Director of Infectious Diseases Improvement & Clinical Research Innovation
@UPMC
@PittDeptofMed
. Host, Breakpoints
@SIDPharm
. Passionate about patients.
my grandpa has been in the hospital for the past week w/ Acinetobacter baumannii bacteremia.
I keep deleting this, but I think I need to share what I learned about antibiotics and fear, and reinforce the life-saving nature of stewardship [thread] 1/
Started from a basement (literally), never DREAMED of a window office!
Excited to announce my new role as Director of Infectious Diseases Improvement & Clinical Research Innovation
@UPMC
. Yay for continuing our systemness from Covid into everywhere else we use antimicrobials!🦠
I never want to hear another word EVER about the cost of new antibiotics, ESPECIALLY those with mortality benefit and/or improved safety compared to less expensive alternatives, if we are giving remdesivir to all hospitalized patients with COVID-19. Ever.
#IDWeek2020
sometimes reviewers comments are so kind they lift you through the whole week and reinvigorate a bunch of projects on your list that you were losing steam to tackle 🤍 thank you, kind kind reviewer.
My uncle was Covid+ 11/15, died 12/1.
Planning a limited capacity, distanced funeral is painful.
Being scared of people bringing food or doing any usually-comforting-but-now-risky act is an absolute mental disaster.
Knowing millions have experienced this or worse... no words.
Never thought in a million years as a pharmacy student that one day I'd write a chapter in DiPiro (one of the main textbooks). Thank you
@jpogue1
for the sponsorship &sharing your endless knowledge and
@julie_justo
for being an amazing coauthor! Covid is awful but yall are great.
I developed Covid symptoms and tested positive Wed
By Sat, I felt fantastic
Today, I feel like death. If I were eligible for Paxlovid, would have finished yesterday.
Be cautious of rebound symptom data— reporting bias is strong, my N=1 tells me it happens w/o treatment too :)
just got a manuscript rejection and the reviewer included a nice explanation of a key point we missed plus an interesting and helpful reference we didn't know about. it is really great when peer review works as it should. thank you, reviewer
#2
(yes, 2!) for your time.
To all the future PharmDs—happy
#MatchDay2022
Eve from someone who matched to her 3️⃣rd choice & spent the day helping one of her best friends who didnt match scramble. Match Day for me was long, painful. I promise you, things will be okay no matter what happens tomorrow. Promise.
nobody:
absolutely fucking nobody:
🇺🇸: let’s force women to give birth despite our abysmal maternal mortality rate (for which we have done no major health reform) and then do nothing to keep the kids alive either (because 2A ✌🏻)
Thank you
@JAMA_current
& Dr. Angus for the opportunity to write this. And THANK YOU to the 100s of
@UPMC
clinicians/scientists for all you do to take care of our current & future
#COVID19
pts and for constantly reading my remdesivir emails. You’re heroes.
recently having episodes of tachycardia followed by passing out (I am okay).
wearing Holter monitor.
almost every HCW (literally double digit amounts of humans) I’ve told about this has responded something to the effect of “been there done that”
why is this normal?
Congratulations to
@ACCP
members Lucas Hill, Kirk Evoy, and
@ErinMcCreary
who were selected by the 2021 ACCP Awards Committee to receive the College’s prestigious 2021 New Educator, New Investigator, and New Clinical Practitioner awards, respectively. 👏👏👏
aspiring pharmacists— I will read and provide feedback on your cover letters and CVs for free. the journey is hard and expensive enough as is, please don’t buy in to things like this. especially when they’re dragging you.
I think every unit should have a decentralized pharmacist— but— I feel most passionately that every Emergency Department should have a pharmacist present 24/7. I staffed as an ED pharmacist for 2 years and the decisions made around antibiotics and fluids alone… 🤯
~13000 high priority pts(CLL,ritux,etc)
456 Evusheld doses(ps-why no i?)
29% of pts receiving drug are from a disadvantaged neighborhood (lottery to allocate)
5 regional clinics (stood up over a holiday)
100s of ppl who make this happen
@UPMCnews
1 very happy (&tired) pharmacist
Our data comparing subQ to IV casirivimab and imdevimab are now available
@medrxivpreprint
Better put, our story of how we solved a health system capacity management crisis is online for all to review and comment :)
1/n
@UPMCnews
@IDPittStop
@PittTweet
bursting with pride for Josh, stellar pharmacy resident, & Viv + Peyton, 2 amazing students (now pharmacists!) who collaborated on implementing this change + collecting the data over 3+ years.
