The inoculum effect. Can we use BL/BLIs in ESBL infections?

We’re told that if our patients have infections caused by ESBL producers, we should use carbapenems to guarantee effect. At the time of prescription, we often don’t know if this is what’s infecting them, so they might justify empiric carbapenems if in a high-risk group. Even at the time the MALDI and the initial susceptibility … More The inoculum effect. Can we use BL/BLIs in ESBL infections?

Not so EaSyBLs

I have a confession to make. ESBLs confuse me. The antimicrobial arms race is a 20th century phenomenon. Bacteria had ruled man for millennia: Bacteria-Man 1:0. Then Alexander Fleming forgot to tidy away his lab bench one weekend. Man had the upper hand and the golden age of antibiotics had begun. Bacteria-Man 1:1. (Well, okay, … More Not so EaSyBLs

NO cardia

68 year old woman with a relapsing pneumonia. 3 admissions over 6 months. No pathogen on BAL. Response to meropenem each time, gets about 2 weeks and is discharged. This time is admitted febrile, dyspnoeic and has a ‘rash’ on her legs.  Really it’s multiple pustular lesions on her legs.  Meropenem is commenced and she … More NO cardia

TB mortality

A case of old fashioned ‘consumption’.  Pulmonary tuberculosis that seems to eat away at the flesh of the whole body, whilst slowly also gnawing away the lungs. 34 years old and 35 kilograms in weight, HIV negative.  Not much of a left lung and advanced cavities in the right.  Sensitive TB, treated with Rifampicin, Isoniazid, … More TB mortality