Morning, Brilliantly put, Ron, this is what we teach. If your organisation has a robust system of antibiotic stewardship and great support from microbiology we need to encourage early MDT conversations rather than with-holding potentially life-saving treatments.
Heather Sent from my iPhone On 10 Feb 2014, at 22:27, "Ron Elkin" <[email protected]<mailto:[email protected]>> wrote: Antivirals and no antibiotics if it's viral? "If" is the big word here. How confident can one be of no bacterial superinfection (eg staph, strep, pneumococcus) in the presence of an apparent viral pneumonia. It is one thing to acknowledge the differences between clinical and lab findings in viral and bacterial infection. It is quite another to withhold antibiotics in the belief that you are right. This is especially true if the patient has evidence of severe sepsis or septic shock where the mortality risk is 30-50%. I'm attaching a study as an example but believe the conclusions are potentially misleading and require context. In table 4, the odds of bacterial infection are approximately 12% if there are 5 out of 5 criteria favoring virus, and 29% if there are 4 of 5 criteria. Rather than be wrong 12-29% of the time and accept a 30-50% mortality risk unnecessarily, I for one would prefer to give antibiotics and stop them in 48-72 hours when the clinical and laboratory course, including negative cultures, provide additional assurance that one is not dealing with bacterial infection. In comparison, the mortality risk of antibiotics for 48-72 hours, later proven unnecessary, is trivial. Some of my colleagues will disagree... but if they lose their bet, it is the patient who pays. I'd be happier making this bet in the absence of severe sepsis or septic shock. Vancomycin for cellulitis - not always ideal depending on context. Diabetics for example may have gram negatives contributing to the problem. "Credit" for a broad spectrum antibiotic cannot replace analysis of antibiotics given and actual culture and sensitivity results. For logistic reasons the SSC does not compile this information. Ron Elkin, MD California Pacific Medical Center San Francisco, CA On Wed, Feb 5, 2014 at 9:52 AM, Karin <[email protected]<mailto:[email protected]>> wrote: Along that lines, would vancomycin for cellulitis be considered a "fail"as it is not a "broad spectrum" antibiotic? Karin Sent from my iPhone > On Feb 4, 2014, at 9:22 AM, > <[email protected]<mailto:[email protected]>> wrote: > > I would think not, if it's a viral sepsis. Treatment with Tamiflu is > appropriate care for it, and it isn't bacterial. > > > Susan M. McKinney, RN > Clinical Quality Coordinator-Sepsis > Clinical Documentation Specialist > Rapid City Regional Hospital > 605-719-4428<tel:605-719-4428> > 605-484-7381<tel:605-484-7381> > [email protected]<mailto:[email protected]> > > > > -----Original Message----- > From: > [email protected]<mailto:[email protected]> > > [mailto:[email protected]<mailto:[email protected]>] > On Behalf Of Sue Beswick > Sent: Monday, February 03, 2014 2:33 PM > To: > '[email protected]<mailto:[email protected]>' > Subject: Re: [Sepsis Groups] flu and choice of antibiotic or not to give one? > > With our severe sepsis flu admits, a number are being admitted without a > broad spectrum antibiotics - only getting tamiflu. > We aren't using the sepsis database yet but hope to soon - would that be a > fail? > > Thanks > Sue > > Sue Beswick RN, MS, CCNS, CCRN > Clinical Nurse Specialist - MSICU > Greenville Health System > 701 Grove Road l Greenville, SC 29605 > Office: 864-455-4884<tel:864-455-4884> > > If not this, then what? If not now, then when? If not me, then who? > > - John Lewis > > > -----Original Message----- > From: > [email protected]<mailto:[email protected]> > > [mailto:[email protected]<mailto:[email protected]>] > On Behalf Of > [email protected]<mailto:[email protected]> > Sent: Friday, January 31, 2014 3:08 PM > To: > [email protected]<mailto:[email protected]> > Subject: Sepsisgroups Digest, Vol 94, Issue 8 > > Send Sepsisgroups mailing list submissions to > > [email protected]<mailto:[email protected]> > > To subscribe or unsubscribe via the World Wide Web, visit > > https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=264ab120a21b69ffdb5400be85897bba2d955544ecbcdf5b4cdba11188b07586 > > or, via email, send a message with subject or body 'help' to > > [email protected]<mailto:[email protected]> > > You can reach the person managing the list at > > [email protected]<mailto:[email protected]> > > When replying, please edit your Subject line so it is more specific than "Re: > Contents of Sepsisgroups digest..." > > > Today's Topics: > > 1. Sepsis tool APACHE question (Dian Nuxoll) > 2. severe sepsis screening tool question (Dian Nuxoll) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Thu, 30 Jan 2014 18:00:54 +0000 > From: Dian Nuxoll > <[email protected]<mailto:[email protected]>> > To: > "'[email protected]<mailto:[email protected]>'" > > <[email protected]<mailto:[email protected]>> > Subject: [Sepsis Groups] Sepsis tool APACHE question > Message-ID: > > <943b1cfe9fc3db41ac39532172f66b1b71376...