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February 21, 2018

Can't Fight Evolution

The patient is a recalcitrant IVDA who keeps leaving the hospital before she completes a course of antibiotics for her TV MRSA endocarditis.

That is putting it mildly. The most she has stayed in hospital is 10 days, usually averaging 4-5 days, just until her fever resolves, when she needs to answer the siren call of heroin.

The result has been evolution in action. Each admission the MIC to vancomycin has inched up from .5 to 1 to 2 and now it is 4.

She is kind of a human Mega-Plate.

Now the question is treatment. Vancomycin is out.

Daptomycin seems reasonable, but I worry we will breed resistance ever faster to this antibiotic.

Among daptomycin-susceptible MRSA isolates from patients who had never received daptomycin, hig...

Posted By: Mark Crislip  

February 19, 2018

Blind Pigs and Acorns

The patient has short bowel requiring TPN and is pacemaker dependent.

Given the nature of this blog you likely have a vague sense of foreboding, knowing that this could be bad combination since I lead with that information.

It was.

She became fungemic with C. albicans and her line was removed without a resolution of the fungemia. Evaluation of the valves and pac...

Posted By: Mark Crislip  

February 14, 2018

Why so cereus?

I got an invite today that I had to not so respectfully decline. The makers of ceftazidime-avibactam (currently $342 a dose) are having a speaker at Mortons (where the cheapest steak is $59) to discuss their product. I entered the speakers name into Dollars for Docs. As of 2015 he has received $693,000 in payments from drug companies. Whoa. Probably close to a million my now. I guess academia j...

Posted By: Mark Crislip  

February 12, 2018

Nutri-Matic Medicine

Sometimes I think people take a course before being admitted to hospital called How to Tell Your Doctor Everything that Does Not Matter but Nothing that Does. But it seems people excel at telling me information that has nothing what so ever to do with the issue at hand. It seems to be getting worse of late, perhaps due to all those commercials telling us to talk everything over with ou...

Posted By: Mark Crislip  

February 5, 2018

Odd Odd

There are common presentations of common diseases, odd presentations of common diseases, common presentation of odd diseases and, what you never want to be, is the odd presentation of an odd disease.

The patient is young and healthy who presented to his primary doctor with shoulder pain in his dominant arm. Maybe, just maybe, he might of tweeked it playing softball. But zero medical pro...

Posted By: Mark Crislip  

January 31, 2018

January Haiku

the literature

summed up in 5-7-5

what more do you need? 

hepatitis e

causes encephalitis

a pig liver curse

resistant gc


Posted By: Mark Crislip  

January 29, 2018

I never meta static infection I liked

The patient is admitted with pneumonia. It was a biphasic illness, a week of fevers, myalgias, headache, and dry cough that resolved for about three days, enough to return to work. Then it came back with a vengeance, more chest pain, the cough now productive.

He is admitted with a nice, consolidated, lobar pneumonia and pneumococcal bacteremia. Certainly been there, doing that this year...

Posted By: Mark Crislip  

January 24, 2018

Second Degree

The last 48 hours have been, lets say, interesting for a grumpy old man who increasingly only wants to kevtch.

A couple of months ago I mentioned that I have resting richard face. At the time I said I wasn't angry or upset, it is just that my baseline expression is to scowl. My dad was the same way.

Now I am not so sure. Sometimes, ...

Posted By: Mark Crislip  

January 22, 2018


Any sufficiently advanced technology is indistinguishable from magic.

Arthur C Clark

Not really true, I kind of agree with Technology isn't Magic: Why Clarke's Third Law always bugged me.  But ID has always seemed so 18 century. Agar plates, serology’s, and,...

Posted By: Mark Crislip  

January 17, 2018


Fashions come and go in medicine, and I am not talking sartorial.

At some point this century the abbreviation for pneumonia became pna. PNeumoniA?!? Really? It occurred about the same time people started spinning their pens on the thumb, a nervous habit unknown when I was in medical school. This skill is likely to bec...

Posted By: Mark Crislip  

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About This Blog

For the Benefit of Mr Kite, there will be ID tonight. Infectious Diseases! Antibiotics! Viruses and Bacteria and Fungi! Oh my! Exclamation marks!!!!!! No trampolines, nor will any band be playing at 10 to 6. And Henry the Horse died of the Strangles. Sorry. That's the problem with infections.

The endless excitement that is the daily practice of Infectious Diseases in a Portland teaching hospital! The need for meta data!

Every day I make infectious disease rounds in the hospital and see at least one cool case or learn something new. 25 years and I still do not know everything. Why be selfish and keep all of that wonder and knowledge to myself? This blog will be a mostly qod account of days events, a cool ID case, a referenced pearl, and a minimum of 1 horrible, yet ultimately feeble, attempt at humor.

While usually written in the present tense, the cases are not necessarily current and all identifying information is altered or obscured as long as it is not absolutely pertinent to the case. Can't have a female with prostate infection for example.

I write these at night or in spare moments. There is always someone who will quibble about spelling, punctuation or grammar. My response is live with it. It's a blog, not Mandel.

Read and listen to more of me at my multimedia empire linked below.

The first 2 years blog posts have been collected and edited and are available as The Puswhisperer, Volumes 1 and 2. Really. Perfect for the pus lover in your life.
Because The World Needs More Mark Crislip (tm).
Flies in the Ointment: Essays on Supplements, Complementary and Alternative Medicine (SCAM).
A carefully selected and edited compendium of my best blog posts from The sections have been edited for redundancy, updated for 2017, and classified into themes including my influenza rants.

All on Amazon.

Disclosure: Mark A. Crislip, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Pusware LLC
Have a 5% or greater equity interest in: Pusware LLC (owner)

  • Mark Crislip

    Mark Crislip, MD, has been practicing in infectious diseases in Portland, Oregon, since 1990. He is nobody from nowhere, but he has an enormous ego that leads him to think someone might care about what he has to say about infectious diseases. And so he blogs and podcasts and writes on the most endlessly fascinating specialty in all of medicine. Links to his multimedia empire of blogs, podcasts, books, apps and tweets can be found at

    Mark A. Crislip, MD, has disclosed the following relevant financial relationships: Owner, Pusware LLC. He as not talked to a drug rep in over 25 years and does not even eat the pizza provided at conferences. But he is for sale for the right price. Please. Someone. Buy me.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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