for the time being, this is my VERY PRECIOUS possession -- data ESBL ku, and my thumbdrive utk ku simpan data. Hilang salah satu, mau aku menangis nanti huwarghhh
"CTX-M type ESBL" is my other 'passion'..
triple disc = can u see the 'keyhole phenomenon'?? that's ESBL +ve E.coli [keyhole phenomenon = zone of enhancement due to presence of clavulanic acid]
routine antibiotic sensitivity testing (AST), keyhole phenomenon between Ceftazidime and Augmentin discs (the 2 discs on the top) = also indicates ESBL +ve
this is my 'suspected' strain - sensitive to Ceftazidime (CAZ) but Resistant to Cefotaxime (CTX) on routine AST. When i did the triple disc test (using both CAZ and CTX disc against Augmentin (AMC) disc in the middle, this was the results = no 'keyhole' between CAZ(left) & AMC(middle), in fact CAZ seems to be sensitive, whilst between CTX (right) and AMC, the enhancement is obvious = indicates ESBL +ve. Maybe it's CTX-M???? hmm.. i'm about to find about it
so to find about the CTX-M types ESBL, these are what i need to do starting January 2009 until December 2009 -
i have to collect all ESBL-producing E.coli and Klebsiella spp. strains (confirmed and suspected strains based on CLSI Guidelines),
then do confirmation test (using triple disc test [as above] and/or combination disc test] for phenotypic characteristics,
then genotypic testing with PCR to look for CTX-M gene and also their groups.
I'm really looking forward for this project but it really really takes my time... there're plenty of works to do..
from searching every request forms for all E.coli & Klebsiella spp isolated from ALL SAMPLES (has to be done almost everyday or the max once in 3 days),
to searching the plates for strains collection,
to keeping the strains in the TSB,
to resub the strains for further testing including disk diffusion test, DNA extraction and finally the PCR...
then i need to enter all the patients' datas (including the non-ESBL E.coli & Klebsiella spp for prevalence purposes)
[but thanks a zillion to adik-adik MLT ku yang sudi membantu - Putri & Ain, yang kadang2 ku suruh diorang sub and simpan kan strain-strain berharga ku itu...]
-- nway, it still makes me exhausted even before the project reach its halfway... plus my condition lately- strucked by 'kepenatan' & 'kemalasan' tahap maxima.... cam nak give up je... BUT.. i can't. WHY??
becos it's my thesis project meaning 'WAJIB" and
also becos it's may passion.. i love to do it.. i'd like to know our own prevalence of ESBL in PPUKM as well as in Malaysia. There are very few research done in M'sia about this (to date), so i want to be the first to discover CTX-M type ESBL in M'sia (or at least in PPUKM).. hmm.. wish me luck.. (takut PCR tak jalan je, touch the wood!)
On the 18th April, i went to a launching symposia for "ESBL consensus" in One World Hotel.. with the topic: "Use & Abuse of Antimicrobials : Are we Getting What We Deserve?" -- speakers were: Prof Dr. K.E Lim, Dr. Christopher Lee (ID from Sg Buloh Hosp) and a guest speaker Prof Dr. (aramak forgot his name sorry! Nnt update balik)
the talk was very informative - and updates to the current issues on ESBL. And most importantly, the new consensus for all doctors/clinicians in managing ESBL infections in Malaysia.. 'please clinicians, use your antimicrobials wisely, we dont want to end up with no antibiotics to treat infections with this multidrug resistant organisms in the future'
teman-teman seperjuangan tgh khusyuk
finally, abis launching, dinner kul 10.. pulun makan tak hingat apa, mana taknye, lapo sehh....
balik around 11pm, tp ku hanya menumpang orang, TQ!! Sampai rumah, bebudak comots dah ZZzzz, so pas solat isyak, diri ku pon terus tumbang walaupon perut masih penuh dgn juadah 'supper' yang sgt heavy buat malam itu, rezekii kannn. Alhamdulillah tak heartburn :D. Penat tul satu hari tu sbb pagi gi Pesta Buku kat PWTC (free Lunatots CD punya pasal), pastu balik2 je dah ke symposium ni plak...
actually ada video masa launching, tp takleh nak upload plak.. kewrlll gak 'launching' dia..
sorry if some of u dont understand the terms used in this entry. If i explained everything here, it'll take me more than half day to explain and maybe few days for u to understand