@exchmail3.evergreenhealthcare.org<mailto:943b1cfe9fc3db41ac39532172f66b1b71376...@exchmail3.evergreenhealthcare.org>> > > Content-Type: text/plain; charset="us-ascii" > > Under "oxygenation", am I correct to assume this pertains to intubated > patients only? > > Under "FIO2 0.5 or more, A-aDO"-is that the same as A-a Grad? What is this > exactly? > "< .05, use PAo"-is this the same as PO2?, if not, what is it and how do I > find it? > > Appreciate your help! > > > Dian Nuxoll, RN, BSN Clinical Quality Analyst - Quality Management > 425.899.2359<tel:425.899.2359> I EvergreenHealth MS-62, 12040 NE 128th St., > Kirkland, WA 98034 > Follow EvergreenHealth on > Facebook<https://urldefense.proofpoint.com/v1/url?u=http://www.facebook.com/evergreenhospital.org&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=3b35de904851eb91e3d45ca634838bab8ba9ca34fc55743cfae67a8929fd16cb> > and > Twitter<https://urldefense.proofpoint.com/v1/url?u=http://twitter.com/&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=6b0144da39452d8e26e1b10886d93189488bb43183633961d63b1110616485b1> > | > www.evergreenhealthcare.org<http://www.evergreenhealthcare.org><https://urldefense.proofpoint.com/v1/url?u=http://www.evergreenhealthcare.org/&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=1156521227ee03e04b5cf1bb2a2ec9091e2b9f45df0e862de2bc844655629104> > > > Please note: My e-mail address has changed to > [email protected]<mailto:[email protected]> > > > DISCLAIMER: > EvergreenHealth Confidentiality Notice: This email message, including any > attachments, is for the sole use of the intended recipient(s) and may contain > confidential and privileged information. Any unauthorized review, use, > disclosure or distribution is prohibited. If you are not the intended > recipient, please contact the sender by e-mail and destroy all copies of the > original message or you may call EvergreenHealth in Kirkland, WA U.S.A at > (425)899-1740<tel:%28425%29899-1740>. > -------------- next part -------------- > An HTML attachment was scrubbed... > URL: > <https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140130/5eef97f0/attachment.html&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=55ae85e2df0b3327c455d1ed185f17159ae6cb5ee7775446035d3cc59fa8ed59> > -------------- next part -------------- > A non-text attachment was scrubbed... > Name: Picture (Device Independent Bitmap) 1.jpg > Type: image/jpeg > Size: 2471 bytes > Desc: Picture (Device Independent Bitmap) 1.jpg > URL: > <https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140130/5eef97f0/attachment-0001.jpg&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=74f40e1e8bb8392e5abe2e4bb5938c0e448a3256f5d4d273db9b57e85bb75f66> > > ------------------------------ > > Message: 2 > Date: Thu, 30 Jan 2014 23:00:41 +0000 > From: Dian Nuxoll > <[email protected]<mailto:[email protected]>> > To: > "'[email protected]<mailto:[email protected]>'" > > <[email protected]<mailto:[email protected]>> > Subject: [Sepsis Groups] severe sepsis screening tool question > Message-ID: > > <943b1cfe9fc3db41ac39532172f66b1b71376...@exchmail3.evergreenhealthcare.org<mailto:943b1cfe9fc3db41ac39532172f66b1b71376...@exchmail3.evergreenhealthcare.org>> > > Content-Type: text/plain; charset="us-ascii" > > Regarding #3. On screen 2: in evaluating the acute lung injury, does the > patient have to be intubated for this or just have an ABG? > > Dian Nuxoll, RN, BSN Clinical Quality Analyst - Quality Management > 425.899.2359<tel:425.899.2359> I EvergreenHealth MS-62, 12040 NE 128th St., > Kirkland, WA 98034 > Follow EvergreenHealth on > Facebook<https://urldefense.proofpoint.com/v1/url?u=http://www.facebook.com/evergreenhospital.org&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=3b35de904851eb91e3d45ca634838bab8ba9ca34fc55743cfae67a8929fd16cb> > and > Twitter<https://urldefense.proofpoint.com/v1/url?u=http://twitter.com/&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=6b0144da39452d8e26e1b10886d93189488bb43183633961d63b1110616485b1> > | > www.evergreenhealthcare.org<http://www.evergreenhealthcare.org><https://urldefense.proofpoint.com/v1/url?u=http://www.evergreenhealthcare.org/&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=1156521227ee03e04b5cf1bb2a2ec9091e2b9f45df0e862de2bc844655629104> > > > Please