Home » Antimicrobial Stewardship » The Microbiome and Their Not so Welcome Relatives

The Microbiome and Their Not so Welcome Relatives

If you ever you feel alone, don’t! Because you have millions and millions of bacteria that are so so happy you are there!

I still remember this joke from microbiology lab, *sigh* but it takes on a new meaning in ID. So which of our ‘friends’ is causing infection vs. just along for the ride? Staph epidermis may sound inert but with a nephrostomy tube it could be (spoiler alert, was) a recipe for pyelonephritis….

The first two weeks of my ID and Antimicrobial Stewardship rotation have been an eye opener to the wonderful world of infections disease and antibiotic treatments! Working with my preceptor during ID consultants has been both exciting and challenging. The infections we see on a daily basis have included everything from polymicrobial VAP, infective endocarditis with Staphylococcus aureus, urosepsis with mixed Proteus mirabilis and Morganella and a large hematoma infected with group A streptococci…just to name a few. My knowledge of antibiotic selection and treatment durations in these complicated infections has been growing at a super sonic rate. I am quickly realizing that the treatment of infection can follow a dynamic course, which is not always predictable. These patients require close monitoring and meticulous follow-up to prevent recurrence, complications and secondary nosocomial infections. Importantly, the necessity of source control, adequate drug potency and penetration at the site of infection cannot be understated. Patient, organism and antimicrobial specific factors need to be carefully considered when choosing appropriate therapy.

No ePortfolio post would be complete without a progress report. At the end of week two, I am following 11 patients from an ID perspective, which is in line with one of my rotation goals. I continue to work to shorten my assessments in these focused work-ups. I believe having a more in-depth understanding of how to interpret the laboratory C&S results and test panels (including limitations) will be beneficial in decreasing my time to complete a comprehensive work up. Since beginning this rotation, I have a better understanding of where these fit into the clinical picture. An example is how to interpret C. difficle testing results, which is more confusing to clinicians that one might think. Antibodies, toxin A/B and NAT testing, oh my!

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