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 Amikacin stat and isolate the patient ASAP. Also send us a blood culture, sputum and urine and we’ll see what we can grow. As there is a risk of enteric fever, make sure you write High Risk on the request form please!”
However, at the same time the Sister from Phlegming Ward was calling the Infection Control Nurses to say she thought they might have an outbreak as they had a number of patients that had all been in the same bay who were now all suddenly septic!
The Infection Control Nurses told the Sister they’d drop everything and hurry along to assess the situation; so they brought forward elevenses to a 10am cake break and then off they went… which is pretty speedy for IC! (…I am going to be in so much trouble for writing that!!!)
When they arrived on Phlegming Ward the corridor looked dark and gloomy. The overhead strip lights flickered on and off like a broken strobe light at an 80s disco. A trail of bright pink slime oozed its way across the broken floor tiles disappearing off into the distance. Nothing moved; everything was silent. The ICNs looked through the doors to see carnage. To be fair it was often a chaotic place where no one ever washed up their coffee cups, so mould outbreaks were common. They entered the ward. This seemed different; the patients looked terrible, emaciated and sunken eyed which, although food was being cut back to make hospital savings, shouldn’t be noticeable quiet yet. There was also blood and vomit everywhere, as well as some funny looking bright pink stains no one quite knew what to make of, and the over-worked staff looked like they had finally lost the plot!
“But does that include shutting us in, we’re ICNs, surely we have immunity, don’t we!?!” asked the more junior ICN in a fragile voice.
“Yes! It includes us” the Senior ICN said in a sober tone. This heroic act saw the loss of two ICNs but before they succumbed to whatever this was, they called back to the IC team office…
“This is bad, really bad, and it is spreading quickly. So quick there is no time to even set up an outbreak meeting. You need to act and act now…” …the word “now” faded into harrowing cackles and the line went dead.
“I’ve lost contact with the ICNs on Phlegming Ward” sobbed the Nurse Consultant ICN
“It’s probably just a normal black spot in the Trust’s mobile phone coverage”, piped up another ICN, trying to hide his fear.
Another phone rang making them all jump. The caller ID showed it was the Phlegming Ward Nurses Station. Tentatively one of the ICNs picked up the phone… all they could hear were screams and munching sounds. Either someone had eaten the last of the box of chocolates in front of everyone else, or Phlegming Ward had fallen to the Enemy!
“It’s not bad comms” quivered the Nurse Consultant ICN, “I’m afraid they’re goners, we’re going to need more than mops and clinical waste bags on Phlegming Ward!”
The ICN team scrambled into action, once they had each done 3 circuits of the office with hands aloft screaming in panic, they reverted to the calm unflappable professional front they put on to the rest of the hospital and called a meeting with the IC Microbiologist, the Microbiology Registrar and the Antimicrobial Pharmacist.
Soon they had a plan of action. They gathered as many antibiotics as they could find including Meropenem, Amikacin, Linezolid, Tigecycline, and even some left over “Cefiderocol grenades” from “that other patient from last week”, and loaded them into their newest infection prevention devices, the semi-automatic syringe-dart guns! (Note: Cefiderocol is IV only and does not come in “grenade” form, but it can be used for severe drug-resistant infections caused by Gram-negative bacteria… and sadly we don’t currently have semi-automatic syringe-dart guns).
“Good work, we’re going to have to split into teams. At least two people per team, each armed with as much antibiotic as they can carry. Then we will track it down and blast it with the antibiotics. We have the ‘tools’ team, so let’s get this done!” The IC Microbiologist seemingly had practised this motivational speech a bit too much! Sharing out the antibiotics the team wished each other good luck and moved off along their separate trails.
“We’re going to need stronger antibiotics!” shrieked the Registrar much to the annoyance of the IC Microbiologist but she refrain from starting an impromptu lecture on antibiotic strength verse appropriateness!
They also dispatched the Cleaning Bots to monitor and control the Phlegming Ward environment… they would have liked to have the skills of the professional cleaning staff but as they are part of the Unison industrial action over the rubbish pay offer they have been given, they are understandably “on strike” (yes an extra 72p per hour is rubbish and insulting for such an important job!!!).
