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Thread: Nurses, Re Complex Infection

  1. #1

    Nurses, Re Complex Infection

    I asked in my old post, but it wasn?t addressed. I?ve read over and over on here how SCIs usually have complex infections that require a longer run of antibiotics. I just finished a 7 day prescription and still have symptoms. Yet every doctor I speak to looks at me like I?m nuts for asking for more than 7 days. What to say?

    I dunno...I?m exhausted of this. For now, it?s wait a couple days and get another c&s. Then 3 days for results...and here I am already showing symptoms.

  2. #2
    Senior Member pfcs49's Avatar
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    get another doctor, or somehow educate this dumb mutherfucker!

    Sorry to be glib! It's from 25 years of dealing with (some) incompetent, ignorant, stubborn, egomaniacal, terrible communicator, ................well, I think you understand!
    69yo male T12 complete since 1995
    NW NJ

  3. #3
    Did you have fever as part of your UTI signs and symptoms?

    Which doctors are you talking to?

    A urologist knowledgeable in neurologic urology should be very familiar with the differences between treatment of a complex UTI vs. a simple UTI (such as occurs in AB people). Research indicates that people with SCI, especially chronic SCI, have more and thicker biofilm in their urinary tract, which is why a longer course of antibiotics is required for effective treatment.

    Here is an article you may want to show to them that indicates that 2 weeks of treatment with antibiotics is recommended for those who have pyelonephritis (which is a UTI involving the kidneys as well as the bladder). https://emedicine.medscape.com/artic...71-overview#a4

    Here is another which recommends treatment for 14 days if a fever was part of the presenting signs and symptoms: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066481/

    Here is another: https://www.tandfonline.com/doi/abs/...nalCode=yacb20
    and another: https://www.clinicalmicrobiologyandi...066-0/fulltext

    Was the antibiotic you were taking based on a urine C&S (culture and sensitivity)?

    (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.

  4. #4
    First, thank you. Sincerely

    As for the fever, no. For my history with SCI and infections I’ve never ran a fever. I get the chills, sweating, overall body discomfort and pain. Sometimes where I grunt or scream out due to the discomfort. And the usual stinky, cloudy urine. Before my fall, in 2010, I went septic from a staph infection and was hospitalized on Vanco for 7 days and never ran a fever. It’s weird, but that’s how it’s been.

    I have spoke with my primary care and last night with an ER doctor. Both said that it is “common medical knowledge” to not “over treat” an infection, regardless of SCI, due to risk of resistance. I’m in the process of changing doctors, but need to have referrals finished, so I can have other issues handled. I’m hoping it’s all handled by the end of the month. This morning my urine is somewhat clear, no real cloudiness, but still sediment and just doesn’t look “right” to me. But I feel a bit better. Still a bit nauseous and feel weak...but maybe that’s a result of losing sleep and dealing with this for weeks. I’m hoping that’s the case.

    And yes, the antibiotics I was taking were from a c&s taken on dec 27. Started on the 1st of January. It was resistant to cipro and sensitive to doxycycline and keflex, so they prescribed both. Keflex 500mg 4x day, Doxy 100mg 2x a day. I finished them last night and still felt like crap so I went to urgent care to get another week, and they didn’t do it (long story short).

    When should I submit another c&s? I’ve heard 24 hours to 72 hours after stopping abx, but would appreciate your suggestions.

    Very much appreciated. Thank you for the articles. They’re more than helpful, and give me some ammo for the inevitable back and forth with my doctor. You’re wonderful at what you do...and even tho we haven’t met, I hear you telling me “good work, now do it more often” every time I do a pressure release or check my skin...since I’ve read so many of your responses. Thx again

  5. #5
    Yes, you should wait for 48-72 hours after the last dose of prescribed antibiotic before submitting another culture.

    What is your bladder management? Intermittent cath? Indwelling catheter? Reflex voiding?

    If an indwelling catheter, you should change catheters when starting treatment for a new UTI, and ideally when collecting a urine specimen. Never take your specimen from the drainage bag except with a newly inserted catheter.

    Did you have blood work to see if your WBCs were elevated when you were having symptoms?

    (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
    Intermittent cath 6x daily

    WBC were elevated but not over the top. I don’t remember the number. IV was a recommendation, as was some form of a 5 day shot, but doctor went with the oral med. I’ll submit another culture on Saturday then. Thank you

  7. #7
    The problem with the medical field is they think they know best about something they don't live with. We know when we got a uti starting. And we can't function properly with one. So they want you to suffer until you get more discomfort feelings.
    I was very fortunate that I had a urologist that understood this. If I had to wait 3 to 4 days for a c & s test. That is 3 to 4 days out of work. That is nuts.

  8. #8
    Senior Member pfcs49's Avatar
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    I have an envelope with several C&A scripts from my primary care Dr. I also have Cipro on hand.
    As soon as I think I'm infected, I get a specimen and immediately thereafter start on Cipro.
    My primary care Dr will call me with results even on the weekend as soon as they're available, and call in a script to the pharmacy.
    69yo male T12 complete since 1995
    NW NJ

  9. #9
    Quote Originally Posted by TheRainman View Post
    The problem with the medical field is they think they know best about something they don't live with. We know when we got a uti starting. And we can't function properly with one. So they want you to suffer until you get more discomfort feelings.
    I was very fortunate that I had a urologist that understood this. If I had to wait 3 to 4 days for a c & s test. That is 3 to 4 days out of work. That is nuts.
    This approach has led to our problems with multiple drug resistant (MDR) bacterial infections.

    No one is saying you should not be placed on antibiotics immediately when you have the signs and symptoms of a true UTI (not just colonization), but before that is done, you should obtain a specimen for urine C&S. While that test is being run, take the antibiotic prescribed, but when the C&S results come back, the responsible provider will change you to the appropriate antibiotic if the tests indicate that you sensitivity results show that a better antibiotic is the best for treatment. For people with SCI, often their infections are resistant the the "usual" antibiotics, so this is critical that your true UTIs be handled this way.

    (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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