Question for Dr. Hive

[snowbeltmom]

My younger brother (late 30's) has been in the hospital since Monday.  Last week he developed what he thought was a small bug bite on the back of his neck.  It grew and became so painful that he went to urgent care.  They immediately send him to another hospital for a CAT scan.

 

He was told that he has some kind of infection, but they still don't know what it is.  They have been giving him high-powered antibiotics via IV since Monday, but they don't seem to be working as the infection is now close to his spine.

 

Should it be taking this long to figure out what is going on?  Should he be looking to get a second opinion? 

 

I have googled his symptoms and staff infection is what google suggests he might have.  I am concerned that it is taking so long to identify what the heck is going on.  Is it normal to take so long for cultures to come back from the lab?

[zyxwvut]

I would be concerned, too!  At the very least, they should be able to tell you when the cultures will be back.  I know of a friend who had an infection on their neck, and they needed surgery to cut it all out and clean it.  Then they were on antibiotics for a long time, and had to have it drained several more times.  

 

Maybe you would feel better if you talked to a patient advocate at the hospital.  They can help sort through what is going on, and help you decide if it is a reasonable course of action.  

[snowbeltmom]

I would be concerned, too!  At the very least, they should be able to tell you when the cultures will be back.  I know of a friend who had an infection on their neck, and they needed surgery to cut it all out and clean it.  Then they were on antibiotics for a long time, and had to have it drained several more times.  

 

Maybe you would feel better if you talked to a patient advocate at the hospital.  They can help sort through what is going on, and help you decide if it is a reasonable course of action.  

 

I forgot to mention that a surgeon has cleaned it out twice now.  I am concerned that maybe it would be a good idea to get some second opinions, which is not happening right now.  However, I have no experience with this at all and maybe all of this is normal and no matter what doctor/hospital he was at, the approach would be the same.

 

[displace]

Most infections are immediately gram stained to give an idea of what it might be. Preliminary Cultures come back in 24-48 hours. The problem is sometimes the cultures grow nothing (if he was on antibiotics before the culture was sent, this could happen). The other problem is they may grow a wide range of bacteria, confusing what is actually the problem and basically negating or degrading any usefulness of the culture.

 

In addition they test for sensitivity to antibiotics, which takes longer, sometimes 3+ days. He can easily ask what the preliminary cultures showed. There should be some news (either multi-bacterial, no growth, etc).

 

I hope he gets better soon!

[EmseB]

Cultures can take awhile to come back, but it is concerning that the antibiotics are not helping at all in the meantime.  It can take up to five days to get specific results.

 

Is he feverish and such like the infection is going systemic/septic?  Or is it just the localized pain?

 

We dealt with a horrific bout of MRSA last year, and I ended up having to stand over the hospitalist's shoulder while he showed me the culture results and the antibiotics used to treat it.

 

I would be asking every person that stepped foot in his room what the culture results say.

[EmseB]

I forgot to mention that a surgeon has cleaned it out twice now.  I am concerned that maybe it would be a good idea to get some second opinions, which is not happening right now.  However, I have no experience with this at all and maybe all of this is normal and no matter what doctor/hospital he was at, the approach would be the same.

 

 

Graphic question:

 

Was this done in his room, or was it actual put-him-under surgery?

 

Cleaning it out is one thing (excision and drainage).  But sometimes they have to actually just cut the whole thing out under general.

[EmseB]

Also (sorry for the multiple posts) it is hard to get a second opinion in the hospital IME, just because usually the hospitalists are overworked as it is.  What helped us immensely was having an infectious disease doctor to come in and review our case. The hospital should have one on staff/call.  We did not know to ask for this, but during our second bout with the infection the hospital called her in.

 

There was still aggravation because all of the orders still had to go through the hospitalist, but the ID doc was much more knowledgeable and someone we could see out of the hospital in her office when he had a occurrence.  So we at least got information from her, and when the hospitalist drug his feet we could say, "Well the ID doc said this, could you talk with her?"

Edited December 15, 2016 by JodiSue

[DesertBlossom]

That's really scary. This summer my SIL developed an infection in her foot that went from mild to severe within a day. She ended up in the hospital for about a week. They cultured it, but it came back negative for staph, strep and salmonella. IIRC. They weren't really sure what it was but were giving her heavy abx for a really long time. For a couple days while she was in the hospital there was chance they were going to have to amputate her foot to stop the spread of infection. It was really scary. They finally got it under control, but months later she's still not 100%.

[City Mouse]

My mom get strange un named infections rather frequently. If he went into the hospital sometime on Monday, it has only been three days. Based on my mom's experiences that does not seem out of the ordinary. She is usually in the hospital for a full week with out-patient I.V. antibiotics to follow for a couple of weeks. Usually she does get referred to an infectious disease specialist, but that does not happen right away.

 

Now, my mother is much older than he is and has several medical issues that make the situation worse. She does not feel much pain, so infections are usually pretty bad before she even notices to go to the doctor.

[snowbeltmom]

Graphic question:

 

Was this done in his room, or was it actual put-him-under surgery?

 

Cleaning it out is one thing (excision and drainage).  But sometimes they have to actually just cut the whole thing out under general.

 

I am not sure.  I know that he is in a private room and they took him out of the room to perform the procedure, but no one mentioned that he was put under general, so I doubt if he was.

