Seeking any experience with a UTI with staph epidermidis

[rendean]

I didn't want to be left out so I brewed my own UTI several months back and it is still brewing but just on a simmer level. Two separate urine clean catches grew over 100,000 of staph epidermidis which is usually considered a contaminant since it is a common bacteria found on the skin of healthy people.

Contaminant levels are usually under 10,000 colonies (?) but my urine for C&S has grown the same on two consecutive cultures. Most of the drugs it is sensitive to are IV except for Bactrim to which I am allergic.

Anybody with some advice? My docs are still pondering and I won't know until later today or first thing tomorrow.

Thanks,
Ren

[rendean]

Thank you  Mary. I appreciate all the positive thoughts I can garner. C. diff and Staph epi is too much for one body to handle, especially one riddled with MS.

Ren

[twopack]

Would those be coconut maroons?  Or morons with nuts?  Of course it's Friday!!  I do believe that is part of the strategy sometimes.  If it's REALLY important, the ER can spend hours researching it over the weekend.

Poor Epi is apparently much too plain a gal to garner any respect among the medical elite.  Too bad.  I fear she will take some by surprise one day after she visits the specialists in plastics.  She'll be irresistable by then.

For your sake Ren, I'll hold onto that info about S Epi's aversion to blood.  Will keep you in my thoughts.

Mary

[Quixotic1]

There is too much I need to rant on here and it has all been said.  Keflex is a wimpy urine drug and lousy for Staph epi.  Your docs are being maroons!  You need an ID specialist.

I'm too tired and in pain to rant.

The urologist should have at least done sterile cath for the ultimate answer as to whether this is a local (vaginal) overgrowth and, thus a contaminant, or whether it is in the urine.

Okay, they test for leuckocyte esterase to determine "white cells".  Epidermis cells do not produce that.  Then there is the venerable custom of spinning the urine and looking at the cells.  Leukocytes don't even bear a faint resemblance to skin cells under the microscope.  Two EXTREMELY easy ways to tell if the cells are sloughing from skin or mucosal surfaces or if they are part of an infection.

Ren, you need a CBC, a Chem Panel and a Sed Rate.  Sheesh!  This is truly scary.  At least when I got my diploma it cost a whole bundle, so we really had to be certain we wanted one.

Staph epi sepsis is truly rare in anyone with an intact immune system.  Ren, if you are on one of the CRABs then you are okay.  If you have advanced to one of the stronger meds, there is some danger for you.

And, of course, it is Friday.

Quix

[Lulu54]

If they're handing out MD's in cracker jack boxes I think we should all go looking for that prize.  I t sure sounds like these docs got their fancy diplomas through the easy way - or at least they want to take the easy way out now.

Good luck with finding someone to understand what everyone here already gets..........

Lu

[rendean]

Thanks Mary, you  echo my thoughts exactly! The vancomysin p.o. will treat C. Diff but doesn't have enough GI absorption to help with the staph epi. It has to be IV.

The nephrologist read me parts of the report last night when he called so I'm unsure the exact numbers of what the report listed.

I've put in a call to my GI doc who has me scheduled for a colonscopy in 10 days to ask his opinion regarding starting the new meds and if a CBC or perhaps a blood culture BEFORE the new treatment so as not to muddy the waters.

The rest of my docs only work half days on Fridays and I slept in and missed the chance to call, espeically the PCP for an ID consult.

Thanks for the input!

Ren

[twopack]

Oh Ren, I am at a loss as to why these docs should be so clueless.  It's not like information regarding the growing virulance of staph epi as a resistant organism is a well guarded medical secret.

I sure don't understand why they just don't hook you up with some vanc.  As I said before, it is effective against most staph epi.  It's a drug of choice in treating Clostridium difficile as well.  If you have recent history it would seem to make the most sense to use vanc to address both the UTI and colitis unless there is a contraindication.

