Madison Salam
@madison_salam
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ID Clinical Pharmacist @ UColorado 🧫⛰️🦬 Gamecock alum, dog mom, outdoor enthusiast, clindamycin hater
Colorado
Joined September 2022
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Pinned Tweet
Ecstatic to announce I’ve accepted a position to stay on at University of Colorado as an ID pharmacist! So grateful and SO excited 🦬🖤⛰️
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My new stewardship rule: if you spell meropenem as "meropenum" you get an auto ID consult thank u, next
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In effort to continue life-long learning as I transition into my career as an ID specialist- I welcome you to my learning board! Follow along to continue learning with me and please feel free to send requests my way via DM 🥳🦠🧫
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Ecstatic to officially announce I’ve accepted a position to stay on at the University of Colorado as an ID clinical specialist! So grateful and SO excited ⛰️🦬🖤
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Will my parents finally stop asking when I’m done with pharmacy school y/n?
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She’s published! Oral amoxicillin-clavulanate may be an appropriate alternative for ceftriaxone non-susceptible UTIs🦠 Check it out 👉🏼
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Things I did not expect to provide antibiotic recommendations for today in Denver, CO: shark bites 🦈
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babe wake up new Pseudomonas just dropped
📢📢📢 The
@CDCgov
released a
#HealthAdvisory
on February 1, 2023 warning about an outbreak of extensively drug-resistant
#Pseudomonas
aeruginosa associated with EzriCare Artificial Tears 🦠🧫
Be sure to check out the full advisory:
#TwitteRx
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Maybe it's the match day tweets, but feeling extra gratitude today for the ability to introduce myself with the credentials I've worked 6 years for next to an academic medical center I'm humbled to represent. It's the little things🥰
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Closing thoughts from my Peds ID rotation: I am now fully terrified of Group A Strep
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Stop 👏🏼prescribing👏🏼Paxlovid👏🏼if👏🏼you👏🏼can't👏🏼assess👏🏼DDIs👏🏼
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Week 3️⃣ of clinical pearls! This week (inspired by our entire immunocomp ID service) CMV resistance!
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Such a joy presenting my PGY-1 research project at
@IDWeek2022
! You ever just know you picked the right career?🥰
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Update to this weeks list: hydatid liver cyst, parvovirus, strongy hyperinfection, syphlitic aortitis, gummatous syphilis, pulm nocardia, disseminated cocci 😵💫 who said learning stops after residency
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When you’re trying to discuss skincare but you’re also on immunocompromised consults
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Recruiting all my Gram negative resistance specialists! Thoughts on mechanism? Do you trust ceftriaxone? (cUTI, pt seems to be responding thus far)
Carbapenemase PCR negative (IMP, VIM, KPC, NDM, OXA48)
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We’re hiring a 3rd ID PharmD! 😸🦠
Come work with an incredible group of people and complex patients at UCHealth! Feel free to message me with questions
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When the team "broadens" from cefepime > ceftazidime for new GPC in clusters in bcx
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Covering the stewardship chat for a few days and I alllllmost forgot how good it feels going from a carbapenem to Macrobid for an ESBL cystitis 😍
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It’s the most wonderful time of the year 🤩 Come see me at Poster Hall 6 to find out if bezlo+fidax is *really* worth it 🙌🏼
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MALARIA MYSTERY! A thread
60 yoM originally from Ethiopia returns to the States after visiting his family and is diagnosed with mild/mod P. vivax malaria. He's treated with 3d of Coartem and appropriately dosed primaquine. He feels he has returned to normal at his f/u appt. (1/?)
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I understand inflation but I draw the line at Starbucks now requiring 100⭐️ for a free drip coffee instead of 50⭐️….. ima still go though
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So many errors and over generalizations 😖 this is why I never provide these types of references to my learners
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been on service but we are back with another week of pearls!!
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Update: Pt completed a 2-wk course of IMI/REL 1.25g q6 over 3h + extended-interval tobramycin and is now doing very well! More evidence to optimize PK/PD of our drugs. YAY!!
Bat signal to
#IDTwitter
:
Other sensitivities are pending but pt's last PsAR (12/2022) was cefiderocol >=32 (R), colistin: 1 (I), imi/rel 4/4 (I). Help.
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@PhlawlessPharm
Me swiping a 10mL syringe of 1 mg/mL epi out of another code responders hand after she told me “meds are covered, you can go back to bed now”
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@NussbaumMD
Things I have genuinely seen on my verification screen:
- Doxorubicin / mean to order doxycycline
- RSV maternal vaccine in a 32 week GA premie / meant to order Beyfortus
- Heparin 20,000 units SQ TID / mean to be IV
- meropenem in a patient admitted for status on VPA
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My stewardship tactic this week: “please? it’s my birthday”
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Bat signal to
#IDTwitter
:
Other sensitivities are pending but pt's last PsAR (12/2022) was cefiderocol >=32 (R), colistin: 1 (I), imi/rel 4/4 (I). Help.
