Going the Extra Mile in Clinical Microbiology
Just before Christmas, the SGH Diagnostic Bacteriology blogger put up a post on how to isolate Group B streptococcus (GBS) from raw fish samples. SGH Department of Pathology used to have a Food and Water Microbiology Lab, but that was closed several years ago, before the move to the new Academia building. The clinical microbiologists and technologists at the current laboratory deal with human clinical samples almost exclusively. The effort to culture GBS from a non-human source is not trivial, and in fact, most clinical microbiology laboratories in Singapore (certainly all the private laboratories) would not have bothered, notwithstanding the need to identify the source of the GBS outbreak. It is someone else’s (i.e. NEA and AVA laboratories) problem.
This is perhaps the most recent and dramatic example of clinical microbiologists from SGH going the extra mile, but there’s been a long history of it, including – just from the past two years:
- Looking for carbapenem-resistant Enterobacteriaceae from hospital sewage.
- Figuring out how best to diagnose and speciate microsporidia from eye specimens, and looking through local sports fields for their presence.
- Swabbing ward sinks and the hospital environment for extremely drug-resistant (XDR) Pseudomonas aeruginosa. Done beyond the call of even infection control duties.
- Figuring out that “parasite egg-like” particles in a patient’s stool sample were actually fungal spores from his lingzhi pills.
…and the list goes on.
These activities raise several interesting and troubling issues, especially for the bureaucratically-minded, including:
- Are the microbiologists wasting institutional resources?
- Are they negatively impacting the bottom-line of the microbiology laboratory?
- What should be the extent of a clinical microbiologists’ job scope?
- Should such a culture be preserved or limited?
Whatever. Sometimes it may be best to take the longer view of things. I for one – having worked in a number of hospitals both public and private in Singapore – consider the SGH clinicians privileged to have the services of such microbiologists. This may well also be a passing phase – it is entirely possible that future generations of clinical microbiologists will no longer go to such lengths (or will be granted the independence to do so) in pursuit of their craft or to get to the bottom of a clinical mystery. And that would be a shame.