different hospitals, different patients

One cool thing about microbiology is getting a sideways glance at the epidemiology of a lot of diseases, both in seeing what specimens get handled and in observing trends over time.

One example comes from my being at the "downtown" hospital this month. With a much more indigent population, the AFB bench is a lot busier because of all the tuberculosis patients. However, the hospital only runs fungal cultures once a week, whereas my program's "main" hospital does it every day. Why? If I remember the explanation correctly, the main hospital does a lot of fungal cultures on immunosuppresed patients, mostly transplant recipients. The downtown hospital doesn't do transplants, though. They have a whole lot of HIV patients, but the regular blood culture bench is sufficient to look for most fungal infections that they might have.

Even more interesting is a story the main hospital's lab director has told us once or twice. A few years ago, Klebsiella Pneumoniae Carbapenemase started popping up. These are Klebsiella pneumoniae bacteria that are resistant to one of the most powerful categories of antibiotics. One particular strain, KPC 2, first showed up in New York. The very first KPC strain our lab saw was KPC 2, in a patient visiting from New York. After he arrived, a bunch more examples showed up. The patient returned to NY, and the incidence of KPC 2 died down. Of course, KPC 3 started showing up and got a stronger foothold in the area. A few weeks ago, another KPC 2 specimen registered in the lab, and yep, the patient was from New York. The clinical approach would be the same in all these cases, but it's fun to keep tabs on this sort of stuff.