Wow. That makes me wonder if an infectious disease person should become involved. Two organisms appearing in two separate collections makes me wonder what could be going on. Did you get "sensitivities" (MIC/MBC) information with the cultures? They may not have done any since there are two organisms, neither predominant. If the urologist or whoever originally ordered the culture can get them to perform the MIC on both, you may get good info if there is one antibiotic that will get both. The other suggestion might be to have someone do a suprapubic tap (I know, not pleasant) without the catheter itself being involved. It would be difficult as your bladder is usually empty, but if things get backed up, that could be when this could be done. What organisms were found, @John Brunner ?
Yeh, I hope my urologist is on top of this. I have had samples taken from very old bags without this happening. Here's the lab report: That's all there is. The rest is boilerplate. It's identical to the previous one. I have to agree with you...two in a row is not contamination.
Greater than two. They are assuming contamination, but they don't know history perhaps. Did you previous mixed culture go to LabCorp as well? >100,000 CFU/mL is very worrying. I don't know what to say if your urologist doesn't get involved with this. That is why I suggested the bladder tap to take the catheter out of the equation. Culture the urine, then culture the inside of the catheter after removal and see what that produces. It might be difficult, but perhaps you could speak directly with the Microbiology supervisor at a local lab or the Lab Director and see what they have to say. If you can get through to the Micro people at LabCorp, that would be even better...but almost impossible. The local folks may not want to dela with you as the culture wasn't done in their lab and Burlington is a nightmare but your urologist might be able to talk with them.
The previous culture also went to LabCorp. Keep in mind that I flush the thing every day...sometimes twice a day. But I'm very careful to wash my hands and to wipe the end of the cath off with alcohol. I do the same thing when I swap day bag/night bag...nozzles get wiped with alcohol. Every lab I've done that has found the klebsiella has been >100,000 CFU/mL. I cannot recall how many successful cultures have been done on me, so I doubt that sample contamination is the issue. I clean off the entry point for the spc with soap and water when required, but that's been a "since Day 1" thing without ill effect. I hope I've not introduced anything, but there's no external infection and nothing untoward on the cath. In fact, when I get my cath swapped, the nurses always comment on"how good the site looks" relative to what they see with others. [rant] These places shove a cath inside of you, strap a bag on your leg, kick you out the door and say "Good Luck!" without any Care & Feeding instructions whatsoever. The same thing goes with this spc. No advice, no handout, no guidance, no nuthin. Heck, it was 2 1/2 months after the procedure before I saw my doctor for the first time. I ask Nurse A if I can use saline solution (vs just sterile water) to flush and she says "Yeh, we just use whatever bottle we happen to grab." Nurse B says "OMG, you fool! NEVER use saline solution!!!" A nurse tells me to put lemon in my water to remediate the sediment, and my doctor looks at me as though I got the advice from RastafarianClinic.com I had to be extremely aggressive to get my first 24 hour urine collection after many blockage crises, and just a week ago it was only through my own initiative and my own stubbornness that we find out I got struvite stones, so I avoided being put on meds to reduce calcium levels while the struvite continued unabated. Yet these people document my record with judgemental slander because I insist on driving the bus. And this is the best practice I have found![/rant] *sigh* The second lab results were just pushed out this morning. We'll see what my doctor says Monday. They are supposed to call me to schedule lessons on the antimicrobial flush and to schedule a CT scan for stones. I'll raise this lab issue with them if they don't raise it first. I have no idea when my doctor reviews each day's new lab reports. I don't want to start that flush without knowing what we're trying to kill (besides me.) But with these lab results, I'm kinda motivated to start something ASAP...and maybe get another script. And all of this after I've been on a maintenance dose of Macrobid for 4 months. Maybe it prevented something really bad.
Oh, I understand you are careful. I proposed the bladder tap to separate what is in your ladder from what is in or on the catheter. I have seen catheters growing things in the very antiseptic coating designed to prevent bacteria. This was a big thing in the 1980s when Zephiran (benzalkonium chloride) was used to coat and flush catheters. Zephiran killed everything they tested it against but missed that it was used in the medium to culture Pseudomonas aeruginosa. Oops! So everybody was developing P. aeruginosa-infected catheters. I am not suggesting that is happening to you, but it still seems reasonable to separate what is on the catheter and being cultured, from what is floating around in your bladder and perhaps forming stones or gravel.
