Antibiotic resistant bug

[paramoto]

I have posted here many times about my struggles for over a year with a hospital aquired e coli bacteria. After every round of antibiotics, it comes back shortly theafter with more resistance. It was sensitive to nitrofurantoin, so I took 22 days, first two a day, then three a day finishing with 6 days four a day. Two days later my urine was dirty and smelly. That was 12 days ago.

i have been instilling Puracyn manufactured by Occulus three times a day, 20cc or 40 cc, leaving it in for around one hour. I think this has helped me not get a fever or chills these 12 days. I had another culture just to be ready in case more severe symptoms develop, and it appears that I am running out of bullets. Some antibiotics it says ESBL, which sounds serious when I read about it. The bug (E Coli) is only sensitive to:

Amicacine
cefoteta
Ertapenem
imipenem
Meropenem
Pip/Tazo
Tigeclicline
Doripenem.

intermediate resistance to Nitrofurantoin and amoxiciline.

It seems that the doctors dont know what to do. I have seen an infectious desease specialist several times throughout the year but the bug always comes back. What is the correct protocol for cases like this? Any input will be greatly appreciated.

[JacksonsGirl]

I feel your pain~ My husband went through months of fighting resistant bacteria (MRSA & PSEUDOMONAS) in his lungs. He ended up on IV antibiotics at home, two very strong ones, and this went on for a few months. At times, the fevers would cease, but they would always be back again. The PCP just kept throwing antibiotics at us like crazy. After so many courses, we saw infectious disease, and she said to just stop the antibiotics. The fevers stopped shortly after.. It was so strange. I was getting really nervous, as he was on the strongest antibiotics available.
We also have constant UTI's and he takes Methenamine Hippurate for that. If he gets one, we wait until the day he stops antibiotics, and immediately start Methenamine, along with 1,000 mg of Vit C per day. This keeps the UTI's away fairly well as long as he takes it when he is supposed to. Its the only thing we've found so far that keeps it under control. We did try vetericyn briefly but got frustrated with it and stopped. Admittedly didn't give it much of a chance, but he got a UTI while we were using it, and we changed gears.
I would trust infectious disease more than your PCP~ I know ours has no idea what to do when things like this happen. If I were you I'd go back there again and tell them whats up, and maybe check into the Methenamine if you're getting desperate. All the best!

[SCI-Nurse]

E. coli is not necessarily hospital acquired. It commonly lives in your intestines. Is it ESBL +?
Most likely the reason it is coming back is because it is in your intestines and recontaminating in some way.After treatment are they reculturing to ensure clean. Do you have kidney or bladder stones?
Bladder is emptyinh? Not under high pressure-urodynamics showing ok?
Only treat if you have symptons- not by the smell of urine.
CWO

[gjnl]

Refresh our recollection...how do you manage your bladder?

All the best,
GJ

[paramoto]

I cath around 9 times a day CJ, when I travel I wear a foley for a few days. CW I know it was hospital aquired because I had very few infections prior to a cystoscopy/colonoscopy i had done the same day, sept. 30, 2013. That very same week my problems with this bacteria started, except that each cycle it becomes more resistant, now it appears sensitive to only IM or IV antibiotics. Doctors are trying to fight this without antibiotics this time, so far with very minor symptoms. Though today my temperature was a little low and I felt a little cold for a while. No fever.

[gjnl]

No doubt you won't want to here this, but your story sounds very much like mine about 5 years ago. I managed my bladder with intermittent catheterization and used an indwelling foley when I traveled, which wasn't all that much. Instead of cathing 4-6 times a day (considered normal and typical), I had to cath frequently and finally got to the point where I was cathing about every 2 hours. Our lives pretty much revolved around my need to cath. Neither of us got much sleep, work was impossible. We were pretty miserable. I was on the antibiotic merry-go-round. Finally had to go on months of home administered IV antibiotics.

I got my insurance company to approve consultations with a neuro-urologist at Standford Medical Center. I had a complete urological work up including urodynamics. The outcome of the testing was that I had to make a decision about a different way to manage my bladder. Major, complex surgeries with long recovery times were discussed as was a simple suprapubic catheter placement. My primary care physician is a good guy, who took the time to discuss my options with me and together we decided that taking baby steps was my best option. Within a couple weeks, I had the suprapubic placed, within a month, it was healed. It was about that time that I learned about Vetericyn. I have had the suprapubic catheter for about 4-1/2 years and it was one of the best decisions I have made in living with spinal cord injury. I do have one regret...I didn't do it sooner.

All the best,
GJ

[paramoto]

GJ, thanks. What are your thoughts on the bacteria and prognosis? Had a urinalysis today, leucos are 20, nitrites are positive, bacteria abundant. Do I have a chance of handling this with Vetericyn and D mannose? Or should I be on the lookout for invanz which the doctor prescribed in case symptoms worsened.

[gjnl]

GJ, thanks. What are your thoughts on the bacteria and prognosis? Had a urinalysis today, leucos are 20, nitrites are positive, bacteria abundant. Do I have a chance of handling this with Vetericyn and D mannose? Or should I be on the lookout for invanz which the doctor prescribed in case symptoms worsened.