The Thing’s trail was unmistakable. Pink slime was everywhere, moist and glistening. The Thing was not subtle, it was covering everything in its path, doors, walls, the floor, even those posters that extolled the Trust’s values, nothing was sacred.
“Come in boss” said the Senior ICN quietly into her comms set. “We’ve got eyes on the target, it has somehow spread to the Critical Care unit, and it is huge. It’s evolving even as we watch. It appears to be smothering an Anaesthetist but hasn’t seen us yet. We’re moving into position”.
The ICNs let rip with every tool they had: hand washing, appropriate PPE, universal precautions, careful antibiotic choices, numerous posters, and they even tried the “glow and tell” machine (yep, that’s what they call the UV light box that helps teach people how to wash their hands properly)!
“Errrrr, boss? Bad news. We gave all our standard advice, used everything we had against the Thing. Meropenem, Amikacin and even a few Cefiderocol grenades just for good measure, and nothing. It shrugged it all off like it was just a stiff breeze. This is the most damn antibiotic-resistant Thing we’ve ever seen. It’s even gone through the wall, and we’ve lost it. Sorry boss, we tried.”
As everyone listening into this tried to digest the devastating news, the lights went off. In a sudden moment, darkness fell. A few moments later the emergency generators kicked in and a dim light rose to bathe the frightened faces of the remaining Infection Control Team.
“It cut the power”, shrieked the Registrar into his handset.
“What do you mean IT cut the power?” said the IC Microbiologist, “the Thing is just a… bacterium! It does not have opposable thumbs?”
“Back to the Office,” ordered the Nurse Consultant ICN, “get back to the office. We need another plan!”
Trying to keep the IC team calm, the IC Microbiologist attempted to reassure them that the situation wasn’t dire, “Now here’s what we’re gonna do. This Thing CANNOT spread faster than we can track and contain it; after all, we are the Infection CONTROL team! So, hold your position and do not, I repeat, do not draw attention to this Thing!! It will all be OK, don’t worry, I’ll speak to the Duty Microbiologist, just keep an air of calm, help is on the way”, but the IC team were having none of it.
The IC Microbiologist went to see the Duty Microbiologist to explain the situation.
The Duty Microbiologist jerked awake, wrenched out of his pleasant dreams of chocolate and ice-cream, to a screeching sound. Flailing his arms around to try not to fall of his chair he sent his cold cup of coffee flooding across his desk, staining his worklist and removing all remaining legibility from his scruffy handwritten notes.
It took a moment to realise it wasn’t the fire alarms but something more sinister, the IC Microbiologist, who was concerned about a highly transmissible “Thing” on Phlegming Ward!
“Oops, this morning I asked for advice by the ward doctor of Phlegming Ward about a patient being seen by Critical Care Outreach, and I told them to send a patient’s sputum sample to the lab” said the Duty Microbiologist.
“No! Then it’s escaped Phlegming Ward already and that’s how it got to Critical Care... that means… it’s not contained!” cried the IC Microbiologist.
“Oops” said the Duty Microbiologist.
“Is that all you can say, this is dire!?” cried the increasingly terrified IC Microbiologist.
“Yes…oops… sorry?!” answered the Duty Microbiologist with a wide “Wallace and Gromit style” grin.
“Are you crazy? Did you not get your coffee this morning!?”
“Oops, no, I spilt most of it just now! You frightened me!” answered the Duty Microbiologist.
“Right drink the rest of that cold cup of coffee and come with me, this is getting away from us…! We need to stop this in the lab…please tell me they were going to label it hazardous and high risk so that the lab don’t process it on the open bench… Not that old chestnut again! It is becoming tedious through constant repetition” muttered the IC Microbiologist under her breath.
“I did ask them to mark it High Risk” the Duty Microbiologist said pathetically.
“Good, then let’s go” …The IC Microbiologist and the Duty Microbiologist peered through the lab’s glass door… the lab was a scene of carnage, with the shattered remains of petri dishes everywhere.
“Looks normal” said the Duty Microbiologist.
“Looks like the Kiestra machine has packed up again” said the IC Microbiologist, thinking about the last “oops episode” when the unstoppable demand from a bulging laboratory network piled up and there was no backup machines for when things “like this” went wrong.
