Few tidbits from the ADS on ID.
- Presence of polymorphonuclear cells (PMNs) indicates inflammation
- Beware of epithelial cell contamination in a sample
- Coagulase-negative Staphylococcus spp is often a contaminant of blood cultures
- A C&S will NEVER have PO susceptibility data due to concerns with bioavailability. Consult microbiology if you need direction.
- Eosinophilia increases suspicion of allergic reactions or parasitic infections
- Lymphocytosis increases suspicion of malignancy or bacterial infections
- Acute phase reactants are non-specific but add to the overall picture
- Pearl: cellulitis treated with ABX will appear to worsen for 2-3 days due to killing of bacteria and subsequent release of endotoxins
- Some antibiotics perform poorly in acidic environments, so therefore will not penetrate and treat an abscess.
- When do you consult microbiology?
- Need more specific identification on an organism
- Need additional susceptibility or MIC data
- Need guidance on which test to use to identify a bug
And of course, this fun gem: