I honestly had so much fun on the antimicrobial stewardship service. Apart from learning all about diagnostics, assessing fluid samples, shadowing wound care, attending microbiology rounds, and having a process to assess infection, I think where I grew the most on this rotation was communicating with the medical team. This rotation forced me to be 100% comfortable with my recommendations (at least when it came to antibiotics) and it was valuable for me to be thrown right in and defend those recommendations. Goals and objectives. Did I meet them?
Goal #1: Develop a framework and approach to assessing the patient with a suspected infection. I think I achieved this – for a variety of infections (CNS, SSTI, pulmonary source, endocarditis, GI source, cystitis and pyelonephritis, C diff) I became familiar with how a diagnosis of an infectious process is reached.
Goal #2: Begin to have a framework for correlating clinical presentation to specific microbiological etiologies. Although this is not always possible, in the case of pneumonia or cellulitis, sometimes one can have a higher pre-test probability of a suspected bug based on radiological findings or clinical presentation. See Nuggets of Knowledge for more.
Goal #3: Develop a convincing yet professional approach to communicating interventions from Antimicrobial Stewardship to physicians and other health professionals who are most responsible for the patient. Yep. Definitely feel better about this. It was helpful for me to bounce recommendations off Michelle and have her play the physician. What if the response is “my patient got better on antibiotics”, but you feel like the patient does not even have an infection? What if the response is “I’m gonna keep him on vancomycin ‘just in case'”, even though the patient has never swabbed positive for MRSA and doesn’t have any other risk factors?