My thoughts on the Future of Infectious Disease and Medicine

A few Friday afternoon consults for prosthetic joint infections got me thinking about the whole issue of preventing surgical site infections (SSI). It is quite common in cardiothoracic surgery and orthopaedic surgery for patients to be screened pre-operatively for Staphylococcus aureus colonization with a nasal culture or PCR. Those who are positive are prescribed nasal Mupirocin to rid the carrier state in hopes of decrease the risk of SSI. Additionally, since patients can carry S. aureus elsewhere (axilla, inguinal, perirectal) patients are instructed to bathe with Chlorhexidene pre-operatively. Despite these decolonization attempts one study showed that 20% of patients remained colonized with MRSA and continued to have SSIs (Baraz et al. Clin Orthop Related Res 2015). What occurred to me in a review of the literature is that maybe we are focusing on the wrong site of colonization. Approximately 20% of people have intestinal colonization of the gastrointestinal tract.

In today’s day and age organizations including hospitals hire outside consultants to address an issue or challenge that has arisen. These consultants are considered experts in the subject matter and are usually independent entities and command large sums of money for their efforts. It is a very good gig if you can get it as I have benefited from this role many times myself! Consultants work on their own timelines and upon completion of their work presents a plan to the senior leadership of the organization. It is pretty unheard of for senior leadership of an organization not to enact the recommendations of the consultant. The reasoning is “hey this person is an expert and we have paid him/her a lot of money, so he/she must be right”. When you think about hiring external consultants I want you two remember the cult movie “Office Space”. The company, Initech, had hired these two ass clowns   Bob Slydell and Bob Porter, “the Bobs”, to decide who would be let go from the company.

I recently read a publication in JAMA (JAMA. 2017;317(20):2105-2113) comparing outcomes in academic hospitals and non-teaching community hospitals for Medicare recipients. A statistically significant 1.5% higher mortality was observed in the non-teaching community hospitals than in academic centers. This higher mortality rate was observed for such routine infectious disease conditions including pneumonia (1.5%) and urinary tract infections (1%). As an ID physician who worked at academic centers for 11 years and in a non-teaching community hospital for the last 5 years this sent me into deep thought regarding why this difference existed.   There are no special diagnostic modalities or treatments for pneumonia and UTIs available at academic centers. There may be experts or “key opinion leaders” in pneumonia and UTIs at academic centers but they certainly would not be on hospital service enough to influence outcomes to this extent. My hypothesis is that that the increase in morta

Recently I was contacted and interviewed by a party to get my feelings about the state of treatment of Lyme disease. On the phone we lamented about the sizable number of poor souls who continue to suffer symptoms after what is considered standard of care treatment. I made it clear to the interviewer that I practice only evidence-based medicine and that I treat patients based upon the IDSA guidelines. I also railed against physicians who treat patients with months of parenteral antibiotic therapy for “Chronic Limes’ Disease” (ha ha). I stated fairly aggressive and believe that such practices opens the patient to life threatening infections including catheter-related bacteremia and Clostridium difficile colitis. After I got off the phone I started to do some soul searching. I have gotten so used to saying the same lines over and over again, but when was the last time that I actually had looked at the literature? The answer obviously was way too long ago. I was able to