Bad to the Bone: Oral Antibiotics for Orthopedic Infections and Lung Ultrasound for Decompensated Heart Failure

Katie Wiskar, GIM fellow at the University of British Columbia, and Paxton Bach, general internist in Vancouver are back on The Rounds Table.  This week they are covering oral versus intravenous antibiotics for bone and joint infections (OVIVA trial) and lung ultrasound integrated with clinical assessment for diagnosing acute decompensated heart failure (ADHF).

Complex orthopedic infections are managed with prolonged courses of intravenous antibiotics, which place a large burden on patients, involve risks, and are resource-intensive.  Paxton covers a noninferiority trial in which the use of oral antibiotics was compared to intravenous antibiotics for the treatment of bone and joint infections and treatment failure at one year was assessed.

ADHF is a common cause of dyspnea however its diagnosis is still a challenge. Lung ultrasound has emerged as a bedside tool that can be used to evaluate patients with dyspnea.  Katie discusses a trial which compares the addition of lung ultrasound, versus chest X-ray and serum brain natriuretic peptide (BNP), to clinical assessment on the diagnostic accuracy of patients with acute decompensated heart failure.

Finally, The Good Stuff segment.  Paxton shares an article discussing “collective intelligence” and a study on how the number of physicians weighing in on a case improves accuracy.  Katie describes how, on the other hand, a potential drawback is the “bystander effect” where the buck is constantly being passed from one team to another and can be detrimental to a patient’s care.

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Paxton Bach @paxbach and Katie Wiskar @katiewiskar.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. OVIVA: https://www.nejm.org/doi/full/10.1056/NEJMoa1710926

2. Lung Ultrasound: https://www.ncbi.nlm.gov/pubmed/30690825

Good Stuff

1. The Doctors Will See You Now: https://www.hsph.harvard.edu/news/features/improving-doctors-diagnostic-accuracy/

2. Not-My-Problem Problem: https://www.nejm.org/doi/full/10.1056/NEJMms1813431

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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