S01E3: What is microbiology?

Hosted by RCPA Vice President, A/Prof Trishe Leong, Micro Waves is a spin-off podcast series aiming to educate and grow awareness of the pathology career. In the third episode, we explore the work of a Microbiologist and speak with Dr Caitlin Keighley on this critical area of medicine. 

Transcript

00:00:00:14 - 00:00:09:06

[Dr Caitlin Keighley]

Microbiology is important to know because what's there could be harmless to you or it could kill you in the next 24 hours.

00:00:15:03 - 00:00:21:08

[A/Prof Trishe Leong]

Associate Professor Trishe Leong. I'm an Anatomical Pathologist and I'm the vice president of the Royal College of Pathologists.

00:00:24:06 - 00:00:29:04

[Voiceover]

Find your path to pathology with the RCPA Micro Waves podcast.

00:00:33:07 - 00:01:08:07

[A/Prof Trishe Leong]

Everyone, and welcome to another RCPA Microwaves podcast. I'm Associate Professor Trishe Long I'm an anatomic pathologist and I'm also the vice president of the Royal College of Pathologists. And today, I'm delighted to speak with Dr. Caitlin Kelly. Dr. Keeley, is a microbiologist and infectious disease physician. She has worked across Australia. You have really worked across Australia, Caitlin, because the only state you haven't worked in I think is Western Australia, otherwise Queensland, Northern Territory, A.c.t., South Australia, Tasmania and now New South Wales.

00:01:08:07 - 00:01:10:13

[A/Prof Trishe Leong]

You are collecting the set.

00:01:11:02 - 00:01:15:11

[Dr Caitlin Keighley]

Yeah that was the aim, actually. I did some student elective time im WA

00:01:17:07 - 00:01:45:12

[A/Prof Trishe Leong]

Ticked it all off. Caitlin is active in the sphere of antimicrobial resistance research. In 2019 she received an RCPA Foundation research grant to investigate antibiotic resistance in Candida Tropicals, and this project looked into using whole genome sequencing to identify genetic differences. She's also a contributor to the Wollongong Anti-Microbial Resistance Research Alliance, which some of you may or may not know better as WARRA.

00:01:46:03 - 00:02:09:10

[A/Prof Trishe Leong]

I like a good acronym. Caitlin has a full life outside the laboratory too, and when she's not working you might find her running, cycling, practicing kung fu, Latin dancing or playing the violin. Dear listeners, for the purposes of balance, I feel I should say that when you when I'm not working, you may find me sitting on the couch eating fried food, watching Netflix or staring into space.

00:02:10:00 - 00:02:22:09

[A/Prof Trishe Leong]

So now I think we have we have covered the full spectrum of pathologist recreational activitie.s Caitlin, welcome and thank you for coming on the Micro Waves podcast.

00:02:23:01 - 00:02:24:04

[Dr Caitlin Keighley]

Thank you very much.

00:02:25:03 - 00:02:38:13

[A/Prof Trishe Leong]

So the kick off question which I ask everyone and you know, I don't know, I'm waiting for someone to maybe I'm waiting for someone to slip up? But tell our listeners, what is pathology from your from your perspective?

00:02:39:12 - 00:03:09:10

[Dr Caitlin Keighley]

Pathology is the scientific basis of medicine. It is the basis of diagnosis and facilitates treatment, determines outcome. And for infections, it facilitates prevention of transmission and outbreaks. And there is power in diagnostic certainty. The testing allows refinement of syndromic medicine. Pathology sharpens the approach. In Australia, we have one of the best laboratory systems in the world, and it's because we have constantly evolving standards, quality systems.

00:03:09:10 - 00:03:20:07

[Dr Caitlin Keighley]

And every lab has to have a medically qualified pathologist within a discipline. And for me, it's the best bits of clinical medicine I love the problem solving and making a diagnosis.

00:03:20:14 - 00:03:41:08

[A/Prof Trishe Leong]

That's great. How about your your particular discipline, microbiology? You know, you guys you guys are the rock stars at the moment, I think when we were pre-pandemic, he said. You know, you talk about pathology. Everyone thought you were talking about blood tests. Now, probably everyone thinks you're talking about no swabs. I'm What can you tell for the purposes of people who've been living under a rock?

