• Kaelyn Turner

But did you die? Part 2.

Well peeps. I'm averaging a solid 1 blog per month. Fantastic.

Urgent Care life has been packed and eventful.

Now I can talk about my pregnancy since we announced on social media to all the people.

I am *exhausted*. Currently in my 17th week. Every normal daily activity feels like a max effort.

Attention attention: This is NOT a complaint. It's just a statement about my current status.

The fatigue did not leave me in the 2nd trimester. But.

I am not sick. I eat a lot of food. I can still manage to exercise with pretty decent intensity 1-2x/week. Still working 12 hour shifts. Nothing is going wrong thus far. #Blessed.


The amount of coffee they allow you to have is not enough coffee.


Never have I ever laid on the couch for hours?! Like ever in my entire life. I have always watched TV standing or sitting up on the floor, or while dancing as a child, and I have the attention span of a mosquito so in general most movies are a no-go. I have difficulty staying seated for a whole meal at home and work. Pregnancy is wild - total opposite. Too tired to get up to even eat something that is already ready. #StruggleBusLevel1000


At this point, I have completed multiple Netflix docuseries, including Cecil Hotel... o m g ...


.obsessed.

photo source and a write up (1).

10/10 would visit this hotel, except at the very end they said they sold it and remade it into low income housing and a new hotel on the other side. BOO. leave it haunted. over it.


K.

This is a follow up sort of blog after the Penicillin allergy one. I'm not sure why I thought these were related but I'm sure somewhere deep in my pregnancy brain, I made a connection that made sense.


Culture and Sensitivity!
Yay!

Many of you have probably heard these words, or maybe you already even know what they mean. Maybe you have no idea what I am about to type about. Either way, cool.


Wait. I just giggled because the title is "But Did You Die?" and I put a picture of the Hotel Cecil in here LOL yikes!! IYKYK. Def making that the thumbnail.


I really like getting to the point, which is surprising based on how long and drawn out my blogs are. SO the bottom line purpose of culture and sensitivity, is to make sure that when you have an infection, whether it be bacterial, viral, fungal, or other (don't know what "other" would be but it seemed to fit right there), that you are taking the "Right Drug for Your Bug."


So, what is a "culture"? We'll use bacteria.

"During a bacteria culture test, a sample will be taken from your blood, urine, skin, or other part of your body. The type of sample depends on the location of the suspected infection. The cells in your sample will be taken to a lab and put in a special environment in a lab to encourage cell growth." (2)


So, the nurse, or doctor, or someone in between, collects a sample of your body fluids, or tissue or blood, in various ways, as sterilely (didn't know that was a word) as possible, and sends it to a lab. Most of the time, culture results will be available 2-3 days after collection. Viral cultures tend to take longer than bacterial.


Let's use urine. You go to a clinic, because you think you have a UTI (urinary tract with a T infection, or bladder infection). They ask you for a urine sample and tell you to clean yourself really well before you pee in the cup. Often, we have little dipstick machines in our clinics that can give us a vague "yes" or "no" answer to - do I have a UTI? Many factors can influence these results. So ... if you're seeing a GOOD, thorough, not even necessarily NICE provider - they will not rely solely on your "urine dip" to determine how to treat you. Sprinkles on the cake would be if they were good, thorough AND nice AND they send your sample to the lab for a formal analysis and a culture!


K buuuut my pee burns, I feel like I need to go every 4 seconds and barely anything comes out and I feel like I might be getting fever. What to do? Cannot live this way for 2-3 more days until you get results, lady.




Enter stage left: Empiric Antibiotic Therapy. (em-peer-ick, emphasis on the peer). I searched the internet far and deep for a simple, straightforward definition to source for EAT, and couldn't find a good one. So.. Prescribing Empiric Antibiotics means, "to use broad-spectrum antimicrobial agents as initial empiric therapy (sometimes with a combination of antimicrobial agents...) with the intent to cover multiple possible pathogens commonly associated with the specific clinical syndrome." (3) Not helpful for this blog, not the vibe I'm going for.


Translation: A "broad spectrum antimicrobial agent" is an antibiotic that covers a wide range of bacteria types. We choose antibiotics "empirically" based on where on/in your body the infection is located, whether or not you have fever, whether or not you have other medical conditions that will get you sicker quicker, etc... I mean, I know we make it look easy, but we really do think about these things and have to consider each patient individually.


Per another website: "The word empirical comes from Greek empeiria which in direct translation means experience. Not that far back in the past, in the middle of last century, the physician used to practice »the art of medicine«. There was a general belief that through rigorous medical education, exposure to colleagues and individual experiences each physician always knew and did the right thing. The treatment was litteraly empirical."

These days, in 2021, there are years and years of research studies for most infections we encounter day-to-day, and researchers/doctors/lab people have identified common bugs that give us infections in certain parts of our bodies. Fast forward to your appointment or your clinic visit - we have been taught, in nursing, nurse practitioner, physician assistant, dental, or medical school, which empiric antibiotics to pick as a "first line" or "first option" for specific, common problems. (6)

Cute duck. Keeping urine as the theme, because it's a GREAT example:

"According to the National Kidney Foundation, 80 to 90 percent of UTIs are caused by a bacteria called Escherichia coli(E. coli)." (4)

So like - if I'm seeing you in urgent care, or the primary care office, 80-90% of the time, I'm going to pick an antibiotic that treats E. Coli UTI (Macrobid, or Nitrofurantoin is my first pick), and I won't be wrong. And then in a couple days you'll start feeling better and then you'll go on Facebook or Google and write a really nice paragraph about me because I helped you after you were feeling miserable!!!


