Blood culture bottle top
Here are the notes you were promised: BC Med 2010
Septicaemia lecture
August 11, 2010 By 1 Comment
That soprano again
August 10, 2010 By 3 Comments
Remember AIDA? She’s made a few appearances lately, most under the guise of clinical tropical medicine. But the first outing for this useful acronym was in connection with a clinical teaching unit on the management of septicaemia. Those notes will be handy if you miss out on today’s lecture (15:00hr, FJC LT, QEIIMC).
Dirt & disease way up north
May 25, 2010 By Leave a Comment
Once again melioidosis is in the news. Queensland Health’s Dr Jeff Hanna has highlighted the melioidosis hot spot recently identified in the vicinity of Townsville, and Darwin melioidosis export Prof Bart Currie fronts up on the ABC’s 7.30 Report tonight.
Changing climate conditions in the north, particularly in the northwest, are thought to be responsible for some of the apparent increase in cases that can be blamed on severe weather events. But occupational activities as diverse as expansion of farming, the mining industry and even the local film industry could all contribute to an increase in meaningful encounters with a contaminated environment, and therefore subsequent cases of infection.
For a recent on-line review on melioidosis, see Life in the Fast Lane.
Melioidosis treatment
April 28, 2010 By Leave a Comment
An update on how to treat melioidosis has just been posted by one of the open-source, on-line journals. This article provides a handy summary of current treatment options in a Table, dividing treatment into three phases of infection: 0, 1 and 2.
Melioidosis is a complex bacterial infection, treatment of which combines the urgency of treating rapidly fatal Gram negative septicaemia with the need for eradication of long-term persistent disease in pulmonary, soft tissue, skeletal and other organ systems. Incremental improvements in treatment have been made as a result of multicentre collaboration across the main endemic region of Southeast Asia and northern Australia.
There is an emerging consensus on the three main patterns of antimicrobial chemotherapy; initial (Phase 1) treatment, subsequent eradication (Phase 2) therapy and most recently post-exposure (Phase 0) prophylaxis. The combination of agents used, duration of therapy and need for adjunct modalities depends on the type, severity and antimicrobial susceptibility of infection. New antibiotic and adjunct therapies are at an investigational stage but on currently available data are unlikely to make a significant impact on this potentially fatal infection.
This treatment guide has been added to our FAQ page. The entire article can be obtained via the journal’s website.
Reference:
Inglis, T.J. The Treatment of Melioidosis. Pharmaceuticals 2010, 3, 1296-1303 [Reference]
When the fat lady sings
April 22, 2010 By 4 Comments
Why make a drama out of a crisis when you can turn in into a proper opera? The particular crisis the μGnome is concerned about here is the one that sucked him into μGnostics in the early days; the one that travels under a series of guises and that is variously known as septicaemia, systemic infection, blood poisoning, bacteremia and (for the four letter acronym fanatics) SIRS.
Before the days of high-tech medicine, the doctor had to hitch up his waistcoat as he bent over the patient to feel their sweaty brow and feel their thready pulse. There was weighty certainty in his prognostications as he proclaimed an imminent fever crisis. He might not have been able to tell you what the microbial cause of the infection was (μGnosis, or ætiology) but, by golly, he could make it all sound very grim.
The difference now is that we are no longer willing to wait for diagnostic certainty if it is at the price of increasing mobidity or risk of death. Septicaemia remains a potentially fatal condition, even in the best equipped centres. The diversity of potential infective agents will keep the attending physician guessing until we have faster, more accurate decision support tools. And a series of non-infective conditions may be mistaken for sepsis.
Which brings us to critical decision points: in a previous study we discovered almost by accident that if you performed a blood culture on the day the patient arrived in hospital there was a significantly lower mortality rate than if you delayed blood culture until the next day. We interpreted this incidental observation to mean that thinking about septicaemia early in the piece probably means you do something about it like start IV antibiotics earlier. In other words, it implies that there is a critical decision point somewhere in that first few hours after hospital admission. The clever people who are working up molecular tests to tell us exactly what the μGnosis is shortly after the patient arrives with a fever aim to exploit that crisis point. None of those new methods have quite made it over the line yet, so we have to make do with the good old blood culture for the time being.
Hence the opera, and not just any opera. The one that matters is AIDA. In this case the letters are an aide memoire for
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Assess (the patient)
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Inoculate (the blood culture)
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Decide (how to manage the patient), and
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Act (to start antibiotic therapy)
Specific skills need to be mastered in the correct use of blood cultures as part of the clinical investigative repertoire. These are summarised below in a Medical Interns talk. The part that the μGnome regrets cannot be provided on-line is the practical task of performing a blood culture. That is something practitioners will have to practice themselves. Happy bug hunting.
