Ever tested patients for procalcitonin to use as an adjunct bio marker to aid in determining quantity of bacterial insult? Or to use as differentiator between viral and bacterial?? Or to utilize to ensure correct antibiotic is being deployed??
Thx for your input to this comments section. Lots of sharing and therefore learning going on.
Ever tested patients for procalcitonin to use as an adjunct bio marker to aid in determining quantity of bacterial insult? Or to use as differentiator between viral and bacterial?? Or to utilize to ensure correct antibiotic is being deployed??
Thx for your input to this comments section. Lots of sharing and therefore learning going on.
I think academic Physicians are interested in using procal and other markers for such differentiation but (and obviously I'm speaking only for myself here) when a patient is very ill, the risk of antibiotic overuse is far outweighed by the risk of imminent death or permanent disfigurement from delay to antibiotic administration.
If sepsis/meningitis are on your differential, you get your blood culture, try to get your csf and start appropriate empiric antibiotics because it's way more important to keep your patient alive than to prove how smart and crafty you are with untested, unproven and, quite frankly, useless additional diagnostic steps.
But that's just me and I don't even practice "real" medicine anymore. I'm outpatient in the community (not ER). But if I found out that I or my loved ones were being put on hold waiting for some nonsense surrogate marker, we're gonna have words.
I think also, early in my career, the notion of viral vs bacterial seemed like an interesting question. However, when you see, let's say 1000 patients a month (my average) and basically all of them are fine, then maybe 5 or 10 seem sick enough to require antibiotics, I'm not playing any games for "antibiotic stewardship". I don't care what some uninvested bureaucrat says about it.
Taking this one step further into the emergency world or the critical care world: if someone is actually sick (like "sick" that only someone who has been through medical school and Residency and paid attention can understand), you give the antibiotics and anyone who is antibiotic-phonic better sign a waiver that they are willing to die for their philosophy. And if it is a child, the parents better be willing to sit in jail for making a decision that leads to their child's death
Good points Nate. Procalcitonin is a 20 minute assay and gets back results to docs about as fast as a cbc and no slower than csf. Yes, always adhere to emergency protocol but procalcitonin offers multiple diagnostic benefits post тАЬstarting of ED interventionsтАЭ. Yes, education intensive assay. ThatтАЩs where intensivist/some pharmacists/infectious Disease specialist(s) can aid.
My point was more along the lines of: more data points isn't always better for patient care. If the procal is low, are you gonna bet your patient's life on dc'ing antibiotics if they are ill appearing and responding well on antibiotics?
Just to give a simple analogy that is way less high stakes: in my (granted, brief) career, I can count on one hand the number of times a strep test has changed my management. When they look, sound and smell "streppy", it's almost instantly GAS and when they don't, it's not. When I've tried to explain to parents what "carrier" means, I've been proven right over and over again when we retest when well and get a positive culture.
My point is that there is no substitute for education, training, experience and a confident practitioner who puts their name and reputation on the line for every decision they make. Any academician can hide behind their title or their clinical trial and make proclamations that have no bearing on the decisions that clinicians ultimately make based on their eyes, ears and hands (and sometimes noses).
And I say this as someone with infinite respect for academia and research but it needs to stay in its place until ready for primetime.
Ever tested patients for procalcitonin to use as an adjunct bio marker to aid in determining quantity of bacterial insult? Or to use as differentiator between viral and bacterial?? Or to utilize to ensure correct antibiotic is being deployed??
Thx for your input to this comments section. Lots of sharing and therefore learning going on.
I think academic Physicians are interested in using procal and other markers for such differentiation but (and obviously I'm speaking only for myself here) when a patient is very ill, the risk of antibiotic overuse is far outweighed by the risk of imminent death or permanent disfigurement from delay to antibiotic administration.
If sepsis/meningitis are on your differential, you get your blood culture, try to get your csf and start appropriate empiric antibiotics because it's way more important to keep your patient alive than to prove how smart and crafty you are with untested, unproven and, quite frankly, useless additional diagnostic steps.
But that's just me and I don't even practice "real" medicine anymore. I'm outpatient in the community (not ER). But if I found out that I or my loved ones were being put on hold waiting for some nonsense surrogate marker, we're gonna have words.
I think also, early in my career, the notion of viral vs bacterial seemed like an interesting question. However, when you see, let's say 1000 patients a month (my average) and basically all of them are fine, then maybe 5 or 10 seem sick enough to require antibiotics, I'm not playing any games for "antibiotic stewardship". I don't care what some uninvested bureaucrat says about it.
Taking this one step further into the emergency world or the critical care world: if someone is actually sick (like "sick" that only someone who has been through medical school and Residency and paid attention can understand), you give the antibiotics and anyone who is antibiotic-phonic better sign a waiver that they are willing to die for their philosophy. And if it is a child, the parents better be willing to sit in jail for making a decision that leads to their child's death
Good points Nate. Procalcitonin is a 20 minute assay and gets back results to docs about as fast as a cbc and no slower than csf. Yes, always adhere to emergency protocol but procalcitonin offers multiple diagnostic benefits post тАЬstarting of ED interventionsтАЭ. Yes, education intensive assay. ThatтАЩs where intensivist/some pharmacists/infectious Disease specialist(s) can aid.
My point was more along the lines of: more data points isn't always better for patient care. If the procal is low, are you gonna bet your patient's life on dc'ing antibiotics if they are ill appearing and responding well on antibiotics?
Just to give a simple analogy that is way less high stakes: in my (granted, brief) career, I can count on one hand the number of times a strep test has changed my management. When they look, sound and smell "streppy", it's almost instantly GAS and when they don't, it's not. When I've tried to explain to parents what "carrier" means, I've been proven right over and over again when we retest when well and get a positive culture.
My point is that there is no substitute for education, training, experience and a confident practitioner who puts their name and reputation on the line for every decision they make. Any academician can hide behind their title or their clinical trial and make proclamations that have no bearing on the decisions that clinicians ultimately make based on their eyes, ears and hands (and sometimes noses).
And I say this as someone with infinite respect for academia and research but it needs to stay in its place until ready for primetime.
Edit: inevitably*