Stanford Antimicrobial Safety & Sustainability Program
@stanfordasp.bsky.social
🏆 IDSA Center of Excellence in Antimicrobial Stewardship | CDPH AMS Honor Roll Gold | WHO Collaborating Centre
🩺 Stan Deresinski, Marisa Holubar, Alex Zimmet, Amy Chang, Emily Mui, Lina Meng, Will Alegria, David Ha
🔗 http://med.stanford.edu/bugsanddrugs
🩺 Stan Deresinski, Marisa Holubar, Alex Zimmet, Amy Chang, Emily Mui, Lina Meng, Will Alegria, David Ha
🔗 http://med.stanford.edu/bugsanddrugs
For more info, refer to the:
🔗2025 IDSA UTI Guidelines (www.idsociety.org/practice-gui...)
🔗JAMA WikiGuidelines (doi:10.1001/jamanetworkopen.2024.44495).
🔗SHC UTI guidelines: med.stanford.edu/bugsanddrugs...
🔗2025 IDSA UTI Guidelines (www.idsociety.org/practice-gui...)
🔗JAMA WikiGuidelines (doi:10.1001/jamanetworkopen.2024.44495).
🔗SHC UTI guidelines: med.stanford.edu/bugsanddrugs...
Antimicrobial Guidebook
med.stanford.edu
November 12, 2025 at 5:12 PM
For more info, refer to the:
🔗2025 IDSA UTI Guidelines (www.idsociety.org/practice-gui...)
🔗JAMA WikiGuidelines (doi:10.1001/jamanetworkopen.2024.44495).
🔗SHC UTI guidelines: med.stanford.edu/bugsanddrugs...
🔗2025 IDSA UTI Guidelines (www.idsociety.org/practice-gui...)
🔗JAMA WikiGuidelines (doi:10.1001/jamanetworkopen.2024.44495).
🔗SHC UTI guidelines: med.stanford.edu/bugsanddrugs...
The IDSA now considers infections beyond the bladder as complicated UTIs, regardless of gender. 🏥 See IDSA's infographic on uUTI vs cUTI classifications.
November 12, 2025 at 5:12 PM
The IDSA now considers infections beyond the bladder as complicated UTIs, regardless of gender. 🏥 See IDSA's infographic on uUTI vs cUTI classifications.
A: No, he does not have a complicated UTI! 🚫 While you might think male gender or anatomical issues such as kidney stones or stents, or immunocompromised status would always qualify a UTI as complicated, this is no longer supported by IDSA.
November 12, 2025 at 5:12 PM
A: No, he does not have a complicated UTI! 🚫 While you might think male gender or anatomical issues such as kidney stones or stents, or immunocompromised status would always qualify a UTI as complicated, this is no longer supported by IDSA.
🔗 For more details, refer to NCCN 2025 on the prevention and treatment of cancer-related infections. www.nccn.org/guidelines/g...
🔗SHC guidelines: med.stanford.edu/bugsanddrugs...
🔗SHC guidelines: med.stanford.edu/bugsanddrugs...
Guidelines Detail
www.nccn.org
November 5, 2025 at 5:38 PM
🔗 For more details, refer to NCCN 2025 on the prevention and treatment of cancer-related infections. www.nccn.org/guidelines/g...
🔗SHC guidelines: med.stanford.edu/bugsanddrugs...
🔗SHC guidelines: med.stanford.edu/bugsanddrugs...
Guidelines strongly recommend against adding vancomycin empirically based on persistent NF of unknown etiology in those with severe mucositis who are already receiving piperacillin/tazobactam, cefepime, meropenem, or other ABX with oral flora coverage.📜🚫
(NCCN 2025)
(NCCN 2025)
November 5, 2025 at 5:38 PM
Guidelines strongly recommend against adding vancomycin empirically based on persistent NF of unknown etiology in those with severe mucositis who are already receiving piperacillin/tazobactam, cefepime, meropenem, or other ABX with oral flora coverage.📜🚫
(NCCN 2025)
(NCCN 2025)
📉 The addition of vancomycin does not appear to decrease episodes of gram-positive bacteremia or help with defervescence in FN patients with severe mucositis who are already receiving piperacillin/tazobactam compared to placebo. (NCCN 2025)
November 5, 2025 at 5:38 PM
📉 The addition of vancomycin does not appear to decrease episodes of gram-positive bacteremia or help with defervescence in FN patients with severe mucositis who are already receiving piperacillin/tazobactam compared to placebo. (NCCN 2025)
A: No. 🚫 Chemotherapy-related GI mucositis predisposes patients to bloodstream infections by viridans group streptococci and gram-negative rods.
