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Had ablation. Blood culture showed positive for gram negative bacilli. On vancomycin and zosyn. Suggested hysterectomy. Guidance?

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Posted on Mon, 8 Jul 2013
Question: Hi Doc. My wife had an ablation on the 11th. By the evening of the 13th we were in the ER. She is still in the hospital, with an infection in her outer is. She's had six blood cultures, only first one returned and plated positive, for gram negative bacilli (ecoli). Antibiotics currently on, vancomycin and zosyn. Yesterday she had a partial DNC, with a pediatric catheter implanted and draining. The cultures from the DNC came back today (preliminary) gram positive cocci. Dr says the antibiotics can't get into the uterus due to the procedure on the 11th and doesn't know where to go from here. At one point said may need hysterectomy. We are seriously considering requesting a transfer to a level one facitily....
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Answered by Dr. Rakhi Tayal (56 minutes later)
Hello,
Thanks for posting your query.
After an ablation procedure, the blood circulation to the endometrial cavity is severely compromised which mainly helps in fighting off the infection.
Since the systemic antibiotics are not able to control the infection well even after a treatment for last more than 5 days, hysterectomy may need to be considered to save the life.
You must consider a transfer to level 1 facility under these circumstances.
Hope this answers your query. I will be glad to answer the follow up queries that you have.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Rakhi Tayal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Rakhi Tayal (36 minutes later)
Thank you for replying, Dr. Rebecka's not had a fever in 28+ hours. Last white blood cell count was taken approximately 19hrs ago, level was 14.9 (highest level to date). Abdomen feels distended in left lower quadrant. Good appetite.
Could this be the start of recovery, or a worsening condition being masked by the antibiotics?
doctor
Answered by Dr. Rakhi Tayal (7 hours later)
Hello.
Thanks for writing again.
The absence of fever and a good appetite are favorable symptoms. The total WBC count of 14.9 is also not very high.
The mild distension of abdomen is not worrisome as long as her bladder and bowel movements are normal, urine output adequate and there is no foul smelling discharge from vagina. The symptoms that you have described are indicative of the beginning of recovery.
If the infection spreads then the symptoms cannot be masked by the antibiotics.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Rakhi Tayal (1 hour later)
Hello Doc. I greatly appreciate your time.
There is still no fever: temperature has ranged 98.0 - 98.9. WBC from 4 hours ago is 10.0. Her urine output is very good, though has watery bowl movements, of which we are told is due to the antibiotics. Has very loud bowl sounds.
The drainage is consistent, though not heavy and considered serosanguinous (unsure of spelling) ... is lightly colored blood with clear fluid ... still no odor.
doctor
Answered by Dr. Rakhi Tayal (18 minutes later)
Since the WBC count has decreased, it suggests that the infection is under control. The serosanguinous discharge from the uterus will also subside in next few days. Since the discharge has no bad odor, it is likely to be a reactionary fluid due to inflammation in the area.
The watery bowel movements can be due to the antibiotics she is taking. Taking probiotics will help in controlling this after consulting with her gynecologist.

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I wish you the very best in whatever you do.
Warm regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Rakhi Tayal (20 minutes later)
Doc, your time and advice have been invaluable. Thank You!
doctor
Answered by Dr. Rakhi Tayal (34 minutes later)
Hello.
Thank you.
I am glad I could help.
Wishing your wife an early and trouble free recovery.
Best Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Had ablation. Blood culture showed positive for gram negative bacilli. On vancomycin and zosyn. Suggested hysterectomy. Guidance?

Hello,
Thanks for posting your query.
After an ablation procedure, the blood circulation to the endometrial cavity is severely compromised which mainly helps in fighting off the infection.
Since the systemic antibiotics are not able to control the infection well even after a treatment for last more than 5 days, hysterectomy may need to be considered to save the life.
You must consider a transfer to level 1 facility under these circumstances.
Hope this answers your query. I will be glad to answer the follow up queries that you have.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Rakhi Tayal.