00:03:42:03 - 00:03:53:02

[A/Prof Trishe Leong]

Can you tell us a bit more about microbiology and what what it is that you do and and how you sort of look? What's your place in the whole medical system? In the pathology system?

00:03:54:00 - 00:04:39:00

[Dr Caitlin Keighley]

Yeah, absolutely. Well, during COVID, this best explains it. Microbiology is the diagnosis of any infection. So viruses like COVID, bacteria like Staphylococcus aureus, fungi like Candida and parasites like malaria. Microbiology is important to know because what's that could be harmless to you or it could kill you in the next 24 hours. So for example, bacteraemia is more lethal at 30 days than a myocardial infarct. Pay attention when you get a call with a Gram stain result from blood cultures!

00:04:39:14 - 00:04:57:01

[A/Prof Trishe Leong]

And I mean, obviously then you must work pretty closely with, with your clinical colleagues and you're actually a dual trained doctor as well, your infectious disease physician as well as, as well as a microbiologist. How do those two of those two sides of the coin interact?

00:04:57:14 - 00:05:22:00

[Dr Caitlin Keighley]

Yeah, yeah, absolutely. Well, with other, um, pathology disciplines, we share specimens. So for example, when someone has a lung, that, that specimen will go to his pathology where they might find a cancer. And that's probably what they were looking for. And hopefully the specimen will also go to microbiology to look for an organism because occasionally, it's not cancer, it's actually Cryptococcus, which is good news for the patient!

00:05:23:02 - 00:05:53:08

[Dr Caitlin Keighley]

And certainly, you know, without a pathology system, they work together to arrive at a diagnosis outside of pathology. It's inextricably linked to other specialties, both microbiology and infectious diseases. And they provide a unique window into patient's lives. And that's because, you know, people acquire infections because their immune system isn't optimal. So they might be haematology patients, cancer patients or diabetics or because of something they've had done.

00:05:54:01 - 00:06:17:13

[Dr Caitlin Keighley]

So they might have a prosthetic valve or prosthetic joint. Because of where they've gone, their travel. Who they've been around, so that you know, whether they've been around animals or insects or who they've been with. So, you know, their sexual history is relevant or whether they're around little kids. So in that way, you know, it it links with other pathology disciplines.

00:06:17:13 - 00:06:23:09

[Dr Caitlin Keighley]

It's inextricably linked with other specialties in medicine, both across internal medicine and surgical specialty.

00:06:24:00 - 00:06:42:07

[A/Prof Trishe Leong]

So, of course, you know, we can't let you get through this interview without talking about COVID. Sorry. Can you maybe give us a snapshot of what your experience has been like over the last two years with the COVID pandemic? As a microbiologist?

00:06:43:13 - 00:07:23:08

[Dr Caitlin Keighley]

Yeah, absolutely. It's been an incredible and at times exhausting experience, across the lab and across infectious diseases, in every area of clinical medicine involved. Yeah there were new things every day. And it involved at times, working close to around the clock and providing this unique cross-section across the lab. And you know, how things work from the point of the patient arriving and collection all the way through to really revolutionizing, result delivery and, and all, all of those post-analytical processes.

00:07:23:14 - 00:07:34:00

[Dr Caitlin Keighley]

There was a lot that was made possible in pathology and across medicine that was expedited because of code that hadn't been possible previously.

00:07:34:06 - 00:07:59:00

[A/Prof Trishe Leong]

Yeah. I mean it's, it has been fairly ghastly. But on the other hand, we agree we've advance things in ways that we hadn't really even thought about before. Before 2020. Yeah. So under normal circumstances, when we're not in the middle of a pandemic crisis, what would you know in 2019, what did you do? What does did a day of a microbiologist look like?

00:07:59:09 - 00:08:02:04

[A/Prof Trishe Leong]

What's a typical day for you?

00:08:03:04 - 00:08:35:02

[Dr Caitlin Keighley]

Yeah, absolutely. Well, you know, in the microbiology lab itself with the culture readings, I would advise on processing what is significant and you know, how to work it up in terms of, achieving an identification of different bacterial isolates or fungal isolate, uh, handling results. So blood culture results, uh, culture results from sterile thoughts, serology results and explaining these to clinicians and ensuring that handled with the urgency they warrant and providing clinical advice on further steps.

