Its a complicated tale

Ashley Kate's line cultures are STILL positive.  From this point it all gets a little complicated.  I'm going to do my best to document it here for future reference and as a bonus if your interested you get to read it too. If its not of interest to you don't worry...feel free to skip it.

The bugs id is Enterococcus Faecalis.

Its a natural inhabitant of the intestinal and female genitalia tracts.  So we know it came from inside of her.

It being an opportunistic bacteria made its way to her central line.

It can be life threatening.

It is known to be extremely hardy.  "It has an intrinsic resistance to many antibiotics and a remarkable capacity for developing resistance to others."

"Its naturally high levels of antibiotic resistance contribute to its pathogenicity."

Vancomycin is usually the last "big gun" chosen to treat it.  Its ability to become vancomycin resistant is a fearful reality.  This was our first choice to battle the infection.  It didn't work.  It did do damage that has yet to reverse to her kidneys.

It showed sensitivity to both vancomycin and ampicillin.  This means in the lab they have been able to effectively kill the bacteria with each of these antibiotics.  In her line we have had no luck yet.

In most cases it proves to be VERY difficult to clear from the line.

In any other patient the line would be removed and a new one placed in another location.

All physicians working on her case know and realize this is not an option so we just keep treating.  They are working hard to figure out a plan.

We saw infectious disease this morning and began the new treatment plan.

The original idea and most ideal for success is to mix  ampicillin and gentamycin. This is not an option because of the damage her kidneys have sustained from the use of vanc earlier this month.  Gentamycin is also nephrotoxic. The risk of further damage is too high at this time with her kidney numbers.

Instead we will continue treating with ampicillin every 8hours and in between the infusions we will lock the line with the antibiotic allowing it to dwell inside the catheter for the 7 hours in between. We will also lock the other lumen for the 6 hours that her TPN is off.  Each day we will alternate the routine between lumens.  Cultures will be drawn again on Tuesday and Friday of next week.

Hopefully this will work.

In the meantime her med schedule is such that we had to pull Allie from a tournament in San Antonio this weekend.  My heart is sad for Allie, but she is so understanding and so amazing. She is a great big sister.   I do my very best to keep life as normal as possible for the older kids and to keep them as involved in their activities as much as we can.  Traveling that far from home is not a good idea while we are working through this infection.  I'm disappointed, but know its what is best.

Ash remains her self.  The only difference we see in her is a few small fevers here and there and some extreme thirst while her BUN is so high.  We are running extra IV fluids for her to keep her comfortable.  She is funny and silly.  Still laughing most of the time and sleeping well.

I've never seen a line infection such as this in Ash.  She's not acting sick which tells us she's not systemically infected with the bacteria.  Our hope is to keep it isolated in the line and keep it from spreading throughout her blood stream.  Not knowing if or when that could happen is why we must keep her close to home.  Just in case.

Overall, it sounds complicated...but we are still living life...just keeping it close to home this holiday weekend.