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Thread: Klebsiella pneumoniae

  1. #11
    Senior Member air ohs's Avatar
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    Quote 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

  2. #12
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    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.

  3. #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?

  4. #14
    Quote 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.

  5. #15
    Quote 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.

  6. #16
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    Quote Originally Posted by SCI-Nurse View Post
    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)
    Yes. I’ve had extreme nerve pain and spasticity since Saturday and nightly soaked clothes and sheets from sweating then freezing while spazzing cycles. I’m normally 3-5 nerve pain but 6-8 since Saturday. And the urologist office failed to get iv antibiotics set up even though they knew since 8am. So I’m hopeful to finally start treatment today.

    Then I need to find a new urologist who cares about patients who are suffering. I worked a full day, managed to get to PT and still had time to determine which antibiotic I was going to need in spite of the pain, but they couldn’t find time to get the treatment set up. Crazy.
    T3 complete since Sept 2015.

  7. #17
    Quote Originally Posted by Mize View Post
    Yes. I’ve had extreme nerve pain and spasticity since Saturday and nightly soaked clothes and sheets from sweating then freezing while spazzing cycles. I’m normally 3-5 nerve pain but 6-8 since Saturday. And the urologist office failed to get iv antibiotics set up even though they knew since 8am. So I’m hopeful to finally start treatment today.

    Then I need to find a new urologist who cares about patients who are suffering. I worked a full day, managed to get to PT and still had time to determine which antibiotic I was going to need in spite of the pain, but they couldn’t find time to get the treatment set up. Crazy.
    I seem to remember that the SCI nurses have said, and I know it was GJ's experience that urologists don't necessarily make the best go to physician for treating urinary tract infections. I think the SCI nurses have said urologists are essentially surgeons, and taking the time to treat urinary tract infections doesn't pay the bills and takes up way too much of their time.

    GJ found that having a good understanding with his primary care physician about how SCI complex urinary tract infections should be treated, i.e., urinalysis and culture & sensitivity tests to determine the best antibiotic to treat the bacteria and a longer course of antibiotics was more satisfactory than consulting with the urologist. He used the urologist to have an annual consultation and check up, routine tests and ultrasound imaging, and of course the placement of the suprapubic catheter.

    If and when, urinary tract infections were more difficult to treat, an infectious disease doctor was always more adept at managing antibiotic treatment.

    NL

  8. #18
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    NL, I cannot tell you how much it means to me that you stay and continue to help us.

    thank you so much.
    Last edited by Mize; 01-09-2020 at 01:24 PM.
    T3 complete since Sept 2015.

  9. #19
    Did you have a fever? Always check for fever if you are having symptoms of a UTI. Fever is a diagnostic criteria for a true UTI, and the most important one (in addition to elevated WBCs in your blood count) for determining that you have pyelonephritis, which is a UTI involving both your kidneys and bladder, and which definitely requires aggressive and prompt treatment as a complex UTI. If you take your temperature and can report that to your physician when you suspect a UTI, they should take prompt action.

    Urologists that specialize in neurologic urology are actually expert in treatment of UTI in persons with SCI, as should be physicians who are board certified in Spinal Cord Medicine, and physiatrists who specialize in SCI management. While an infectious disease physician may be great, they may not be expert in SCI specifically, and generally will not see or consult on management of UTIs directly with the patients without a referral from your primary provider or urologist. Most primary care physicians (family practice, general practice, internal medicine) are not very knowledgeable about anything to do with SCI/D, but you may find one who is willing to learn about it.

    (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.

  10. #20
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    Cincinnati has only one board certified SCI doc and he’s VA only. I see a PMNR usually. My urologist is the department head at University of Cincinnati hospital but clearly not competent with SCI.

    I have run a low grade fever with night sweats all week. He knew this.

    Fortunately the ER docs are better. I’m through my first IV and they’ve cleared me of any stones with a CT.
    Won’t be 100% certain no sepsis until the blood cultures come back but it seems unlikely as my fever is still low grade.
    T3 complete since Sept 2015.

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