What causes frequent bladder infections in a bedridden quadriplegic patient?

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Posted on Fri, 19 Jun 2015 in Infections
Question: My husband primary diagnosis is MS; he is a quad. we perform bowel and bladder care for him (straight catheter) using very strict sterile process. (in 25 years he has never even had a bed sore, which is proof that he is well cared for at home.)
In the last 11 months he has been on an 1 of 4 oral antibiotics. Each time for 7 days, wait three days, retest, one bug appears to be gone (using the basic lab criteria) another rises. During the 1st 5 (of the 11) months his primary doctor referred him to a overworked urologist, after 3 months he referred him to an overworked infectious disease specialist who refused to give him IV therapy administered using Home Health. In other words if the patient could come into his office each day he would receive IV antibiotic hooked up to a pump connected to a picc line and go home for the treatment. This is 100% not doable for this patient.

Last month the patient ended up in the hospital and received Zostrin for 2.5 days which appeared to work wonders then was discharged with NO antibiotics! Waited 3 days, retested then put on an ORAL antibiotic for 10 days, waited 3 days, retested now the order is for another ORAL antibiotic.

He has a picc line. Its been proved that he has two underlying bugs. No one will order the IV treatment using the already (unused) picc line.

In my opinion this ongoing problem has been perpetuated by not treated both bugs at the same time; and because the duration of the antibiotics has been too short. Why would a doctor not want or be able to treat his condition? The lack of treatment is affecting the mans overall health!
Today he may end up back in ER---
By the way- His insurance is Medicare/Medicade (albeit Medical in California).

doctor
Answered by Dr. Sabiha Banu 15 hours later
Brief Answer:
some bugs do not need aggressive treatment

Detailed Answer:
Hi
Thanks for using HCM.

I really appreciate your concern, strength & courage to accept & endure with the bedridden quadriplegic patient that too with home care & no bedsores.
God bless you.

These patients are more prone for infections, especially with indwelling catheters, tubes,peripheral lines or PICC, as in your patient.
Every culture (blood, urine, stool or catheter tip)at different occasions show different growing organisms (either bacterial or fungal), sensitive to different antibiotics and anti-fungals either lower or higher drugs.(mimicking nosocomial infections)

Most of the normal flora from the stool itself tend to cause these resistant or sensitive urine infections(either e-coli or klebseilla) where the colony count is considered.(more than 1 lakh is treated).
Prolonged antibiotics itself can lead to fungal infections which should be considered with anti-fungal treatment.
Your treating doctor could have decided not to give antibiotics maybe depending on his condition.

you can as well discuss with him for the removal of PICC line,which itself becomes a nidus for infection (& also when not in use).
Any requirement of antibiotics can be taken care with simple peripheral line under medical supervision.

When you are taking such good medical care with regular culture, do not worry on the line of treatment, until he has any intermittent/ continuous rise in temperature,chills, rigors,cold peripheries,hypotension, tachycardia, decreased oxygen status, metabolic/lactic acidosis, altered renal functions, raised WBC count, irritability,culture colony counts more than 1 lakh & anaemia which are all signs of infection leading to sepsis.

you can supplement with good, nutritious,immuno-boosting diet, protein(aminoacid preparations), antoxidants to improve his immunity to prevent infections.

wishing him good health.
All the best, take care.

Dr sabiha banu(ICU, PAIN & CRITICAL CARE SPECIALIST)



Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sabiha Banu 19 hours later
Thank you. Yesterday I did request they remove the picc line if it wasn't going to be used. They did remove it this morning. What a waste. It should not have been put in; there lies my frustration. I believe his doctor is wise; however when a doctor does not discuss the treatment plan or discuss the risks my mind goes in circles.

thanks again ...
doctor
Answered by Dr. Sabiha Banu 2 hours later
Brief Answer:
good decision to get the PICC line removed immediately

Detailed Answer:
Hi
Thanks again for following up with HCM.

It is really a good decision to get the PICC line removed immediately, when not in use.

As the patient`s care taker you will be more experienced than the the treating doctor due to the 24 hours care taken by you.
so do not get frustrated, you can discuss all these health related issues with your treating doctor.

Please be free & trusted, to discuss the same & related doubts any time, we through HCM are always there to help you.

Take care of yourself, & do not go into frustration leading to depression.
wishing good health (to your husband).

All the best, take care.

Dr sabiha banu(ICU, PAIN & CRITICAL CARE SPECIALIST)
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
Answered by
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Dr. Sabiha Banu

Pain Medicine & Palliative Care Specialist

Practicing since :2000

Answered : 746 Questions

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