surgeons nose

[Robert Morrell Jr.]

On Tue, 8 Aug 1995, HANS BUSK wrote:
> RJ> former infects a patient with MRSA, we will treat with vanc. If the
> RJ> later infects a patient with MSSA we will also treat with vanc,
> RJ> usually even (sadly) after the susceptibility report comes back.

> You can't be serious, I thought the medical profession was some kind of 
> academic profession.

I said sadly, but I can see their perspective. In our environment (a 
tertiary care facility) some doctors are never sure that the organism we 
recover is in fact what is responsible for the infection. What if the 
staph aureus we recovered from the blood is in fact skin flora 
contamination and the real culprit is an enterococci that was not 
recovered? Then switching to oxacillin would hurt the patient. The best, 
most informed docs do sometimes switch, but in most instances that I 
observe, no switch is made unless the patient is not responding. So, the 
patient is getting better, and we tell them to switch, some doctors say, 
leave well enough alone!
Another complicating factor is the fact that when dosing costs are added 
in, vanc can be cheaper than ox (since it can be dosed less often that 
oxacillin.
> 
> Do you also routinely add ciprofloxacin, mefloquine, and amphotericin B 
> to the treatment, just to be sure not to miss a typhus, malaria and 
> yeast infection?

You weren't listening. Our MRSA % are about 50% (10% of our community 
acquired staph appear to be MRSA!) With that kind of 
rate would you flip a coin and treat a suspected staph infection with 
oxacillin? It would be negligent to do so, in my opinion. 
The treatments you list are for relatively rare or up front identifiable 
infections. If however, our yeast infection rate rose above 10%, I'd bet 
that empiric therapy would for fluc would become standard.
This is not an academic game of chess, it is a battle to keep patients 
alive. Waiting on lab reports on a specific case, ignoring cumulative 
statistics, is not the way to keep them alive.

If you have such a problem with switching to higher powered antibiotics 
when old ones become less effective, then why are you even using 
oxacillin? Why not treat with penicillin, or sulfa drugs, until a lab 
report comes back? Save lots of money...(NOT)

*                     Bob Morrell                       *
*              bmorrell at isnet.is.wfu.edu                *
* The operation was a success, as the autopsy will show *