Right. Eye roll. Keep dreaming.

In medicine: the only constants are change and surprise. There is an exception to almost EVERY rule. Something can go the same way 99 times, and you get comfortable, and then on the 100th time the patient responds or reacts differently, and therefore - so do we.

SO. You pee in the cup. We see markers of infection on your urine dip. You have all the right symptoms. We give you Macrobid. And we send your sample to the lab because we are

good, nice, thorough providers, and 3 days later (the one in the picture came back quick) we get a screen that looks like this:


Alright. Soooo the "Final" "Micro" Report tells us precisely which bug (or bugs) are growing in your specimen. Whether it would be urine, blood, wound drainage, poop, spinal fluid, throat fluid, sores, whatever it may be. Another word for bug would be microorganism.

This patient has an E. Coli UTI. K now slide over the the next picture with the chart.


Here we have arrived at the "Sensitivity" part of the "Culture & Sensitivity"! Yay! Almost done!

This patient's E. Coli UTI, is "sensitive to" or "susceptible to" nearly every class of antibiotic that this lab runs on urines. The little "S's" on the far right tell you which drugs you can use for this patient. The "R" at the very bottom stands for "Resistant" = meaning this person's E. Coli bug will be resistant to treatment with that antibiotic (which is Bactrim). Translation: it ain't gonna work.


Sensitivity: "Sensitivity analysis, also called susceptibility testing, helps your doctor find the most effective antibiotic to kill an infecting microorganism...It also determines the ability of the drug to kill the bacteria...The results from the test can help your doctor determine which drugs are likely to be most effective in treating your infection.

Doctors use sensitivity testing to determine the right antibiotic treatment for an infection and to monitor changes in bacterial resistance to antibiotics." (5)


Seems pretty self explanatory and straightforward. However, just like you've heard in the news about new COVID variants, bacteria can morph too. Some bacteria have become "multi-drug resistant" or "extended spectrum", which means, the regular medications won't clear them anymore.... Additionally… you may be a special unicorn that is in that 10% people that have an uncommon bug causing you an infection. We would never know unless we cultured your specimen, and if you are a unicorn, we may have you on an empiric drug that won’t work. Which means you stay sicker longer, risk complications, and you take an antibiotic TWICE because you don’t get better, you come back to see me in urgent care, and we have to go to plan B. Gross, that really sucks.

Final point - When we get cultures on you, and we choose an empiric antibiotic, sometimes we will call you in 3 days and say you need to switch medications. This doesn’t mean we are incompetent, or did anything wrong, it just means we know how to fine tune your treatment now, and we aren’t going let you go a whole 10 days on something we now know won’t work.

Tidbit: Taking an antibiotic that you have left at home is always sketchy. Use the example above.. You were given Bactrim last time you had a UTI or a staph skin infection... you didn’t finish it.. You had 4 pills left and you took them and they are not helping… “But they were prescribed by my doctor! But he gave me this last time for a UTI why can’t you just give me that again?”

What did you learn about that specific patient‘s urine culture and sensitivity?

It‘s the ONE thing on the list that wouldn’t work! (Bactrim works for a lot of UTIs but it’s not the first line drug and for our patient, this time, it isn’t right).

Guys. Gals. And everyone in between - STOP taking antibiotics every time you are sick.


If you're new here, let me tell you - I love a reality check. Reality checks are delicious.


Warning. Unpopular OPINION ahead:

Every now and then, you're just going to have to be uncomfortable for a little while.

Your sinus infection. Your bronchitis. Your cold. 9/10x - an antibiotic is NOT going to fix it, fam. Because more often than not, you have a viral infection. We are HUMANS with spit, and snot and holes all over our bodies. We are GOING to get sick sometimes. If you are sick ALL the time - you need to dig deeper, look into your lifestyle, your habits, and if those are sqeaky clean - it's time for a trip to your doctor because something is wrong.


If you have that big meeting, presentation, trip, dance recital, exam, wedding, whatever in the next day or 2 and you came down with an illness - there is nothing that will "knock it out" faster than a strong, intact immune system. No antibiotic, no steroid will fix you 90% of the time. You got a UTI stealing the pep in your step? Yep - we can fix that quick. Ear infection? There's a shot (and pills) for that ... as long as you aren't allergic to Penicillin (see "But Did You Die? Part 1). If you are running to the Urgent Care demanding an antibiotic and a steroid shot (most frequently referred to "a z pack and a cortisone shot to knock it out" that we are 10000000% certain you won't take the antibiotic that we reluctantly give you for the full 5-10 days) you are truly hurting both yourself and kind of other people too with antibiotic overuse.


What doesn't kill you makes you stronger - most of the time.


ANYWAY if you're still reading and haven't x'ed this out yet. That’s the gist.

For those critical readers, I’m not addressing multiple bugs, empiric coverage for multiple bugs, diabetics with infection, sepsis, limitations due to allergies or drug drug interactions… Just so you know that I know that I know there’s more to the story… I know.

Concepts are the name of my game.


That’s a wrap!! Hope you learned something!


(1) https://www.countryliving.com/life/travel/a45235/creepy-history-cecil-hotel-los-angeles/

(2) https://medlineplus.gov/lab-tests/bacteria-culture-test/

(3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031442/

(4) https://www.healthline.com/health/e-coli-uti#E.-coli-and-UTIs

(5) https://www.healthline.com/health/sensitivity-analysis

(6) http://esgap.escmid.org/?page_id=389


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