antibiotic appropriatness

Art Papier MD apapier at LOGICALIMAGES.COM
Sun Nov 10 17:44:44 UTC 2013


In addition to wrongful diagnoses of "urosepsis" there is also the problem
of premature closure around the patient presenting with a red leg and the
related diagnostic oxymoron "bilateral cellulitis".    We showed in a study
of consecutive admissions at 2 hospitals a diagnostic error rate of 28% for
patients with suspected cellulitis.  Patients with stasis dermatitis
was the most frequent error.   One of my colleagues tells me of a case of a
patient admitted for cellulitis (which she did not have) given IV
antibiotics, develops c. diff and died.  

Our company is participating in a multi-hospital and BC/BS supported quality
initiative to address diagnostic error around presumed cellulitis.  Here is
a web page describing the scope of the problem and the project

Please contact me off the list if you have any questions.  I see you are
just down the thruway, almost neighbors.





Art Papier MD

Chief Executive Officer

3445 Winton Place . Suite 240 . Rochester NY 14623 

(585) 427-2790 x230 .  <mailto:apapier at>
apapier at

Logical Images



From: Sanders, Alan [mailto:Alan.Sanders at SPHP.COM] 
Sent: Friday, November 08, 2013 2:54 PM
Subject: [IMPROVEDX] antibiotic appropriatness


I have been involved intimately with two antibiotic stewardship programs for
the past seven years, and it is remarkable how many inappropriate course of
antimicrobials are prescribed, for days, when no infection is ever
documented.  Most commonly, these  antimicrobials are initiated in the ED
and continued on the hospital ward, often on a hospitalist service, for  a
"urosepsis"  which never exists.  This makes up a major part of our daily
stewardship rounds which we do on the wards, with the charts, and EMR.
Going down the wrong road with this and other diagnoses (often CAP) leads to
enormous antimicrobial costs, and clearly misdirects the whole team from
what is really the correct diagnosis.

Alan Sanders, MD

Chief of Medicine

St.Peter's  Hospital , Albany NY

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