 

[snowbeltmom]

Also (sorry for the multiple posts) it is hard to get a second opinion in the hospital IME, just because usually the hospitalists are overworked as it is.  What helped us immensely was having an infectious disease doctor to come in and review our case. The hospital should have one on staff/call.  We did not know to ask for this, but during our second bout with the infection the hospital called her in.

 

There was still aggravation because all of the orders still had to go through the hospitalist, but the ID doc was much more knowledgeable and someone we could see out of the hospital in her office when he had a occurrence.  So we at least got information from her, and when the hospitalist drug his feet we could say, "Well the ID doc said this, could you talk with her?"

 

Thanks for the suggestion about the infectious disease specialist.  I will pass this info on to my sil.

 

[snowbeltmom]

That's really scary. This summer my SIL developed an infection in her foot that went from mild to severe within a day. She ended up in the hospital for about a week. They cultured it, but it came back negative for staph, strep and salmonella. IIRC. They weren't really sure what it was but were giving her heavy abx for a really long time. For a couple days while she was in the hospital there was chance they were going to have to amputate her foot to stop the spread of infection. It was really scary. They finally got it under control, but months later she's still not 100%.

Wow that is really scary. 

[snowbeltmom]

Cultures can take awhile to come back, but it is concerning that the antibiotics are not helping at all in the meantime.  It can take up to five days to get specific results.

 

Is he feverish and such like the infection is going systemic/septic?  Or is it just the localized pain?

 

We dealt with a horrific bout of MRSA last year, and I ended up having to stand over the hospitalist's shoulder while he showed me the culture results and the antibiotics used to treat it.

 

I would be asking every person that stepped foot in his room what the culture results say.

 

The doctors told my parents that they are giving him quadruple the dose of antibiotics.  I don't know if he is running a fever.  The pain must be pretty bad because they are also giving him morphine.  The update from my parents this morning is that they are hoping to get the culture results back today.  I didn't realize that it would take so long to culture something, but the posts in this thread have made me feel better that the time frame is normal. 

 

[fraidycat]

I have nothing to add re:medical, but I want to offer you :grouphug: and add that I hope your brother is back to feeling well soon!

Edited December 15, 2016 by fraidycat

[snowbeltmom]

I just got an update: the doctors have narrowed it to MSRA or MS(something else that also has two letters in it).  Does anyone have experience/knowledge of this?

[SparklyUnicorn]

I just got an update: the doctors have narrowed it to MSRA or MS(something else that also has two letters in it).  Does anyone have experience/knowledge of this?

 

Yes.  It's hard to get rid of because it is resistant to many of the commonly used antibiotics.  It's not generally a problem for people with good immune systems.  It's usually contracted in hospitals or nursing homes. 

 

My sister had it and she does have a compromised immune system, but still managed to eventually get rid of it. 

 

(I'm assuming you mean MRSA.)

Edited December 15, 2016 by SparklyUnicorn

[SparklyUnicorn]

My BIL also had it and it showed up as a sore on his leg.  Took awhile for that to resolve and I guess it was quite painful, but he did get better.

 

 

[snowbeltmom]

Yes.  It's hard to get rid of because it is resistant to many of the commonly used antibiotics.  It's not generally a problem for people with good immune systems.  It's usually contracted in hospitals or nursing homes. 

 

My sister had it and she does have a compromised immune system, but still managed to eventually get rid of it. 

 

(I'm assuming you mean MRSA.)

 

Yes, I meant MRSA . The other possibility also begins with "MR".  My brother does not have a compromised immune system, but he works in a hospital.  This thread has reassured me that the hospital is handling it the correct way and that it may take more time to cure than I thought it should. 

 

[EmseB]

I just got an update: the doctors have narrowed it to MSRA or MS(something else that also has two letters in it).  Does anyone have experience/knowledge of this?

 

Yes.  But unlike Sparkly, our experience is that an extremely healthy person with a fully functioning immune system got it without being exposed to any of the common sources and couldn't kick it for about 3-4 months.  It included two hospitalizations, two surgeries (like going to the OR surgeries) and many weeks of antibiotics, and I had to learn how to do wound care after the surgeries.  Fun times!

 

The good news is that if he can tolerate doxycyclene (sp?) it is a fairly effective drug.

 

Our main problems came when the infection reoccurred and medical people refused to believe that it could be the same bug so they would not diagnose and treat it as such, and that inevitably landed him in the ICU with sepsis.  They claimed since he had been on doxy for so long it could not possibly be the same infection, so they would do an incision and drainage and then send him on his way.  They were wrong.

 

You can PM me with further questions, but I'm not a doctor.

Edited December 15, 2016 by JodiSue

[SparklyUnicorn]

Yes.  But unlike Sparkly, our experience is that an extremely healthy person with a functioning immune system got it without being exposed to any of the common sources and couldn't kick it for about 3-4 months.  It included two hospitalizations, two surgeries (like going to the OR surgeries) and many weeks of antibiotics, and I had to learn how to do wound care after the surgeries.  Fun times!

 

The good news is that if he can tolerate doxycyclene (sp?) it is a fairly effective drug.

 

Our main problems came when the infection reoccurred and medical people refused to believe that it could be the same bug so they would not diagnose and treat it as such, and that inevitably landed him in the ICU with sepsis.  They claimed since he had been on doxy for so long it could not possibly be the same infection, so they would do an incision and drainage and then send him on his way.  They were wrong.

 

You can PM me with further questions, but I'm not a doctor.

 

Yeah my BIL was pretty miserable for probably 2 months.  He didn't end up in the hospital, but he missed about a month from work (and he's a teacher so that was not good).