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PO Versus IV Antibiotics for Osteomyelitis and Endocarditis: What’s the Evidence?

By Jacqueline Sherbuk, MD

August 5th, 2021

Dr. Sherbuk compares and contrasts the advantages and disadvantages of of intravenous versus oral antibiotic therapy regimens in the treatment of infections of bone and the heart in this new podcast. She begins by reviewing the history of osteomyelitis treatment, noting that IV therapy really predominated until the late 1980’s, then the first clinical studies of oral antibiotic therapy for osteo began. Dr. Sherbuk then focuses on the OVIVA trial. She concludes that although multiple RCTs demonstrate noninferiority, further research is needed on this treatment modality. The speaker next reviews PO Step-down therapy for endocarditis, including the POET trial. She concludes that PO step down therapy is an option for certain endocarditis patients, though several issues remain unclear including the length of the IV antibiotic lead-in, the preferred oral regimen, and the frequency of monitoring.

Malaria: Scourge, Mosquito-borne Malady, or just a Permanent Pandemic

By Richard L. Oehler, MD

July 23rd, 2021

Dr. Richard L. Oehler, Professor of Medicine at the University of South Florida Division of Infectious Diseases, presents a talk on the leading single infectious diseases killer of mankind. From its origins at the dawn of humanity throughout Greek, Roman, Middle Age, and contemporary history, Malaria has been a constant threat to civilization and continues to profoundly affect communities in the developing world. Dr. Oehler begins by discussing Malaria’s presence in modern literature, and the well known historical figures that have battled it. Next, he mentions how malaria has been in factor in US millitary history, from the Civil War to the great wars of the 20th century and even to the building of the Panama Canal. The epidemiology of malaria in the 21st century is then discussed, including the heavy burden of the world’s malaria cases currently occurring in Sub-Saharan Africa. The malaria life cycle is reviewed, and the specifics of transmission (including the role of the anopheles mosquito) are conveyed. Next, Dr. Oehler shares information on the clinical manifestations of Malaria, including the distinction between complicated and uncomplicated disease. Other topics mentioned in his lecture include Malaria host genetics, Malaria therapeutic recommendations, Malaria in travelers, Malaria prevention (including chemoprophylaxis), and vaccines.

Clostridium Difficile: History, Management, and Updates

By Alberto Contreras, MD

July 19th, 2021

Dr. Contreras, Infectious Diseases fellow at the University of South Florida, discusses a review of Clostridium difficile disease, a major healthcare-associated disorder. He begins by discussing the history of this potentially devastating disease. He then reviews basic epidemiology trends over the last several decades. Next, he reviews C. difficile risk factors. Following this, Dr. Contreras shares the latest recommendations from the recently published new C. difficile IDSA guidelines, including recent changes to the initial treatment of first outbreaks of the disease. Lastly, Dr. Contreras discusses management options for recurrent C difficile, including fecal transplantation, Bezlotoximab, and other potential future therapies.

Updates in Coccidioidomycosis

By Fariba Donovan, MD, PhD

May 20th, 2021

Dr. Fariba Donovan, Assistant Professor of Medicine at the University of Arizona, and Faculty Member of the Valley Fever Center for Excellence in Tucson, presents her thoughts and perspectives on Coccidioidomycosis, a soil fungus that produces a variety of different pulmonary and non-pulmonary human infections in both immunocompetent and immunocompromised hosts. Dr. Donovan begins her presentation by discussing the epidemiology of Cocci, including the regional areas of high endimicity and typical environmental exposure risks. She then further defines the typical signs of mild self-limited “Valley Fever” and differentiates this from disseminated forms of the infection. The diagnostic work up of Cocci is then reviewed, and she then describes patient treatment, outcomes, and prognosis. Lastly, Dr. Donovan comments on the risks of endemic mycoses on patients on the newer immunomodulatory agents.

Pandemics That Changed History

By Michele Davis, MD

May 6th, 2021

Dr Michele Davis, Infectious Diseases fellow at the University of South Florida, discusses historical pandemics of the past in this intriguing podcast. Dr. Davis begins her presentation by defining what constitutes a “pandemic.” She then describes ancient pandemics such as the Plague of Athens, Antonine, Cyprian plague, the Antonine plague, and the Justinian plague. Communicable plagues of the middle ages are also covered, such as leprosy, the black death, the first cholera pandemic, and the Spanish Flu. Finally, pandemics of the last few decades are also explored, including HIV/AIDS, SARS, and COVID-19. Lastly, Dr Davis discusses the lessons learned from previous outbreaks and how pandemics demonstrate why equitable access to health care resources is so critical.

