Brad Spellberg @BradSpellberg
CMO Los Angeles General Medical Center, hospitalist, infectious diseases expert, researcher bradspellberg.com Joined March 2016-
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Seeing a lot of procalcitonin hate. 26+ RCTs is not weak evidence, folks. Just make sure you have a good stewardship program if you want procalcitonin to work to reduce unnecessary antibiotic use. x.com/nateshivelymd/…
Seeing a lot of procalcitonin hate. 26+ RCTs is not weak evidence, folks. Just make sure you have a good stewardship program if you want procalcitonin to work to reduce unnecessary antibiotic use. x.com/nateshivelymd/…
@dralicehan @BradSpellberg @IdVilchez @DrToddLee @Gnfidz @syctong @wwrighID IV TMP/SMX carries lots of ADRs, fluid, etc. TMP high Vd may be suboptimal for bacteremia. Unknown PKPD target to guide dosing/frequency. Can be used successfully after clearance (SABATO and others).
My experience is that everyone should send me a check for $1000 right now. Yes, Im using the word "should" or "must". Although I don't have data to support it, it is consistent with my experience. And Im a full Professor. And I've written guidelines. So, you have to listen to me.
My experience is that everyone should send me a check for $1000 right now. Yes, Im using the word "should" or "must". Although I don't have data to support it, it is consistent with my experience. And Im a full Professor. And I've written guidelines. So, you have to listen to me.
@BradSpellberg @DrToddLee @TorontoIDDoc @edenhelmi @Cortes_Penfield Guideline writers before Wiki guidelines live footage below
Latest #ClinicalConundrum from @LAGeneralMed 30yo M w/ESRD on HD, lupus & APLS w/recurrent VTE/PE. Had been on warfarin but complicated by hemorrhagic stroke in setting of supratherapeutic INR 3mo previously. What would you do re anticoag? #MedTwitter
As @LAGenHospMed indicated, Hospital Medicine is leading the way in @LAGeneralMed 's journey to high reliability. From our Governing Body report. Amazing transformation of both mortality and length of stay. More exciting news about our hospital-wide transformation coming soon!
As @LAGenHospMed indicated, Hospital Medicine is leading the way in @LAGeneralMed 's journey to high reliability. From our Governing Body report. Amazing transformation of both mortality and length of stay. More exciting news about our hospital-wide transformation coming soon! https://t.co/LeDLhNZniC
@DrToddLee @DrNeilStone Highlights the need for a highly effective #hospitalist group. @LAGeneralMed our #hospitalist group has driven down LOS *and* inpatient mortality to among the lowest in the @Vizient network
@KuhnboBio @baym Numerous studies in agriculture (mostly animals rather than soil). See nam.edu/antibiotic-res…
TB IGRA for diagnosing active TB Useless when positive Useless when negative Remember that next time you are tempted to order it
TB IGRA for diagnosing active TB Useless when positive Useless when negative Remember that next time you are tempted to order it
@BradSpellberg 💯, market looks much better than 10 years ago, still not amazing, but I think CPE nowhere near as bad in terms of tx options, and we have a few for VRE also etc.
Well said. I will add, having been actively involved in policy solutions to the AMR problem since 2003, hyperbole DOES NOT HELP! We are substantially better off today than in 2009. The Chicken Little syndrome costs credibility. Constant exaggeration makes solutions less likely.
Well said. I will add, having been actively involved in policy solutions to the AMR problem since 2003, hyperbole DOES NOT HELP! We are substantially better off today than in 2009. The Chicken Little syndrome costs credibility. Constant exaggeration makes solutions less likely.
Now THAT…THAT is the best response by far. Simply genius. All you out there should be following @LAGenHospMed. It’s these pearls of wisdom y’all are missing out on.
Now THAT…THAT is the best response by far. Simply genius. All you out there should be following @LAGenHospMed. It’s these pearls of wisdom y’all are missing out on.
Don’t get me wrong I cannot wait for Ontario to cover IGRAs, but I do actually like that they’re not available at all to inpatients. An IGRA never needs to be done on an inpatient.
Don’t get me wrong I cannot wait for Ontario to cover IGRAs, but I do actually like that they’re not available at all to inpatients. An IGRA never needs to be done on an inpatient.
