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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · 2d

Sometimes, the sodium content of antibiotics matters. Just last week, there was a CHF patient with pneumonia who wasn’t improving - It turns out that the culprit wasn’t infection severity; it was likely the sodium load from Zosyn (piperacillin–tazobactam). Check out our "fry scale."

Another Mastery Monday: Sometimes, the sodium content of antibiotics matters. Just last week, there was a CHF patient with pneumonia who wasn’t improving as expected. It turns out that the culprit wasn’t infection severity; it was likely the sodium load from Zosyn (piperacillin–tazobactam). Patients with CHF are often restricted to < 2 g sodium/day. Sometimes, Zosyn alone pushes them past that (especially if mixed in normal saline, which varies by institution). Add in maintenance fluids and other IV medications, and sodium can add up quickly. It's just another thing you need to keep an eye on, especially if patients are not improving as expected and are critically ill or have kidney or heart disease. I built this chart directly from package inserts (some sources assume a standard diluent, I did not). Since diluents vary by institution, you can use it to calculate your own total sodium load.

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · 7d

It's Wednesday and I forgot to post our Mastery Monday post on here. Oops! Drug fever is relatively uncommon, with estimates varying but often placing it around 3-5% of drug-related adverse effects or 1-3% of fevers of unknown origin. If you see a persistent fever, it could be worth considering.

Signs and symptoms of drug fever include an early onset, unremitting fever, multiple negative blood cultures, the patient seems well for the degree of fever and being on an offending drug.

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · 16d

Mastery Monday: I wouldn't say Tygacil is a first line
for VRE, but it's an option (and it can be a good one for
polymicrobial intrabdominal infections associated with
VRE). Linezolid is an option even if someone is on an
SSRI, depending on the patient.

Enterococci are gram-positive, facultative anaerobic cocci in short and medium chains commonly found in the intestines of humans and animals. The two clinically relevant species are Enterococcus faecalis and E. faecium. Aminopenicillins, like ampicillin and amoxicillin, are usually the drugs of choice. Most resistant isolates are susceptible to vancomycin. Enterococci can acquire resistance to vancomycin through genes (e.g., vanA, vanB operons) that alter cell wall binding through the horizontal transfer of mobile genetic elements, like plasmids and transposons. This is common in E. faecium (approx. 80%) and E. faecalis (approx. 5%). Aminopenicillins remain an option for ampicillin-sensitive VRE strains. Alternative treatments are required for both penicillin and vancomycin resistant strains.

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · 23d

Mastery Monday: Azithromycin is a fun antibiotic to learn about because it's kind of weird. It's also not as effective as it used to be, which is a global concern due to overprescribing because it is cheap and easily accessible. Who hasn't had an unnecessary Z-Pak? I think most of us have.

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Sep 15

Mastery Monday: This week it's oral cephalosporins.The main point is that even though your isolate is susceptible to a ceftriaxone, that doesn't mean the drugs will cover it. We usually use cefazolin as a surrogate.PharmSoHard did a really good podcast about cefdinir data and controversies in 2023.

Mastery Monday: Since it's early in the school year for our new students, residents, and fellows, I thought I'd start doing some "Mastery Monday" posts with some simple, easy to digest facts that will help you all grow into good stewards. This week it's oral cephalosporins. The main point is that even though your isolate is susceptible to a ceftriaxone, that doesn't mean the drugs will cover it. We usually use cefazolin as a surrogate marker here. Also, cefdinir is kind of twerpy. It's bioavailability isn't great, it's half life isn't long. . . It still works for some infections (PharmSoHard did a really good podcast about the data and controversies in 2023, I'll link it - it goes a bit more in depth than my BioticMon cards).

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Sep 8

Mastery Monday: Since it's early in the school year for our new students, residents, and fellows, I thought I'd start doing some "Mastery Monday" posts with some simple, easy to digest facts that will help you all grow into good stewards. If you have an idea for a future topic, let me know.

A scale with ciprofloxacin, levofloxacin, and moxifloxacin on it with some facts about quinolones.

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Sep 5

We have Amanda's CAP guideline summary here, though there is a little controversy with this one!

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Aug 21

I've summarized the new cUTI IDSA guidelines (they came out on July 17. A new CAP guideline came out then too but there's some IDSA/ATS drama so I was waiting on the official IDSA letter for that one - who knew ID was so spicy?).

Visual summary of the new IDSA cUTI guidelines

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Jul 19

Sunday kicks off Shark Week, and it’s also the 50th Anniversary of Jaws this summer! You might wonder what sharks have to do with stewardship. As apex predators, they face many of the same challenges we do. Stewardship is a team sport and affects the whole ecosystem! #SharkWeek #jaws50

We’re gonna need a bigger boat to tackle antimicrobial resistance in our oceans! Did you know sharks have been found carrying resistant bacteria like Pseudomonas, Vibrio, Aeromonas, Enterobacterales, and Psychrobacter in their jaws? Sharks sampled off the Florida Keys showed the highest resistance to various drugs.

