Another one bites the dust! My last case presentation of residency *confetti emojis galore.* This patient was on my ward but not one I was following until I saw the confusing combination of daptomycin and cloxacillin. When I inquired with the AMS pharmacist they explained why they were using it, but I wanted to look further into it and realized it was worthy of being my last case presentation! Patient was persistently bacteremic with MRSA despite adequate vancomycin therapy so the decision was made to switch to daptomycin and add cloxacillin for synergy. But wait cloxacillin…for methicillin-resistant Staph aureus… that makes no sense… or does it? See my slides attached for the evidence about this combination as salvage therapy for MRSA bacteremia. Cloxacillin and daptomycin, a case of two too much?
In terms of presentation delivery it was interesting delivering to a brand new group at ARH. I was glad to have other learners in the audience as well (and E2P year 2 student and another resident). We also had some of the disp pharmacists and clinical technicians join. I tried to ensure that any concepts I took for granted (e.g. MIC) were thoroughly explained as the baseline of knowledge in the room was likely variable. I felt like I kept good eye contact with everyone and tried to keep everyone engaged (although I think the treats my preceptor brought helped with that as well =P). All in all I was happy with how it went, although I really do want to work on continuing to slow down when I speak. I’ve noticed that my fastest pace is always at the very beginning when I am explaining all the background, which in theory is the worst time to speed through material because I may not give the audience adequate time to understand the background before delving into the clinical question and pt specific info. Something I will continue to work on!