Antibiotic Steward Ba.. @ABsteward
56K Followers 125 Following Stay up-to-date in Infectious Diseases, Clinical Pharmacist, Antibiotics #IDXposts AKA #IDTwitter T🌟P influencer,@Wiki_Guidelines ,#Interstellar,🌹❤️MiskAdi @IDdocAdi
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17K Followers 2K Following Physician, educator, historian, author, co-director @iMEDEducation @BIDMC_IM, host of #histmed podcast @BedsideRounds, studies 🤖+🧠. He/him/his. 🖖🚲@BradSpellberg @ABsteward @seanongwx @UQ_GAMECHANGER Even with CRE nothing makes a difference. Built in 25-30% mortality regardless what you use or when you give it. It’s likely host factors. Time to rethink CMS mandates
@BradSpellberg More than begin useless, there is data suggesting that CT before LP is actually harmful for patients. …mpublications.onlinelibrary.wiley.com/doi/10.1002/jh…
@sebpoule @DrToddLee @VanceFowler5 @BradSpellberg @Amit_Achhra @ABsteward @LordAlirezaF I cannot not confirm nor pre-specify that I would… not.
Seeing a lot of procalcitonin hate. 26+ RCTs is not weak evidence, folks. Just make sure you have a good stewardship program if you want procalcitonin to work to reduce unnecessary antibiotic use. x.com/nateshivelymd/…
This is BIG! @ESCMID emergency department abx #stewardship guidelines will be recommending procalcitonin to guide initiation (vs withholding) of antibiotics in patients with LRTI! 🔥🔥🔥#ESCMIDGlobal2024
🔥GAME CHANGER RCT🔥 Multicenter open label Cefiderocol was non inferior and not superior to SOC antibiotics in patients with Healthcare Associated and Hospital-Acquired GN bacterial BSI Slides shared by @seanongwx #ESCMIDGlobal2024 A game-changing trial? #IDXposts
@BradSpellberg @IdVilchez @sebpoule @VanceFowler5 @Amit_Achhra @ABsteward @LordAlirezaF Be happy you aren't a stroke neurologist...
@DrToddLee @VanceFowler5 @BradSpellberg @Amit_Achhra @ABsteward @LordAlirezaF Am I the only one in the room thinking it’s getting more and more difficult to understand and interpret study results ? Or I’m just becoming lazy ? - a regular/normal/average ID doc
@Amit_Achhra @ABsteward @LordAlirezaF @BradSpellberg @VanceFowler5 Look at daptomycin nejm 2005 Ceftobiprole nejm 2023 Margin is similar for treatment failure I believe we can and should plan for tighter margins but that's easy enough to say when you don't have to pay for that trial!
@BradSpellberg @Amit_Achhra @ABsteward @LordAlirezaF @VanceFowler5 Yes though you need to prespecify the margin in advance! Agree if the one sided 97.5% CI is well below YOUR personal NI margin which is below the prespecified margin, that also has some meaning
@DrToddLee @ABsteward @LordAlirezaF @BradSpellberg @VanceFowler5 Thanks @DrToddLee seems they did prespecify. But how does NI margin affect this interpretation- it was 20% I think which feels too big?!
@Amit_Achhra @ABsteward @LordAlirezaF @BradSpellberg @VanceFowler5 If prespecified properly. Usually it's non inferior first then superior. But it could be done the other way.
@ABsteward @LordAlirezaF @BradSpellberg @DrToddLee @VanceFowler5 Question for trialists: can we confidently conclude non-inferiority from a superiority trial which failed to show superiority? @DrToddLee
@BradSpellberg @DrRossanaRosa @TomSchmidt30 I’m questioning this.
@TomSchmidt30 Well, @BradSpellberg coined the term Eminence-Based Medicine, I think 🧐
Best advice I got today: “Question everything your attending says.” By that look at where the recommendations come from, is this data driven, expert option, or their practice style? Thanks, @DrRossanaRosa! #ESCMIDGlobal2024 #IDTwitter
🔥DOTS🔥 The most anticipated RCT #ESCMIDGLOBAL2024 Dalbavancin is non-inferior to SOC by clinical efficacy for complicated SAB incl Rt sided IE 2 doses Dalba 1500 mg on days 1 & 8 or 4-8 wks of SOC(cefaz or naf:MSSA;vanc or dapto:MRSA) DOOR at D70 Slides shared by @LordAlirezaF
@BradSpellberg @ABsteward @microregistrar For some reason, you never see written in a chart "going to step down the heparin drip to warfarin or apixaban". So I guess people ok with that IV-->PO conversion. But antimicrobials through the vein are clearly magic 🪄