But the real horror isn’t a shark bite (though, let’s avoid that). It’s that these sharks were exposed to resistant bacteria or antibiotic pressure and developed resistance in the first place. It’s likely from antibiotics in sewage, pharmaceutical waste, or agricultural runoff. This issue impacts us all. Let’s protect our waters and our antibiotics!

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Jul 4

Did you know that today's holiday used to be associated with tetanus? The severity of the disease led some to compare the holiday's death toll to that of major battles for independence.

Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Jun 23

Check out our latest blog post to join our education committee and find out more about the ADH survey.
www.arstewardship.org/post/join-ou...

Join Our Education Committee

We want to expand our outreach from the Summit to other parts of the state to further stewardship efforts. If you'd be interested in joining our education committee to discuss what opportunities you'...

www.arstewardship.org

Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · May 30

If you’re like me and couldn’t make it to MAD-ID, you can follow here.

Contagion® @contagionlive.bsky.social · May 30

💡Great afternoon of interviews with insightful takeaways on improving patient care and implementing guidelines! 🦠💊 #MADID2025 @mad-id.bsky.social #IDsky #MEDsky #AMRsky

Stay updated with onsite coverage here: www.contagionlive.com/conference/m...

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Apr 30

I'm behind on my MMWR, but the March 27th edition had a case study about an Arkansas splash pad and a fatal N. fowleri infection. I'm sure most of us remember the case (it was in 2023) but it's an interesting article with some information about the almost always fatal amoeba.

Fatal Case of Splash Pad–Associated Naegleria ...

This report describes a fatal case of Naegleria fowleri ...

www.cdc.gov

Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Apr 22

Happy Medical Laboratory Professionals Week to all the lab peeps. We couldn’t do it without you.

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Mar 1

What a great #ARSAS yesterday! Thank you to everyone who attended! We couldn’t do it without your support.

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Feb 13

Five days isn’t always enough, just usually.

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Reposted by Arkansas Antimicrobial Stewardship Foundation

Gomolemo from South Central @gomolemousa.bsky.social · Feb 12

New Mexico has entered the chat...

www.koat.com/article/new-...

New Mexico reports first case of measles in 2025

The New Mexico Health Department has confirmed a measles infection in Lea County.

www.koat.com

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Reposted by Arkansas Antimicrobial Stewardship Foundation

Bug Pharmacist // Tim Gauthier @idstewardship.bsky.social · Feb 9

📝 Here are cliff notes on the new FDA-approved product #Emblaveo

www.idstewardship.com/drugs/aztreo...

💠 IV only
💠 Activity vs Ambler Class B metallo-beta-lactamase (MBL) producing gram negative bacteria (e.g., NDM)
💠 Likely will be expensive
💠 Has been approved in Europe since April 2024

#IDsky

Aztreonam-avibactam (Emblaveo)

Aztreonam-avibactam (Emblaveo) photo source pfizer.nl KEY POINTS Aztreonam-avibactam (Emblaveo) is the combination of aztreonam (a monobactam) that interferes with bacterial cell wall synthesis and av...

www.idstewardship.com

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Feb 13

Not as long as Drake is going to spend in litigation - ~68 hours depending on the tissue.

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Feb 12

Yo, doc. So they say the half-life's long.

Kendrick Lamar with "When you see someone has been on 5 days of IV azithromycin."

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Reposted by Arkansas Antimicrobial Stewardship Foundation

Open Forum Infectious Diseases @ofidjournal.bsky.social · Feb 12

Big Data Bayesian Truths: No Vancomycin Trough Concentration Target is Sufficiently Precise for Safety or Efficacy

✅ Just Accepted
#IDSky

Big Data Bayesian Truths: No Vancomycin Trough Concentration Target is Sufficiently Precise for Safety or Efficacy

Therapeutic drug monitoring is standard of care for vancomycin because of the known efficacy and safety exposure window [i.e. area under the concentration-time curve (AUC) of 400-600 mg*24hours/L]. Despite guideline recommendations, AUCs are infrequently calculated because of the perceived adequacy of trough (Cmin) concentrations.

buff.ly

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Feb 12

Our love for stewardship is infectious! Find out more about all the great topics at the stewardship summit on our site: www.arstewardship.org/event-detail...

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Jan 31

Are your stewardship interventions love notes or lectures? Learn how to increase your influence with communication strategies at our conference on Feb 28!

Poem: Gram-negatives stain red,
Gram-positives stain blue -
Your infection is viral,
No antibiotics for you.

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Jan 24

I'm excited to post our summit schedule (www.arstewardship.org/summit for the full schedule). I seriously can't decide which of the breakouts I want to see. I want to see them all!

For the full schedule in a more readable form see https://www.arstewardship.org/summit

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Arkansas Antimicrobial Stewardship Foundation @arstewardship.bsky.social · Jan 13

A great feature on one of our board members, Shanda Ferguson, Pharm.D. The featured article underscores her commitment ensuring that residents of Arkansas receive the highest standard of care, even in rural areas.

Family Motivates UAMS College of Public Health Student to Serve - UAMS News

Shanda Ferguson, Pharm. D., a student in the University of Arkansas for Medical Sciences (UAMS) Fay W. Boozman College of Public Health’s Master of Health Administration (MHA) program, has witnessed s...

news.uams.edu

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