Infectious diseases and AMR
Microbiological tests for the diagnosis of sepsis and bloodstream patients can save lives: Lali's story
The NICE guidance on Sepsis (2024) recommends taking blood cultures in patients with moderate to high risk for sepsis, assessing using risk factors and the national early warning score (NEWS).
Not feeling quite right
Lalitha Ratnaraja, 82, loved to swim three times a week at her local swimming pool and was an avid traveller, going abroad at least once a year.
One day when out with friends, Lali felt a twinge of chest pain. Thinking it was musculoskeletal she carried on with her day. When the pain didn’t go, that evening she rang her daughter, a doctor. “I just felt a bit unsteady on my feet”, said Lali, “just a bit out of puff”.
Feeling that Lali was not well, her daughter drove her to her nearest emergency department.
A&E was busy; Lali and her daughter had to wait four hours to be triaged. Waiting allowed Lali’s daughter to observe her mother, “Mum sat there very quietly and hardly spoke. I was worried”.
When Lali was seen, she was put in the high-risk group for sepsis. The triage nurse quickly found her a trolley. A doctor took blood cultures and a chest Xray. Lali was admitted to hospital on intravenous antibiotics. “I was a bit scared” she said, “but I knew I was in safe hands”. The chest Xray showed extensive right sided pneumonia. Lali was kept in hospital for initially for “one” more night.
The laboratory diagnosis
The next day was a public holiday, but clinical microbiologists were still working. With the availability of rapid tests, the team identified the organism (Streptococcus pneumoniae) and had a full antibiotic susceptibility profile the same day. This meant the team could give Lali more targeted antibiotics, making it less likely she’d develop drug resistance or a gut infection. Her daughter said, “Mum was really unwell but knowing we had an organism and was on the right antibiotics provided some comfort”.
Sadly, Lali’s pneumonia led to complications, developing pus around her lung which required a chest drain. The infection also spread to her wrist and thumb, causing a small pocket of pus. On top of this, she picked up another infection in hospital, so her antibiotics had to be changed for a while. “The antibiotic they changed to still covered the Streptococcus pneumoniae” said Lali’s daughter. “I felt reassured that her bloodstream infection was still being treated.”
A targeted recovery
Lali eventually spent nearly eight weeks in hospital and needed rehabilitation afterwards. “I feel eternally grateful to the hospital for treating me so well” she said. “If it weren’t for them, I wouldn’t be alive today”. Her daughter added “Because the team followed the sepsis guidance and took a blood culture, the clinical team knew what antibiotic to treat my mum with, and what complications there might be. Without it she may have remained on broad spectrum antibiotics for the duration of her treatment.”
The initial blood cultures helped guide treatment options for Lali throughout her journey. Without them, Lali’s pneumonia and other infections would have been treated with broad antibiotics to cover all possible germs, without knowing exactly which one caused the illness. This prevented hospital associated complications for Lali, ensuring that she didn’t have to stay in hospital for longer than was necessary.
Hospital level care and testing; where it is needed most; Sam's story
Hospital at Home care, combined with point of care testing, provides an alternative solution to potentially stressful hospital visits for the elderly.
The NHS is increasingly introducing virtual wards (also known as Hospital at Home) to support people at the place they call home, including care and nursing homes, where patients can get the care and testing they need at home, safely and conveniently, avoiding potentially stressful and lengthy hospital stays.
The point of care testing devices used by the Hospital at Home team are supplied and governed by healthcare scientists with specialist skills to ensure that results are accurate, giving the team confidence and trust in the devices they use every day.
A marked decline
88-year-old nursing home resident, Sam Wise, enjoyed spending his time with fellow residents in the common room and particularly looked forward to sharing his mealtimes with his friends. However, when Sam came down with a bad cough, he deteriorated quickly, becoming much frailer and was quickly unable to leave his room.
Sam was initially prescribed oral antibiotics but after ten days it was clear there was no improvement in his symptoms. Sam was keen to avoid attending hospital clinics, concerned the hospital visit might result in a potential overnight stay in an unfamiliar environment. Staff at the nursing home became increasingly concerned that Sam’s symptoms were getting worse.
Hospital at Home provides an alternative solution
Sam was referred for IV therapy through the Hospital at Home team to manage his chest infection. The team were able to perform point of care testing for blood CRP, a marker that indicates whether the patient has a viral or bacterial infection. The CRP result indicated the patient did not have a bacterial infection, explaining why the antibiotics had not been an effective treatment. The Hospital at Home team immediately stopped the antibiotics and prescribed antiviral treatment.
Care and recovery, in comfort at home
By providing hospital level care at home, Sam’s request for no hospital admission in his personalised care plan was prioritised and the point of care tests permitted immediate targeted treatment, avoiding further unnecessary antibiotic treatment.
After the treatment, Sam quickly recovered. He was once more back to feeling his old self. Sam was soon able to return to the common room activities and once again enjoy his favourite pastime of sharing a meal with his friends and fellow residents.