Fikree

Clinical Pharmacist at Universiti Malaya Medical Centre • Interests: AMS, ID, Critical Care, HIV 🦠💊

[Pharmacotherapy @PharmacoJournal]

A summary of clinical and pharmacokinetic/pharmacodynamic (PK/PD) data that compare dosing strategies for skin and soft tissue infections. OPEN ACCESS: https://t.co/gee0AMMgDq

[ACIN Capitulo Central @acincentral]

La neumonía por Pneumocystis jirovecii (PJP) ya no es exclusiva de pacientes con VIH. Su incidencia está aumentando en personas inmunocomprometidas sin VIH, lo que exige mayor sospecha clínica, diagnóstico temprano y estrategias de profilaxis individualizadas. Una excelente revisión sobre los estándares terapéuticos en 2026. #Infectología #PJP #Antimicrobianos #MedicinaIntensiva @Lauranocuab

[Alí Sebastian Meza @AliSMV7]

Meningitis, encephalitis, and beyond: A practical intensive care unit guide to severe central nervous system infections

https://t.co/gklfQ3TFLu

[My #HadithTime @myhadithtime]

Rezeki Datang Melalui Anak

Kaum Quraysh terdahulu pernah membunuh anak mereka kerana bimbang terhadap rezeki anak tersebut, sedangkan Allah telah pun menjamin dalam al-Quran tentang rezeki setiap anak kita.

Semoga Allah membimbing kita.

[Dr. Sh. Haifaa Younis @DrHaifaaYounis]

Keep remembering the death. It will calm you down. Because everything that gets us upset is about Dunya.

[Mayo Clinic Infectious Diseases @MayoClinicINFD]

ID board review:

A 36-year-old woman develops ascending paralysis after a diarrheal illness. Stool culture previously grew Campylobacter jejuni. Which neurologic complication is most likely?

A. Myasthenia gravis
B. Guillain-Barré syndrome
C. Multiple sclerosis
D. Tabes dorsalis

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🆕💥🔴Cefazolin for all or just some?
A review of cefazolin for surgical site infection prophylaxis in patients with β-lactam allergies #idxposts https://t.co/bhVXbuYW8p

[Debbie Goff @idpharmd]

New commentary on Antimicrobial Stewardship in LMICs Purpose-driven People in Nature https://t.co/BokJKwdEM0 @ABsteward @BRxAD @BradSpellberg @RodneyRohde @hboucher3 @CarlosdelRio7 @PaulSaxMD

[Fikree @fikreeahmad]

@MicroLukas Reassess if the would culture needs treatment, if it does then perhaps cefepime? - covers both MSSA and P. aeruginosa. If not then pip-taz. If no clear indication for the wound to be treated, cefazolin all the way. Not a fan for cefazolin + ceftazidime 😅

[Yazid Hamka @yazid_hamka_]

Jangan cemburu dengan rezeki orang lain.

Setiap orang akan dapat bahagian yang Allah dah tetapkan.

Ada nikmat. Ada juga ujian.

Setiap orang takkan pernah sama. Sebab itu, hanya Allah yang mampu menilai kita.

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🆕💥🟢Retrospective observational study
Anti-MRSA Cephalosporins + Daptomycin as Initial Therapy for MRSA Bacteremia: Does a “Hit Hard and Fast” Strategy Improve Outcomes?
#idxposts #DOOR https://t.co/tmxkAH35QV

[Brad Spellberg @BradSpellberg]

@DiorIzzy @DrToddLee I always do 600 once daily. Evidence from TB is that 600 BID is not more effective but is more toxic. No evidence either way for E. faecalis specifically, but it will be more toxic, and we need people to tolerate the drug to complete therapy. AUC24 of 600 daily is outstanding.

[Leonardo Santos @Leo_Santo5]

💉🏥Elección Empírica y Dosis de Antibióticos en Pacientes Críticos

🔰📚Crit Care Clin 2026

https://t.co/831irnWhJq

Enlace a Artículo Completo👇🏻✅🆓
https://t.co/xumUMHaxVK

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

"Flu"cloxacillin is out, cefazolin is in.
SNAP RCT + CloCeBa RCT
Cefazolin is non-inferior to Anti Staphylococcal Penicillins (ASPs) for treatment of MSSA bactremia and causes less AKI and should be 1st line therapy #idxposts #ESCMIDGlobal2026

[ESCMID @ESCMID]

The ESCMID Global Abstract Book 2026 is now available on our webpage and free to download.

