ID physician @CUHKMedicine • #abxstewardship • #penicillinallergy • Certificate in Travel Health®
Hong Kong
Joined October 2019
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One of the biggest reasons why we need antibiotic stewardship is to avoid creating scary monsters like this⬇️
How are you going to treat this?
Among patients who had undergone orthopedic surgery and received local antibiotics, a short course (≤7 d) of systemic antibiotics was noninferior to a long course (≥4 wk) with respect to definite treatment failure by 12m.
doi.org/10.1056/NEJMoa250675…
@ABsteward
@BradSpellberg
Timothy Li retweeted
A brief tweet string on why @ABsteward and I agree with @TorontoIDDoc that this case report is fire.
Many doctors continue to refuse to use oral therapy for S. aureus bacteremia despite now fairly overwhelming evidence that it is effective, and safer, than all IV-therapy...
Timothy Li retweeted
Today in @NEJM we show that cefazolin should be the preferred agent for MSSA bacteremia
nejm.org/doi/full/10.1056/NE…
We also show in @TheLancet that penicillin should be preferred to anti-staphyloccal penicilins for PSSA
thelancet.com/journals/lance…
@snap_trial @RIMUHC1
Timothy Li retweeted
One of the most confusing aspects of antibiotic resistance is the distinction between ecological resistance and clinical resistance. Clinical resistance is a construct based on CLSI breakpoints. We would all like to think those are based on clinical data but we know they are not.
Timothy Li retweeted
Amazing 😍
🔥SHORTEN 2 RCT
A 7-day treatment course is superior to 14 days for uncomplicated Pseudomonas aeruginosa bacteremia bacteremia, achieving similar clinical response rates with lower antibiotic exposure, fewer superinfections, and fewer serious adverse events
Seven days is not inferior (and better!!) to 14 days for the treatment of Pseudomonas aeruginosa bacteremia @shorten2trial presented at @SEIMC_
Amazing work led by @josemolinagb and Jose Miguel Cisneros 🙌🏻
@ABsteward @BradSpellberg
@ProaValme @guiaprioam
Timothy Li retweeted
Our @wikiguidelines letter to the editor regarding the controversy between IDSA and ATS on CAP guidelines is now published. Time for societies to modernize their approach to guidelines to STOP creating care standards based on opinions. @ABsteward @DrToddLee @AnilMakam @medrants
In this RCT from 🇮🇳 (n=140), a 7-day antibiotic regimen for uncomplicated culture proven neonatal sepsis is not inferior to a 14-day regimen
Excluded: S.aureus, fungal, CNS, septic arthritis, osteomyelitis
#shorterisbetter
@BradSpellberg @ABsteward
doi.org/10.1007/s00431-026-0…
Timothy Li retweeted
piperacillin-tazobactam is safe in patients with PCN allergy
you can tell this simply from the molecular structure if you believe in chemistry
I blogged about this five years ago: emcrit.org/pulmcrit/piptazo-…
here is real-world data to support this 👇
Is piperacillin-tazobactam safe in patients with penicillin allergy?
🆕🔥🟢Piperacillin–tazobactam tolerability in patients with a labeled penicillin allergy (PIPPEN)
Of the 191 patients included, 98% were found to tolerate one or more doses of piperacillin–tazobactam.
This included 95 patients with “low risk delayed reactions,” 90 patients with “high risk anaphylactic reactions,” and 2 patients with “well-documented delayed reactions,” to penicillins. Only four patients out of 191 had documented intolerance to piperacillin-tazobactam post-exposure
All patients in the “anaphylactic allergy or anaphylactic like reaction” subgroup tolerated one or more doses of piperacillin–tazobactam.
cambridge.org/core/journals/…
Timothy Li retweeted
Is piperacillin-tazobactam safe in patients with penicillin allergy?
🆕🔥🟢Piperacillin–tazobactam tolerability in patients with a labeled penicillin allergy (PIPPEN)
Of the 191 patients included, 98% were found to tolerate one or more doses of piperacillin–tazobactam.
