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Thread: Darn Klebsiella

  1. #1
    Junior Member
    Join Date
    Nov 2015
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    south central, Pa
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    Darn Klebsiella

    Hi, I am new here, I see a lot of interesting thoughts and advice. I been a T2 post 40+ years and have worked 38 years. I have always worn an external catheter made myself or used urocon type. Last year I been having an increase of uti infections with Klebsiella Pneumoniae being the culprit, clean catch and off to lab I go. I can?t remember last I time got real ill and I don?t want to, So I went to local Uro and had Cat Scan done and no stones anywhere and kidneys good, Then cysto done and nothing wrong but thickening wall of bladder..Uro put me on Rapaflo to relax the sphincter to see if it would help. He believes Urecholine doesn?t work, But I do notice urination after taking it (25 mg 4X) been on this all my years, along with Vitamin C 500 mg 4X.
    I cannot get rid of the same bug this year. I?ve had several UTI?s about 1 a month for the last 5 to 6 months and Uro or primary doc gets me on Cipro for 7days (allergic to Bactrim, ok with macrodantin) maybe I should be a longer script?. I?m looking for advice from SCI nurse or anyone. My Uro wants me to start IC myself now but it has me anxious to concerned to start this, because of the huge life style change. The Uro sent me home with script for red silicone 16fr caths and a booklet on how to. I questioned some DME?s to order and found there arelots of type of Caths and for insurance my preference the script should be more specific. All were surprised he did not have anyone show me how to learn/train on use IC especially an SCI patient, I called back and a nurse stated that they do provide training. The Uro had me stop the Vitamin C which I?ve taken for years. I thought VC was supposed to be good for bladder, he disagrees. He believes D-mannose and cranberry supplements are not proven so doesn?t see benefit. I know I don?t void totally and hence bugs can infect me, after reading so many threads here I?m at a loss as to first how to get rid of this
    Klebsiella Pneumoniae infection for good and second better bladder management. Will IC get rid of the infection? Or just lesson them. Why does it keep coming back within 2 weeks. Am I being bullheaded in the change to IC and hurting myself. Can?t I use an external cath? Does any para?s?. I wonder how I will know when to cath thru out the day. I do not want an accident occurring while driving or at work, or anywhere visiting, etc. and what about sleeping? Since I have a spastic bladder that just voids. Should I seek a SCI specialist center since my city is small? Or second opinion. You would think I'd be more educated on all these things!

  2. #2
    Welcome to Care Cure Community.

    You've had an exceedingly long run on an external catheter. External catheters are not commonly recommended by rehab centers these days. They opt instead for CIC (Clean Intermittent Catheterization) or IC.

    When you go to an IC program, you need to take an anticholinergic medication (oxybutynin or a similar drug) to help prevent bladder spasms and help the bladder hold more urine. You also need to monitor you I/O (input, what you drink -- output, what you void) and plan on a cath schedule of every 4-6 hours.

    Most insurance companies and medicare cover up to 200 catheters a month so there is no need to reuse catheters, which can help prevent urinary tract infections. I use a supra pubic and am not that familiar anymore with preferred catheters, but from what I have read here, many prefer a silicone catheter over a red rubber or latex catheter.

    Residual urine in the bladder is a breeding ground for infection and as long as you stay on an external catheter, you are going to continue to have a problem with infections. That isn't to say that you won't get an infection on IC, you will, but hopefull they won't be frequent.

    All urinary tract infections in people with a spinal cord injury are considered complex instead of simple urinary tract infections. Complex UTIs should be treated after a culture and sensitivity indicates which antibiotic will be most effective. A 10-14 day course of the antibiotic should be taken. Two to three days after the end of the course of antibiotics, you should have another urinalysis (UA) and culture & sensitivity (C&S). If there is indication of bacteria present, another course of antibiotics should be taken. When an infection is particularly stubborn, it is a good idea to consult with an infectious disease doctor. You may need to take a course or two of an IV antibiotic over a 4-6 week term. I've found that urologists aren't particularly interested in managing urinary tract infections, and infectious disease doctors take a greater interest in these kinds of cases.

    I am proponent of using Microcyn Technology either Microcyn, HydroCleanse, or Microcyn AH as a bladder instillation to help prevent urinary tract infections. Many of us here have used these products, off label,
    and have had very good luck reducing the risk of infection.
    See these threads:
    http://sci.rutgers.edu/forum/showthr...light=microcyn

    http://sci.rutgers.edu/forum/showthr...light=microcyn

    http://sci.rutgers.edu/forum/showthr...light=microcyn

    All the best,
    GJ

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