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  • Klebsiella pneumoniae

    Klebsiella pneumoniae have you had this how did you get rid of it .this uti wont go away dr has tried cefalex and nitro foranton macrodid

  • #2
    The way to get rid of it is to use the antibiotic that the culture says it is sensitive to. Also, make sure that you get the longer dose prescribed since you are a person with SCI. and of course, drink tons of water.

    ckf
    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
      Originally posted by SCI-Nurse View Post
      The way to get rid of it is to use the antibiotic that the culture says it is sensitive to. Also, make sure that you get the longer dose prescribed since you are a person with SCI. and of course, drink tons of water.

      ckf
      sorry i dont explain myself very good these 3 antibiotics all said the bug was sensitive the nitro i took for 15 days 2 x a day.
      waiting to hear from uroligist.
      was curious if this is a bug that is treatable thanks

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      • #4
        Originally posted by air ohs View Post
        sorry i dont explain myself very good these 3 antibiotics all said the bug was sensitive the nitro took for 15 days 2 x a day.
        waiting to hear from uroligist.
        was curious if this is a bug that is treatable thanks
        I had Klebsiella pneumoniae a few times when I was managing my bladder with intermittent catheterization. Medscape.com has quite a comprehensive article on treatment of complicated infections caused by this bacteria and its subsets. You can read the entire article at https://emedicine.medscape.com/article/219907-treatment. You may be required to register at this site to read the article. Below are a couple excerpts from the article.

        Bottom line, I'd suggest you make an appointment with an infectious disease doctor. I have found that they can manage antibiotic therapy with more skill than urologists. You may need intravenous treatment or a round or two of intravenous treatment followed by oral medications.

        Antibiotic considerations for resistant infections

        Beta-lactamases are constitutive, are usually produced at low levels, and provide resistance against ampicillin, amoxicillin, and ticarcillin.

        ESBLs are plasmid mediated, confer multidrug resistance (TEM or SHV types), and are detected by in vitro resistance to ceftazidime and aztreonam. CTX-M type ESBLs, which hydrolyze ceftazidime much less than other third- and fourth-generation cephalosporins, are more prevalent and have proliferated in the Escherichia coli ST131 lineage. [11]

        K pneumoniae carbapenemases (KPC; Ambler class A beta lactamases) confer broad resistance and are associated with a higher mortality rate (>50%). Many isolates are a single sequence type, ST258. Susceptibility is limited to gentamicin, tigecycline, and colistin.

        Metallo-beta-lactamases (Amber class B) include imipenemase (IMP), Verona integron-encoded MBL (VIM), and NDM-1 and are generally resistant to all antibiotics except tigecycline and colistin.

        OXA-type carbapenemases (Amber class D) include OXA-48 and weakly hydrolyze carbapenems, broad-spectrum cephalosporins, and aztreonam but express resistance or decreased susceptibility to carbapenems.

        ESBL-producing isolates are treated with carbapenems.

        Isolates that produce carbapenemase are resistant to carbapenems, penicillins, cephalosporins, fluoroquinolones, and aminoglycosides. Treatment options are limited to colistin (preferred for UTIs), tigecycline, and, occasionally, intravenous fosfomycin.

        Combination treatment with colistin, tigecycline, and carbapenem may improve survival in bacteremic patients. [1]

        Consider tissue drug penetration such as lung penetration for pneumonia and urine concentration for UTIs.

        For liver abscess, percutaneous drainage may be considered.


        K pneumoniae UTI

        Uncomplicated cases caused by susceptible strains may be treated with most oral agents except ampicillin. Monotherapy is effective, and therapy for 3 days is sufficient.

        Complicated cases may be treated with oral quinolones or with intravenous aminoglycosides, imipenem, aztreonam, third-generation cephalosporins, or piperacillin/tazobactam. Duration of treatment is usually 14-21 days. Intravenous agents are used until the fever resolves.

        Other measures may include correction of an anatomical abnormality or removal of a urinary catheter.



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        • #5
          thank you very much

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          • #6
            Anytime.
            ckf
            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


            • #7
              For me Levaquin worked. I had a very long course of it, I don't remember exactly but it was very long, might have been a six week course. (I'd been fighting klebsiella for months). But I agree with ckf. I also agree with gjnl: when I had a resistant infection the infectious disease doctor was the one who figured out how to cure it.