At this stage of the game, if I were you, I'd seek out another infectious disease doctor (if you don't have confidence in the one you have been seeing), get a full urological work up (preferably with a urologist who has experience with SCI and frequent and recurring urinary tract infections), and consider another way to manage your bladder.

That said, Vetericyn (HydroCleanse) and D-Mannose are not antibiotics. Both products probably work best when there is no urinary tract infection present. The intent of these products is to help reduce colonization and help prevent (in the case of D-Mannose, e. coli based infections, only) urinary tract infections.

I know it is not easy to try to come to terms with altering your routine and your body. It should be said that a suprapubic is reversible (with some precautions). Often times doctors use a temporary suprapubic to allow the bladder to heal from one malady or another.

Are you taking any anticholinergic medications, i.e., oxybutynin, vesicare, santura etc? I took them when I used to intermittent cath to help reduce spasms and allow the bladder to hold more urine, few caths per day. I take them now, with the suprapubic catheter, in very low concentrations to help keep the bladder from shrinking too much.

How old are you?

All the best,
GJ

[paramoto]

I am 50. I take Oxybutynin and Myrbetriq (Second month on Myrb.) I have an appointment with my ID doctor on Monday. Until then I hope to remain asymptomatic. My urinalysis today showed positive nitrites, 20 leucocytes and abundant bacteria, pretty much identical to the one last week. I feel kind of cold and a little weird, but not terribly bad.

At this stage of the game, if I were you, I'd seek out another infectious disease doctor (if you don't have confidence in the one you have been seing), get a full urological work up (preferably with a urologist who has experience with SCI and frequent and recurring urinary tract infections), and consider another way to manage your bladder.

That said, Vetericyn (HydroCleanse) and D-Mannose are not antibiotics. Both products probably work best when there is no urinary tract infection present. The intent of these products is to help reduce colonization and help prevent (in the case of D-Mannose, e. coli based infections, only) urinary tract infections.

I know it is not easy to try to come to terms with altering your routine and your body. It should be said that a suprapubic is reversible (with some precautions). Often times doctors use a temporary suprapubic to allow the bladder to heal from one malady or another.

Are you taking any anticholinergic medications, i.e., oxybutynin, vesicare, santura etc? I took them when I used to intermittent cath to help reduce spasms and allow the bladder to hold more urine, few caths per day. I take them now, with the suprapubic catheter, in very low concentrations to help keep the bladder from shrinking too much.

How old are you?

All the best,
GJ

[gjnl]

I am 50. I take Oxybutynin and Myrbetriq (Second month on Myrb.) I have an appointment with my ID doctor on Monday. Until then I hope to remain asymptomatic. My urinalysis today showed positive nitrites, 20 leucocytes and abundant bacteria, pretty much identical to the one last week. I feel kind of cold and a little weird, but not terribly bad.

I was 64 when I had my suprapubic placed and probably should have done it when I was about 55 and certainly by 60.

All the best,
GJ

[paramoto]

Those who know, should I take Hiprex even if I am colonized and fighting the development of a full blown infection? Would it help fight off the infection or should I wait?

[gjnl]

Those who know, should I take Hiprex even if I am colonized and fighting the development of a full blown infection? Would it help fight off the infection or should I wait?

Unless your doctor has prescribed it for this bout of infection, I wouldn't take it, until you talk with the doctor. Should not be taken if taking a sulfonamide (Bactrim or Septra). Urine must be acidic when taking Hyprex.

All the best,
GJ

[paramoto]

The bug is resistant to bactrim, my urine is very acidic. Hiprex is not known in my area, but it is possible that the ID doctor knows about it, but I will not see him until monday. I am trying not to take antibiotics until I see the iD doctor. Will hiprex in any way aid in the development of resistant bacteria?

[Brent K]

I had an experience just like the one you are going through. I picked up a bug while having an x-ray done. I had an abrasion on my wrist, the next day it was infected and infection was spreading up my forearm. I was given an antibiotic for it and it went away but that's when I began having urinary tract infections. So, yeah, you can pick up bacteria that turns to infections in a healthcare facility. I would do like GJ recommends and try to find a good urologist. The primary care and infectious disease physicians that I was seeing couldn't treat me. I ended up in the hospital with sepsis and damaged kidneys. The doctor treating me while in the hospital referred me to a good urologist. I had an SP done and haven't had a uti since. I can't hold urine in my bladder now without getting a uti. I'm colonized but haven't had any symptoms.

[ctoom91]

I have the same bug.I acquired it while riding out Hurricane Sandy in crap hospital then a crap nursing home.Got MRSA and a stage 4 wound as well.Hooray! Sandy.Ask your ID about Fosfomycin.It's $120.00 but it will knock back the infection.If your symptoms get to bad a 7-10 day regimen of the carbapenems may be necessary.If you don't have stones the IV ABX could kill it or at least give you months free of infection.Hiprex will not cause resistance.It's expensive and it didn't help me.