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Unclearable ESBL Klebsiella pneumoniae UTI

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  • Unclearable ESBL Klebsiella pneumoniae UTI

    So I'm sure some of you have read the battles I've had with MRSA osteomyelitis and my recent hemipelvectomy, but there is something else I have been battling this year, an ESBL Klebsiella pneumoniae UTI.

    I hadn't had a UTI in over 4 years, so I can guarantee I picked this up nosocomially since I've been in the hospital about 9 months this year. I've been on IV antibiotics for 11 months, but each time I would come off of them, I would go septic (either due to the osteo or the UTI) within 2 weeks.

    How have IV antibiotics not been able to clear this? I've been on ertapenem (Invanz), which is part of the only class of drug this bug is susceptible too. Each time I was on antibiotics, my labs would look good and my urine would be clear, but once I come off, it comes back. I was imaged and there are no kidney stones, and my cath technique is clean.

    My latest course of IV antibiotics finished last week, and I'm already getting symptoms again: my penis/bladder is burning beyond belief, my bladder is giving me sensations of needing to urinate at extremely low volumes, my body voids randomly even after I cath, smelly urine, cathing blood, and the nurse just took my vitals and I have a low grade fever (99.7).

    I saw this coming 2 days ago and had them run a UA and CBC. The preliminary results show Klebsiella pneumoniae which I know will come back as ESBL, and my white count is slightly elevated.

    If nothing is done I will go septic within the next few weeks. I am so fed up with this. So what, I'm supposed to be on IV antibiotics for the rest of my life? At some point this bug will become resistant and then I'm screwed, as from my research there is little the medical profession can do for a Klebsiella pneumoniae infection once it becomes resistant to carbapenems.

    Can I not catch a single ^&$*ing break?

  • #2
    Have you had tests for urinary stones in other than your kidney?? Evaluation for prostatitis? Klebsiella can be found often in stone material, and in an infected prostate, both of which can protect the bacteria from antibiotics and then re-seed bacteria into the urinary tract.

    Have you seen an infectious disease physician about this colonization??

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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    • #3
      I'm having similar issue with that bacteria. After taking a course of antibiotics for about 60 days, it's back again. I'm scheduled to see urologist on Wednesday. So far, I'm just experiencing mild discomfort, but this past summer I was hit by severe chills and vomiting and had to leave work. This is getting old!

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      • #4
        Originally posted by SCI-Nurse View Post
        Have you had tests for urinary stones in other than your kidney?? Evaluation for prostatitis? Klebsiella can be found often in stone material, and in an infected prostate, both of which can protect the bacteria from antibiotics and then re-seed bacteria into the urinary tract.

        Have you seen an infectious disease physician about this colonization??

        (KLD)
        I'm still in the hospital healing my flap, ID should be stopping in today. What exactly should I mention to them, I'll go by your advice. I've only been tested for kidney stones.

        ID knows, they wanted to see what would happen when I came of IV, again.

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        • #5
          A urologist should assess you for prostatitis. You should annually have an ultrasound of your entire urinary tract (kidneys, ureters, bladder) to screen for stones.

          Ask the infectious disease physicians if there are other possible areas that should be assessed for sequestering this bacteria that causes you to get it back over and over.

          (KLD)
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

          Comment


          • #6
            Hoping your infectious disease doc had some answers today. Thinking about you. This could easily be any of us.
            Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

            T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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            • #7
              I am feeling neglected at this hospital now. I started feeling symptoms 4 days ago and had them run a UA. Infectious diseases hasn't come in to see me, even though they promised, for two days now and they are doing nothing to treat me. My bladder is on fire and referring pain everywhere else making my nerve pain extremely worse.

              I haven't been able to do my seating protocol for 2 days now because I am in so much pain. They also removed my ability to utilize IV pain medication because I've been here so long and they want to transition patients to oral. I've taken 3 times my usual dose of narcotics but it hasn't touched the pain.