November 5, 2025 at 5:38 PM
A: No. 🚫 Chemotherapy-related GI mucositis predisposes patients to bloodstream infections by viridans group streptococci and gram-negative rods.
For more on our institution's SHC Pneumonia Guidelines, check the figure and link below! 🔗https://med.stanford.edu/bugsanddrugs/guidebook.html#pulmonary
October 29, 2025 at 7:07 PM
For more on our institution's SHC Pneumonia Guidelines, check the figure and link below! 🔗https://med.stanford.edu/bugsanddrugs/guidebook.html#pulmonary
For HAP/VAP, check procalcitonin levels. If it’s <0.3 after 48 hours or drops by 80% from initial value, consider stopping antibiotics early if the patient is improving
October 29, 2025 at 7:07 PM
For HAP/VAP, check procalcitonin levels. If it’s <0.3 after 48 hours or drops by 80% from initial value, consider stopping antibiotics early if the patient is improving
Guided by clinical response? 🩺 A recent RCT found that when guided by clinical response (afebrile, HD stable/off pressors), 3-7 days of treatment was just as effective as ≥8 days for VAP, plus fewer side effects! 🙌
October 29, 2025 at 7:07 PM
Guided by clinical response? 🩺 A recent RCT found that when guided by clinical response (afebrile, HD stable/off pressors), 3-7 days of treatment was just as effective as ≥8 days for VAP, plus fewer side effects! 🙌
For VAP patients on stable ventilator settings (PEEP ≤ 5, FiO2 ≤ 40%), consider stopping antibiotics in ≤3 days! 🕒 Studies show similar outcomes for shorter courses. 📉
October 29, 2025 at 7:07 PM
For VAP patients on stable ventilator settings (PEEP ≤ 5, FiO2 ≤ 40%), consider stopping antibiotics in ≤3 days! 🕒 Studies show similar outcomes for shorter courses. 📉
🩺 Clinically, identifying a lactose fermenting GNR is particularly useful for ruling out Pseudomonas.
⚠️ Many non-lactose fermenters (especially Stenotrophomonas, Burkholderia, and Acinetobacter) can be very challenging to treat. ID consultation should be considered for invasive infections.
⚠️ Many non-lactose fermenters (especially Stenotrophomonas, Burkholderia, and Acinetobacter) can be very challenging to treat. ID consultation should be considered for invasive infections.
October 23, 2025 at 5:51 PM
🩺 Clinically, identifying a lactose fermenting GNR is particularly useful for ruling out Pseudomonas.
⚠️ Many non-lactose fermenters (especially Stenotrophomonas, Burkholderia, and Acinetobacter) can be very challenging to treat. ID consultation should be considered for invasive infections.
⚠️ Many non-lactose fermenters (especially Stenotrophomonas, Burkholderia, and Acinetobacter) can be very challenging to treat. ID consultation should be considered for invasive infections.
🔍 Lactose Fermenting GNRs:
E. coli
Klebsiella
Enterobacter
🔍 Non-Lactose Fermenting GNRs:
Pseudomonas
Proteus
Acinetobacter
Stenotrophomonas
Burkholderia
E. coli
Klebsiella
Enterobacter
🔍 Non-Lactose Fermenting GNRs:
Pseudomonas
Proteus
Acinetobacter
Stenotrophomonas
Burkholderia
October 23, 2025 at 5:51 PM
🔍 Lactose Fermenting GNRs:
E. coli
Klebsiella
Enterobacter
🔍 Non-Lactose Fermenting GNRs:
Pseudomonas
Proteus
Acinetobacter
Stenotrophomonas
Burkholderia
E. coli
Klebsiella
Enterobacter
🔍 Non-Lactose Fermenting GNRs:
Pseudomonas
Proteus
Acinetobacter
Stenotrophomonas
Burkholderia
💡 A: Lactose fermentation is a quick test the microbiology lab can perform on GNRs to help narrow the microbiologic differential diagnosis.
