Category Archives: Confessions of a Microbiologist

“Making a difference to gonorrhoea treatment”


For several years now, the core empirical treatment for gonorrhoea has been intramuscular ceftriaxone. This wasn’t always the case, but the resistance rates for both penicillin and ciprofloxacin have crept up to levels that meant using them as empirical antibiotics was no longer a satisfactory option.

N. gonorrhoeae is particularly vulnerable to antibiotic resistance, essentially because it has no hiding place.

There are not many viable options left after ceftriaxone, so we end up using ceftriaxone on everybody with gonorrhoea or suspected gonorrhoea. And as a result we are starting to see ceftriaxone resistance…

Selection pressure…

The solution of course is to avoid using ceftriaxone on every patient for empirical treatment of gonorrhoea. 

And this is now becoming achievable with the release of a commercial rapid diagnostic PCR assay, ResistancePlus® GC ,that not only detects the presence of N. gonorrhoeae (using both OPA and PorA targets), but also looks for the mutation conferring ciprofloxacin resistance (GyrA S91 F).

In the patients who have ciprofloxacin susceptible gonorrhoea, this will allow oral ciprofloxacin to be prescribed in a timely fashion, thus allowing the selection pressure of ceftriaxone on N. gonorrhoeae to be reduced.

This is a great example of how good diagnostic stewardship can lead to good antimicrobial stewardship. Hopefully such advances in molecular diagnostics will prevent the rather ugly scenario of “untreatable gonorrhoea”

Michael

“Permission microbiology”

One of the great things about having your own microbiology blog is that you don’t need to ask anybody for permission. You can write about whatever you want, even if it is only remotely related to microbiology! You have no deadlines to meet. If you want to post three articles in a day, you can. If you want to take a break for a couple of months, no problem.

Even though you don’t need permission, you do need to be ethically and professionally responsible for what you put out there into the ether.

Permission-no, responsibility-yes.

I have never been very good at asking for permission. This is probably due to the fact that I have a somewhat rebellious nature, and a healthy disrespect for authority. I have an inherent dislike of my personal agenda being at the mercy of someone else! I have always preferred begging for forgiveness than asking for permission.

Of course, sometimes you have to ask for permission. On the occasions where asking for permission is unavoidable, then the way you ask for it is extremely important in determining the chances of success…

I.e. “I am planning to do X & Y. Please let me know if there is any reasonable objection to this” is much preferable to “I am hoping to do X & Y. Is this ok with you??”

There is a subtle but critically important difference.

Within the practice of microbiology, there are lots of things you don’t need permission for… You don’t need permission to prepare a presentation for your colleagues, write a journal article, or even write a book. You don’t need permission to question a dubious result or a dodgy methodology, or to suggest a new idea. You don’t need permission to ask for a pay rise, a promotion, or to apply for a new job.

Permission is often something we wait for when it isn’t really needed…

Michael

“Flu in Kathmandu”

When I was offered the chance to go to a WHO influenza meeting in Kathmandu, I grabbed it with both hands. Such opportunities certainly don’t come by every day…

However the trip to Nepal did not get off to the best of starts.

On the flight to Kathmandu, I started to get toothache. By the time we landed I was in agony. The pain was compounded by the fact that my suitcase didn’t make the connection at Singapore. Ouch!

Things could only get better…

However my initial impressions of Kathmandu did little to lift my spirits. There were three power cuts in the first 24 hours, apparently a hangover from the 2015 earthquake. I had to pass on coffee in my hotel room as the tapwater had a distinct greeny brown tinge to it. I then attempted to do some initial exploration of the city on foot, but crossing roads in this city is not for the faint-hearted! Eventually fatigue and my nerves got the better of me and I retreated to the safer confines of my hotel room, wondering just what I had got myself into…

But things did eventually improve (as they almost always do!). The conference started the next day and it was good to focus for a change on just one microbiological subject (influenza) for two and a half days, as this allowed the acquisition of some in-depth knowledge. It was also good to speak to representatives from countries that I have very little knowledge of and have certainly never met anybody from before , i.e.  Timor Leste, Mongolia, Bhutan. The Nepalese people themselves were very friendly and as most of them knew a little bit of English, it was easy to strike up a conversation.

And my suitcase eventually turned up, albeit the day before I was due to leave (carry-on bag next time!). As for my toothache, the hotel concierge kept me going with a steady supply of paracetamol, which took the edge off the pain and allowed me to function. I fear a visit to the dentist will be required though on return to NZ.

The highlight of the whole trip was the final day visit of local hospitals, public health laboratories, and the Nepal National Influenza Centre. This was a fantastic opportunity to meet local laboratory professionals, and to discuss what particular challenges they faced in a sometimes challenging environment. I was extremely impressed at the systems they had in place.


“Lab and hospital tour in Kathmandu”

So despite the challenges the trip turned out to be hugely educational, both in an academic and cultural sense. I learnt a good deal about Influenza, and even more about Nepal. It is very different to New Zealand! I look forward to going back there one day,  hopefully to do some trekking in the Himalayas.

And I have made a new resolution:- to attend at least one microbiology conference a year in a place I have never been to before, even if I have to pay for it myself.

Michael