Robert Morrell Jr.
bmorrell at ISNET.IS.WFU.EDU
Tue Aug 8 19:36:39 EST 1995
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
> 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 *
More information about the Microbio