Category Health Pathology NSW
Antibiograms for HNELHD 2022
Collated antibiograms compiled by Dr Rob George, Pathology NSW are now available via the HNE intranet at this location . This is the summary report : Antibiograms_2022_-_HNE_LHD
Micro lab comments: candidaemia and candiduria
Candidal bloodstream infection represents a high risk infection, even for immunocompetent patients. Mortality is significant even for IV line-associated candidaemia. Blood cultures are seldom contaminated by fungi and any patient with an isolate must be subjected to careful clinical assessment. Our comment serves to give a few reminders that follow on from the liaison between the […]
Microlab comment: beta-haemolytic streptococci isolated from blood
Here is another one used for uncomplicated bloodstream infection events: Infections due to these species of streptococci are usually rapidly responsive to appropriate antibiotic therapy which can be of short duration with no minimum IV requirement as endocarditis is not a usual consideration. Penicillin resistance has not been documented and flucloxacillin is just as active (see […]
Micro comments unpacked: Gram negative bacteraemia
Here is an example comment from Pathology North which is added to positive blood culture reports when a Gram negative coliform species ( Enterobacteriacae eg. E. coli) has been isolated: The comment’s rationale is to promote short course treatment and also to prompt oral antibiotic switching in a timely manner. It also prompts consideration of source […]
Maximising the value of blood cultures
Blood cultures give a critically important window on bacterial and fungal sepsis, providing direct patient treatment guidance and reliable antimicrobial susceptibility data that are used to construct cumulative antibiograms and empirical treatment guidelines. They also help to rule out serious bacterial infection, provided that collection occurs prior to antibiotic treatment and an adequate patient sample is taken. Here […]
What are cumulative antibiograms ?
Antibiograms summarise local antimicrobial susceptibility in order to guide appropriate antimicrobial prescribing. Ideally they are updated annually by microbiology services to provide a current picture of bacterial susceptibility and the local incidence of key sentinel resistant pathogens.
C-reactive protein or erythrocyte sedimentation rate?
CRP is considered a better marker of the acute phase of the inflammatory process and can be used to assess response to therapy. Repeating the test more frequently than every 2-3 days is not indicated. There is also little rationale for performing both CRP and ESR when looking for indirect evidence of systemic or local site infection. […]
Avoiding unnecessary urine cultures and treatment
Urine samples are often submitted seemingly without a clear clinical justification. As bacteriuria is a common finding in the elderly, diabetic patients and patients with longterm indwelling or suprapubic catheters, a lab report with a positive culture might then prompt unnecessary antibiotic treatment. The following guide might assist:
AIMED - Let's talk about antibiotics 
Pathology stewardship – an essential element of AMS
Poor antimicrobial prescribing decisions often are triggered by laboratory results that create red herrings or worse. Inappropriate/ poor specimen collection and/or a request form that provides no context to the investigation often sets the ball rolling. Inappropriate workup and reporting of contaminant or colonising isolates may then follow (it may be impossible for the lab […]