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Did a nasal swab out of nose and found Ecoli. History of sinus issue. CT scan done. Should I be worried?

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Question on nasal swabs? My IM doc did a nasal swab out of nose and found Ecoli. This was after taking 10 days of Augementin 875 BID and Spectracef 400mg BID.

I have a history of sinus issues. Two sugeries. ENT looked at me last week and ran CT. CT showed minor issues, nothing that they have not seen on me before. I have had weird pathogens in my body before. Ecoli in lungs and Serrita Marcences in lungs.

Here is the question. One ENT wants me to do nothing, since my symptoms are finally gone. Another wants me to go ID route. I have done ID before. In the past 3 rounds of rocephine 1mg push IV for extented periods of time.

This strain of e coli is not resistant to much. But 20 days of AB's should of cleaned it out? I am tired of being on AB's. I am going to give myself CDIF at this rate.

Bottom line is this? E Coli heavy growth in nasal swab. (After 20 days of AB's. Symptoms are for the most part gone. I done rinse everyday.) Should I be worried that Ecoli is in nose? Second, does it warrant another round of AB's? Or even ID route?


Posted Wed, 22 Aug 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 3 hours later
Hi,

Thank you for your query.

1. The cause of your problems is Biofilm formation in your sinuses. There may be associated allergic, fungal and mucus related conditions. The simplest example of Biofilm is the sludge or slime seen in drainage pipes or the moss seen along water channels. The Biofilm represents colonies of different types of bacteria living together like a 'city' with different micro organisms taking up different tasks or 'profession's like we do in our communities. Some of them secrete a matrix that protects them all. Due to close proximity, these bacteria share genetic material and may be genetically distinct from those that are grown in lab cultures. Hence they do not respond to the same antibiotics that they show sensitivity to in lab studies. Bacteria like E coli are notorious for antibiotic resistance and can cause other species like staph to become more resistant by exchange of genes and chemicals. Ecoli and Serrita Marcences are both from the Enterobacteriaceae family which are relatively unaffected by Augmentin and Spectracef.

2. I would like to see any CT Scans that may have been done in the past. You may share them here. The reason is to see if the previous two surgeries were adequate. This is because poor ventilation and drainage of your sinuses is the most important cause of Biofilm formation.

3. You should wash your sinuses with a solution of normal saline with a pinch of salt and baking soda added to it. This alkaline nasal douche will help break up the Biofilm and allow penetration by other antibiotics. You may add an antibiotic like tetracycline or chloramphenicol. However this should be done under medical supervision.

4. If you are preparing the saline solution at home,
(i) I will recommend that you use Normal Saline 0.9% which is used for IV infusions.
(ii) Household salt may contain anti-caking agents and too strong or too weak a solution will damage your delicate nasal mucosa.
(iii) If you still want to prepare the solution at home prepare a mixture of Sodium bicarbonate (loosens crusts) 50 gm, Sodium biborate (antiseptic) 50 gm, Sodium Chloride (for isotonicity) 100 gm and then add 1 teaspoon to 300 ml XXXXXXX warm water.
(iv) Another option is to add a pinch of baking soda to a pinch of common salt, + XXXXXXX warm water,
(v) Attach a piece of rubber catheter to a 20 cc disposable syringe. Keep your head bent forwards and downwards, mouth kept open while performing this alkaline nasal douche.

5. You should draw their attention to Biofilm formation, which is a relatively new concept. Rocephin (Ceftriaxone) must have helped reduce symptoms.

6. Supportive treatment such as mucolytics, anti allergics, anti fungals, steam inhalation and dental hygiene should be taken. Surgical debridement, removal and disruption of the Biofulm requires repeat or revision surgery.

I hope that you do not have any other immune suppressive disorder such as diabetes. In such cases oral steroids are contra-indicated.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Did a nasal swab out of nose and found Ecoli. History of sinus issue. CT scan done. Should I be worried? 38 minutes later
Culture shows is not resistant to much. Question is, do I do Iv Rocephine again? Immune system is fine. Do I just live with it or try to kill it? Tetracyclice is resistant. I am allergic to cipro. They want me on Augmentin for a month.
 
 
Answered by Dr. Sumit Bhatti 56 minutes later
Hi,

Thank you for writing back.

1. I will revise a quote from the answer above "Due to close proximity, some of these bacteria share genetic material and may be genetically distinct from those that are grown in lab cultures. Hence these genetically similar bacteria do not respond to the same antibiotics that they show sensitivity to in lab studies XXXXXXX

2. You may try other higher generation antibiotics such as Carbapenems instead of Augmentin for a month. You may be dealing with a nosocomial ESBL (extended spectrum beta lactamase) E coli.

3. If you have no symptoms you have reached a carrier status. Most physicians will not treat this. However at least some attempt should be made otherwise these resistant bacteria may launch an opportunistic attack if your immune system is weakened by some other medical condition in the future.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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