From '23-'25 LA General Medical Center underwent a once in a generation workforce transformation, caused by fiscal & regulatory pressure. Our article describing causes & outcomes is published! Critical lessons for health systems in a time of federal uncertainty. www.dovepress.com/articles.php...
My friend we’re putting together a letter on this point. You want in? Email me and I’ll send you the link to participate.
Hey @infectedterran.bsky.social, my brother in Scrubs! Have you seen it yet? Man, just watched the first episode and it was like coming home after a long journey. I really missed them, and the tone was just perfect. Whaddaya think?
Happy to attend virtually! I’m sure Devin Clark would be willing to as well! He gets full credit for the study.
Not so. Fidaxamicin did not provide longer term follow up.
Right. But seems as good or better than fidaxo at a fraction of the cost.
Yeah I’m with you. We did the stewardship intervention cuz it was so commonly inappropriately ordered.
Rock on my brother in ampho-hating!
@drboulware.bsky.social
Oh, well if it’s the blue alien dudes from avatar then yeah i get your point. All available evidence indicates that amphotericin causes them to turn green (cuz, yellow + blue = green). And green, as everyone knows, is good.
I know some folk think it shouldn’t be used for gatti. I can’t imagine why. Gatti doesn’t have higher fluc mics. It isn’t harder to kill. It’s more inflammatory & prone to infection in hiv-neg pts. Why would that mean AMBITION won’t work? Burden of proof is on the more harmful Tx, not the safer one.
Yup! Have a pint buddy!
0 reason to think things would be difft in non HIV, children, xenomorphs, non carbon based life forms, or any other excuses stubborn deniers have. My suggestion? Do some yoga. Meditate. Light incense. Relax. And stop torturing your patients with 2 weeks of amphoterrible. Subtle as always, I know.
0 reason to think things would be difft in non HIV, children, xenomorphs, non carbon based life forms, or any other excuses stubborn deniers have. My suggestion? Do some yoga. Meditate. Light incense. Relax. And stop torturing your patients with 2 weeks of amphoterrible. Subtle as always, I know.
And a congratulations to the humble @drboulware.bsky.social, who published a thoughtful editorial accompanying the study. Dr. Boulware is a true leader in ID, and it is an honor to have him evaluate our study. I encourage everyone to read his team's editorial!
jamanetwork.com/journals/jam...
Thank you my friend! Based on your original work!!!!
US docs gotta get on board & stop pretending things that work in other countries won't work in US. AMBITION protocol is MUCH safer and MUCH more patient centered, and just as effective as 2 weeks of old, sad, amphoterrible. @absteward.bsky.social
Patient-directed discharges (i.e. leaving against medical advice) dropped from 35% to 12%.
Major congratulations to the authors: Devin Clark,
Brad Spellberg @bradspellberg.bsky.social , and colleagues.
In an excellent study of real world outcomes in LA General Medical Center, after implementing AMBITION single dose liposomal amphotericin protocol for crypto meningitis:
Similar survival without recurrence
Fewer severe adverse events
Shorter hospitalization (lower cost)
dx.doi.org/10.1001/jama...
Is It Time to Use Single-Dose Amphotericin B for HIV-Related Cryptococcal Meningitis in the USA?
The answer is yes!
doi.org/10.1001/jama...
As above, I’m good with mono therapy linezolid
I’m fine with oral linezolid as mono therapy. I do tend to use dual for others (amox+rif, amox+FQ, FQ+rif). But that’s cuz I’m chicken. Not because I’m really sure it’s needed.
Do you remember those old beer commercials? “Why ask why? Try Bud Dry.”
All this isolation stuff is non evidenced based nonsense. Cluster randomized trials have shown it doesn’t work. We no longer isolate for MRSA.
Behind the scenes 🔥🔥 with all the laughs on the latest Febrile Podcast @febrilepodcast.com with @lageneral-id.bsky.social and @bradspellberg.bsky.social #IDSky
player.captivate.fm/episode/dd68...
No the patients got variable days of IV. But no relationship between number of days of IV prior to oral fosfo and outcomes.
Not for me, no. I’d want source control of course.
Yes there are 2 published observational studies. 1 from our group. Both were cUTI but both had bacteremia it’s described.
Highly recommend you check out @bradspellberg.bsky.social book "Broken, bankrupt and dying". Achieving universal coverage can be done in many different ways. The rest of the developed world has done it in all different ways (government coverage, private/public, state subsidized etc).
Hasn't been much discussion of the 40% failure rate to fill ID programs this match year. Interesting. Wonder if anyone is ever going to do anything about that?
🆕🎙️🔥Febrile Podcast just dropped!
✅ID Jedi @bradspellberg.bsky.social
✅Mini-cases OM,IE,Bacteremia
✅IV vs PO debates
✅Duration of therapy
✅Shmidelines Vs WikiGuideline
✅A must-listen for every antibiotic steward! #IDsky #EMIMCC
febrilepodcast.com/episodes/
open.spotify.com/episode/6dkJ...
Full blown dementia with psychosis can be quite entertaining when Im off my meds. Have a listen!