The WBC were from epithelial cells?  I don't get it.  What type of epithelial cells were they?  Did the report say?  How many WBC and epi cells?  Have you been tracking your body temp?  It's not always easy to know when you're elevated without actually using the tool.

Any chance the pain doc will treat or at least do a repeat CBC?  He seems to be the only one who is using his credentials instead of just hanging them on the wall.

Vent away girl......and do it with gusto until somebody with a script pad sits up and takes notice.

Mary

[rendean]

Thanks Bob, that's what I thought too. That is what enrages me so much. The labs don't do the testing and print the results as  a hobby, they are there for use a tool. Guess despite their reputations and posting as the "Best Doctor in ______" they aren't any sharper than a bowling bowl if it's something they haven't seen before.

Thanks for letting me vent.
Ren

[COBOB]

Sorry your doc is a bone head.  Some subtypes of Staph epi are somewhat resistant to cephalosporins.  Rather than picking something with "some sensitivity,"  he should have used something with demonstrated sensitivity.  Ask your GP or Best Doc out of the bunch if the would check with and Infectious Disease Specialist.  This is how bugs become resistant to an antibiotic.

Bob

[rendean]

I'm fuming at the stupidity and lack of knowledge that exists in "reputable" doctors.  Got in on a emergent basis to see a urologist I had since many years before. He was sharp as a tack then, now, he's as sharp as the leading edge of a bowling ball.

He didn't listen nor did he pay a whole lot of attention to the drug list of things I already take and my allergies. He said let's get a urine for C&S. I said, for the second time, I've already done 2 and the only difference were the sensitivity results. Same pathogen.
He orders a copy of the C&S done at the local hospital and I get a hmmm, your right.

So, he prescribes Keflex since the sensitivities include some IV cephlosporins but did not say Keflex. I questioned him re this and he said they're all in the same class. His script was for Keflex 100 mg , twice a day for 7 days. Keflex doesn't even come in a 100 mg strength. I politely repeated "100 mg' and got no response.

So, on to my next victim. My nephrologist/BP doc whose medial assistant had ordered a repeat C&s along with a urinalysis to be done automatically and manually.  BP doc says it's susceptible to mostly IV meds and then he orders Keflex too and Flagyl as well since I just got over a C. diff infection.

I had left two messages for BP doc's assistant to call me back but the one I left with her after going to the idiot urologist was definitely fiery, so she had the doc actually call me. His reasoning was since there were WBC present he attributed them to the epithelial tissue present in the sample. He asked if I was having symptoms. Why would I bother if I wasn't symptomatic??????????????

Arrrrrrrrrrrgh!

Thanks for "listening". I'm off to have a glass of wine before I start the Flagyl since alcohol and Flagyl cause nausea and vomiting.

Ren

[rendean]

My thanks to all of you for your advice!! My CBC that was last done a month ago didn't show any irregularities. My nephrologist/BP doc did a protein electrophoresis to differentiate what kinds of protein I was spilling into my urine. My neuro saw the labs, my BP doc saw the labs, my PCP saw the labs  and no one said squat about the results.  

The medical assistant at the BP doc's office ( Tammy) suggested I go to a urologist (her idea not the doc..smart lady). My BP doc looked at the sensitivities and suggested Ancef. He was only in the office this morning for an  hour before heading over to the dialysis center. Tammy said she didn't like the looks of my urine analysis as well as the C&S. She said she would talk to him if he came back to the office today , if not first thing in the morning.

I saw my pain management doc today. I told him about the urine culture and how it may have impacted on my pain levels due to an MS flare, and when he heard Staph epidermidis, usually a hospital superbug, he said get to a urologist as soon as I could. So, tomorrow will be spent finding a urologist to see. Hopefully, the BP guy can get me in tomorrow with his connections.

Again, thank you to all of you who responded with information and caring thoughts. All of it is very much appreciated!

