Dr. Joshua Sterling

So there is interest in it.

I think the future is really going to be being able to tailor

a pre-, peri-, and post-operative antibiotic course to a patient to kind of understanding where they are, what, how their other health parameters play into it, you know, instead of just saying, you know, if regardless of what else is going on in the patient, if this comes back, this is what we're going to do.

Taking into account their, you know, are they immunocompromised?

Is there a reason where, you know, maybe they don't have as much reserve as another patient, so we should err on the more cautious side in terms of treating things.

And then really bacteria do help us.

And so, you know, again, moving the conversation away from sterilization and complete cleaning of the GU tract to restoring that balance so that everything is functioning the way that it should be.

Yeah.

I mean, I'm sure you see us too, but I see it in my patients where, you know, they had one bacteria all the time.

They weren't really symptomatic.

And then, you know, they got treated enough and suddenly they have a different bacteria and then now they're very symptomatic.

So we've kind of eliminated what was there and allowed a space for this new bacteria to grow and flourish.

And, you know, there are numerous patients that I can point to where in an effort to try to help them and treat them, we actually made them worse because, you know, we turned something that was asymptomatic into something that was symptomatic.

Yeah.

Yes.

So there was a model at Hanover Medical School from 2022 where it's basically putting in parameters.

You know, I know every urologist wants to kind of do things their way, but I think if there are guidelines for it across the department, you can really move the needle on what the bacterial resistance is in your practice pattern.

Again, they saw, I think it was just a year after doing this, a 25% reduction in terms of quinolone resistance for the E. coli in the patients that they were seeing.

It was a little less than 20% reduction of antibiotic use across it, and it was just putting in some

basic checkpoints, instead of flexibly doing something to be proactive and thoughtful about who you're giving antibiotics to and why.