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Medical Bacteriology
  1. J Kerr

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P Hawkey, D Lewis, eds. Oxford University Press, 2003, £40.00 (paperback), pp 409. ISBN 0 19963 778 4

Medical Bacteriology, 1st edition (Hawkey and Lewis), is an excellent book and was part of a Practical Approach series published by IRL Press in 1989. This book had chapters on the bacteriology of urine, normally sterile fluids, the respiratory tract, the genital tract, superficial and deep tissue infection, intestinal disease, susceptibility testing, antibiotic assays, reporting and record keeping, quality control, outbreak investigation, and epidemiology. I was given a free copy by an antibiotic representiative while training for the MRCPath examination in microbiology. I read it several times, used it at the bench, added my own notes, and inserted many extra pages. It was a great back bone for the development of practical skills and understanding their importance.

Medical Bacteriology, 2nd edition, again edited by Peter Hawkey and Deirdre Lewis, is a little thicker and larger than its predecessor, with the same chapter and appendix headings. Its “practical approach” is still a central theme and has been enhanced with the use of black text boxes to describe particular protocols. For example, how to perform the Stokes’s method of susceptibility testing using both band and rotary plating methods to standardise the inoculum, and dilution protocols for aminoglycoside assays on the Abbott TDX/FLX analysers. These are useful and highlight the importance of an understanding of the principles of a particular test for the reader. For example, in the case of antibiotic assays that are usually highly automated using specialised machinery, a student would ideally first acquire knowledge of the biochemical basis for the antibiotic assay, and subsequently develop the knowledge of how to work the machine; despite the fact that it is possible to perform the test without an understanding of the rationale.

The chapter on antimicrobial susceptibility testing has doubled in size since the first edition, reflecting in part a greater number of options for susceptibility testing and their automation, and efforts to standardise the approach to antibiotic susceptibility testing in the UK. Automation is discussed in depth, including the fact that automated readers for disc susceptibility testing have become increasingly important, particularly when used in conjunction with the BSAC disc susceptibility method, and reduce errors in transcription, operator variability, and interpretation, while enhancing the epidemiological usefulness of this information. Completely automated susceptibility test methods are also described—for example, systems by Microscan and Vitek. These have been commonplace for over a decade in large North American laboratories, but are not commonly used in the UK. However, with an increasing requirement for the integration of information technology systems within healthcare institutions and 24 hour working in clinical laboratories, there will be an increasing need for these solutions.

In conclusion, despite the fact that this book is now just a little too big to fit into a standard white coat pocket, it is nevertheless a comprehensive, accessible, and eloquent review of those processes essential to medical bacteriology, and as such is still valuable for both students and experienced staff.