Podcast 1: AMS General Principles

1. Identify which clinical features generally point to safe oral stepdown for patients with infections

2. Compare the clinical features that point to antibiotic failure vs. source control issue vs non-infectious mimicker in a patient with apparent antibiotic non-response

3. Apply knowledge of these principles to 2 patient cases.

The first episode of the SOS AMS podcast focuses on general clinical topics in AMS, such as discerning when a patient has improved clinically and is appropriate for stepdown to an oral antibiotic. Our hosts Julia and Nicki explore key clinical features and patterns for distinguishing antibiotic failure from a source control issue or from a non-infectious mimicker of infection in patients who are not responding to antibiotics. The principles discussed are applied to two patient cases at the end of the podcast. Relevant references can be accessed in the References tab.

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Podcast 2: Bugs and Drugs

1. Recognize commensal flora of different physiologic regions of the human body.

2. Understand the link between the human microbiome and empiric antimicrobial selection.

3. Describe some general trends for antibiotic coverage of gram positive and gram negative organisms.

4. Rationalize the guideline-suggested empiric therapy for different infections using knowledge of the human flora and antimicrobial spectrum.

In this next episode of the SOS AMS podcast, our hosts lay a foundation for future podcasts by outlining the most commonly encountered microbes in clinical practice, and the antibiotics used to treat them. They then apply this knowledge of microbiology and antibiotics by rationalizing the guideline-suggested antibiotic treatment of various different infections. Relevant references can be accessed in the References tab.

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Podcast 3: Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD)

1. Describe the pathogenesis of AECOPD

2. Distinguish bacterial AECOPD from non-bacterial AECOPD and distinguish both of these from CAP.

3. Rationalize the antimicrobial therapy selection for treatment of bacterial AECOPD.

4. Apply knowledge of AECOPD to diagnose and manage a patient with COPD who presents with new onset respiratory symptoms.

This episode of the SOS AMS podcast focuses on the diagnosis and management of AECOPD. Our hosts review how to identify which patients may benefit from antibiotics, and discuss appropriate antimicrobial agents for AECOPD. They finish the podcast by applying the principles discussed to a patient case, going from differential diagnosis to management. Check out the clinical decision-making matrix for a summary of our top 3 differential diagnoses and the relevant references in CDM and References tabs.

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Podcast 4: Community Acquired Pneumonia (CAP)

1. Identify the mechanism by which patients become infected with community acquired pneumonia (CAP)

2. Discuss selection of empiric therapy in CAP in the context of commonly implicated pathogens

3. Describe clinical features suggestive that coverage of atypical pathogens would be necessary

4. Apply knowledge of CAP to a patient case

During this episode of the SOS AMS podcast, Julia and Nicki dive into the diagnosis and management of community-acquired pneumonia (CAP). They discuss the pathogenesis, microbiology, and treatment of CAP, with a brief discussion of the role of atypical pathogens. Our hosts then apply principles discussed to a patient case, going from differential diagnosis to management. Check out the clinical decision-making matrix for a summary of our top 3 differential diagnoses and the relevant references in CDM and References tabs.

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Podcast 5: Hospital Acquired Pneumonia (HAP)

1. Rationalize antimicrobial selection for HAP using knowledge of the commonly implicated pathogens.

2. Discern when MRSA coverage may be needed empirically.

3. Recognize when oral stepdown may be appropriate.

4. Apply knowledge of HAP to diagnose and manage a patient with new onset respiratory symptoms in hospital.

This episode of the SOS AMS podcast focuses on the diagnosis and management of hospital-acquired pneumonia (HAP). Our hosts discuss the pathogenesis, microbiology, and treatment of HAP, with a brief discussion of when we would empirically cover MRSA as opposed to just MSSA. They then apply the principles discussed to a patient case, going from differential diagnosis to management. Check out the clinical decision-making matrix for a summary of our top 3 differential diagnoses. Relevant references can be accessed in the References tab.

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Podcast 6: Skin and Soft Tissue Infections (SSTIs)

1. Describe the clinical presentation of cellulitis.

2. Identify the usual pathogens implicated in cellulitis.

3. Describe “red flag” features concerning for necrotizing soft tissue infection.

4. Rationalize empiric therapy selection for mild, moderate, and severe cellulitis.

5. Apply knowledge of SSTIs to manage a patient presenting with new cutaneous findings.

In this episode of the SOS AMS podcast, our hosts discuss the diagnosis, microbiology, and management of cellulitis. We also discuss clinical features that could be suggestive of a necrotizing soft tissue infection, to highlight when we would want to obtain a stat surgical consultation. We end the podcast by applying principles discussed to a patient case, like always, going from differential diagnosis to management. Check out the clinical decision-making matrix for a summary of our top 3 differential diagnoses and the relevant references in CDM and References tabs.

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Podcast 7: Diabetic Foot Infections (DFIs)

1. Describe the pathophysiologic processes that lead to diabetic foot ulcers.

2. Contrast microbial colonization from infection in the context of the usual microbial environment of diabetic foot ulcers.

