I see so many attendings basically see SIRS criteria met on labs without patient having a source of infection and basically get started on antibiotics until infection is ruled out usually with blood cx etx. Is this bad practice.
I see so many attendings basically see SIRS criteria met on labs without patient having a source of infection and basically get started on antibiotics until infection is ruled out usually with blood cx etx. Is this bad practice.
I see so many attendings basically see SIRS criteria met on labs without patient having a source of infection and basically get started on antibiotics until infection is ruled out usually with blood cx etx. Is this bad practice.
It really depends on how unobvious the source of infection and how great your suspicion I suppose.
Patients who are not infected and get an initial round of unnecessary antibiotics don't have big morbidity and mortality, but those patients who are infected and miss getting timely empiric antibiotics can have big morbidity and mortality.
It’s a judgment call. If someone is sick enough to be in the hospital -and- I think it might be because of infection, yes I would rather get the cultures and treat empirically until stabilized or culture neg based on most likely source. The downsides of not treating an infection that is making someone qSOFA+ type sick outweigh the risks of overtreatment for a dose or two in my judgment, a lot of the time. If I’ve got a solid other diagnosis to explain the illness and the findings, and no real suspicion of infection, probably no antibiotics.
It’s really bad practice to let people get sicker and die from untreated infections under your care in the hospital, so.
On the ID service, I didn't see alot of FUO but it happened a few times. Each time the hospitalist would consider potential areas of sources. It usually ended up being malignancy. Either way, by the time ID was consulted they were on vancomycin and zosyn and they gave ID the reigns to stop or start abx.
I'd be cautious with this kind of attitude. This is the sort of thing that leads to "pan-scan" "broadspectrum cover" and all sort of shotgun approach. There are specific cases where I don't have a clue and you are right, I rather don't take the chance if the picture is not clear. But I don't think that's the sentiment of the OP. In my experience, the vast majority of these "SIRS + empiric coverage without clear source" is a whole bunch of nonsense and this is indeed bad practice, in fact, it is malpractice. NOTHING that we do in medicine is without a cost, the levofloxacin for fake pneumonia that ruptures the tendon of a patient could just as easily lead to a sue as a missed septic shock that received no antibiotics. We seem to be biased towards the "forgot to do this" mentality and completely ignore the "did this dangerous med/test for a non-existing illness".It’s a judgment call. If someone is sick enough to be in the hospital -and- I think it might be because of infection, yes I would rather get the cultures and treat empirically until stabilized or culture neg based on most likely source. The downsides of not treating an infection that is making someone qSOFA+ type sick outweigh the risks of overtreatment for a dose or two in my judgment, a lot of the time. If I’ve got a solid other diagnosis to explain the illness and the findings, and no real suspicion of infection, probably no antibiotics.
It’s really bad practice to let people get sicker and die from untreated infections under your care in the hospital, so.