George Koch

Right.

When you give someone a couple extra antibiotics and, you know, they may never have trouble.

Very few of them actually get C. diff.

But you're right.

It's like really hard to say, man, we just did this.

really tough four-hour case for this person you know they they really like kind of put themselves in our hands and i really don't want them to have a complication let me just give them something and then they'll have it you know and then we won't have to worry about it but i you know there's there's definitely been some i think it's glenn wormberg from cleveland he was when he was a resident cleveland clinic had a bunch of like biofilm research that showed that like

Even even small doses of antibiotics like will change biofilms and will change urinary microbiomes like pretty quickly and can cause some resistance patterns pretty quickly.

So like, you know, it makes us feel good because we feel like we're protecting our patients, but maybe we're not.

We just like the horizon time of the problem is not within our, you know, catheter pole.

So we don't think about it.

Yeah, I think that it, you know, it's...

You know, I think it's rare that we see the urethroplasty patient that ends up like that with, you know, no oral options.

But it's the neurogenic bladder patients and the SP2 for life patients, the spinal cord injury patients that, you know, you never quite know what their infectious symptoms are.

They're not classic.

They don't have, you know, feeling below their belly button.

And then, you know, you have a patient calling and they tell you they have an infection and

And you want to, you know, you want to take care of those patients.

But on the flip side, you look at their culture and it's like you can only give them IV antibiotics if you want to treat that bacteria.

And you have to start making the decisions every single time.

Do I want to treat that bacteria?