Sorry tale

This weekend’s West carried an Agenda story on the inquest of a young mother who died shortly after giving birth to her fourth child. There has been plenty of interest in the local press as the inquest ran its course. The cause of death appears to have been streptococcal septicaemia that went unnoticed until too late in the day to avert a catastrophic outcome.

Leaving legal due process to continue its proper course, there is one theme that often gets missed when we’re trying to get wise after the event. That is the disregard many of the gnome’s colleagues have for blood culture. The West states that the medical staff found the blood culture bottles were past their shelf life and therefore felt they could dismiss the preliminary lab results. But if we scratch a little below the surface, we find that even the preliminary results of ideally primed culture bottles usually take 12-24hr to flag positive in the automated processor. At that stage all we have is a Gram stain, and so many of our Gram positive results turn out to be skin contaminants that it is difficult to get excited until definitive culture results come through after another 12-36hr delay.

It’s remarkable that we have so many patients with septicaemia admitted to hospitals in developed countries yet have not come up with a faster means of deciding on a μgnosis. Clearly the main deciders of outcome occur too early in the course of septicaemia to be affected by the results of blood culture. Roll on direct molecular detection tests.


Leave a Reply