Hospitalists need to pay attention to dramatic changes in technology, including the emergence of the polymerase chain reaction (PCR) test.
The Hospitalist surveyed half a dozen infectious disease (ID) experts—some of whom also have experience as hospitalists—what they would tell a roomful of hospitalists who were curious about ID. Based on those discussions, we offer 10 tips that should help hospitalists treat their patients more effectively.
Hospitalists routinely care for patients with infections, or symptoms of infections, or suspected infections that might not even be infections at all. Many times, hospitalists have more than one treatment option. So which is the best to use? Is there a better option than the therapy that first comes to mind? What about that new antibiotic out there—is it really worth it?
All the while, hospitalists who want to practice conscientious medicine have to be careful they don’t overuse broad-spectrum antibiotics so that bugs’ resistance to the drugs is not speeded up unnecessarily.
In short, infectious diseases can be dicey terrain.
1. Prepare for the reality that the availability of new drugs is shrinking because of antibiotic resistance.
That grim fact might be cause for hospitalists to seek help from ID specialists at their hospitals, says John Bartlett, MD, professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore and founding director of the Center for Civilian Biodefense Strategies. The FDA has approved just two new drugs for major infections in the last five years, he says.
“The FDA faucet is really dry,” says Dr. Bartlett, a world-renowned speaker on ID topics and a frequent speaker at SHM annual meetings. “There are no new antibiotics to speak of, no new antibiotics for resistant bacteria. And there’s not likely to be any for several years. So [hospitalists] are going to find themselves painted in a corner, and they’ll probably have to ask for help.”
Leland Allen, MD, an infectious-disease specialist at Shelby Baptist Medical Center near Birmingham, Ala., who worked as a hospitalist for nine years, says hospitalists should not hesitate to seek assistance. “It’s never a burden to do a consult,” he says. “The reality is that it’s a lot less work if you consult early rather than waiting until the patient is sick.”
Dr. Bartlett says hospitalists should brush up on the use of colistin, a drug developed in 1959 that has been little used and requires careful dosing to avoid toxicity. “We’re finding more and more patients that that’s the only thing we’ve got for them,” he says.
If you’re going to practice 2012 medicine and infectious disease,you’ve got to know about the rapid movement in micro-biology. It’s very fast.
—John Bartlett, MD, professor of epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, founding director, Center for Civilian Biodefense Strategies
2. Familiarize yourself with new technologyfor identifying bugs.
“Mass spectrometers have been used for identifying microorganisms through a computerized database, and these units are just starting to become available to large health centers,” says Robert Orenstein, DO, associate professor of medicine in infectious diseases at the Mayo Clinic in Phoenix. “This allows you potentially to identify some of these microorganisms almost immediately—if they’re in the database, which is the key.”
Dr. Bartlett says it’s important for hospitalists to pay attention to the “dramatic changes” in the technology, including the emergence of the ppolymerase chain reaction (PCR) test.
“They have to be aware that there are methods that are very sophisticated and very sensitive and specific,” he says, adding that hospitalists have to keep up with what the methods can measure and what their limitations are.