I was inspired by a recent talk given by @sargsyanz about use of empirical Abx in certain clinical scenarios.
Suppose a patient has vertebral osteomyelitis or septic arthritis.
Do you give empirical Abx, or do you wait until you have a sample?
1/
Suppose a patient has vertebral osteomyelitis or septic arthritis.
Do you give empirical Abx, or do you wait until you have a sample?
1/
The take-home message is:
It depends!
There's not a uniform strategy that can be recommended in all scenarios!
2/
It depends!
There's not a uniform strategy that can be recommended in all scenarios!
2/
Factors to consider include:
- Acuity of pt's current illness (are they having sepsis or hypotension?)
- How quickly can a sample be obtained?
- Is the patient immunocompromised or otherwise at high risk for rapid deterioration?
- Duration of the patient's illness overall
3/
- Acuity of pt's current illness (are they having sepsis or hypotension?)
- How quickly can a sample be obtained?
- Is the patient immunocompromised or otherwise at high risk for rapid deterioration?
- Duration of the patient's illness overall
3/
If pt is ill with sepsis/hypotension, probably better to:
- Obtain blood cultures
- Start empirical Abx
- Try to get a sample as quickly as possible
4/
- Obtain blood cultures
- Start empirical Abx
- Try to get a sample as quickly as possible
4/
If patient is stable and illness has been more subacute, may be reasonable to:
- Obtain blood cultures
- Observe patient closely
- Obtain sample as quickly as possible
5/
- Obtain blood cultures
- Observe patient closely
- Obtain sample as quickly as possible
5/
Also, if pt has clear signs of sepsis (fever, tachycardia, tachypnea, leukocytosis, etc.) but no obvious source (neg U/A, NL CXR, and no skin/soft tissue infxn):
- Don't hold Abx!
- Give empirical Abx because of degree of illness
- Continue searching for a source of sepsis
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- Don't hold Abx!
- Give empirical Abx because of degree of illness
- Continue searching for a source of sepsis
6/
Hope this was helpful as a way to think about these tricky situations!!
Fin/
cc: @BCMIDFellowship @BCM_InternalMed
Fin/
cc: @BCMIDFellowship @BCM_InternalMed
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