@PaulSaxMD @SameerKadri12 Wow!!! This is unexpected... I love TMP-SMX over levofloxacin. Its hard for me... not sure whether or not I am ready to make this change based on this study. Wonder what other thinks about. @BradSpellberg @wfwrighID @DrToddLee @SAIRABT @Cortes_Penfield @OncIDPharmd

@IdVilchez @SameerKadri12 @BradSpellberg @wfwrighID @DrToddLee @SAIRABT @Cortes_Penfield @OncIDPharmd Studies like this don't establish a new standard of care, but they do force us to acknowledge that the data behind some of our practices are not based on the highest quality evidence. Based on this study, I would say that we don't know which is better, T/S or levo.

@PaulSaxMD @SameerKadri12 I don’t know…blood vs respiratory breakdown is interesting. tmp/smx dose (and adrs) arent listed. a lot of colonization gets treated especially when you look back to 2005. Kudos for the effort, but this is a tough question to answer retrospectively.

@ErinMcCreary @SameerKadri12 How would you study it prospectively?

@PaulSaxMD @SameerKadri12 Minocycline needs one like this too 😄

@PaulSaxMD @SameerKadri12 @Ahmed_HBabiker 🙌

@PaulSaxMD @SameerKadri12 And survey says: Vitamin L! ;)

@PaulSaxMD @SameerKadri12 What’s truly terrifying is that there have been cases of S. maltophilia being resistant to both Levaquin & Bactrim, but more so with Levaquin if I’m not mistaken.

@PaulSaxMD @SameerKadri12 Thank you for highlighting this study.

@PaulSaxMD @SameerKadri12 Couldn't agree more. Many critical questions won't be answered by RCT. Leveraging large EHR datasets to address them is crucial. Well done, @SameerKadri12 , @sarahrenee314 and @SadiaSarzynski !

@PaulSaxMD @SameerKadri12 This seems like about as well done a study as could be done with this dataset, but the selection bias with Steno to me is way too strong to do anything retrospectively, especially with no standard infection definition. We need an RCt which, as the authors note, is very hard

@PaulSaxMD @SameerKadri12 @MRScip_PharmD

@PaulSaxMD @SameerKadri12 As rigorous as you can get with retrospective data. I am extremely jealous at the use of overlap weighting as a statistical method. This weighting mirrors RCTs more closely, and weights cases higher with more clinical equipoise between treatments. Very strong.

@PaulSaxMD @SameerKadri12 Not sure that any data is better than no data. Low quality evidence brought to many disaster in the past