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September 25, 2014

Say Yes to the DRESS

The bane of my SSI (surgical site infection) existence is P. acnes and summertime. I suppose that should be the banes of my existence. 

Summertime always sees a spike in wound infections, especially those that occur 3-4 weeks after surgery and are usually S. aureus.   My brilliant idea (as are all my ideas) is to use SMS/Texting to remind patients about proper wound care after discharge. SMS has been effective in getting people to be more compliant with their adherence (or is it adherent with their compliance) for taking medications. Why not use the technology to improve post operative wound care?  Seems an excellent idea to me.

P. acnes is going to be less amenable to amelioration, ...

Posted By: Mark Crislip  

September 23, 2014

In Medicine You Can Never Know Enough

I work hard to keep up in ID. For my Puscast I skim at least 2000 (yes, that's two thousand) titles a month, download and read about 180, end up discussing around 40. Then there are the references in this blog and the half dozen times I search PubMed or Google every day to answer the questions that pop up from consults or curbsides. And it is still not enough. It is never enough.

Case i...

Posted By: Mark Crislip  

September 19, 2014

Angsty Doubt

I do a lot of driving as part of the job and it is Audible books that make it enjoyable. Sometimes it even makes me a better driver as I slow down so I can finish a chapter. Most of my 'free' time is spent writing and if it was not for Audible I would get very little reading done.

I started a new book today that looked very promising, The Minotaur Takes a Cigarette Break, where...

Posted By: Mark Crislip  

September 17, 2014

Bare Foot in the Garden

The patient is a middle aged male walking barefoot in the backyard when he stepped on a three tined garden claw. It almost went all the way through the foot, tenting the skin on the top. Gives me the willies just thinking about it. The claw had been used for spreading compost in the garden. He had claw removed, the foot cleaned ,and was given amoxicillin-clavulanate.

The foot did not ge...

Posted By: Mark Crislip  

September 16, 2014

Grumpy and Getting Worse with Age

I am having more senior moments. Word finding is more of an issue. I just stop mid-sentance because I cannot find the word I want.  The other day I was picking up my son at a meeting and going down the steps tpo leave and I opened the door to the janitors closet rather the front door of the building I was exiting. That led to no end of amusement on the part of my son.

Another sign ...

Posted By: Mark Crislip  

September 11, 2014

Uncertain Certainty

Life used to be simpler. In the old days I often had no idea what was going on in a patient. I mean nothing. Not a clue. I knew they were ill, that they probably had an infection, but I had a limited number of diagnostic and therapeutic options.

I have mentioned in the past that my first consult in practice died and at autopsy had cardiac aspergillus. I may have made that diagnosis...

Posted By: Mark Crislip  

September 8, 2014

Why? How Long?

The diagnosis is not in question. A right middle lobe lung abscess. The patient had been ill for about a month with mostly fatigue and weight loss, and given the size of the abscess, almost 6 cm across, it had been there for a while. Cultures grew S. anginosus, on of the milleri group of abscess causing Streptococci.

The question that is at issue is why. Dentition is not th...

Posted By: Mark Crislip  

September 3, 2014

Past TB. Current Treatment?

There was a time before antibiotics, when all the physician could do was support the patient and watch the patient get better or not.

70 years ago the patient developed TB, probably from a family member. He tells me that he went to the doctor every week for a chest x-ray and blood work. That is a lot of radiation to a kid and as an adult he developed a non-Hodgkins lymphoma. Related...

Posted By: Mark Crislip  

August 29, 2014

Man Oh Man

The patient is an elderly female with the usual medical problems of age: diabetes, obesity, hypertension, chronic renal insufficiency and a pacemaker.

She has chronic, severe, lymphedema and comes in with fever and chills to another hospital. Cellulitis is the diagnosis and she rapidly improves on cefepime. The blood cultures grow Acinetobacter baumannii. Not high on list of...

Posted By: Mark Crislip  

August 27, 2014


The patient has end stage liver disease with all the metabolic complications: elevated bili, low albumin, coagulopathy and ascites.

She is on a quinolone for SBP prophylaxis and comes in with fevers, diarrhea and abdominal pain. C. difficile toxin is positive. Not too much of a surprise since few antibiotics drive superinfections like quinolones. They are great ...

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 on Amazon as The Puswhisperer, Volumes 1 and 2. Really. Perfect for the pus lover in your life.
Because The World Needs More Mark Crislip (tm).

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.

    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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