Ren

[Lulu54]

Quix was on my case about not getting a CBC done along with the urine analysis to make sure my UTI had not gone further .... turns out she was right, as usual.  :-)

Ren, some of your recent woes could very well be connected to this infection - Mary is right about getting it cleared and seeing if perhaps some of your problems clear.  I've noticed my left hand tremor that had been around for a good three months or so has now disappeared since I did the IV antibiotics - I'm thinking it was rigors and not tremor.

-L

[COBOB]

Current recommendation is Culture and Sensitivity from a clean catch urine, Antibiotics should be used on the basis of antibiotic susceptibility test of a sample.. In general, most potent antibiotics are vancomycin, linezolid, daptomycin, gentamicin and rifampin.

Infected prosthetic valves, articles and cerebro-vascular shunts usually have to be removed and replaced

Bob

[twopack]

I believe most resistant staph epi infections are responsive to Vancomycin which is available for both oral and IV administration.  The question will be whether the oral route is able to get blood levels to sufficient levels.

You might want to google ESBL (extended spectrum beta lactamase).  This is an emerging label for many bacteria that are able to produce an enzyme that makes antibiotics ineffective.  It is not bacteria specific but is a characteristic many types of bacteria are developing, especially those in health care environments.

Like Lu, I believe this is an infection that needs treated.  If your doc doesn't get on it soon Ren, I'd be asking to be consulted to an Infectious Disease specialist.  Unfortunately, we have seen that it isn't that hard to have a UTI go 'viral' so to speak.

In today's world it shouldn't be a problem to get treatment with an IV antibiotic in an outpatient or home setting if that is what it takes.  The very reason to do a sensitivity is to bypass useless antibiotics and use an effective one straight away.

Hope they get it right for you quickly.  If your body has been busy keeping this in check for several months, it's no wonder that everything else is also harder to manage right now.  This wears you down without you even being aware how hard you are fighting.  Turn this around and you might be surprised how much better you feel in general.

Just telling you what you already know.
Mary

[Lulu54]

Ren, You know my recent experience with the UTI going up into my kidneys and spreading through my blood.........  keep at the doctors to find something for you, even if it is IV antibiotics.  don't be lulled into the same place I found myself.  Ditto to the cloudy urine as the only symptom.........

best,
Lulu

[Sparkysarah]

Sounds like you are cooking something that none of us want to try, but judging from the recent posts on UTI's recently many seem to have experienced. Sorry that this seems to be lurking and hope that your kidneys are Ok and you can find something to get rid of it soon.

Love, hugs and sympathy

Sarah x :)

[RedFlame]

Hi Ren,  Damage to your kidneys is a serious thing.  Can you call the docs and 'encourage' them to be more aggressive?   Make sure you are drinking lots of fluids, especially cranberry juice.  I suggest drinking copious amounts of it.  

I know staff is a hard thing to beat though, so they need to give you the right drug.

I hope you get some relief soon!

You deserve lots of hugs today'

(((hugs)))

Red

[COBOB]

Well, the good news is that Rifadin (Rifampill) is available in 150mg and 300mg capsules and tetracycline is a pill.  If your bug proves sensitive, at least you may have an oral combo to kill it off.  Since  this is a totally different class of antibiotics than is normally used, there is very little resistance to these drugs.

Bob

[rendean]

Thanks Bob, I appreciate the info.Didn't know about the biofilms.

My worry is since it's been lingering for awhile with only cloudy urine as a major sign that it may be wreaking havoc with my kidneys. Last labs showed small amount of protein but that was thought to be transient since it didn't appear on the next test.

Thanks again,
Ren

[COBOB]

There is a study out there http://www.advancesinpd.com/adv88/pt6antibotic88.html  thT suggests the Rifampill + tetracycline might be effective against  staph epidermis biofilms.  This is an emerging and problematic hospital acquired infection (Staphylococcus epidermidis, has emerged as major nosocomial pathogen.)   The "biofilm" subtype refers to its ability to adhere well to body tissues.  The lab could test for sensitivity to Rifampill.  They would not normally do this since Rifampill is used to treat TB.

Bob


Figured it was worth mentioning.