Blindly following guidelines… not such a good idea after all…
Microbiology Nuts & Bolts - The Bug Blog
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1y ago
I have a problem with antibiotic guidelines. Okay, I know that’s a controversial statement for a microbiologist to make given all the efforts that have been put in over the last 15-20 years to try and make antibiotic prescribing better, but let me explain.   Or better yet, let me ask you a question. How do you choose an antibiotic?   Nowadays, when I ask this question, I get a really irritating answer, “I look at the guidelines”. Image: Mark Rogan So basically, people check their brains at the door and just follow what is written down on a piece of paper or on a computer screen, wi ..read more
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Keep losing my focus…do I need to book an eye test?
Microbiology Nuts & Bolts - The Bug Blog
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1y ago
Over the past few weeks I have seen a lot of patients being admitted with infections due to the bacterium Staphylococcus aureus, which we have grown from their blood cultures. S. aureus is a common pathogen, but the number of positive blood cultures has been above our normal baseline, and I have found myself giving the same advice over and over again to the ward doctors looking after these patients.   S. aureus bacteraemia is a serious infection with a mortality of at least 20%; that is on average 20 in 100 people with S. aureus in their blood will die despite what we do to try and help ..read more
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October 27th, 2022
Microbiology Nuts & Bolts - The Bug Blog
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1y ago
The Duty Microbiologist had just got to the duty desk when the phone rang, 09:02 no time to even pour a cup of coffee… this was going to be a bad day!   The ward doctor from Phlegming Ward was treating an unknown illness in a patient who had just returned from a holiday from the Indian Subcontinent.   It sounded bad… they were septic, with low blood pressure and a very high lactate. The Critical Care Outreach Team were on their way but the team were worried the normal IV Amoxicillin, Gentamicin and Metronidazole for sepsis wasn’t working!   “Change to Meropenem, give a dose of A ..read more
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City of Hope
Microbiology Nuts & Bolts - The Bug Blog
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1y ago
I grew up in the 1980s. I know I’m getting old, not far off 50 now, but I still remember the impact of the discovery of Human Immunodeficiency Virus (HIV) and the effect it had on society.   I remember the prejudice. I remember the offensive term Gay Related Immune Deficiency (GRID) and the unhelpful public health campaigns. I also remember the movie Philadelphia with Tom Hanks and Denzel Washington which showed how many people felt about HIV. I remember being in a class at school called “Personal and Social Vocational Education” where we were discussing what we would do if we came across ..read more
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Retirement Planning - Why antimicrobial resistance is important to me!?
Microbiology Nuts & Bolts - The Bug Blog
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1y ago
This may seem like a strange question for a Microbiologist to ask but it’s not as straight forward as many people think. I have blogged about this kind of thing before, but recent conversations with other healthcare workers have shown me that many still do not understand the effect that antimicrobial resistance is going to have on the wider scope of medicine. Well, it’s my blog so I’m going to blog about it again… ?   Most people, including healthcare workers, think that antimicrobial resistance’s biggest threat is related to our ability to treat common infections such as pneumonia, urina ..read more
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I suspect serious mistakes occur daily in the NHS
Microbiology Nuts & Bolts - The Bug Blog
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1y ago
Things go wrong in medicine, people make mistakes, sometimes patients come to harm. I know that sounds obvious, but I think it is something that the healthcare profession and the public often forget. No one is infallible. No one is right all the time.   The microbiology laboratory I work in is one of the biggest in the country and it processes about 1.5 million samples per year. That’s 1.5 million results. Do I think we get every one of those results correct… no. That would be unrealistic and I’m not that gullible (or fabulous!). Even if we were only wrong once in every 10,000 samples (0 ..read more
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Are you pooping out polio?
Microbiology Nuts & Bolts - The Bug Blog
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1y ago
In 1988 the World Health Organisation announced its intention to eradicate polio by 2000. It was a lofty goal but one that was achievable as polio only infects humans, and so if they can stop polio spreading between people then it can be eradicated, and the way to stop spreading polio is to vaccinate against it. Editor Chief in Charge, in her previous incarnation as a physiotherapist, treated polio patients with calipers like this... yep she's that old... Oi, they were adults who had had it years earlier, not children The two polio vaccines were developed in 1955 and 1960 in the USA by Jonas ..read more
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£100,000 compensation, give me $3million!
Microbiology Nuts & Bolts - The Bug Blog
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1y ago
Haemophilia is back in the news with the UK government being advised most strongly by Sir Brian Langstaff, in the Infected Blood Inquiry Interim Report, to issue immediate £100,000 compensation to the men, women and children treated by the National Health Service for conditions like haemophilia, who were given infected blood and infected blood products since 1970. Haemophilia is a genetic disease where the person affected is unable to produce certain blood clotting factors which results in them being at risk of spontaneous bleeding and life-threatening haemorrhages. It is estimated that about ..read more
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Fish tank, who ha ha…
Microbiology Nuts & Bolts - The Bug Blog
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1y ago
“Hello, is that the Duty Microbiologist? I’m a local GP, could I please discuss a patient with you?”   The Microbiologist put down his cup of coffee, yep, coffee, it may be the hottest day of the year out there, but here in the lab it’s air-conditioned to the point of refrigeration!!!!   “Go on then” said the Microbiologist being his normal cheery self. ​Unperturbed, and being used to this particular Microbiologist’s ways, the GP continued.   “This chap is in his 40s and I have been treating him for a skin infection, but it’s getting worse. He’s had courses of Flucloxacillin, E ..read more
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Have you got genetically mutated ears?
Microbiology Nuts & Bolts - The Bug Blog
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1y ago
​Many hospitals rely heavily on aminoglycosides within their antimicrobial regimens. Locally we use Gentamicin as our go-to aminoglycoside of choice for sepsis (combined with Amoxicillin and Metronidazole) as well as for severe pyelonephritis amongst other things. In fact, it was one of my favourite choices for buying time to work out what is wrong with septic patients who cannot afford to wait for a diagnosis before treatment is started. ECIC (a.k.a. my wife) used to tease me that Gentamicin was the only Microbiology oncall advice needed and therefore our cat could do the oncall… how rude! G ..read more
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