Clinda/Vanc vs Linezolid for NSTI in
@OFIDJournal
patients who refuse a vaccine b/c theyre “only” EUA & then get Covid and THEN yell @ my team of incredible, dedicated people who literally work ~16 hrs/day every single day to procsss mAb referrals that we dont get them an *EUA* mAb fast enough are crushing our healthcare souls
I feel closer to an actual nervous breakdown right now re: COVID stuff than I did in April last year. Maybe it’s because we have tools to fight it and we just aren’t using them? It’s one thing to watch the world burn. It’s another to watch it burn holding a turned-off hose.
✅ RCT data shows no difference in AKI btwn TZP+ VAN vs FEP+VAN
✅ “authors provide a roadmap for such embedded randomised clinical trials”
the coolest thing about ACORN is the fact that they did it. learning while doing!!
@syctong
@JAMA_current
Dr. Pranita Tamma of
@HopkinsMedicine
reviews mechanisms of resistance of carbapenems and activity of new and pipeline agents for MDR GNR
#ThreeRiversASP2019
ATTACK Trial results
#ECCMID2022
: efficacy & safety of sulbactam-durlobactam (SUL-DUR) vs colistin for Acinetobacter baumannii complex. Sulbactam has intrinsic activity against AB (PBP binding); durlobactam potent inhibition of class A, C,D beta-lactamases
strep pneumo urine antigen rarely changes clinical management!!! and lacks sensitivity for S pneumoniae PNA!!!! 🛑 plz stop ordering them on every admitted patient with CAP!!!!
sincerely,
the tortured lab dept
#thingswedofornoreason
@MattDavis138
kind of struggling to contribute meaningfully on here lately for many reasons. but since the
#medtwitter
fam is carrying a lot of heavy right now, here is a picture of my dog to break up the doom scrolling.
#noratherapy
it has taken me a few days to tweet this because I can’t think of a caption that does these women justice. the
#Breakpoints
podcast family is truly special. I’m so so thankful for these amazing hosts (and humans) and to share our nerdy souls with the
#IDWeek2022
community
two years,
26,769 unique patients, and
27,108 infusions later
the monoclonal antibody for treatment of COVID-19 program comes to an end today.
it is so sad this safe, effective therapy is not an option for now
thankful for where we've come and ready for the challenges ahead
issues w/empirical ABX treatment
1️⃣up to 50% of febrile episodes in ICU aren’t infectious
2️⃣30-80% of pts w/sepsis are culture negative
3️⃣most pts w/community-onset sepsis dont have resistant pathogens yet broad abx are frequently administered
#ECCMID2022
I’m a big believer in finding the silver lining of drug shortages but this one is the holy grail: finally the date everyone realizes there is almost no role for clindamycin in the care of patients with infectious diseases
(zosyn+linezolid for nec fasc don’t @ me)
.
@ryankshields
demonstrating why relebactam restores imipenem activity against Pseudomonas aeruginosa whereas vaborbactam doesn’t help meropenem against this bug
#GCCAMR23
There is no evidence supporting the assertion that remdesivir (or cyclodextrin) is nephrotoxic at currently used doses / durations. There is good evidence from vori experience that it doesn’t matter at all. Renal function SHOULD NOT alter your remdesivir prescribing!
#IDWeek2020
y’all. I have never fangirled so hard. dr. robert bonomo making his
#Breakpoints
🎧 debut to talk gram-negative efflux, porins, pbps, and beta lactamases 😍
@ryankshields
is very smart too.
new episodes from
@SIDPharm
dropping 10/22 and 10/29 🤩
Crying happy tears for a lot of reasons, but the reality of a Black, Indian American, *woman* Vice President is sinking in and there aren’t words for that truth or for this moment.
Kamala Harris has made history.
She brings a legion of firsts to the vice presidency: She will be the first woman, the first Black person, the first Indian American and the first Asian American to hold the office.
kids of America out here holding it together b/c *theyre consistently trained in active shooter drills* b/c they get shot at in schools. meanwhile, they aren’t even IN school b/c govt failed them & 350K+ Americans so tremendously. but don’t worry, they arrested 15 people tonight.
