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Thread: Unclearable ESBL Klebsiella pneumoniae UTI

  1. #1

    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. #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.

  3. #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!

  4. #4
    Quote 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.

  5. #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.

  6. #6
    Senior Member lynnifer's Avatar
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    Hoping your infectious disease doc had some answers today. Thinking about you. This could easily be any of us.
    Make America Sane Again. lol

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

  7. #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.

  8. #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.

  9. #9
    Quote 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.

  10. #10
    Quote 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.

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