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Live footage of me editing "Manuscript_FINAL_version16.doc"
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Hobbies include: not starting Aztreo+Avycaz twice in two days 😅
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Pulling up to cross cover immunocomp service, waking up sick, and opening the list to 2 patients on cefiderocol, one on foscarnet, and one on cidofovir
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As encouraged by
@PharmerMeg
, what would you do with this respiratory culture? (Poll in next tweet)
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Just had my first "reviewer 2" experience and whewww you guys weren't kidding😅
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Guys I’m jk on this being because I got hired we had a shortage and changed a surgery pathway but I do still hate clinda
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As a reminder, CYP2D6 genotype testing is available but typically takes a while to return depending on your lab. Other drugs affected by altered CYP2D6 metabolism include many psych meds, dextromethorphan, and certain opioids. THANKS FOR FOLLOWING! *fin*
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Sooo pumped for this to finally be out! Amazing work from some of my favorites:
@JJenretteRx
@MattMil81732351
@kcmolinaID
Single dose Aminoglycoside implemented in the ED can help avoid hospital admissions. Awesome pilot series led by
@JJenretteRx
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Does anybody remember the ertapenem x6wk paper in hidradentitis supperativa that was popular on ID twitter like a month ago? :) TIA!
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@drtimothyli
Was so sad to miss this session! Did they discuss the divide between pk/pd and clinical outcomes? NTM seems to be one of the few disease states that are not subject to the laws of math lol
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@sallymansour_
And the pinned tweet about her being a self-proclaimed superhero hahaha wonder what organization deemed her that title!!
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Any PGY1s who are looking for an ID PGY2 spot - can’t emphasize the great work that comes out of HH enough!
@Floralquinolone
Not sure if here is the best place to tag on but, Hartford Hospital is going into Phase II for our ID PGY-2 program. If anyone is interested in hearing more about the program, feel free to send me a DM as a previous-resident turned preceptor!!
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RPDs and Residency Committees:
Yes or no to descriptions for APPEs and projects on CVs? I was taught no (and mine does not have them) but don’t want to lead my learners astray when I review CVs
Favor yes
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Favor no
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Favor no, w/ exceptions
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IDC, just be consistent
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@PharmerMeg
Here was what my Instagram friends think I do all day based on my Google history: 😂
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@IDiots_pod
📢i am so tired of amox/keflex being called low %F in the same breath as cipro being called high %F!📢 Love this chart
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@siamoxicillin
Because gent is not derived from the bacterial genus Streptomyces like tobramycin is :-)
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Exciting review that will certainly make its way into my daily practice - more great work out of this amazing group
Cefazolin in the CNS? One question this provoked: what matters? CSF levels? Interstitial levels?
@KaylaAntosz
@BBookstaver_USC
@jc_pharmacist
et al.
Cefazolin in the Treatment of Central Nervous System Infections: A Narrative Review and Recommendation
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@EMToxRx
@accpemedprn
@SAEM_AEMP
@ASHP_EMPharm
Our stewardship pharmacists do urine culture review but if we see 1x aminoglycoside from ED and culture remains susceptible we do consider it treated. Luckily high %S here so we haven't had to call anybody back, but if culture resulted R after discharge we would call back
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Real exposures and infections I have seen lately:
Bit by rat = rat bite fever
Hand-feeding pigeons = cutaneous crypto
Its almost like the textbooks knew what they were talking about 😅
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As a refresher: P. vivax has a dormant hypnozoite form that lives in hepatocytes. Coartem is only active against circulating trophozoite/metrozoite forms of P. vivax. For "radical cure" a hyponozoite-active agent (Primiquine) must be used
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Team Strep anginosus 😍
What is your favorite smell in Microbiology? ASCLS members get to share their love of
#MedicalLaboratory
science (and all the smells) with fellow laboratorians who get it. Join the Membership Monday conversation at ASCLS Connect.
#IamASCLS
#Lab4Life
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Eagerly welcoming
@Blaketarvy
to Denver this week as an ID PGY-2!
