Battling the bugs: Microbiology and the NHS

Words by Nicola Simcock, Edited by Joe Crutwell

For this month’s SciBar we were taken on a microbiology rollercoaster; from the highs of an ‘outstanding’ care quality commission assessment, to the lows of the Bristol stool chart. Angela Geering ─ a Training officer and Advanced Biomedical Scientist ─ talked us through her experiences as a Blood culture section lead at the Freeman hospital.

Rosy-cheeked from the warm weather, the crowd at The Old George soon learned the impact of the sunny season on hospital infection rates. The lure of an open-toed sandal leads people to finally confront those discoloured toenails and cases of athlete’s foot skyrocket. As BBQs are fired-up, hungry people take their chances with undercooked chicken, meaning Salmonella diagnoses become commonplace.  However, as the worrying list of bacteria grew, Angela reminded us how these invaders are rapidly diagnosed and treated within our beloved NHS.

Integrated laboratory medicine ─ testing and treating medical samples in hospital laboratories ─ provides 70% of diagnoses. Everything can be screened for infection; from ‘standard’ samples like blood, stool and urine, up to transplant organs, heart valves and solid joints. Even swabbing the inside of a detached finger is not beyond Angela’s expertise. Such examples, and many more, all contribute to the 1 million samples that are processed through the Newcastle facility every year.

Impressively, Angela and her team can identify a positive blood culture within 30 minutes. Some bacterial classification involves spreading blood cultures on agar ─ a jelly-like substance enriched with different nutrients. When stored at an appropriate temperature, nutrient-rich agar promotes rapid bacterial growth. Special compounds can be added to the agar to help identification. For example, E. coli (Escherichia coli) ─ a major culprit for urinary tract infections (UTIs) ─ will appear pink on the appropriate agar. Once grown, the size and shape of a bacterium may also reveal its identity, and microscopy is used to locate clusters, pairs, rods or chains. Angela notes that many routine lab tests are still manual – requiring an actual scientist to run the test and/or analyse the results. However, with improving technology, an increasing number of tests are becoming automated to reduce labour, time and cost of analysis.

Caption: The friendly ‘face’ of Giardia lamblia – a common faecal parasite. Transferred through infected water or food, it colonizes and reproduces in the small intestine causing diarrhoea and abdominal pain.

 

It’s unsurprising that work as a biomedical scientist can sometimes get a little smelly, but this doesn’t deter the team from “putting patients at the heart of everything we do”. This became clear as Angela described the network in place to ensure efficient transfer of medically relevant information. Following sample analysis, the team work closely with consultant microbiologists and medical staff to advise on treatment options. From receiving samples, right through to treatment, experts in every step of the process contribute to a positive patient outcome.

Understandably, speed of diagnosis is important, especially if there is an unknown outbreak on a ward. One bacteria high on the NHS ‘watch-list’ is Clostridium difficile, also known as C. difficile or C. diff. C. diff was named for being notoriously ‘difficult’ to grow and study in the lab. Infections usually occur following antibiotic-use that degrade the existing ‘good’ bacteria in the gut. C.diff symptoms include diarrhoea and stomach cramps, however, if untreated, the infection can become much more serious. An outbreak of C. difficile is so tricky to contain that hospitals operate strict patient-care procedures, equipment cleaning methods, and there is even a financial incentive to prevent its spread. Only 76 cases of C. difficile are allowed per calendar year, with each additional case costing a hospital £10,000.

With hospital-outbreak horror stories vivid in the mind, this was a main source for questions from our crowd. We learnt that MRSA (Methicillin-resistant Staphylococcus aureus) ─ a familiar villain of newspaper headlines ─ is now considered ‘old-school’ in microbiology circles, with an NHS target of zero cases for 2018/19. There is however, a new bacterium to keep our biomedical scientists busy: Carbapenemase-producing Enterobacteriaceae, or CPE for short. CPE cases are increasingly detected in UK labs and worryingly, are showing signs of multi-drug resistance.

Currently, antibiotic resistance is as high on the international public health register as terrorism. While alarming, we can take some comfort in the fact that the risks of this threat are being taken seriously. Angela also helped to stem our fears with the news that; while resistance is a problem, her team are yet to face a patient they couldn’t treat. Alongside their dedicated work in the lab, members of the team additionally scan the medical literature to predict what beastly bacteria may be next to infect the North East. The team are up to date on the threats and well-prepared for how to deal with them. So, try not to worry, it seems we’re in good hands!

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