I will share one of mine where I left off the MDM and got audited by an asshole ID specialist. I had a
5 month old female patient with normal exam but fever to 103. I would love to always do cathed urines but parents think you are torchuring them. So I did a bagged urine and the micro was >20,000. I wanted to do a cath on that but they refused so I treated with cefdinir to cover the usual E. coli. The culture grew two bacteria. Enterococcus and E. colo. So, I added amoxicillin. The E. coli did come back sensitive to amoxicillin but in Maine that is 50%.
My MDM should have been
Urine grew two pure bacteria, one of which is ALWAYS resistant to cephalosporins (the enterococcus) and E. coloi which is 50% of the time resistant to amox. So, I had started with cefidinir. Not having the C & S back, I knew the E. coli was covered by not the enterococcus in a bady with a 103 fever. So, I added cefdinir.
That would have covered me, yes a bagged urine is not great but if there are no contaminants then it is just as good. Yes amox would have covered both but I didn't know that at the time. So, the EXPERT ripped on "contamination" and two antibiotics (after the fact). Never got to talk to this expert who doesn't know how to manage UTIs. A cathed specimen wouldn't have changed anything unless there were five other bacteria growing.