🎉 Happy first week of PGY2 ID residency, folks! Welcome to the incredibly nerdy & fantastic world of infectious diseases pharmacy! 🤓🤩🥳
📢 Let’s start with a role call of any new ID residents! RPDs, RPCs, residents, anyone can participate 😎
#IDtwitter
#TwitteRx
#MedTwitter
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This week’s article:
Noted low quality evidence, but fantastic review identifying no safety signals thus far for PsAr carbapenem resistance using ETP > MEM
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@Floralquinolone
Hot take: I actually felt like the spreadsheet helped me. If I saw interview offers on the sheet and had an empty inbox, it softened the blow when I got THE rejection email. Seems to be v unpopular opinion though and do not recommend unless you're sure you're this kind of person
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Incredible advocacy for the profession over here at
@CUDivofID
! Congratulations Dr. Grundy on a high-impact pub👊🏼
Congratulations to my colleague Brian Grundy on this great and much needed paper!
Complexity of Infectious Diseases Compared With Other Medical Subspecialties | Open Forum Infectious Diseases | Oxford Academic
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Thank you to my incredible co-authors and mentors who got me through every step of this:
@PharmerMeg
@MattMil81732351
@kcmolinaID
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Calling all
#IDTwitter
friends (especially TxP ID!)
67yoF, h/o kidney transplant. Admit with unresolving diarrhea. GI PCR positive for the following analytes: C diff toxin B, E.Coli O157, STEC, ETEC, Salmonella.
What’s your treatment approach?
Tx CDI only
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Tx CDI + Salmonella
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Tx CDI, assess, reeval sx
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other (respond below)
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@PharmerMeg
Never a dull day 😹😹😹 if anybody gets bitten by a dolphin I am fully prepared to defend my antimicrobial selection
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@InYourFAECIUM
Bloodstream 2/2 gut translocation, patient is neutropenic and decompensating, escalated to ICU today but remains off pressors. No info yet about BL/BLI on the current isolate. We were going to do tobra and imi/rel at 1.25 q4 attempt to hit an MIC of 4/4 (last Dec '22 isolate)
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One thing about my patients: they’re gonna be in good hands with our team!! 🤲🏼💛🖤
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What’s your favorite antimicrobial and why is it omadacycline?
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Getting people home for the holidays is always such a happy little light in the day ☺️
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Does anybody have institutional access to this article? Thanks in advance!
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Primiquine (PQ) is a prodrug activated by CYP2D6. 2D6 is known to have vast heterogeneity in encoding alleles that can produce phenotypes ranging from nonfunctioning to hypermetabolic CYP2D6. There are data suggesting CYP2D6 knockout mice do not respond to PQ (Pybus 2013)
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Immuncompromised host (OLT), 2/2 bcx with this C&S. Hemodynamically stable, CTAP and UA unrevealing. No more info at this time. What are you starting?
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@Floralquinolone
@PharmDbyMe
But also I love to be transparent that I matched at my
#4
for PGY-1 and it got me everything I needed for my career including some of my closest friends! Everything works out!
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@InYourFAECIUM
@GermHunterMD
@pranita_tamma
@OncIDPharmd
@davidvanduin
@ClancyNeil
@CIDJournal
@BradeKPharmD
@PharmerMeg
They already all knew the aminoglycoside updates from February when I taught a lecture yesterday! Smarty pantses <3
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Enter: TAFENOQUINE! A synthetic analog of primiquine that does not require CYP2D6 for activation. It's a 1x oral dose of 300 mg during primary treatment. It's CI in pregnancy, carries a risk of hemolytic anemia in G6PD deficient patients, and can cause psych disturbances.
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#IDTwitter
sound off: in an HD patients who makes ~some~ urine are you more, less, or equally likely to consider a true UTI?
(Assume pyuria, positive culture, unable to endorse symptoms)
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@danbacic
We may or may not have a case report in press 😉 I’ll link it here when it’s official!
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He represents to the ED 10mo later with similar symptoms. The very astute ED doctor rechecks his blood parasites which are POSITIVE for P. vivax! He denies any exposures, travels, or sick contacts. He is adamant he took all primiquine. WHAT COULD THIS BE!
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@PharmD_Kev
I think it's gotta be a KPC with the way that avibactam is restoring CAZ (and it's PsAr so I'm sure toss some porin changes in there lol). Do you have imi sensis or any molecular carbapenemase panels?
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ID Twitter: do you consider carbapenem > ciprofloxacin a deescalation? (for sake of context we'll say ESBL+ E. cloacae in the bloodstream, patient doing well, not going home anytime soon). Why or why not?
Yes
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No
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@MattDavis138
Don't you know Ancef only exists preop? It disappears off the EMR as soon as they leave the OR!
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@BaptistGtr
Our resident offices were always full of memes, photos with coresidents and a spot to decompress! so much learning already happening outside the office during residency 🥰
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@LumirKunovsky
Coverage is now quite poor given developing resistance, astronomically higher risk of C diff than other abx, and toxin inhibition benefits have been demonstrated with linezolid. IMO no role for clinda in 99% of cases!
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