This included 95 patients with “low risk delayed reactions,” 90 patients with “high risk anaphylactic reactions,” and 2 patients with “well-documented delayed reactions,” to penicillins. Only four patients out of 191 had documented intolerance to piperacillin-tazobactam post-exposure
All patients in the “anaphylactic allergy or anaphylactic like reaction” subgroup tolerated one or more doses of piperacillin–tazobactam.
cambridge.org/core/journals/…
New diagnostic tools to help end TB, recommended by WHO on World TB Day
who.int/news/item/24-03-2026…
Timothy Li retweeted
Antibiotics probably aren’t beneficial for patients with cirrhosis & GI bleeding
It will take time to change practice on this, but this is probably ripe for some antimicrobial stewardship
The idea that a few doses of ceftriaxone improve *mortality* in GI bleed was always sus…
classic teaching: cirrhosis + upper GI bleed = antibiotics for everyone.
But how strong is the evidence behind that practice?
This Annals of Emergency Medicine Systematic Review Snapshot highlights a Bayesian meta-analysis of 14 randomized trials examining antibiotic prophylaxis in cirrhotic patients with upper GI bleeding. The analysis raises important questions about duration of therapy, while also reminding us about the limitations of older, heterogeneous trials and potential bias in the data.
📚 The takeaway: worth reading, worth discussing, and worth scrutinizing the methods before changing practice.
Check out the full Systematic Review Snapshot in Annals of Emergency Medicine and decide for yourself.
Reference:
Prosty C, Noutsios D, Dubé LR, et al. Prophylactic antibiotics for upper gastrointestinal bleeding in patients with cirrhosis: a systematic review and Bayesian meta-analysis. JAMA Intern Med. 2025;185:1194-1203.
Discussed in: Annals of Emergency Medicine Systematic Review Snapshot.
#EmergencyMedicine #MedEd #FOAMed #EvidenceBasedMedicine #AnnalsOfEM
Another case of fatal infection by Clostridium species @ASMicrobiology
Gas gangrene due to C.septicum subsequent to pecking by a rooster🐓
➡️rapidly progressive myonecrosis (several cm/hour)
➡️spontaneous cases are a/w GI malignancy or hemat disorders
doi.org/10.1128/jcm.01300-25
Timothy Li retweeted
A single course of antibiotics can disrupt your gut microbiome for up to 8 YEARS, according to this new Nature Medicine study 💊🤯
Avoid antibiotics unless absolutely necessary and consider taking probiotics to counteract these effects.
Massive Intravascular Hemolysis from C. perfringens Bacteremia @NEJM
⭐️Dehemoglobinized red cells
⭐️Intra- and extracellular GPB
A rare diagnosis to consider in patients with:
➡️undifferentiated illness with shock, and
➡️grossly hemolyzed blood samples
doi.org/10.1056/NEJMicm25141…
Routine retesting is not necessary after negative beta-lactam allergy evaluation
In this SRMA of 32 studies with 3414 retest by DPT:
➡️Resensitization rate = 2.44% (similar to new reactions in general population)
➡️ Severe reactions = 0.32% (rare)
doi.org/10.1016/j.jaip.2026.…
Timothy Li retweeted
🔥Just published 🔥
TAPER-V RCT
Initial Vancomycin Taper for the Prevention of Recurrent Clostridioides difficile Infection
In this randomized clinical trial of 256, a 4-week vancomycin pulse and taper regimen *had a probability of 74% to be superior to astandard 2-week pulse regimen in patients a first episode or first recurrence of CDI
*All patients received 14d pulse of vanco (standardized at 125 mg orally 4 times a day at the time of recruitment) →taper (125 mg q12h ×7d,then 125mg q24h ×7d) vs placebo for management of CDI (first episode or recurrence).
Vanco for 10d is obsolete! #IDXposts
jamanetwork.com/journals/jam…
Subacute Sclerosing Panencephalitis @NEJM
The most terrifying complication of measles infection
Curative treatment: none
Prevention: vaccination
nejm.org/doi/abs/10.1056/NEJ…
"Cefazolin does not share any side chains with the currently available penicillins and can be used in cases of suspected or proven immediate type allergy to a penicillin, irrespective of severity or time elapsed since the index reaction."
⭐Surgical prophylaxis
⭐MSSA infection
🔥Just published 🔥
ESCMID Clinical Guidelines on the Evaluation and Management of a Reported Antibiotic Allergy #IDXposts
clinicalmicrobiologyandinfec…
ALT Beta lactams flow shart
