A survey of time management and particular tasks undertaken by consultant microbiologists in the UK.

BACKGROUND: Medical microbiology practice encompasses a diverse range of activities. Consultant medical microbiologists (CMMs) attribute widely differing priorities to, and spend differing proportions of time on various components of the job. AIM: To obtain a professional consensus on what are high-priority and low-priority activities, and to identify the time spent on low-priority activities. METHOD: National survey. RESULTS: Many respondents felt that time spent on report authorisation and telephoning of results was excessive, whereas time spent on ward-based work was inadequate. Timesaving could also be achieved through better prioritisation of infection-control activities. CONCLUSION: CMMs should apportion their time at work focusing on high-priority activities identified through professional consensus.

Infectious spondylodiscitis.

OBJECTIVES: To review the available literature on infectious spondylodiscitis and provide recommendations on management, particularly identification of the causative agent and antimicrobial therapy. METHODS AND RESULTS: The medical literature was searched using PubMed, employing the key words discitis, disc space infection, infectious spondylodiscitis, pyogenic discitis, septic discitis and post-operative discitis. Infectious spondylodiscitis is rising in incidence and diagnosis has been facilitated by the availability of sensitive imaging techniques such as MRI. No randomized controlled studies of antimicrobial therapy were identified in this literature search and there appear to be no UK consensus guidelines on investigation and management. Comprehensive French guidelines have been published and were scrutinized for this review. CONCLUSIONS: Unless the patient is severely unwell antimicrobial therapy should be delayed until a microbiological diagnosis is established. If initial blood cultures are negative then a CT-guided biopsy should be conducted. Tentative recommendations for antimicrobial therapy can be made based on theoretical considerations and limited data from uncontrolled studies.

Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre's syndrome.

Human infection with Fusobacterium necrophorum usually involves F. necrophorum subsp. funduliforme rather than F. necrophorum subsp. necrophorum, which is a common pathogen in animals. Lemierre's syndrome, or postanginal sepsis, is the most common life-threatening manifestation. Tonsillitis is followed by septic thrombophlebitis of the internal jugular vein and then a septicemia with septic emboli in lungs and other sites. Recent evidence suggests that F. necrophorum can be limited to the throat and cause persistent or recurrent tonsillitis. F. necrophorum is unique among non-spore-forming anaerobes, first for its virulence and association with Lemierre's syndrome as a monomicrobial infection and second because it seems probable that it is an exogenously acquired infection. The source of infection is unclear; suggestions include acquisition from animals or human-to-human transmission. Approximately 10% of published cases are associated with infectious mononucleosis, which may facilitate invasion. Recent work suggests that underlying thrombophilia may predispose to internal jugular vein thrombophlebitis. Lemierre's syndrome was relatively common in the preantibiotic era but seemed to virtually disappear with widespread use of antibiotics for upper respiratory tract infection. In the last 15 years there has been a rise in incidence, possibly related to restriction in antibiotic use for sore throat.