@heidiflagg
My other kid: "This doesn't scare me. I would have just barricaded the doors and hid under the desk. That's what they teach us in school." 😭
OUR KIDS DESERVE BETTER THAN THIS.
No words other than this is truly the honor of a lifetime and that I believe in Auburn, and love it. Thank you,
@AuburnU
@AUHSOP
@UWHealth
@UPMC
@IDConnect1
for teaching me and giving me the opportunity to be a pharmacist. War Eagle 🦅
hello to every insurance company,
there is absolutely no way on this earth that Evusheld should require prior authorization. please update your policies ASAP.
sincerely,
every healthcare worker who definitely doesn't have the energy to complete unnecessary paperwork
moment of vulnerability because I had several genuine and inspiring and validating and raw convos during and after
#IDWeek2023
. it was an amazing week AND it’s okay to not be totally okay sometimes :)
this is the greatest thing ever.
@districtbrews
collaborated with the ID group
@uabmedicine
to make a beer where 10% of sales support a student-run free clinic,
@equalaccessbham
. everyone in the area go buy this now. and then administer via continuous infusion 😉
@SEdwardsPharmD
THE RESULTS ARE IN 🗳️👏
Congratulations to the Newly Elected
@SIDPharm
Board Members for 2023-2024! 🎉🎉🎉
President-Elect:
@ErinMcCreary
, PharmD, BCPS, BCIDP
Secretary:
@helennewland
, PharmD, BCIDP
Board Member-at-Large: Whitney Buckel (
@tinymuscles
), PharmD, BCIDP
today
#Breakpoints
passed the 250,000 listen milestone ☀️ this podcast has been the most amazing journey of meeting the coolest people, learning so much, and sharing with all of you! thanks
@jpogue1
and
@julie_justo
for this vision and everyone at
@SIDPharm
. Onward!
Huge congratulations to the most humble and hardest working colleague ever,
@ryankshields
! It is a legit honor to learn from you and our patients are super lucky to have you!
@IDPittStop
@PittDeptofMed
#ECCMID2022
Late Breakers🚨 SABATO trial—5330 pts assessed to enroll 213 with low-risk SAB. Early PO switch non-inferior to completing 12-16 total DOT with IV ABX & assoc w/shorter hospital LOS. important to diligently assess patients who are actually low risk before switch to PO
“They ought to put the vaccine in Cracker Jack boxes. Then everyone would want one!” - Grandpa McCreary
(this is the best, best day. way to go
@WV_DHHR
for reaching seniors who live at home.)
I get asked this a lot so here are our “rules” for Evusheld:
Vax ➡️ Evusheld: 14 days
Evusheld ➡️ Vax: currently 30 days, proposing to move to ‘no wait’
Sotrovimab ➡️ Evusheld: wait until patient out of contagiousness period as defined by infection prevention and clinically well
Only side effects: Relief, hope, joy
But man does everyone else in the world need this ASAP, too. We have a lot of work to do. Mask up, discuss hesitancy empathetically, help w/ clinics, get creative w/ logistical barriers to distribution (esp to elderly @ home, high ADI areas)
ZERO percent of septic patients on CRRT achieved serum concentrations >4x MIC of Pseudomonas spp. for the recommended time when receiving cefepime at 2g q12h dose. Zero. Percent.
#ashp18
I agreed to do a peer review. A few days later my grandpa died.
@PergamIC
reassigned the review without question.
@MichaelGIsonMD
not only did the review but also emailed me condolences (after picking up my work!) Thanks arent enough but man this community continues to humble me.
Sending positive vibes and lots of this emoji 🤗 to everyone in health care today, especially those helping coordinate remdesivir allocations at the local level. You are not alone in any of the things you’re feeling or four letter words you are saying, I promise.
@julie_justo
.
@JGPharmD
presents nice table on therapeutic drug monitoring of azoles. would argue for posaconazole TDM even if using delayed released tablets based on these recent data:
#accpam19
my favorite person peacefully went to be with my grandma this morning. he was unparalleled. in kindness, wisdom, and the way he steadfastly, deeply loved. being your granddaughter is the greatest honor.