GIRFTpathology

Background Urine cultures are often contaminated, making interpretation difficult. Pure growths may often not reflect infection and may be due to contamination - in our lab only one third of pure growths from pregnant women are reproducible.  In pre-op urines mixed growths make optimising prophylactic antibiotics difficult. We often end up giving broad spectrum antibiotics to cover all the organisms in a mixture as there is insufficient time to get a repeat. Alternatively, multi-resistant organisms may not be covered adequately. For patients with bacteraemia from a urinary source, many have a mixture in their urine culture. This compromises early rationalisation of antibiotic therapy. The Peezy has been designed to try to improve the quality of urine specimens by automatically discarding the beginning and end of the urine sample. In 2018 we trialled its use in pre-operative patients. These are the results. Number of patients The Peezy was used for both orthopaedic...

Suspicion of sepsis : Improving the Signal to Noise Ratio The concept of the SoS paper is reasonable (Inada-Kim M, Page B, Maqsood I, et al Defining and measuring suspicion of sepsis: an analysis of routine data BMJ Open 2017;7:e014885. doi: 10.1136/bmjopen-2016-014885) . We know that coding of sepsis is poor. This absence of reliable data makes it hard to compare approaches over time and between locations. The SoS paper basically lists a lot of codes that the authors associated with infection. The authors identified 267 codes indicating possible infection. There were 47475 cases with these codes as a primary diagnosis, with 3440 associated deaths. We felt that several of these reflected conditions that were not primarily infective in nature (or at least in which antibiotics would not be a main component of acute management) We removed the most common of these. 11.          N12.X - Tubulo-interstitial nephritis, not...