Wednesday, 14 January 2009

Bacteraemia.

Bacteraemia "recorded" Only

I always think that is an interesting word. To the lay person it means " bacterial infection". To medics, we all know that bacteraemia cannot be diagnosed without obtaining a blood culture. Essentially, the patient may have MRSA but if the blood culture is not taken by the doctor, they cannot be diagnosed to have " bacteraemia".

The Health Protection Agency lists this article "Quarterly Reporting Results for Clostridium difficile infections, MRSA bacteraemia and GRE bacteraemia"

So the language is particularly interesting. They specify " bacteraemia" not simply "MRSA infection". It is a nice way to hoodwink the public.

So what happens if the blood cultures are not done by doctors?

We go to the NHS Documentation and see what the recommendations are

Blood cultures are taken to identify patients with bacteraemia. There are many signs and symptoms in a patient which may suggest bacteraemia and clinical judgement is required, but the following indicators should be taken into account when assessing a patient for signs of bacteraemia or sepsis:

• core temperature out of normal range;
• focal signs of infection;
• abnormal heart rate (raised), blood pressure (low or raised) or respiratory rate (raised);
• chills or rigors;
• raised or very low white blood cell count; and
• new or worsening confusion.
NB: Signs of sepsis may be minimal or absent in the very young and the elderly.
So if the above symptoms are not present, there is no blood culture. For many elderly patients the above symptoms are not present. For instance, there may be no temperature change or there may be atypical signs and symptoms. It also fails to address the fact that many people don't behave like the textbooks. Each Trust has their own protocols for blood cultures. Put it this way, doctors don't do cultures unless they really have to or to put it another way, they are not encouraged to do so unless it is imperative. The criteria of blood cultures is arbitrary, open to interpretation and without proper guidance or guidelines, it is open to varying subjective assessment.

So if blood cultures were not done, there would be no diagnosis of bacteraemia. If there was no diagnosis of bacteraemia, there would be no record in the government statistics. If there is no record, the government can legitimately say that those aren't MRSA bateraemia cases. For all those patients who have MRSA in their sputum or on their skin or even wound MRSA and subsequently die, are not part of the statistics for the government, yet they all have MRSA infection.

To illustrate the above, my father had MRSA in his sputum, MRSA on his skin, a high white count but because no blood cultures were done, MRSA was not on his death certificate and he is not on the government statistics cited as a " MRSA related death". I wonder how many patients come within this group? I wonder if the actual number of MRSA deaths is much higher than the "bacteraemia" counted up.

It is my view that there is a culture of not recording MRSA deaths by not doing blood cultures. It is quite a clever way of convincing the UK population that we don't have a problem or that the problem is improving. It would be nice to know how many blood cultures are actually done on patients with an "infection". :). I believe the answer would be " very few".

Dr Rita Pal
http://www.ward87.blogspot.com
http://www.nhsexposedblog.blogspot.com

2 comments:

Mark Wadsworth said...

Well, that's one way of getting the numbers down.

Dr. Liz Miller said...

Yes - good article Rita,