              ID docs I guess don't want to treat with antibiotics until they have definitive data showing this is an infection and not simply colonization (my CBC white count was fine, and my original UA wasn't that high in leukocytes), but I have never had this extreme burning and I am having all the symptoms of what's turning into a full blown UTI. If it was a simple colonization, I'd be asymptomatic.

              The nurses are livid and there's nothing they could do. The attending ID said he would stop by today, and he no-showed. They literally are not treating an active infection and letting me lay here. All they gave me 30 minutes ago was pyridium.

              This is so wrong on so many levels.

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              • #8
                Are you in the USA (sure would be good if you completed your profile!!!)?? If so, the hospital should have a patient representative or patient advocate. Ask to speak to this person right away tomorrow morning. They can follow up on the failure of the ID physician to do your consult, and any other complaints you have.

                (KLD)
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                Comment


                • #9
                  Originally posted by SCI-Nurse View Post
                  Are you in the USA (sure would be good if you completed your profile!!!)?? If so, the hospital should have a patient representative or patient advocate. Ask to speak to this person right away tomorrow morning. They can follow up on the failure of the ID physician to do your consult, and any other complaints you have.

                  (KLD)
                  The ID doctor stopped in. I was respectfully livid and he apologized profusely, saying there was a miscommunication and that they had no idea I was symptomatic. I find that really hard to believe. Regardless, they're starting me back on ertapenem now and they're getting urology involved at my recommendation to investigate further and to try and track down the source of the infection.

                  What if they can't find any indication of something seeding this recurrent infection? Then what?

                  I am in the US.

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                  • #10
                    Originally posted by paraparajumper View Post
                    I am in the US.
                    Please add that to your profile.

                    (KLD)
                    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                    Comment


                    • #11


                      Are you getting adequate nutrients in hospital? Food in Canada comes in pails ... at least in Windsor. I've half a mind to start a farm (or greenhouse in our case) to bedside program here. Meals on Wheels would be better than what they serve in hospital!

                      Probiotics? Drinking adequately? Hospitals can be dry - humidifier? Do you have family able to help? Just curious what state you're in.
                      Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

                      T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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                      • #12
                        Originally posted by SCI-Nurse View Post
                        Please add that to your profile.

                        (KLD)
                        Added the information for you. Wanted to give you an update:

                        CT scan showed thickened bladder wall with calcification, and an enlarged prostate. My personal etiologic diagnosis is bacterial encrusted cystitis. It is pretty rare, but urology agrees that it could be it.

                        I'm finishing up a 7 day course of IV ertapenem tomorrow. 4 days ago they also started me on fosfomycin every 48 hours which will likely switch to once every 10 days once the ertapenem is discontinued. They want me to remain on the fosfomycin for 6 months. I also started yesterday with a amikacin bladder irrigation twice per day for 15 minutes. I believe I'll be doing that 3 times a week for 6 months as well.

                        After all this, they want me to get a full urodynamic workup (I've never had one), but they want to wait for me to complete the entire course of antibiotics first. Hopefully the infection will be gone for good after all of this. I've also thought about doing Microcyn instillations after these antibiotics as a prophylactic measure a couple of times per week.

                        Does all this sound good to you?

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                        • #13
                          Forgot to ask what your bladder management method is. Reflex voiding? Indwelling catheter? Intermittent catheterization?

                          A thickened bladder wall can be trabeculation from a high pressure bladder. An enlarged prostate can be due to prostatitis.

                          (KLD)
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                          Comment


                          • #14
                            I instill microcyn twice a day, maybe for four years now. I think I have had a couple of minor infections during that time. Before that I was always infected and only intravenous antibiotics were sensitve.
                            T6 complete (or so I think), SCI since September 21, 2003

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                            • #15
                              Do you have someone to go through this with you? Family friends etc? I was telling my sister about you because I am the original pressure sore queen. Everyone thinks I have undiscovered diabetes because our mother had a wound that wouldn't heal and it was diabetes leading to an eventual amputation. Now my brother has an amputation and the other brother has diabetes.

                              I do not. I test at least three times per week. But right now, I have a split on my back that just won't heal and it's crawling up to where I can feel. Never without a wound!
                              Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

                              T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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