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December 12, 2016

You woke me for for THAT ?!?

I have basically been on call since 1990. Except for weekends and vacations, the beeper is on. It is one of the reasons I refuse to use my phone as my primary contact for work: I can turn off my beeper but I cannot turn off my phone and I do occasionally want to escape medicine.

I never mind getting  called because I figure there really is no such thing as a stupid question. Someone needs help? They need help.


Beeper goes off at 1am. It s the ER.

The patient was sent sent in for treatment of an MRDO, er, I mean MDRO multi-drug resistant organism, in the urine.

No symptoms. No pyuria.

I said: don't treat asymptomatic bacituriua.

The urine is dark.

That's not a symptom, it's a sign. Don't treat asymptomatic bacti...

Posted By: Mark Crislip  

December 7, 2016

Common and Not So Rare?

The patient presented as a fall due to urosepsis with a pan sensitive E. coli.

E. coli bacteremia is a common enough problem, at around 30-50/100,000 population, so the US has around 150,000 cases a year.

The nice thing about E. coli urosepsis is while it may kill the patient up front (that’s not the nice part) it has little predilection for caus...

Posted By: Mark Crislip  

December 5, 2016

Late Relapse

The patient, an elderly male, had sustained enterococcal bacteremia.

He had the 4 star work up: CT and TEE and no source found. No abscess, no vegetation on the valves, no clot on the pacer.

There are cases of enterococcal pacer infections. I count two on PubMed. But there are cases of everything causing an infection and Enterococcus is not high on the list and taking o...

Posted By: Mark Crislip  

November 30, 2016


The patient has ESLD and recurrent ascites. She requires a paracentesis every week to keep the fluid at a manageable level.

She is admitted for a TIPS and a tap show a jump in white cells to 350. SBP is a worry and two days later the cultures grow?

Candida glabrata.


SBP suggests either hematogenous seeding of the ascites or translocation of bacteri...

Posted By: Mark Crislip  

November 28, 2016

Antibiotic Anger

I do not suffer from road rage. I do spend a lot of time in the car going from hospital to hospital, but I listen to Audible as I drive. I am half way through The Wheel of Time, a 15 volume epic and listening to the trials and tribulations of Rand et. al' Thor (Wheel of Time joke) keeps me mellow. And Audible makes me a better driver, since I don’t speed to prolong ...

Posted By: Mark Crislip  

November 23, 2016

Another Odd Bug in an Odd Place

The title sums up one aspect of an ID practice, second only to making the diagnosis before anyone else on the list of what makes ID fun.  Yeah, I am that petty and competative.

The patient is a mostly healthy middle aged male who has a growing red, hot, tender bump on his abdomen.

Urgent care rightly suspects MRSA and gives TMP/Sulfa.

It doesn’t get better.</p...

Posted By: Mark Crislip  

November 21, 2016


The consult was a diverticular abscess in an otherwise healthy male

Cultures from the IR drainage were the usual: an alpha strep and an E. coli susceptible to everything but quinolones.

The patient was on 250 qid cephalexin.


After 31 years in the biz I have tonnes of facts in my head, many of which are of uncertain provenance. Especially in the pre-...

Posted By: Mark Crislip  

November 16, 2016

Recurrent Uncertainty

I think, of the common infectious diseases, cellulitis is the most straight forward.

Not that you suspect it from the way so many approach the disease, fretting about MRSA and Pseudomonas and giving vancomycin and pip/tazo.

And don’t get me started on how often lymphedema is called cellulitis.

Here is a semi sort of classic case of cellulitis with a twist or two.</...

Posted By: Mark Crislip  

November 14, 2016

Always Ask Why

One man is born a hero, his brother a coward. Babies starve, politicians grow fat. Holy men are martyred, and junkies grow legion. Why? Why why why why why why? Luck! Blind, stupid, simple, doo-dah, clueless luck!

~Harvey Dent

Bugs require an explanation. It you have organism X in space Y, you need a reason. Th...

Posted By: Mark Crislip  

November 9, 2016

Twists and Turns

I discussed a case of C. dubliniensis endocarditis back on 9/12. Some more twists and turns on the case.

The patients disease was community acquired. I think. However his girl friend also had endocarditis with the same MRSA. Not a surprise, Staph often runs in families.

But the girlfriend had a new fever while visiting him in the hospital and her blood cultures grew <em...

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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