note: My e-mail address has changed to > [email protected]<mailto:[email protected]> > > > DISCLAIMER: > EvergreenHealth Confidentiality Notice: This email message, including any > attachments, is for the sole use of the intended recipient(s) and may contain > confidential and privileged information. Any unauthorized review, use, > disclosure or distribution is prohibited. If you are not the intended > recipient, please contact the sender by e-mail and destroy all copies of the > original message or you may call EvergreenHealth in Kirkland, WA U.S.A at > (425)899-1740<tel:%28425%29899-1740>. > -------------- next part -------------- > An HTML attachment was scrubbed... > URL: > <https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140130/300630c5/attachment-0001.htm&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=36a41922cae3b4aa81445b4bba1d5f3564e927e809b2eba2195d4c0d5a64b3c6> > -------------- next part -------------- > A non-text attachment was scrubbed... > Name: Picture (Device Independent Bitmap) 1.jpg > Type: image/jpeg > Size: 2471 bytes > Desc: Picture (Device Independent Bitmap) 1.jpg > URL: > <https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140130/300630c5/attachment-0001.jpg&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=20dfbbc15d5e77e08d6ab2541074fb963d4387aa21d3e9175748271c590f2613> > > ------------------------------ > > _______________________________________________ > Sepsisgroups mailing list > [email protected]<mailto:[email protected]> > https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=264ab120a21b69ffdb5400be85897bba2d955544ecbcdf5b4cdba11188b07586 > > > End of Sepsisgroups Digest, Vol 94, Issue 8 > ******************************************* > > _______________________________________________ > Sepsisgroups mailing list > [email protected]<mailto:[email protected]> > https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=264ab120a21b69ffdb5400be85897bba2d955544ecbcdf5b4cdba11188b07586 > > ---------------------------------------------------------------------- > Regional Health's mission is to provide and support health care excellence in > partnership with the communities we serve. > > Note: The information contained in this message, including any attachments, > may be privileged, confidential, or protected from disclosure under state or > federal laws . If the reader of this message is not the intended recipient, > or an employee or agent responsible for delivering this message to the > intended recipient, you are hereby notified that any dissemination, > distribution, or copying of this communication is strictly prohibited. If you > have received this communication in error, please notify the Sender > immediately by a "reply to sender only" message and destroy all electronic or > paper copies of the communication, including any attachments. > _______________________________________________ > Sepsisgroups mailing list > [email protected]<mailto:[email protected]> > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org <Viral vs Bacterial H1N1. Thorax 2011.pdf> _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ________________________________ Disclaimer: This is an e-mail from Calderdale and Huddersfield NHS Foundation Trust (the Trust). This message and any files transmitted with it are confidential. If you are not the intended recipient any reading, printing, storage, disclosure, copying or any other action taken in respect of the e-mail is prohibited and may be unlawful. If you have received this message in error, please notify the sender immediately by using the reply function and then delete what you have received. The Trust accepts no responsibility for any changes made to this message after it has been sent by the original author. The views or opinions contained herein do not necessarily represent the views of the Trust. This e-mail or any of its attachments may contain data that falls within the scope of the Data Protection Acts. You must ensure that any handling or processing of such data by you is fully compliant with the terms and provisions of the Data Protection Act 1984 and 1998. Please note that as the sender of this email is a Public Authority, the contents of any email received in response, even if marked confidential, may be disclosed in accordance with the Freedom of Information Act 2000 unless legally exempt.
_______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
