{"id":1386,"date":"2011-02-14T21:16:03","date_gmt":"2011-02-15T02:16:03","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=1386"},"modified":"2015-06-04T15:24:00","modified_gmt":"2015-06-04T19:24:00","slug":"pspring-training-pseudomonads","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/pspring-training-pseudomonads\/2011\/02\/14\/","title":{"rendered":"Pspring Training Pseudomonads"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2011\/02\/spring-training-21.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-1390\" title=\"spring-training-2\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2011\/02\/spring-training-21.jpg\" alt=\"\" width=\"342\" height=\"240\" \/><\/a>A few ID\/HIV issues to ponder as we welcome back the most important sport in the universe:<\/p>\n<ul>\n<li>Interesting new <a href=\"http:\/\/www.idsociety.org\/content.aspx?id=4430#cys\" target=\"_blank\">Guidelines on UTIs<\/a> from IDSA &#8212; especially their recommendations\u00a0<em>not<\/em> to use fluoroquinolones for uncomplicated cystitis and to promote nitrofurantoin for 5 days to first-line for this indication. And welcome to fosfomycin &#8212; though this could eliminate one of the ID consultant&#8217;s few remaining tricks when getting a challenging UTI consult.<\/li>\n<li>So opportunistic infections are decidedly uncommon after prolonged virologic suppression, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21208929\" target=\"_blank\">even if the CD4&#8217;s don&#8217;t increase<\/a>. (Read the full paper for details.) I was asked once to give a talk to a group of HIV providers on what to do for persistently low CD4s despite effective therapy. \u00a0It would have been a very short talk &#8212; the answer is basically &#8220;do nothing.&#8221; \u00a0One could argue that we should stop CD4 measurements <em>entirely<\/em> after a couple of years of successful ART.\u00a0 What&#8217;s the point?<\/li>\n<li>Thought <em>M abscessus<\/em> infection was difficult to treat? Turns out it&#8217;s even harder than we thought &#8212; some of the macrolide-susceptible strains are actually &#8220;susceptible&#8221; (note quotes), as they have an inducible macrolide resistance gene (called &#8220;erm&#8221;) that cannot be detected on susceptibility testing.\u00a0 Read this latest study suggesting the importance of surgical therapy <a href=\"http:\/\/cid.oxfordjournals.org\/content\/52\/5\/565.full\" target=\"_blank\">here<\/a>, and this outstanding (and entertaining) editorial <a href=\"http:\/\/cid.oxfordjournals.org\/content\/52\/5\/572.full\" target=\"_blank\">here<\/a> for further info on this always-challenging entity.<\/li>\n<li>The latest ADAP Watch is <a href=\"http:\/\/www.nastad.org\/InFocus\/InfocusResultsDetails.aspx?infocus_id=355\" target=\"_blank\">here<\/a> (PDF) &#8212; and it&#8217;s not pretty.\u00a0 To quote the report:\u00a0 &#8220;As of February 10, 2011, there were 6,235 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in 10 states. This is a 32 percent increase from the 4,732 individuals on the December 2010 ADAP Watch.&#8221;\u00a0 Looks like <em>more than half<\/em> (3,204, to be precise) live in Florida &#8212; seems like some sort of action there is likely soon, right?<\/li>\n<li>I&#8217;ve been reading &#8212; and enjoying &#8212; Mark Crislip&#8217;s <a href=\"http:\/\/boards.medscape.com\/.29f3af03\/\" target=\"_blank\">ID blog over on Medscape<\/a> for several months now. It&#8217;s terrific!\u00a0 Well-written, funny, wise, and full of just the sort of cases we ID doctors see all the time, plus an impressive smattering of literature-citing even in situations that don&#8217;t obviously lend themselves to this approach. I cannot recommend it highly enough.<\/li>\n<\/ul>\n<p>By the way, for those planning the trip out to Boston later this month for the Retrovirus Conference, we have a decided warming trend this week.\u00a0 Snow gone by the opening plenaries?<\/p>\n<p><a href=\"http:\/\/www.sbnation.com\/mlb\/2011\/2\/14\/1992047\/pitchers-and-catchers-three-sweetest-words\" target=\"_blank\">&#8220;Pitchers and catchers&#8230;&#8221;<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A few ID\/HIV issues to ponder as we welcome back the most important sport in the universe: Interesting new Guidelines on UTIs from IDSA &#8212; especially their recommendations\u00a0not to use fluoroquinolones for uncomplicated cystitis and to promote nitrofurantoin for 5 days to first-line for this indication. And welcome to fosfomycin &#8212; though this could eliminate [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,8,9],"tags":[38,165,423,485,486,579,961],"class_list":["post-1386","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-patient-care","category-policy","tag-adap","tag-cd4-discordance","tag-hiv","tag-idsa","tag-idsa-guidelines","tag-m-abscessus","tag-uti"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1386","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=1386"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1386\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=1386"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=1386"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=1386"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}