Posts tagged #infection

Will this new diagnostic test help us prevent antibiotic misuse?

Clinicians seeing a miserable patient with the sniffles or a cough commonly face a challenging choice: give them antibiotics on the off chance they help, or educate a patient who feels gross why those antibiotics won't work. More of than not, clinicians take the easy way out and reach for the prescription pad. 

The problem of course is that this leads to millions of unnecessary antibiotic prescriptions every year. It's one major driver of epidemic antibiotic resistance, and also why the epidemiology of the antibiotic-associated infection C diff is worse than ever. 

This problem doesn't persist because clinicians are stupid or uncaring. Rather, it is their best intentions that lead them astray. Faced with a concrete potential benefit for the patient in front of them versus an abstract risk down the road, often times clinicians choose that concrete potential benefit over a hard-to-imagine intangible risk like antibiotic resistance or future C diff. Even if the risks FAR outweigh any potential benefits.

A point-of-care test that could tell both docs and patients that those symptoms are definitively from a virus could really change that whole dynamic. And, it could save us from a lot of antibiotic misuse.

A new study out today brings us closer to that reality. Researchers out of Duke found gene expression combinations that were nearly unique to viral vs bacterial vs non-infectious illnesses. To learn more, check out this new post by Eric Boodman in STATnews. I was proud to be quoted in it. See also this very thoughtful post by the ever- excellent Judy Stone at Forbes.

This is not the first test to try to tell bacterial and viral respiratory infections apart. Other similar tests have tried the same thing, and seemed promising at the outset but ultimately flamed out. Take procalcitonin testing, for instance. The reason so many tests have failed before is that the promising diagnostic data found in early studies conducted amid artificially distinct clinical populations and implausibly controlled lab circumstances looked much worse once applied to the messy real world of clinical medicine. That's the next hurdle this new technology has to surmount: to show convenient quick utility in real patients in the real world.

I have my fingers crossed that this new technology will be better!

How Hospitals Are Getting Safer for American Children

I could tell I was being watched as I walked into the neonatal intensive care unit.

I took off my white coat, folded my stethoscope in a pocket, and hung the coat in a closet. In a nearby sink I washed my hands for a full minute, scrubbing between each finger before drying my hands.

I approached a high-tech isolette and leaned in to examine my patient, the pink baby within.

A voice stopped me: “Doctor!”

There were footsteps behind me. I pulled back and thought, what did I miss? I retraced each step. Coat. Stethoscope. Hands.

The desk clerk pointed a finger. “Your ring, doctor. You forgot to take off your wedding ring.”

She was right. I rolled my eyes, pocketed my ring, washed again, and went back to my little patient.

Small interactions like these make hospitals safer for children by reducing rates of hospital-acquired infections. Now a new article shows exactly how much safer.

To read more, click on my story over at The Atlantic.

Posted on September 10, 2014 .

Hospitals Are Ground Zero

The MERS coronavirus has now spread from the Middle East to home town USA.

Since both US victims of this resurgent respiratory virus - one in Indiana and another in Florida - are healthcare workers, all eyes have turned to nosocomial transmission. In some locales nosocomial transmission has outpaced the former frontrunner for the MERS transmission prize: camel spit.

Proper infection control, therefore, is hugely important. The CDC recommends special airborne infection rooms, masks, eye protection, gowns and gloves. I remember taking these precautions when the SARS epidemic came through town. In some cases, patients were incredibly sick and it was scary; other times folks with SARS had the sniffles and we made a big deal over very little. Let's hope that as we learn more about MERS, the early reports of 30% case fatality will turn into less sobering statistics. 

Along the way, it's good that the macho culture of medicine has been changing. When I was in training, it was common and even admirable for doctors to work sick. I remember idolizing a medicine resident who did morning rounds with an IV pole at his side. Yet now we know - how could we not have clued in then?!  - that this risks spread of infectious diseases to our fragile patients.

In a nice story just out today titled "Second MERS Case Shows Hospitals Are Ground Zero for MERS," Maggie Fox of CBS News quoted me and others about MERS infection control. 

Posted on May 14, 2014 .

Protect Thy Neighbor

influenza.jpg

We are now deep into flu season. Forty states are reporting widespread influenza, and the number of deaths is greater thane expected.

Hospitalized patients are among the most vulnerable people in flu season. Immune systems already weakened by kidney failure or another major illness, hospitalized patients contract influenza from loved ones and - most ironically - from hospital workers. From doctors to nurses and beyond, a coughing caregivers can be the worst kind of medicine for vulnerable hospitalized patients.

Should hospital employees be obligated to get a flu shot to protect vulnerable hospitalized patients? Some hospitals - including mine - require employees to get flu shots or else suffer consequences such as mandatory masks, furlough and firing. Is this an unjustified infringement on personal liberty, or a thoughtful way to protect the health of our most vulnerable? 

Ethicist Bill Nelson and I explore this controversial issue in a recent issue of Healthcare Executive.

Posted on January 17, 2014 .