October 23, 2025 at 5:51 PM
💡 A: Lactose fermentation is a quick test the microbiology lab can perform on GNRs to help narrow the microbiologic differential diagnosis.
📚 References:
Lipsky et al, PMID: 37779457
Senneville et al, IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023), PMID: 37779457
Lipsky et al, PMID: 37779457
Senneville et al, IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023), PMID: 37779457
October 15, 2025 at 3:57 PM
📚 References:
Lipsky et al, PMID: 37779457
Senneville et al, IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023), PMID: 37779457
Lipsky et al, PMID: 37779457
Senneville et al, IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023), PMID: 37779457
💊 If antibiotic treatment is warranted, focus on coverage for gram-positive organisms, including beta-haemolytic streptococci and Staphylococcus aureus.
🔄 Therapy should ultimately be adjusted based on sterile specimen cultures, NOT wound swabs.
🔄 Therapy should ultimately be adjusted based on sterile specimen cultures, NOT wound swabs.
October 15, 2025 at 3:57 PM
💊 If antibiotic treatment is warranted, focus on coverage for gram-positive organisms, including beta-haemolytic streptococci and Staphylococcus aureus.
🔄 Therapy should ultimately be adjusted based on sterile specimen cultures, NOT wound swabs.
🔄 Therapy should ultimately be adjusted based on sterile specimen cultures, NOT wound swabs.
🔍 Risk factors to consider include:
-Recent cultures isolating Pseudomonas
-Frequent exposure of the foot to water
-Treatment failure with non-pseudomonal therapy
-Recent cultures isolating Pseudomonas
-Frequent exposure of the foot to water
-Treatment failure with non-pseudomonal therapy
October 15, 2025 at 3:57 PM
🔍 Risk factors to consider include:
-Recent cultures isolating Pseudomonas
-Frequent exposure of the foot to water
-Treatment failure with non-pseudomonal therapy
-Recent cultures isolating Pseudomonas
-Frequent exposure of the foot to water
-Treatment failure with non-pseudomonal therapy
💡 A: Contrary to common belief, you do not need to reach for Pseudomonas coverage right away. Anti-Pseudomonals are often overprescribed for DFIs.
📋 IDSA guidelines recommend against empirically covering for Pseudomonas in DFIs unless there’s a septic presentation or specific patient risk factors.
📋 IDSA guidelines recommend against empirically covering for Pseudomonas in DFIs unless there’s a septic presentation or specific patient risk factors.
October 15, 2025 at 3:57 PM
💡 A: Contrary to common belief, you do not need to reach for Pseudomonas coverage right away. Anti-Pseudomonals are often overprescribed for DFIs.
📋 IDSA guidelines recommend against empirically covering for Pseudomonas in DFIs unless there’s a septic presentation or specific patient risk factors.
📋 IDSA guidelines recommend against empirically covering for Pseudomonas in DFIs unless there’s a septic presentation or specific patient risk factors.
🔍 While skin swabs in patients with cellulitis are often not helpful (as they can reflect colonization), I&D (incision and drainage) of a purulent abscess is beneficial. Culture with susceptibility testing allows for targeted antibiotic use.
October 8, 2025 at 2:07 PM
🔍 While skin swabs in patients with cellulitis are often not helpful (as they can reflect colonization), I&D (incision and drainage) of a purulent abscess is beneficial. Culture with susceptibility testing allows for targeted antibiotic use.
💡 A: The first step when evaluating a patient with SSTI is to assess for purulence, which can be manifested as “lumps, bumps, or pus.”
Empiric MRSA coverage is indicated for purulent SSTI, not non-purulent SSTI.
Empiric MRSA coverage is indicated for purulent SSTI, not non-purulent SSTI.
October 8, 2025 at 2:07 PM
💡 A: The first step when evaluating a patient with SSTI is to assess for purulence, which can be manifested as “lumps, bumps, or pus.”
Empiric MRSA coverage is indicated for purulent SSTI, not non-purulent SSTI.
Empiric MRSA coverage is indicated for purulent SSTI, not non-purulent SSTI.