Connor Prosty

PGY-2 Internal Medicine @McGill_DOM

[Connor Prosty @ConnorProsty]

@DrToddLee @doc_BLocke @DrEmilyMcD @BradSpellberg @JAMAInternalMed @reverendofdoubt In post-2004 studies, the probability of superiority of longer durations for all-cause mortality falls to 28%

[Connor Prosty @ConnorProsty]

@doc_BLocke @DrToddLee @DrEmilyMcD @BradSpellberg @JAMAInternalMed @reverendofdoubt eFigure 3 has the probability that RD is <X% plotted. The probability that longer is superior for all-cause mortality is ~70%.

[Connor Prosty @ConnorProsty]

@DrToddLee @ABsteward "Because of COVID-19 pandemic impacts and lack of funding for project extensions, enrollment ended at 81 participants."

[Connor Prosty @ConnorProsty]

@DrToddLee @mangarone23 @ABsteward @DrEmilyMcD @BradSpellberg Nope

[Connor Prosty @ConnorProsty]

@mangarone23 @ABsteward @DrToddLee @DrEmilyMcD Neat read. NI margin is huge and the rationale for NI design is questionable. I had higher hopes for FMT up front. Perhaps vanco then FMT is where the money is at.

[Connor Prosty @ConnorProsty]

@DrToddLee Saw "UTI" recently that turned out to be UGIB + PE + new metastatic cancer

[Connor Prosty @ConnorProsty]

@DrToddLee @bmj_latest Only one way to find out. Can pilot it with our next SRMA. I do like the robvis RoB2 figures though.

[Connor Prosty @ConnorProsty]

@Zaydovudine @BradSpellberg @DrToddLee @ABsteward @DrEmilyMcD Gent is first-line in most recent US AHA guidelines (2015) for CrCl>50. European ESC guidelines (2023) recommend either without preference.

[Connor Prosty @ConnorProsty]

@ABsteward @OFIDJournal I feel like it's important to consider what is driving the hypotension: hypovolemia, that rapidly corrects with fluids, vs more distributive. The latter likely indicating a worse prognosis. Unclear if CDI that rapidly improves with fluids should be labelled/treated as fulminant.

[Connor Prosty @ConnorProsty]

@DrToddLee @ABsteward A subgroup analysis of patients meeting IDSA clinical criteria (new unexplained >3 unformed stools/<24h) for CDI would have been nice. I think this is the question when deciding to treat or not to treat NAAT+/Toxin- patients.

[Connor Prosty @ConnorProsty]

@DrToddLee @ABsteward Not really any data we could use. No comparative mortality data. Recurrence is somewhat captured by conversion to Toxin+, but there's no comment on clinical criteria and this misses Toxin- recurrences. Indeed, the only colectomy attributable to CDI was NAAT+/Toxin-.

[Connor Prosty @ConnorProsty]

@ABsteward @realandyrosser @DrToddLee @DrEmilyMcD We did a subgroup of HIV-negative patients and the cut-off of 80 could still exclude PCP (NPV >95%) at a pre-test probability below 20%, which was similar to the overall analysis.

[Connor Prosty @ConnorProsty]

@onlykirankk @ABsteward From 80-400 the BDG test is indeterminate and can neither rule in nor rule out PCP (i.e., PPV and NPV both <90% across most pre-test probabilities) and alternative PCP diagnostic tests should be pursued

[Connor Prosty @ConnorProsty]

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