I appreciate the extensive review of the research in regards to the perils of providing antibiotics to mostly viral etiologies [“Emergency Physicians Don’t Follow Evidence When Prescribing Antibiotics, and That Needs to Change,” Sept. 2014]. When people do things contrary to the evidence and rational thought, it sometimes is helpful to ask why. It might be helpful to review “The Real Reason People Won’t Change,” Harvard Business Review, November 2001, by Robert Kegan and Lisa Laskow Lahey.
–Anthony Ferroggiaro, MD, MHA
In future versions, it would be useful to discuss the cost of false-positive cultures (usually $4,000–$7,000 per false positive in a hospitalized patient).
Also, it is not so important whether or not a culture is positive but rather how often it changes management. While 4 percent of ED-drawn blood cultures may be positive (and half of those being false positives), a positive culture almost never prompts a change in [antibiotics]. When it does, it is almost always in an immunosuppressed patient or those with severe sepsis/septic shock.
–Stephen Colucciello, MD
Charlotte, North Carolina