Your concerns are warranted. This is a scary series of events and, unless there have been signs of progressive improvement since your last report of November 26, one might question the appropriateness of discharging your daughter from the hospital, with the diagnoses of lung abscess and staph septicemia. I assume that your daughter’s antibiotic therapy is being managed by a pediatric infectious disease (ID) specialist; if not, you should seek such consultation. You would also want to ask the ID specialist if there might be an alternative antibiotic to vancomycin, such as linezolid, if that medicine were deemed appropriate for a 2½ year old child.
You should also consider getting another opinion regarding management of the lung abscess, which is probably the source of staph in your daughter’s blood. It is often difficult and sometimes impossible to eradicate a lung abscess, without surgical drainage. As the surgeon indicated, this would be a high risk procedure but a decision against surgery also carries risk. You should seek another opinion regarding treatment of the abscess from another surgeon and/or a pediatric pulmonologist and you should request that the pulmonologist, the ID specialist and the surgeon convene to discuss the pros and cons of the available and feasible approaches. Do not hesitate to request information or additional consultants, out of fear of offending your daughter’s physicians. There is too much at stake.
Finally you should ask her doctors if the infection might be due to an inherited or acquired immunodeficiency state.
Thanks so much for the reply. First a quick updated on my daughter and a few follow up questions. The Staph infection turn out to be Staphylococcus epidermidis only found on the central line and not in the bloodstream. She ended up staying at the hospital another 5 days. The pediatric ID has her going through a 10 day regime for the Staph and all blood cultures have come up negative and another 3 week regime of Clindamycin for the abcess at home.
As a follow up question, I am still concerned about the abscess and it seems that everyone is just going on the pediatric surgeon's advice that antibiotic therapy will work for the abscess. Originally, the ID doc had concerns about antibiotics pentrating the membrane of the abscess. It makes me nervous that we are solely relying on CAT scans to tell if it's shrinking or not. Plus, even if it shows that it is indeed shrinking, that doesn't necessary give me comfort that the fluid in the abscess is going to stay dormant. There is not a pediatric pulmonologist on the team right now and I am definitely moved to follow your advice on this. How do I go about getting a doctor of this specialty involved? Is there one that your recommend in Denver? Does insurance cover second opinions? Regardless...my daughter is worth it.
Lastly, where would the answer of inherited or acquired immunodeficiency state question lead me?