*WARNING* I lack brevity Other than the biofilm forming, I had only given fleeting thought to the cath material being a causal agent. I've read of folks switching to silicone and hydro gel caths to remediate this issue, but have no idea of their efficacy. The only thing I recently changed was the use of the sterile water. I have 100ml bottles and only use 60ml per flush. I had been throwing the rest away, but a nurse told me it would keep for for a month, and I should put it in an intermediary sterile container to fill the syringe from as they do in their practice (they draw from 500ml bottles.) She told me to sterilize the container with hot tap water. I decided that I did not trust the things that live in my water heater, nor is it hot enough, so I've been sterilizing a small (5 oz) glass by pouring boiling kettle water into in and overfilling it with vast quantities so the hot water spills over the lip and down the sides. I put 60cc of sterile water into that and fill the syringe out of it, reserving the remaining water for the next day. I'm careful to not lay the bottle's cap down or touch it or touch the end of the syringe. It sits for 24 hour max...only 12 hours when I flush 2x/day. I cannot imagine I've introduced anything through that process unless residual boiled tap water might not be sterile. Whenever I wade though this stuff, I have several reactions: -Anger at this disengaged profession that refuses to wander out from under the Bell Curve (although my current doctor is better than that) -Compassion and sorrow for those who are suffering and rely on this industry as their sole resource -Gratitude for friends like you and the others elsewhere and on this forum who share their knowledge, time and compassion. You all bring valuable data, perspective and support to the table, and help me get out of my own head. The fact of the matter is that during any of those ER visits, I would have given anything to be at the place I am right now...struggling but managing it. Looking back on things, it occurs to me that I had all those catastrophic blockages every 14 days, with each of those 2 week periods beginning with a 5 day course of antibiotics to remediate the prior cath's infection. So that means I generated all that sediment during the 8 days after the last dose of antibiotic (assuming a high degree of efficacy.) That is friggin' frightening. And it's interesting that long term 50mg of Macrobid/nitrofuratoin plus the daily (sometimes twice a day) flushing have carried me through 5 catheters, although 2 of those were swapped at 3 weeks (and could have likely gone the other 7 days.) I think all my flushing washes dissolved sediment from in between the crystals in the cath, so pathways are kept open rather than it making cement. And flushing is really a non-event for me, even though I doubt that many others flush that much. The encouraging thing at this phase is encountering sites and articles that are focusing on this issue, rejecting the long-term mantra that blockages are "just a part of having a cath." My doctor is putting me on the antimicrobial flush, which seems to be the best you can do (in conjunction with antibiotics) to remediate this stuff. My parallel path is to call the nephrologist on Monday and set up another appointment. I know that the calcium must be a contributing factor, and other aspects of it have me concerned.
Now I'm reading about using boiling water to clean the container I fill the flushing syringe with, and wonder if I've not messed up. I wonder if I've not really sterilized it vs sanitize it.
A urology nurse told me her way of maintaining catheters for reuse if one cannot afford to use new ones. She stored them in soapy water after use, then, when some had been accumulated, boil them in fresh water, then store them in 70% or greater isopropanol. She considered that sterilized for re-use. I don't know if that applies to you, but it is truly impossible to really sterilize plastics at home. If you maintain a sterile field while entering the bottle, it should be okay for a while. A month seems a bit long.
I felt like I was putting people on the spot asking for specific advice on something that might be causing me infections.
I have not done it on your particular issue but you might research lubrokinase? Could that be injected in through the cath maybe?
My doctor's office called on Friday and told me that they are going to "train me" in how to use an injected antibiotic. I had already read about this, and it seems to make perfect sense, since the catheter provides direct access to where the critters live. It seems pretty basic: inject just like my daily flush, let sit for 10 minutes, rinse. I don't know if there are different flavors for each species of bacteria. It might just be a broad-spectrum anti-microbial. I should paste his summary of my most recent visit here. Apparently my urologist thinks I should see a proctologist to have that stick removed. But the guy is moving forward, using the data he could have refused to collect that contradicts his diagnosis (I can name specific doctors who would have placed ego in front of patient care and I would be in a very bad spot.) And I think those urnalyses are correct...they were not contaminated. My prior 3 catheters all started out with no sediment for the first 2 weeks after they were installed. The one they put in last Wednesday has shown signs of sediment from Day One. This has never happened before, and it's an indication of lots of bacteria. I hope I get an oral antibiotic to knock this stuff out to get me started on the topical injection.