizures, that leave the patient without the abbility to take the treatment orally; the second one is due to the shortage of pyrimethamine in my country (Argentina). Up to today, outcomes were very succesful but, as you mentioned, there aren´t studies of non-inferiority between these two regimens.
    2) Oxacillin is marginally better tolerated than nafcillin
    In Argentina, we don´t have anti-staphyloccocal drugs available, so we use cefazoline as the standard of care in MSSA bacteremia (although, we use 2 grs q8h). Very good outcomes, by the way and no side effects neither. And about susceptibility to Penicilin, there is a study that shows that 80% of Staph aureus (MSSA and MRSA) produce beta-lactamases, and our Micro Lab doesn´t test Penicilin, so we acually have no choice other than cafazolin or cefalotin, the later given 2grs q6h.
    Also looking foward for that SABATO Study results, but just wondering why Linezolid instead of TMP/SMX. I have always had a “gut feeling” that 7 days of iv plus oral will suffice in certain patients.
    Just sharing some of my personal experience.
    And, about the song realted to ID: “Like a Virgin – Madonna” can be added; virgin of antibiotics, that is!
    Best regards!

  8. Johnny Cascone says:

    Thank you for this excellent piece.

    • Chris Graham says:

      I can’t contribute anything meaningful to the ID topics but for music..

      Hot Blooded – Foreigner

      “Well, I’m hot blooded, check it and see
      I got a fever of a hundred and three”

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

Learn more about HIV and ID Observations.