Hi,

Thanks for your post on Health Care magic,

Your urine analysis is well presented and shows clearly that you have bacteruria ( renal stones (if already confirmed) is a serious predisposing factor and might contribute to bacterial resistance.
First the culture has to isolate the germs, then test which antibiotics can work on it. The laboratory has to be well equipped for such testing. Ones the germs is isolated and antibiotics found, treatment will flow. But if the renal stones are still persisting, surgery to remove the stones need to be done to ameliorate the healing process. If there is pus in the kidney then that can also complicate the treatment.
Was the multiple drug resistance tested in the lab or by trial of various antibiotics with you for 6 months?
Antibiotics might also need to be given for a long course and in optimal dosages to treat the infection. Besides the chronic hepatitis and the kidney stones, I do not feel that the UTI is an immediate threat to your life but has to be treated fast before it complicates. Your past medical history shows that you are also at high risk of kidney failure.
An internist/ nephrologist opinion should be strongly solicited.

Hope this helps and I am here to answer more questions.

Dr Nsah

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Hello,

Thanks for updating.
I am glad that urine culture was done at a good laboratory and that a drug could be identified that is sensitive to the resistant bacteria. Monurol (Fosfomycin) is well indicated for UTI especially there is a resistance pattern already detected. A single oral dose and if possible a single maintenance dose can be repeated after 1 week, which is enough to eradicate the germ. A urine analysis will need to be repeat after a week or so to see if the infection has been taken care of.
You do not need hospitalization especially if you are clinically stable. Just see your urologist on the appointment you have with him.

Best wishes

Dr Nsah

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Hello,

Thank you for updating.

I am presuming that it is a urine analysis ( cytology), it simply means that you have elevated white blood cells predominantly neutrophilia ( which is indicative of active bacterial infection). If culture and sensitivity test ( for all antibiotics as you say) is so far not producing antibiotics that can eradicate the microorganism, I'll suggest two options, that your doctor collects your urine sample and contact CDC ( they have up to date research of antibiotics resistance) then provide them with the specimen including your medical history or he should contact a pharmaceutical laboratory that usually manipulate bacteriophages ( i.e viruses that kill bacteria) to produce strains that can destroy the bacteria for you.
But yet, I do believe that, antibiotics sensitivity has not yet been exhausted and so your doctor must not rely on in his laboratory but contact other laboratories to assist.

Hope this helps

Dr Nsah

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Hello XXXXXXX,

First you are not dying. You might develop serious complications with time if the infection is not controlled in due time. You should stay positive. You are having a multidrug resistant E. coli infection of your urinary tract. Your doctor has already notified the MultiCare Infection Control notified that will be considering other options like testing other antibiotics, bacteriophage etc

Thanks and wish you the best

Dr Nsah

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Dear XXXXXXX

Thank you for updating
With your new presentation and past medical history especially that of chronic hepatitis (risk factor of liver cancer) there is a possibility that you are having a metastic malignancy. With lung, bladder/kidney metastases and probably other organs are involved. Super infection or colonization of your urinary tract by common microbes might be as a result of your immune state due to probably the presence of cancer.
Wish to know if your liver function test, kidney function test, protein electrophoresis, serum albumin, CT scan or MRI of lungs, complete blood count, CRP, TNF-alpha, AMAS test etc has been done? Laboratory work up to determine the presence of cancer cells should be done.

- The lung lesions found probably on x-ray as you described (air space disease with peribronchial thickening) are similar to many lung diseases but given your own presentation it could be atelectasis or lung cancer* or cystic fibrosis or others such as pneumonia, pulmonary edema etc. Each of those impressions will require specific tests to rule them out
-low vitamin B12 could be as a result of chronic liver diseases and if blood work comes, it could show megaloblastic anemia
- Schedule OV for treatment options? In US context I will not be able to tell what OV signifies but from your presentation, there are probably referring you to the department in charge of management of cancer patients (but conclusive diagnosis will have to be done). Please just ask a nurse or a health care provider in the hospital where you are being taken in charge and ask them what OV schedule is?
- What questions you should ask now is? Where do you go from here? What specialist should you be seeing? To me your problem requires close assessment by an internist and possible referral to an oncologist or cancer specialist.

From the look of things your problems started mainly from your liver and/or kidney then you developed complications with your lungs.
You needed to be followed up constantly for your chronic hepatitis (by doing periodic liver function tests and monitoring your diet closely)
You have to start on vitamin B-complex supplements. Your doctor has to evaluate all your vital organs like your liver, heart, kidney, lungs and even GIT by running a series of tests.
You need to consult with an internist.

Hope this helps
Dr Nsah

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