00:08:36:02 - 00:09:05:08

[Dr Caitlin Keighley]

Involvement in quality processes and monitoring, test quality and troubleshooting when there is an indication that, um, something isn't going as it should be. Quality improvement projects, review of policy, and that includes inside the lab, OH and S. Also testing strategies for different kinds of infections, updates on new pandemics and what's going around.

00:09:05:10 - 00:09:29:07

[Dr Caitlin Keighley]

You know, there's been COVID, but then there's also been monkeypox, Japanese encephalitis virus. That's the new langya virus. There's always something new to be on top of, uh, handling phone calls, the questions from clinicians about what tests to order, what tests mean, how to manage infections when they've been diagnosed involved in the lab in developing new tests.

00:09:29:07 - 00:09:46:09

[Dr Caitlin Keighley]

Because there's something always that we need to keep on top of. There's always something new that we need to test for in microbiology. Uh, involvement with the hospitals in their antimicrobial stewardship and infection control, uh, involvement with the uni in teaching students and assessment and involvement in research.

00:09:46:11 - 00:09:49:09

[A/Prof Trishe Leong]

That's quite, quite a range of activities.

00:09:50:06 - 00:09:52:02

[Dr Caitlin Keighley]

It is. It's very varied.

00:09:52:05 - 00:10:09:07

[A/Prof Trishe Leong]

Well, I'm I mean, as you mentioned before, some of the diagnoses that you make can make a real difference to patient care and, you know, and, and their treatment Do you have a particularly memorable patient experience or interesting case that you could share with us?

00:10:10:11 - 00:10:37:06

[Dr Caitlin Keighley]

Yeah. I mean, there are so many every, every blood culture for example, is an episode where you can really turn it around and you can target therapy to something that will likely produce a cure. Um, but the, the memorable experiences was when someone had, um, endocarditis and had prolonged fevers and was nonresponsive to standard therapy for endocarditis. And we managed to demonstrate Bartonella henselae as the cause of the endocarditis on culture.

00:10:38:01 - 00:11:06:09

[Dr Caitlin Keighley]

Um, which is, which is a challenging thing to do. Um, another one was a woman who'd had months, years of haematuria and pain. She's actually Australian, but had previously travelled to the Philippines, and she had MTB, a genital, urinary infection. Lots of examples of Cryptococcus, pulmonary and central nervous system infection. Much more common in the indigenous community than non-Indigenous.

00:11:07:01 - 00:11:09:00

[Dr Caitlin Keighley]

For reasons, we're yet to fully explore.

00:11:09:13 - 00:11:17:12

[A/Prof Trishe Leong]

It must be very satisfying to solve that diagnostic mystery. As well as, you know, knowing that you're making a real difference to curing the patient.

00:11:19:04 - 00:11:25:08

[Dr Caitlin Keighley]

Exactly. Well, put. And I would say, you know, is microbiology when you find an answer, you're really finding the cure.

00:11:25:12 - 00:11:26:14

[A/Prof Trishe Leong]

Mm hmm.

00:11:27:06 - 00:11:29:12

[Dr Caitlin Keighley]

Because then you know what to treat them with, they usually get better.

00:11:30:06 - 00:11:43:07

[A/Prof Trishe Leong]

Hmm. So how did it I mean, how did you get into microbiology? Did you like to play in the mud as a kid? Did you have a life-threatening septic experience? What drew you to it?

00:11:44:03 - 00:12:21:09

[Dr Caitlin Keighley]

YeahI always had this question, even from early high school, I was interested in, why people get sick? For me, when people get sick, it was an infection. Why people get an infection and what you do about it when they've got an infection.  I had a formative year. 12 project experience looking at igA levels in full either pre and post exams and my first foray into into diagnosing infections. I suppose microbiology and infectious diseases was the reason I went into medicine.

00:12:24:00 - 00:12:38:13

[A/Prof Trishe Leong]

What traits do you think are important if someone's looking to become a microbiologist? I mean, you want to obviously you want to make sure that your person, your personality and your sort of skill set is right. If you're looking at going into a particular job.

00:12:40:07 - 00:13:10:12

[Dr Caitlin Keighley]

Yeah, absolutely. I would say that there are probably three things that are really important for a microbiologist. Number one is communication because it's so inextricably linked to the other. Yep. Um, that excellent and collaborative communication is super important and being able to rely on the importance and the urgency of results and what to do next. Because it's an area that's always changing a thirst for knowledge is important.

