Monkey see, monkey do: adhering to scientific principles.

摘要

Medical and administrative agencies are focused on optimizingpatient outcome while containing cost. This interest has nurtured the search for best practices and the use of protocols that are proven to be cost effective (1). So far, newer and more expensive medical interventions have been the principal benefactors of the search for best practices. However, there are age-old problems that this line of inquiry has quietly passed over. How to manage bacterial and fungal urinary tract contamination in intensive care unit (ICU) patients who have an indwelling urinary catheter is a glaring example. While clear guidelines specify that asymptomatic urinary contamination should not be treated with antimicrobials (2), Dr. Chant and colleagues (3) succinctly point out, in this issue of Critical Care Medicine, that the term asymptomatic is a conundrum in the ICU patient. Evidence that Dr. Chant and colleagues have caught a brewing issue is shown by the fact that urinary contamination in the presence of comorbid conditions, such as diabetes, requires treatment because of an increase in the risk of systemic infection (4). These authors hypothesize that physicians hold no consensus on treatment options for ICU patients. They open their investigation at the most logical starting point by asking what the current practices are: How do ICU physicians view urinary contamination and how will they treat patients who have additional comorbid complications? Dr. Chant and colleagues chose a Web-based survey to collect information about current practices among ICU physicians throughout Canada.