“Beware the trapdoors”

Experience can often count for quite a bit, it can allow you to avoid pitfalls and focus down on whether you can actually make a difference or not.

Take for example a seemingly simple scenario: a case of Campylobacter jejuni isolated from the stool sample of a hospitalised patient. New Zealand has a high incidence of Campylobacter infection so I would encounter this scenario once every couple of weeks.

This result reflexively makes me think of three trap doors I don’t want to fall through 

1) How long has the patient been in hospital for? Campylobacteriosis almost always has an incubation period of less than 7 days. If the patient has been in hospital for longer than this, think about hospital acquired infection. Get Infection Control to investigate further and look for other cases.

2) Get the Campylobacter result to the clinician quickly. Often campylobacteriosis presents with bloody diarrhoea, and often the laboratory result becomes available at just about the same time as the patient is getting teed up for invasive investigations such as a colonoscopy. During my career I have seen a few patients subjected to colonoscopy when a laboratory diagnosis of Campylobacter has been made but not communicated to the clinicians. Campylobacter results in hospitalised patients do not traditionally require a telephone call, but I generally tend to, in order to avoid this scenario.

3) Does this patient warrant treatment? Treatment for campylobacter gastroenteritis is generally of limited benefit and usually not indicated. However the fact that this patient is in hospital puts them straightaway at the more severe end of the scale. These patients are often immunocompromised or have had prolonged diarrhoea and to be honest my threshold for treating is fairly low. 

Campylobacter jejuni infection is generally not as exciting as some of its more extrovert siblings like Campylobacter fetus. However you still need to be careful. You could have a PhD in Campylobacter but unless you know where the trapdoors are you can still get caught.

Michael

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