Adverse Effects Associated with Cancer Immunotherapies

By Hareesh Singam, MD

April 22nd, 2021

Dr. Hareesh Singam, infectious diseases senior fellow at the University of South Florida College of Medicine, discusses some of the side effects associated with newer cancer therapies in this informative podcast. Dr. Singam broadly divides his remarks into two categories: Syndromes related to Immune Checkpoint Inhibitors, and Syndromes related to CAR-T Cell Therapy. He begins by briefly introducing the Immune Checkpoint Inhibitors (ICIs) and their mechanisms of action. He then discusses mechanisms of ICI toxicity and their clinical features. Dr. Singam goes on to discuss the associated infectious risks and how they are managed. Next, Dr Singham moves on to CAR-T Cell therapy, including its mechanisms of action, what occurs with cytokine release syndrome (CRS), and describes CAR-T Related Encephalopathy (CRES), CAR-T related hematophagic lyphohistiocytosis/macrophage activation syndrome (HLH/MAS), and the factors behind infectious risk after CAR-T therapy. Lastly, Dr. Singam discusses the use of Tocilizumab in CAR-T therapy.

Neglected Gram Positive Bacilli

By Christian Lopez-Padilla, MD

April 15th, 2021

Dr. Lopez discusses the gram positive rods/bacilli which are perhaps lesser well known to the clinician but have important clinical relevance nonetheless. He first discusses the classification system for these bacteria. He then descibes coryneform bacteria other than C. diphtheriae, such as C. jeikeium, which can cause both community-acquired and nosocomial infections. Next, Dr. Lopez discusses Bacilli other than B. anthacis. Erysipelothrix rhusiopathae is an example of this category. Next mentioned are anaerobic non-spore-forming gram-positive rods. Cutibacterium is an example of a pathogen producing infections associated with pustular skin eruptions and infections of implanted hardware. Anerobic spore-forming rods such as Clostridium are a major cause of human infections, including gas gangrene, C difficile, and others. In the end, the listener can easily be convinced that the spectrum of gram positive organisms are equally as diverse as the better known group of gram negative bacteria.

Great Mimics of Infectious diseases: A False Tale of Rashes and Fevers

By Zola Nlandu, MD

April 1st, 2021

Dr. Nlandu, Infectious Diseases Fellow at the University of South Florida, discusses noninfectious conditions that can mimic everyday infectious diseases diagnoses. He begins by discussing hemophagocytic lymphohistiocytosis (HLH), a life threatening clinical syndrome characterized by extreme immune system activation. Next, he covers Behcet’s disease, a form of vasculitis commonly manifesting as mucocutaneous disease. Familial Mediterranean Fever (FMF) is a rarely diagnosed syndrome seen in persons of Mediterranean descent that can mimic many infectious diseases conditions. Lastly, Adult Onset Still’s disease is a syndrome producing a triad of fever, arthrlagias, and a salmon-covered rash. The diagnosis and management options for each syndrome is characterized.

Mycobacterium abscessus in Florida: Epidemiology, Pathophysiology, and Research Implications

By Anthony Cannella, MD

February 22nd, 2021

Dr. Anthony Cannella, Assistant Professor of Medicine at the USF Division of Infectious Diseases and International Medicine, reviews Non-tuberculosis Mycobacteria, with a focus on Mycobacterium abscessus spp. Dr. Cannella begins his presentation by reviewing the microbiology and epidemiology of M. abscessus and their spectrum of disease. He then transitions to discussing the pathophysiology of how these infections occur as well as the pharmacologic options available for treating them. He closes by presenting the research implications of M. abscessus infections from the perspective of the immunological response and pharmacotherapeutic options.

Therapeutic Drug Monitoring: Aminoglycosides and Vancomycin

By Amanda Mercurio, PharmD

February 11th, 2021

Dr Amanda Mercurio, ID clinical pharmacist at the James A Haley Veterans Hospital, discusses the latest guidelines regarding the dosing and therapeutic drug monitoring of aminoglycosides and vancomycin. Dr. Mercurio begins by identifying the pharmacokinetic parameters for dosing antibiotic medications. She reviews the concepts of steady state and loading doses. She distinguishes between concentration dependent, AUC dependent, and time dependent dosing. She then discusses the unique pharmacokinetic parameters for aminoglycosides, including the benefits of extended interval dosing. Dr. Mercurio then goes through a step-by-step process for calculating aminoglycoside dosing based upon preferred nomograms. Next, Dr. Mercurio moves on to Vancomycin therapeutic modeling. In particular, she discusses the differences between older peak and trough-based dosing with the newer recommendations to dose based upon AUC modeling. Dr. Mercurio closes by going through a case-based example of dosing using the new guidelines.