In order to treat Kaoru Kobayashi, the doctors on board the Daishan Island specially organized a multidisciplinary consultation. In addition, the doctors of the medical team who had just arrived at the hospital ship were invited to participate in the consultation.

The higher the level of doctors involved in the consultation, the more departments are consulted, and the easier it is to get the results close to the truth.

The reason why Kaoru Kobayashi was able to get such a multidisciplinary consultation on the morning of the second day of admission was thanks to the medical history information sent by Sun Lien - the patient had been treated with imipenem injection.

Imipenem is a restricted-use antibiotic not only because of its high price, but more importantly, because of its significant effect.

There aren't too many bacteria that aren't susceptible to imipenem. In addition to intestinal bacteria, sporadic antimicrobial bacteria such as Pseudomonas aeruginosa and Proteus mirabilis have occasionally been reported.

During the consultation, the main focus of the discussion among doctors was whether the use of imipenem alone can be recognized as drug resistance. Generally speaking, clinical judgment of drug resistance mainly relies on drug susceptibility testing and doctors' experience.

Antimicrobial susceptibility testing is the gold standard for determining whether a patient is resistant to an infected bacteria, but its initiation requires doctors to actually collect the pathogen that causes the patient's illness and perform it with appropriate testing equipment. For patients like Kaoru Kobayashi, there is only the experience of doctors who can judge drug resistance.

However, the doctors present have a huge disagreement about whether the pathogen infected by Kaoru Kobayashi is resistant to carbapenem antibiotics.

"Even if imipenem is used for susceptible bacteria, the patient's condition does not improve in the short term. The director of the infection department of the Daishan Island patted the table at Liu Tangchun, who was sitting opposite him, "To give antibiotics to patients, you must have enough and full time to judge whether you are resistant to drugs!"

"The patient has only been ill for five days, and he has changed from a healthy person to a patient with a high fever that does not go away, and his consciousness is somewhat unclear!" "Enough time, you are dogmatic! I ask you, enough, but what if the person dies before the foot? Can you still carry people out of the morgue and give them two more days of antibiotics?!"

"Then you can't use the results of one drug to judge drug resistance!" The director of the internal medicine department and Liu Tangchun glared at the blowing beard, "Five days is from the onset of the disease to the serious progression of symptoms, if imipenem is useful, just because his body's recovery progress has not yet shown, what should you do?" Do you want to change an antibiotic a day, do you want to see if the patient dies of liver and kidney failure first, or is he killed by this unknown pathogen first?"

Sun Lien sat in the corner of the conference room shivering, usually he had the impression that the general consultation of the four hospitals was not such a style. At least the doctors in the four hospitals will not slap the table in front of them, and at the same time, they will not start against the other doctor...... Personal attacks.

Could it be that because of the relationship in the army hospital, even the doctors have a smell of gunpowder?

"Don't mention any great achievements to me! You are empiricism!" Liu Tangchun tried to use Sun Lien's diagnostic talent to talk about things, but he didn't expect to be directly pushed back by the director of the University of Internal Medicine opposite, "We are modern medicine, do you understand modern medicine? Evidence-based medicine! If you have to say that the patient is resistant to carbapenem, you can bring out the evidence! Take the test results!"

Liu Tangchun threw the pen on the table in front of him, "Damn, if it weren't for the backward equipment on your ship, Lao Tzu would still use it here to talk to you?!"

The quarrel between the two bigwigs grew more and more angry, and the other doctors either held back their laughter and waited to see the two old men who were one hundred and twenty years old together start a fight, or they did not dare to make a noise at all. Only Dr. Qian Yihong coughed, knocked lightly on the table and said, "I said, two old comrades." We're talking about the patient, not the two of you in the ring for you to fight. ”

Liu Tangchun and the director of the Department of Internal Medicine changed from a tense situation to angry eyes. However, the two of them still seem to be eager to try - after the other person says something wrong, they jump up and spray each other all the way.

"Director Liu, what's going on?" Hu Chunbo sat next to Sun Lien and asked Sun Lien in a low voice, "What grievances does he have with Director Huang?"

"Where do I know where to go......" Sun Lien shook his head, it stands to reason that after Liu Tangchun retired from the army, he went directly to Ningyuan Medical College to study. After graduation, he basically stayed in Ningyuan to practice medicine, and it had nothing to do with Yuanhai Hospital in Shanghai. It is even more impossible to have any personal grudges with the director of internal medicine of Yuanhai Hospital.

"It can't be because the army and navy don't see each other right?" Hu Chunbo was still muttering, "I didn't hear that there was such a contradiction within us......"

"Don't guess, old man. Sun Lien sighed, "Maybe it's just a simple disagreement with the other party's diagnosis?"

The consultation was held in a tense atmosphere. In order to prevent the two old men from suddenly jumping out again and deciding to go it alone, the other doctors sped up the discussion and quickly came to a consensus.

Sun Lien looked at the consensus, almost followed Liu Tangchun's example, jumped on the table and scolded the street.

The consultation opinion was, "Tuberculosis cannot be ruled out with a complete examination." ”

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"Combined with tuberculosis, get your mother's nucleus!" Sun Lien complained angrily to Dr. Jiang, "What are you doing? Just because he coughed twice, he has to suspect tuberculosis?"

"He also has moderate anemia. Everyone is engaged in internal medicine, and of course Dr. Jiang knows what Sun Lien is annoyed about - the meaning of "tuberculosis cannot be ruled out" can basically be understood as "the ghost knows what disease he is". However, in front of Sun Lien, Dr. Jiang still wants to maintain the image of his team. "The urine routine showed that he had proteinuria, but it was less than 24 hours after he was admitted to the hospital, and no statistics are available yet. ”

Sun Lien rolled his eyes and protested at Dr. Jiang's sudden change of subject. Then he asked, "What antibiotic is being given to him now?"

"Temporarily stopped. Dr. Jiang signaled Sun Lien not to get excited, "I asked the laboratory department to draw blood for tuberculosis antibody test." I'll wait until the results are out. ”

"You...... You don't really think it's a tuberculosis, do you?" Sun Lien didn't have the strength to be anxious with Dr. Jiang, and he even had some doubts about whether he was really mistaken. Tuberculosis is variable and indeed less susceptible to carbapenem antibiotics.

"I'm not stupid. Doctor Jiang looked at Sun Lien with a stupid expression, "Isn't this just to save some face for the directors, and when the antibody test report comes out, if it is negative, can't you continue to consider other directions?"

"Doctor Jiang, the test you asked for has come out. A nurse hurriedly walked in from the outside and handed the report to Dr. Jiang, "Do you want to isolate the patient now?"

"What are you doing isolating him?" Dr. Jiang shook his head, and the result report flipped over, "Look, I just said that it must not be tuberculosis, and it is written here, tuberculosis antibody positive...... Positive?!"

Sun Lien poked his head over, looked at the examination report in Dr. Jiang's hand, and fell into a shocked silence with him.

Kaoru Kobayashi's test results were very clear - tuberculosis antibody (+), that is, positive antibody.