3. Identify proper technique for obtaining and interpreting cultures from chronic wounds.

4. Recognize the role of source control in patients with chronic wounds.

5. Devise a treatment plan for a patient with a diabetic foot infection.

This episode of the SOS AMS podcast focuses on the diagnosis, microbiology, and management of diabetic foot infections, specifically in the setting of chronic ulcers. Julia and Nicki discuss important considerations for obtaining and interpreting cultures in this setting, as well as the role played by specific microbes like Pseudomonas, Enterococcus, and MRSA. They then apply the principles discussed to two patients presenting with differing severity of infection. Relevant references can be accessed in the References tab.

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Podcast 8: Urinary Tract Infections (UTIs)

1. Distinguish between asymptomatic bacteriuria (ASB), cystitis, pyelonephritis, and catheter associated UTI.

2. Discuss important considerations for optimal timing and interpretation of urine cultures.

3. Rationalize which pathogens are usually implicated in UTIs.

4. Discuss usual treatment and treatment duration for UTIs

This episode of the SOS AMS podcast focuses on the diagnosis, microbiology, and management of urinary tract infections, including cystitis, pyelonephritis, and catheter-associated UTIs. Our hosts also discuss the pressures in practice that lead to over-diagnosis of UTIs, a significant contributor to antibiotic resistance. They then end the podcast by applying the principles discussed to two patient cases, addressing common practice issues that arise when dealing with patients with suspected urinary tract infection. Relevant references can be accessed in the References tab and we would encourage reading through the excellent 3 page article written by Dr. Tom Finucane of Johns Hopkins that is available there.

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Podcast 9: Intraabdominal Infections (IAIs)

1. Contrast the pathophysiology of cholecystitis, cholangitis, diverticulitis, acute appendicitis, pancreatitis, and liver abscess.

2. List the usual pathogens implicated in community-onset intraabdominal infection.

3. Discuss selection of empiric therapy for community-onset intraabdominal infections.

4. Recognize the importance of source control in management of intraabdominal infections.

5. Apply knowledge of the above to a patient presenting with suspected intraabdominal infection.

This episode of the SOS AMS podcast focuses on the pathophysiology, diagnosis, and management of various community-onset intraabdominal infections. Infections discussed include cholecystitis, cholangitis, diverticulitis, acute appendicitis, pancreatitis, and liver abscess. Our hosts end the podcast by applying principles discussed to a patient case, going from differential diagnosis to management. Check out the clinical decision-making matrix for a summary of our top 3 differential diagnoses and the relevant references in CDM and References tabs.

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Podcast 10: Sepsis NYD

1. Distinguish between sepsis, septic shock, infection with systemic features, and bacteremia.

2. Describe the work-up of a patient with sepsis unclear source.

3. Discuss considerations for appropriate empiric therapy for a patient with sepsis NYD.

4. Apply this knowledge to a patient case

This episode of the SOS AMS podcast focuses on the ID/AMS side of sepsis and septic shock. Our hosts distinguish sepsis and septic shock from infection with systemic features, and bacteremia, both of which are commonly incorrectly referred to as sepsis in practice. They discuss an approach to identifying the source of sepsis in a patient with sepsis NYD, with emphasis on localizing symptoms, investigations, and what to do in the absence of localizing symptoms. They discuss the challenge in finding a balance between good stewardship and the use of aggressive antimicrobial therapy given the high mortality associated with sepsis. They then end the podcast by applying principles discussed to a case of nosocomial sepsis NYD. Relevant references can be accessed at the provided hyperlink.

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Podcast 11: Bacteremia

1. Review interpretation of blood culture results with respect to community vs hospital onset, time to positivity, discerning true pathogen from contaminant, and identifying highest risk pathogens.

2. Explain why identifying the source of bacteremia is critical to the management plan.

3. Review appropriate bundle of care for Staphylococcus aureus bacteremia.

4. Apply the above knowledge to some patient cases.

In this episode of the SOS AMS podcast, Julia and Nicki take a closer look at the management of bacteremia. They discuss interpretation of blood culture results, including distinguishing between contaminant and true pathogen, the clinical utility of time to positivity, and the identification of high risk bacteremias. They discuss a systematic approach to managing patients with bacteremia, and evaluation for sources of infection. They then make specific mention of Staphylococcus aureus bacteremia and the four-pronged bundle of care for Staphylococcus bacteremia as well as discussing the rationale for that bundle. Relevant references can be accessed in the References tab.

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Podcast 12: Applied Bacteremia (3 cases)

1. Case 1: Viridans group Strep “bacteremia” 1 of 2 sets in a patient admitted with AECOPD

2. Case 2: E. coli bacteremia secondary to pyelonephritis

3. Case 3: Staph aureus bacteremia, unclear source

This episode of the SOS AMS podcast is a continuation of the Bacteremia part 1 podcast. In this episode, our hosts apply the systematic approach to bacteremia discussed in the previous podcast to 3 patient cases. Relevant references can be accessed in the References tab.

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