Events

Panelists

Chelsea Modlin, MD
Moderator

Kate Dzintars, PharmD

Olivia Kates, MA, MD

Click here for CME information associated with this event

Lunch will be provided, RSVP to Allison Christopher if you plan to attend

Case

An 84-year-old woman with dementia and multiple chronic conditions is admitted with failure to thrive. Prior to admission she was living at home but was not mobile and was minimally communicative. She has a prolonged admission with many “ups and downs,” during which she receives multiple courses of empiric antibiotics. During her admission, her baseline chronic kidney disease progresses to end-stage-kidney disease, and her husband – who is her surrogate decision maker – agrees for her to undergo surgery to create an arteriovenous fistula for hemodialysis. Her husband does have medical co-morbidities of his own, including lung cancer and a recent history of C. diff colitis.

The surgical wound does not heal well. The team collects a swab of the site at the bedside and sends it for culture, which grows multiple extensively drug-resistant microbes. The surgery team recommends antibiotics because they are concerned that an infection might contribute to delayed wound healing. The infectious disease team recommends no antibiotics because although the wound is healing slowly there is no evidence of overt infection. When both recommendations are discussed with the patient’s husband, he requests that the team give antibiotics to “do everything they can.” The primary team then reaches out to ID to request antibiotic approval for the extended-spectrum antibiotics active against the patient’s resistant organisms, but the ID team is hesitant to approve.

Objectives

• Contextualize the risks and benefits of broadspectrum antibiotics in a clinically ambiguous case
• Frame antibiotic use in terms of short-term and long-term, patient-centered goals or outcomes
• Discuss the tradeoffs between antibiotic use of an individual versus risks and harm reduction for the community