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?
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
Potted history, recent allogeneic SCT for cutaneous t cell lymphoma, grew this in blood cultures and had respiratory signs at the same time. Rapid response to mero, septrin and clari that were started before we grew it, and he hopped on a plane back the day cultures became positive…he made home ok! Now deranged lfts, so … More Mycobacterium peregrinum
We’ve all heard of ‘junk DNA’ – the nonsense 8% of our genome that doesn’t code for anything. It is remnants of old retroviruses that reached a dead end and were no longer able to produce new viral progeny. Signature sequences of their genome were passed on through our DNA, but are not transcribed. So … More What going retro could offer.
TB HIV co-infected patient have a much higher mortality rate than TB mono infected patients. It seems self evident. TB and HIV have a close relationship, the latter greatly enhances the progression of the former. But what factors can be modified, if any? What do these patients actually die of? Are there any interventions which … More TB HIV co-infection mortality
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
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