Infectious Disease Malpractice

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Malpractice related to infections is often about:

  1. failing to diagnose the infection;
  2. failing to prevent the infection; or
  3. failing to properly treat the infection. 

Diagnosis ultimately requires that there be a suspicion or concern for infection. Then a sample must be collected. That sample can come from the urine, blood, cerebrospinal fluid (CSF, or fluid surrounding the brain), pus, or almost anywhere. The sample is then sent for laboratory studies that try to identify the pathogen (bacteria, virus, fungus) either by growing it out in the lab (culture), or testing for the presence of its DNA (PCR testing).

Once the organism is identified, further tests called culture and sensitivity can be ordered to see what antibiotics or antimicrobials the bug is susceptible to or resistant to. Obviously, you don't want to treat a bug with a drug that it is resistant to.

Infection prevent is just as important. Hospital-acquired infections in many cases can be entirely prevented.

Treatment isn't just about giving the right antibiotics. The antibiotics not only have to be effective against the microbe, but they also have to be given for a long enough time, at the right dosage or amount, and through the right route -- for example, IV (intravenous) administration may be required rather than PO (oral).

Too many providers think that antibiotics are enough. 

The other component of infection treatment is source control. If the source of the infection is not adequately managed, then no amount of antibiotics will be enough.

For example, if the source of the infection is a leakage or perforation (hole) in the bowel, that needs to be surgically closed off or else bacteria will continue to leak from the bowel (and the bowel has an almost infinite amount of bacteria). No amount of antibiotics will be enough.

If the source of the infection is a walled-off collection of fluid (seroma), blood (hematoma), or pus (abscess), that collection or pocket of stuff is not getting much blood supply. Antibiotics are brought to the infected areas via blood circulation, but seromas, hematomas, and abscesses don't have great or any blood supply. In that case, antibiotics are not enough. What is required is surgery: surgical excision, debridement, incision & drainage, and washout. 

Only by clearing out that festering, infected pocket can the infection be adequately eradicated.

Failing to achieve source control is malpractice.

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