Reluctant to open the door, instead they called the lab to see what was going on.
“MaldiTOF identify it as Psychrolutes marcidus; it sounds like a new bug. It evolved so fast. Our normal containment couldn’t hold it. Once we knew it was getting out of hand, we threw everything at it. Nothing touched it. It shrugged it all off like it wasn’t even there, and it just kept evolving. It broke through all of our barriers and attacked the staff, and then it smashed its way through the wall and escaped!” Then as an afterthought they added, “what were we meant to do?”
“But did you make sure the lab had taken the necessary precautions? Was it labelled as a High-Risk specimen?” asked the IC Microbiologist, rather insensitively considering they could now see the lab staff huddled to one side of the room, their normally white coats sprayed bright pink!
“Errrr… Yeh, we used Cat 3” said the Biomedical Scientist, “but you know those building works, and the water leaks, and then the power cuts because of the increasing costs of energy… well… it wasn’t quite Cat 3, so whatever it was, it escaped, it isn’t contained, and we’re all potentially contaminated… do you think I should I fill out an incident form?”
The IC Microbiologist groaned, it had gone way-passed an incident form… already word was getting out; the Thing that had escaped Phlegming Ward and the lab had been seen on Critical Care and was now rampaging through the hospital. You couldn’t hide a giant pink gelatinous blob that was busy tearing apart anything it could get its hands own. It had even taken one of the tea ladies who had made a valiant last stand firing sugar cubes with surprisingly great accuracy, but all to no avail.
Just then the Antibiotic Pharmacist came breathlessly into the room clutching boxes of latex gloves and masks in her arms. It was going to take much more to get this back under control. …They needed a new plan of action!
They started to bounce ideas around the room:
- “Get me another one of those nice new shiny signs that says No Entry by order of the ICNs, and quarantine the lab!”
- “Let’s put Fosfomycin in the hospital sprinkler system, stat”.
- “Get some fancy new yellow Hazmat suits before the price goes up further with the cost-of-living crisis”.
- “And order in some packets of shortbread… I need another coffee” added the less-than-helpful Duty Microbiologist
Whilst they were debating their expert response over coffee and shortbread in the staff tea-room, they caught sight of the TV which was on with the sound turned down. The headline text on the BBC News read, “Antibiotic resistant mutant escapes from local hospital!”
The two Microbiologists looked at each other.
“Errrr… do you think it’s too late to ask everyone to wash their hands?” asked the IC Microbiologist.
“Don’t ask me, I’m going home to hide under the bed” replied the Duty Microbiologist.
“ARGH we’re doomed, move to step 5. Burn the place down….It has gone passed its serviceable date by 10 years anyway; the hospital is a temporary building built in the 1970s”.
She was about to give the order to evacuate when she heard the office door behind her start to open, being pushed by bright pink slime…
The inevitable had happened; the post-antibiotic era had arrived… Queue dramatic music and fade to bright pink…
Okay, so uncontrollable bright pink slime isn’t a problem yet, but it’s getting closer! We are already seeing bacteria such as E. coli and Klebsiella pneumoniae resistant to one of our last line antibiotics, Meropenem, with countries like Greece reporting 70% resistance in blood culture isolates with these bacteria.
Even Colistin, which we thought would be difficult for bacteria to become resistant to, has been found to be ineffective for some bacteria; 25% of meat at the point of sale in China has been found to contain Colistin resistant bacteria due to the use of this antibiotic in animal husbandry.
Antibiotic resistance is already a nightmare for Microbiologists. It is one of the biggest threats to public health in the UK today and it is imperative we do everything we can to preserve what we have left, only using antibiotics when we need to, not for every cough and cold, preventing spread of bacteria through good infection control practices and basic hygiene, and supporting the NHS so it can cope with the increased winter pressures and post-Covid back log.
Happy Halloween… and don’t have nightmares, this story is entirely fictional and no tea ladies, patients, Nurses, Anaesthetists, BMSs, Microbiologists, Pharmacists or Infection Control Nurses were harmed in the writing of this blog… the Registrar though… 😊