Relive and review all the amazing accepted abstracts that were presented at the 36th edition of ESCMID Global in Munich, Germany.

https://t.co/sWEMVyTmCn

#ESCMIDGlobal2026

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🆕💥🔴 Review article:Spinal epidural abscess
I like figure below—clear distinction between paraspinal & epidural abscess
Including “zombie tests”(CRP/ESR) in diagnostic workup feels overstated—they don’t change decision-making once suspicion is raised
https://t.co/2E16HRBZrD

[Fikree @fikreeahmad]

@Pharm_BinLin Congratulations @Pharm_BinLin!

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🆕💥🟢Population pharmacokinetics of polymyxin B in critically ill patients with multidrug-resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa infections #IDXposts
https://t.co/vaQNgCGEI1

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🧠 AKI is not just creatinine.
And KDIGO 2026 makes that very clear.

🚨 Big shift in thinking

Acute Kidney Injury (AKI):

👉 Is no longer defined only by creatinine rise

Now includes:

✔️ Serum creatinine
✔️ Urine output
✔️ Biomarkers of kidney damage/stress

👉 Even structural injury alone can define AKI

⚠️ The clinical reality

Creatinine is:

▪️ Late
▪️ Diluted by fluids
▪️ Affected by muscle mass
▪️ Misleading in ICU

👉 Meaning:
We diagnose AKI too late

🧬 New paradigm: function + damage

KDIGO 2026 introduces a 3-axis model:

🟠 Functional decline (SCr, urine output)
🔵 Structural injury (biomarkers)
🟣 Time (AKI → AKD → CKD continuum)

👉 This is a major conceptual upgrade

📊 New AKI definition

AKI is present if ANY of the following:

✔️ ↑ SCr ≥0.3 mg/dL in 48h
✔️ ↑ SCr ≥1.5x baseline in 7 days
✔️ ↓ urine output <0.5 ml/kg/h ≥6h
✔️ Positive kidney damage biomarker

🧠 Staging is now multidimensional

Not just creatinine anymore:

▪️ C → Creatinine
▪️ U → Urine output
▪️ B → Biomarkers

👉 A patient can be:

➡️ C0 U0 B1 = subclinical AKI

🔥 Why this matters in ICU

This explains what we see daily:

✔️ “Normal creatinine”
✔️ But worsening outcomes
✔️ Especially in sepsis, surgery, shock

👉 Because injury precedes dysfunction

⚡ Key clinical implications

1. Earlier diagnosis → before irreversible damage

2. Better risk stratification → biomarkers + clinical models

3. Targeted prevention → not one-size-fits-all

4. Dynamic monitoring → AKI is a trajectory, not a moment

🫀 Hemodynamic connection

KDIGO reinforces:

👉 Kidney = perfusion-dependent organ

✔️ MAP ≥65 mmHg as baseline target but Individualized for chronic HTN patients
✔️ Avoid dopamine (finally dead for renal protection) 🙏🏼

👉 Cardio-renal integration is central

💧 Fluid strategy update

✔️ Prefer crystalloids over colloids
✔️ Prefer buffered solutions over saline
✔️ Avoid both overload AND hypovolemia

👉 “More fluids” ≠ better kidneys

🚀 Future direction

KDIGO 2026 is clearly moving toward:

▪️ Biomarker-guided care
▪️ Early phenotyping
▪️ Personalized kidney protection strategies
▪️ Continuum thinking (AKI → AKD → CKD)

🎯 Take-home

AKI is not a number.
👉 It is a dynamic, multidimensional syndrome

And if you wait for creatinine:
👉 You are already late

📚 Reference
Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2026 Jan;109(1S):S1-S99. doi: 10.1016/j.kint.2025.06.006.

[Leonardo Santos @Leo_Santo5]

Terapia Nutricional y Enfoque por Etapas en UCI 🏥🍽️

📖Definiciones
📊Fases de la Enfermedad Crítica
🥛Requerimientos Específicos
👥Poblaciones Especiales

🔰📚Clin Nutr Metab Care

DOI:10.1097/MCO.0000000000001186

Enlace a Articulo Completo👇🏻✅🆓
https://t.co/xumUMHaxVK