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              • #8
                I would just add that Klebsiella can be associated with both urinary stones (especially struvite stones) and with chronic prostatitis. If you have not been evaluated for either recently, suggest that you do so.

                (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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                • #9
                  dont understand this statement that came back with last CS.

                  1) Klebsiella pnuemoniae
                  The urinary (non systemic) interpretation for Cefazolin can be used to predict susceptability of Cephalexin (Keflex) for uncomplicated UTI.

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                  • #10
                    Originally posted by air ohs View Post
                    dont understand this statement that came back with last CS.

                    1) Klebsiella pnuemoniae
                    The urinary (non systemic) interpretation for Cefazolin can be used to predict susceptability of Cephalexin (Keflex) for uncomplicated UTI.
                    This means that if your culture results come back showing that the bacteria is sensitive to Cefazolin (Ancef), that would also apply to the use of Cephalexin (Keflex). Note though the caveat that this would apply to uncomplicated UTI. By definition, all UTIs in people with SCI should be considered complicated.

                    (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
                      Originally posted by SCI-Nurse View Post
                      This means that if your culture results come back showing that the bacteria is sensitive to Cefazolin (Ancef), that would also apply to the use of Cephalexin (Keflex). Note though the caveat that this would apply to uncomplicated UTI. By definition, all UTIs in people with SCI should be considered complicated.

                      (KLD)
                      Once again thank you very much

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                      • #12
                        My second symptomatic UTI is this bug and doc says the culture says I'm going to need to go on IV antibiotics. They are sending a home Nurse to administer and train my wife.
                        This was all over the phone with little to no details so far - like when will this Nurse be here - so I'm clueless about how long I'll be on them and how many hours/day.

                        Anyone know?
                        T3 complete since Sept 2015.

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                        • #13
                          I just had a culture come back for Klebsiella with a colony count over 100,000. I have heard from physicians, as well as the SCI nurse that even this colony count in the absence of symptoms does not warrant antibiotic.

                          Since I'm feeling no worse for the wear, I declined taking the antibiotic. I thought perhaps I had something coming on, but it may have been just feeling lousy for another reason.

                          I just started hipprex a couple months ago and obviously that did not prevent it, nor did hydrocleanse (50 mL) once per day for three minutes. I just had renal and bladder scans and no stones were present. In fact a small nonobstructing stone in one of my kidneys passed through without my notice, unless it did with symptoms that I have used to, such as increased spasticity for a period of time.

                          Does Klebsiella always require treatment in the colonized patient?

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                          • #14
                            Originally posted by Mize View Post
                            My second symptomatic UTI is this bug and doc says the culture says I'm going to need to go on IV antibiotics. They are sending a home Nurse to administer and train my wife.
                            This was all over the phone with little to no details so far - like when will this Nurse be here - so I'm clueless about how long I'll be on them and how many hours/day.

                            Anyone know?

                            I am assuming you mean a symptomatic UTI, not just colonization? IV antibiotics are most likely needed if this is a symptomatic UTI, and your culture and sensitivity (C&S) shows that the bacteria is resistant to all available oral antibiotics. Most often IV antibiotics are used for 4-7 days in this case. Which antibiotic are you getting IV? Some must be given as often as every 6 hours.

                            (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


                            • #15
                              Originally posted by crags View Post
                              I just had a culture come back for Klebsiella with a colony count over 100,000. I have heard from physicians, as well as the SCI nurse that even this colony count in the absence of symptoms does not warrant antibiotic.

                              Since I'm feeling no worse for the wear, I declined taking the antibiotic. I thought perhaps I had something coming on, but it may have been just feeling lousy for another reason.

                              I just started hipprex a couple months ago and obviously that did not prevent it, nor did hydrocleanse (50 mL) once per day for three minutes. I just had renal and bladder scans and no stones were present. In fact a small nonobstructing stone in one of my kidneys passed through without my notice, unless it did with symptoms that I have used to, such as increased spasticity for a period of time.

                              Does Klebsiella always require treatment in the colonized patient?
                              No, most recommend not treating under these circumstances, unless it develops into a full-blown UTI. If using an indwelling catheter, change it, as the biofilm on your catheter can harbor these bacteria.

                              (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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