00:13:10:12 - 00:13:25:02

[Dr Caitlin Keighley]

There's always something new. Eternal curiosity is helpful. Good organisational skills because the role is so varied in, in what you need to do and what you're involved with. That's very helpful.

00:13:25:11 - 00:13:39:08

[A/Prof Trishe Leong]

So for a prospective microbiology trainee, well, I suppose if someone, if someone's a medical student at the moment, they're thinking about what they want to do in the future, maybe career what's, what's the pathway for them? What do they need to do?

00:13:40:05 - 00:14:03:11

[Dr Caitlin Keighley]

Yeah, they, you can either do microbiology as a specialty in itself, which is five years and the earliest you can apply for that is a new resident. Yes. If you want to starting PGY three or you can do it as a dual specialty combine with infectious diseases in which case you do end up doing five years, but two years of infectious diseases and three years of microbiology in the lab.

00:14:03:11 - 00:14:12:02

[Dr Caitlin Keighley]

And you can apply, well, you still have to do basic physician training and the basic pathological exam. Then you can go into your five years.

00:14:12:11 - 00:14:22:01

[A/Prof Trishe Leong]

And if they if a medical student or a junior doctor wants to find out more, where should they go to? And I ask this in every podcast.

00:14:22:11 - 00:14:48:02

[Dr Caitlin Keighley]

Yeah. Well what I would say is contact, um, your nearest microbiologist. You might be able to, you know, hang out with them for a bit of time, visit the lab and get a bit of an idea and they'll certainly help you with pathways. There are also RCPA student scholarships available. Students get a reduced fee for the basic pathological sciences exam.

00:14:48:02 - 00:14:59:02

[Dr Caitlin Keighley]

That's worth knowing about. There's a virtual path elective that's available, and there's plenty on the RCPA website and on social media, including Twitter.

00:14:59:10 - 00:15:18:10

[A/Prof Trishe Leong]

I mean, I suppose you're just at the start of your career, you've still got many years ahead of you. If you look into your crystal ball what do you think is the future for microbiology? Where do you think the discipline is headed? What new and exciting things can we expect?

00:15:19:10 - 00:15:42:10

[Dr Caitlin Keighley]

Yeah, Um, the hot topic at the moment is genomics. You know, there are varied applications for that. But one of the really exciting things that it will potentiate is hypothesis-free molecular testing. So if you think about it, you know, culture, you don't have to know what you're expecting necessarily you can get surprises because you just culturing and something will come up.

00:15:43:02 - 00:15:54:12

[Dr Caitlin Keighley]

Whereas molecular testing has been targeted. So you're saying is herpes there or not? Yes or no? An geneomics potentially allows you to take a sample of say: what's there?

00:15:56:03 - 00:15:56:09

[A/Prof Trishe Leong]

Mm hmm.

00:15:57:01 - 00:15:59:00

[Dr Caitlin Keighley]

And get an answer or several answers.

00:15:59:03 - 00:16:10:14

[A/Prof Trishe Leong]

Mm hmm. Yeah. I mean, I, for one, am looking forward to finding out more about the microbiome. One day I want to know how all my gut flora is, in fact, controlling all of my actions without me realizing.

00:16:11:13 - 00:16:14:01

[Dr Caitlin Keighley]

Absolutely. Yeah. That's a hot topic.

00:16:15:12 - 00:16:29:02

[A/Prof Trishe Leong]

So thanks very much, Caitlin. It's been fantastic talking to you. Any final words for someone who is considering the micro? This is the make or break. You're going to inspire them. 

00:16:29:10 - 00:16:31:14

[Dr Caitlin Keighley]

I just say it's a fabulous career path.

00:16:32:06 - 00:16:41:11

[A/Prof Trishe Leong]

That's fantastic. Future microbiologists take note! Thanks, everyone, for listening. And thank you very much, Caitlin Kelly.

00:16:42:10 - 00:16:43:12

[Dr Caitlin Keighley]

Thanks so much, Trishe.

00:16:45:11 - 00:16:51:09

[Voiceover]

To find out more about a career in pathology, go to rcpa.edu.au.