e coli ESBL+ urinary infection

April 12, 2012 10:28 PM

After multiple knee surgeries, my mom was just diagnosed with e coli ESBL+ infection.

My age-67 mom had a knee surgery twelve weeks ago. A week later, the tendon snapped. She had another surgery. A week later, the tendon came undone again. Third surgery got infected. (It was thought to be HA MRSA and treated as such—latest diagnosis was that it was a type of "yeast" infection.)

Infection ate away tendon. Fourth surgery to install "steel cable" in place of tendon and insert antibiotic beads. Fifth surgery to debreed and removed beads.

Now, after using a catheter to pee and experiencing discomfort last night, her urine was tested and came up positive for e coli ESBL+. She was moved into quarantine hours ago.

What should my concern level be?

PS she is 5'2", 220lbs, has MS, and type-2 diabetes.

Help, hivemind. Help.

posted by Mike Mongo to health & fitness (6 answers total)

Oh, my heavens, your poor mom.

I am sure it sounds immensely scary that she's been moved to a quarantine floor or ward, but those folks have the resources and training in combatting antibiotic-resistant infection, as well as a more sterile environment than the regular floors or wards.

Something that, if I were in this situation, I would do my best to make sure the doctors keep an eye on is that she's monitored for pneumonia vigilantly; given her age, diabetes, and her MS, she's going to be at some risk for that while being treated for the EBSL E. coli (at least, my dad's doctors suggested that there was some ways that the meds for the former could produce beneficial growth conditions for Klebsiella pneumonia; I am not at all a doctor and perhaps someone who knows way more about this than I will confirm or deny that possibility).

My thoughts will be with her, and you, and with your whole family.
posted by Sidhedevil at 10:40 PM on April 12, 2012

I can imagine that the "quarantine" seems scary, but it's not as bad as it seems. Healthcare workers go room to room, touching patient after patient, many of whom have lowered immunity to infection due to whatever health problems landed them in the hospital in the first place. Keeping your mom under what we call "contact precautions" just means that hospital staff should be wearing a gown and gloves when they go into her room, which they will take off when they leave the room, to avoid spreading the ESBL bacteria to any other patients. Visitors, like you, will most likely not have to wear gloves or anything special, although it's always good practice to wash your hands when you leave the room, and when you get home from a hospital visit.

Regarding the resistant nature of the bacteria, it's actually really good that they found out so quickly that her strain is resistant. Now they can start her on antibiotics that will actually kill the bacteria in her bladder, rather than trying a bunch of drugs that won't work and giving the bacteria more time to grow and multiply. ESBL doesn't mean there's no cure, it just means that some of the standard "this oughta fix it!" drugs don't work. So we use different ones.

What should my concern level be?

On a 10-point scale, if that was my mom, it would ratchet up my concern level about 0.3 from whatever it was prior to the urinary tract infection. And FWIW, the multiple knee surgeries would have had me worried at maybe a 5 or a 6. So at least for me (as a nurse who sees plenty of resistant infections but has little to no experience with joint surgeries), this latest development is not something to lose sleep over. Encourage your mom to make sure the staff are cleaning their hands before they come into her room, to avoid picking up any more resistant bacteria. But certainly don't panic.
posted by vytae at 11:20 PM on April 12, 2012 [4 favorites]

I hope you and your mom stay strong through this ordeal.

IANAD, I doubt they'd even let me play one on TV! However... if it's just a urinary tract infection, and remains one, then I wouldn't be too worried. If you're in and out of a hospital enough, and have a couple catheters for an extended period of time, then I think it's a pretty normal to have at least one infection. Quarantine isn't something to necessarily fear; it's just a necessary level of precaution when dealing with antibiotic resistant strains of bacteria. They aren't putting her there because they've given up, they're just trying to protect other patients and (more broadly) extend the usefulness of existing antibiotics while they aggressively treat her.

One thing that does concern me is the question of exactly why these previous knee surgeries failed. If her body is unable to repair itself, or her immune system is no longer mounting an effective response, then I'm afraid you might be in for a very long and arduous ordeal.
posted by sbutler at 11:21 PM on April 12, 2012

Immune response to bacteria and healing tendon damage have very little to do with one another. There's are some pretty good Kahn Academy videos on the subject of immunology and inflammation if you are interested in that aspect of things, but I imagine you're more concerned about the infection.

The issue with the bug in question is that it is resistant to one class of antibiotics. We have others, so while this isn't good, it's a small fraction of being as bad as it might be. The scary infection control nightmare is a strain of bacteria that is well on it's way to "collecting the whole set" of resistances and that produces a toxin, like some of the multi-resistant staph strains.
posted by Kid Charlemagne at 12:17 AM on April 13, 2012

IANYD. Others have already given you the answer about the ESBL UTI and the fact that it is treatable.

The concern is mainly about the knee. Once a piece of joint hardware gets infected, it is extremely difficult to un-infect it. The big academic hospital where I work sees a lot of patients who have had to have numerous knee surgeries with infection at outside facilities and come in for last ditch efforts. And the additional big problem for your mom is that she's diabetic, and so wounds aren't going to heal well.

Best wishes to you and your mom as she recovers.
posted by treehorn+bunny at 1:56 AM on April 13, 2012 [3 favorites]

Just a note of update.

To all who said the infection was not as big a deal as I thought, you were right! That was small and caught quickly and was treated and has since disappeared. Don't make me cry.

Second, we took my mom from that Rehabilitation Center. My sister and I and a cousin who is a private nurse took over responsibilities for one week before her autograft (tendon replacement). This was one of the most difficult things I have done in my life. It changed me at root. And I am better person for it.

Third, and this is very important, the replacement never got infected. Only the area cut open to initially reattach the tendon. The replacement was—and is—good.

My mom's most recent, closing surgery was five-hours and required a muscle flap from the one (good) leg to be cut and added to her repaired leg along with the cadaver's tendon.

That was 10 days ago. Seven days ago, she took her first walk across the room by herself (with walker) in 3 and a half months. She calls to tell me her progress, how every muscle in her body hurts, how here knee hurts—"but in a different way—and it is inspiring. She sleeps at night because she is tired from using her arms and her legs. (Remember, 5'2", 220 lbs—down 30 lbs since this process started, thank God for small favors.)

And I just wanted to share since all here made such a tremendous difference in how I proceeded. I know AskMefi is awesome but this time you all were part of the team that got my mom on her feet again. Thank you. I am here for you whenever. Blessings.
posted by Mike Mongo at 10:03 PM on May 5, 2012 [2 favorites]