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Desert Island Drugs

25/7/2019

 
Several times a year I get asked for my opinion of what antibiotics to take when going on holiday. It always makes me think back to a Grand Round (a hospital teaching session for the entire medical department) I attended as a House Officer many, many years ago… but NO! Not in the era before antibiotics thank you very much… I’m not that old…!
 
The Grand Round was “Desert Island Drugs” and featured a GP, an Elderly Care Physician and a General Medicine Consultant (who I happened to work for). The basic premise was “what drugs would you take with you if you were to be marooned on a desert island and why?”
​The talks were fascinating. The GP spent about half an hour listing hundreds of medicines for multiple different conditions; his drug kit would have weighed a ton! The Elderly Care Physician said he wasn’t going to go as he was too busy so he was going to send his elderly granny instead; he then went on to list 10-15 drugs his granny would need. While my Consultant stood up and said “I would take heroin (diamorphine) and ONE antibiotic that treats all these infections” he then pulled down a rolling blackboard (that’s the equivalent of an interactive white board to you youngsters) with about 20 infections listed on it. He invited the audience (still sniggering at the heroin reference) to try and guess what the antibiotic was… It took ages for the audience to move away from the big guns like Meropenem and Piptazobactam and realise he was talking about Benzylpenicillin. It was brilliant, he showed that with just two drugs, and an extensive knowledge of his subject, he could manage almost anything the desert island could throw at him… it was inspiring!
 
So based on my memories of the Grand Round (which appear in sepia tones through rose-tinted glasses) I will approach the question about what antibiotics to take on holiday with the premise “less is more”.
 
Where are you going? What are you doing?
My first response to those asking me what to take is to find out more about where they are going and what they are going to be doing.
Expedition antibiotics

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Go on, tell me a story…

19/7/2019

 
Once upon a time… a long time ago… in a distant land… and a galaxy far, far away
why complete microbiology request forms

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What's in a name?

11/7/2019

 
​The Microbiologist was busy authorising the laboratory results when his phone rang. The call identification showed it was Accident and Emergency (A&E) majors so it might be urgent…It was the A&E doctor.
 
“I have a patient with positive blood cultures who we sent home 4 days ago”, they said in a slightly panicked voice.
 
“What did the blood culture grow?” asked the Microbiologist.
 
“They had a temperature of 38.5 oC and so had blood cultures taken, but clinically it looked like they had a viral upper respiratory tract infection, so we discharged them”, came the reply.
 
“But what did the blood culture grow?” asked the Microbiologist again slightly louder this time.
 
“The patient was fine, the temperature settled with Paracetamol. But I think I need to get them back in, repeat the blood cultures and start IV Piptazobactam for sepsis” continued the doctor starting to border on the hysterical.
 
“STOP TALKING, JUST TELL ME WHAT THE BLOOD CULTURE GREW!” shouted the Microbiologist in a last ditch effort to break through the A&E doctors ranting.
 
“Oh! It grew a Cutibacterium spp. and I’ve never heard of it before so thought it must be significant”.
 
“Okay. Take a deep breath and calm down” said the Microbiologist “you might not have heard of Cutibacterium but I am sure you have heard of Propionibacterium acnes?”
 
“Yea, that’s a skin contaminant but it definitely says Cutibacterium” muttered the A&E doctor now frustrated at the Microbiologist!
 
“Good, now let me explain the joy that is changes in names…” replied the Microbiologist, "while you're on the phone do you know what these used to be called too?!? I'm doing a quiz for Friday lunchtime..."
Picture

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Who wants to be a Millionaire?

4/7/2019

 
​I’ve had the dubious pleasure of dealing with various incidents and outbreaks over the years. They can be very stressful experiences for everyone concerned, but a clear methodical approach can go a long way to alleviating the levels of stress both in both you and your colleagues.
 
Imagine the scenario:
It’s 9am and the Senior Biomedical Scientist knocks on your door “ummm the laboratory has inadvertently processed a tissue sample containing Brucella melitensis on the open bench!”
Brucella melitensis incident
Click for larger image

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    Blog Author:

    David Garner
    Consultant Microbiologist
    Surrey, UK

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