Take your time, gather pertinent data, and know what you are dealing with before making kneejerk decisions, a national infectious-disease expert told hundreds of hospitalists this morning at HM11.
Shanta Zimmer, MD, associate professor of medicine and director of the internal-medicine residency program at the University of Pittsburgh Medical School walked hospitalists through a half dozen common and uncommon patients, cases ranging from Staphylococcus aureus to Candida albicans to zygomycosis.
Her main message to hospitalists:
- Not all fevers are infectious.
- Get or repeat blood cultures before starting antibiotics, because although administering antibiotics might be the right thing to do, the effects of the drugs makes it difficult to determine the origin. “Then you have to play the guessing game whether or not to treat,” she said. “There also is a lot of morbidity associated with long-term antibiotic therapy.”
- Remove lines when you are able to do so.
- Hold off on antibiotics when a patient is stable and infectious ediology is unknown.
- Take your time, as “very few things in medicine are an emergency; we often have time to think and make a decision,” she said.
- Narrow antibiotic coverage, when possible.
Dr. Zimmer also warned hospitalists to respect S. aureus, which she says remains a large percentage of her caseload. “It never ceases to amaze me how virulent and aggressive it can be,” she said. “It frightens me.”