Hello, i was wondering if there was any resources that you guys would recommend a somewhat lay person that is interested in how you two as doctors would go about treating antibiotic resistance, what you guys tell patients and what you guys consider when prescribing antibiotics, guidelines etc. Also i was wondering what you would prescribe if one of your patients end up having a resistance bacterium. My current knowledge/ understanding of antibiotic resistance comes from A&P, Microbiology and Ted talks about how phages can help in the treatment of this condition. I’ve read The Antibiotic Resistance Crisis: Part 1: Causes and Threats - PMC and A Review on Antibiotic Resistance: Alarm Bells are Ringing - PMC but there are some terms and concepts that Im not educated in so i dont understand it completely and i was wondering if you guys could help me out.
We don’t “treat” antibiotic resistance.
When prescribing antibiotics, the initial empiric choice is based on the suspected cause / source of infection, and what antibiotic would provide adequate coverage of those suspected organisms.
However, we often obtain culture data (though this takes longer to result) where antibiotic susceptibility testing can reveal evidence of antibiotic resistance, and therapy is tailored accordingly (i.e., you might switch to a different antibiotic that the organism is susceptible to).
Thanks for the link. How often if ever, do you see a “superbug” and or a resistant bacteria? And whilst I have your attention, prostate cancer screenings, are they efficacious and in class we learnedly about PSA and in an audible I learned that sometimes havjnf the PSA test done can lead to false positives.
In the inpatient hospital setting I see/deal with antibiotic resistance all the time, though it’s usually only resistance to a couple antibiotics.
More significant multi-drug resistance (so-called “superbugs”) tend to be seen a bit more often in the medical ICU setting, which is where I’ve seen a few of those – usually in chronically ill patients. For example, I’ve had a case of acinetobacter baumannii infection that was resistant to just about everything except colistin/polymixin and tigecycline (in the setting of end-stage myasthenia gravis and chronic ventilator-dependence, ultimately died). I’ve also seen a couple cases of disseminated XDR Tuberculosis (these individuals died as well).
Yes, PSA tests are tricky. The estimated sensitivity of the PSA test (using a cutoff of 4.0 ng/mL) is about 21% for detecting any prostate cancer and 51% for high-grade cancers. The estimated specificity is 91 percent. The positive predictive value (PPV) for the same cutoff is about 30% (i.e. about 1/3 of men with an elevated PSA will actually have prostate cancer detected on biopsy), and a negative predictive value of 85% for the same cutoff.
Thank you sir.