Monthly Archives: March 2015

“All is not quite as it seems”

Look at any local antimicrobial susceptibility profile worldwide and you are likely to find that E.coli susceptibility to trimethoprim is sitting at somewhere around 75-80%.

So why therefore does trimethoprim remain such a popular choice on empirical antibiotic protocols?

There may be a few reasons for this:

  • The urine specimens that come into the lab are essentially a biased cohort. i.e. they do not represent everyone who will be diagnosed (and treated) with a UTI as many patients will get the diagnosis on the basis of symptoms or dipstick urinalysis alone.
  • Institutes that set antimicrobial susceptibility breakpoints may well err on the side of caution when setting the breakpoints. i.e. they will not want to call an antibiotic susceptible to a bacterium when it is actually resistant.
  • Trimethoprim usually acheives higher concentrations in the urine than elsewhere in the body. 

So the reason that trimethoprim remains on the empirical antibiotic protocols for UTI in so many institutions is because it generally works, and it works in almost certainly a higher percentage than we suggest it does (in the lab).

I am sure there are many stakeholders who have been disconcerted by the in-vitro trimethoprim susceptibility rates to E.coli in their local institution, and may have changed prescribing habits because of it.

In my area, E.coli susceptibility rates to trimethoprim have remained stubbornly stable at around 78-80% for the past 20 years. Trimethoprim has been an empirical choice for uncomplicated UTI in local guidelines for the whole of that time period.

Sometimes you just need to look at the data, then work out how it translates into reality.


I published a similar post several months ago but it was lost from the website due to technical problems. Apologies if this post looks familiar!


“Microbiological Feedback”

I am never short of an idea or two on the microbiological front, with the ideas usually arriving out of normal working hours, in bed, on the toilet, on the bus, after a couple of beers etc.

Some of my ideas are rubbish, some mediocre and a few good (I like to think I have the occasional good idea from time to time!). But how does one work out which ideas have some legs in them?

One of the best ways to do this is to seek feedback on your idea, put it out there to your peers, and see what they think of it.

You might get various responses which might be constructive ( “Yes I like/dislike your idea. However I think you could improve it by doing A, B &C“) or non-constructive (“I like the idea” or “I hate the idea“)

But sometimes you will encounter no feedback at all. This made me think of all the potential reasons for no feedback, which I have listed below:

  • “Other people/stakeholders will give the feedback.”
  • “The person may be offended if I give negative feedback.”
  • “I might be regarded as submissive if I give positive feedback.”
  • “I am too busy to review and feedback on this topic.”
  • “I am not interested enough in this topic to give feedback.”
  • “I don’t know enough about this topic to give feedback.”
  • “I am not in a sufficiently senior position to feedback on this topic.
  • “If I feedback I may get caught up in the politics of the idea/topic.”
  • “I don’t think the idea will work, but if I don’t feedback then it is not my problem.”

and there are probably more..

I always try and work out the reasons for the lack of feedback, particularly if I get no feedback at all on a particular suggestion.

I love feedback, of all kinds.

Positive feedback is useful in suggesting your idea might have mileage.

Negative feedback is equally useful and potentially more so, as it may prevent a bad idea from getting off the ground.

Constructive feedback is the most useful of all as it can cause an idea to evolve and grow.

Encourage feedback at every opportunity, and in return give as much as you can to other people’s ideas. Embrace all types of feedback and don’t shy away from it. Most importantly, the receiving of feedback shows that people care…


"A Stakeholder"
“A Stakeholder”

“Information at your fingertips”

400px-Sony_Xperia_Z1_front_viewWe have just put all our local hospital antibiotic guidelines onto a smartphone app. (Click here for details). This means that the junior doctors, nurses, pharmacists, laboratory scientists and any other interested party can all view the appropriate guideline within seconds on their smartphone. As far as I am aware, we are the first area in NZ to do this for anti-microbial guidelines.

Trust me, this is infinitely better than posters on walls, handbooks, ringbinders, key tags etc. It is also better than guidelines on a PC desktop, for which you need an accessible and available desktop, before having to log on and navigate your way to the correct area amongst the labyrinth of hospital guidelines. The app is  very easy to update (all you need is editing access) and is relatively inexpensive for the software purchase.

Junior doctors, who are the main users of such guidelines, are from the generation which primarily communicate and learn using smartphones. It therefore makes a lot of sense to put antimicrobial guidelines on to such apps.

Occasionally there is a dissenting voice in meetings etc., complaining that such a policy would not work as not everyone has smartphones.

I don’t buy this whatsoever….

If you don’t have a smartphone to view such info, then get one.  To take this further I would recommend that in future, employment contracts should specify that possession of a smartphone to view such information is expected and should not be the responsibility of the employer.

Changing times…