4 thoughts on “Episode 57: Bugs and Drugs Part 2 With Rachel Kruer”

1. When should we be investigating viral causes for infection, specifically in pneumonia? Should everyone be getting a respiratory viral panel? Should we be starting patients on oseltamivir empirically during flu season? This was common practice when I was an intern in the MICU.

   Also, though it was referred to indirectly during the discussion of oral flora, aspiration pneumonitis and pneumonia (not the same thing) are other entities seen commonly in the ICU. I think we’re usually worried about covering oral anaerobes and strep, but staph and pseudomonas can be causative agents in high-risk patients.

   Great talk as per usual!

   Reply

   1. Great question. Here is Rachel’s response:

      I would say that anyone with a good story for flu should have a influenza vial testing (e.g., fever, sore throat, myalgia, arthralgia, cough, runny nose, headache, or suspicion of pneumonia). So yes, during flu season, if concerned for pneumonia, a flu panel should also be sent.

      Our antibiotic guide recommends empiric therapy in patients with fever and influenza-like symptoms during flu season (if within 48-72 hours of symptom onset). Empiric therapy is also recommended in patients with unexplained interstitial pneumonia or new respiratory failure without an obvious non-influenza cause.

      Reply

2. Excellent pod cast.Having worked in two countries with hugely different approaches (one very restrictive, one quite liberal with AB use). To me it’s very clear that a liberal approach gives a very high prevalence of resistive bugs.

   I’m curious about the cessation of antibiotic therapy. Will treating for longer durations increase or decrease the risk for drug resistance ? Or is is more a problem when under dosing ? Especially in the context of triple 3rd or 4th generation therapy.

   thanks !

   Reply

3. Thanks for the comment. Here is Rachel’s reply:

   In the 8 vs 15 days study for the treatment of pneumonia published in JAMA in 2003, there was no difference between the two treatment durations with regard to mortality or recurrence of pneumonia.

   Here’s the interesting part… in patients with nonfermenting Gram-negative rods (including Pseudomonas) there was still no mortality difference, but in the 8 day group, they did have a higher pulmonary infection recurrence rate. However, in the patients with recurrence, MDR pathogens were less common in the 8 day group.

   Thus the recommendation is to treat for 7 days, unless the patient fails to have clinical improvement. Longer duration has been associated with the development of resistant pathogens.

   Reply

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