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Suggest Treatment For Congestiion And Fluid In And Around The Lungs
Question: My father is 79 and contracted MRSA from the hospital. He has CHF with an injection fraction of about 25. He was also showing endocarditis and had 6 weeks of daptomycin. The third week of being off the antibiotics, he had a fever of 102. blood work showed growth of MRSA again. he is now on daptomycin and another antibiotic and is now showing no growth. He has alot of fluid build up all over his body along with congestiion and some fluid in/around the lungs. they are unable to find the source of the reinfectiino. He does have a defibrillator and left over leads from a previous defibrillator. They are thinking this could be the source or possibly his pressure ulcers. they are not very forthright with information except that I should consider hospice care. I really want to try and save my dad. Should I get a second opinion and how risky is it to remove the leads and defibrillator?
Brief Answer:
Removal of defib can lead to cardiac arrest.
Detailed Answer:
Hello
I understood your query and concern.
The source of MRSA re-infection in your case clearly seems to be the contaminated defibrillator leads.Of course the pressure sores can play a minor role.
Relapsed form of MRSA can leave a person quite damaged.
This in your dad's case has resulted in worsening of CHF with development of pulmonary edema.
Its extremely difficult to manage such low ejection fraction of 25% in the elderly.
Removing the defibrillator can be devastating at the moment precipitating the cardiac arrest at some point instantly.So do not choose such an option.
Since he is now again cleared off infection,and showing no growth,it would be ideal to start him on low dose diuretics and inotropic agents to improve the cardiac contractility and eliminate accumulated fluid from the lungs.
Before considering Hospice ,the above procedure can be a given a serious try.
Hope this info is useful to you at the moment,
Post your further queries,if any.
Thank you.
Removal of defib can lead to cardiac arrest.
Detailed Answer:
Hello
I understood your query and concern.
The source of MRSA re-infection in your case clearly seems to be the contaminated defibrillator leads.Of course the pressure sores can play a minor role.
Relapsed form of MRSA can leave a person quite damaged.
This in your dad's case has resulted in worsening of CHF with development of pulmonary edema.
Its extremely difficult to manage such low ejection fraction of 25% in the elderly.
Removing the defibrillator can be devastating at the moment precipitating the cardiac arrest at some point instantly.So do not choose such an option.
Since he is now again cleared off infection,and showing no growth,it would be ideal to start him on low dose diuretics and inotropic agents to improve the cardiac contractility and eliminate accumulated fluid from the lungs.
Before considering Hospice ,the above procedure can be a given a serious try.
Hope this info is useful to you at the moment,
Post your further queries,if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you for getting back to me.
They do believe that he is not strong enough to have any kind of procedure. He is currently on oral lasix, even though i believe intravenous would be quicker but perhaps they are worried about kidney function.
My fear is that if the defib and leads are contaminated, the infection will continue to come back as it appears the infection is unable to clear. How long will a person in his condition be able to take antibiotics. On top of that, he went thru a period before of septic athritis in his right knee. They drew fluid from the knee and nothing is growing there either.
I'm at my wits end and really don't know what to do. He is not able at this time, to go to another facility for a second opinion.
Is it protocol to ask another doctor to request his records for a 2nd opiniion?
And wouldn't TEE tell if there is any contamination on the defib or the leads?
How about a gallium scan to look for infection?
They do believe that he is not strong enough to have any kind of procedure. He is currently on oral lasix, even though i believe intravenous would be quicker but perhaps they are worried about kidney function.
My fear is that if the defib and leads are contaminated, the infection will continue to come back as it appears the infection is unable to clear. How long will a person in his condition be able to take antibiotics. On top of that, he went thru a period before of septic athritis in his right knee. They drew fluid from the knee and nothing is growing there either.
I'm at my wits end and really don't know what to do. He is not able at this time, to go to another facility for a second opinion.
Is it protocol to ask another doctor to request his records for a 2nd opiniion?
And wouldn't TEE tell if there is any contamination on the defib or the leads?
How about a gallium scan to look for infection?
Brief Answer:
TEE is an excellent tool.
Detailed Answer:
Hello XXXXXXX XXXXXXX
Welcome back.
If the contamination of defib leads is the occult/recurrent source of infection,then the patient in his condition will be able to tolerate antibiotics for a period of approximately 30 days,provided the renal function is closely monitored with low dose oral lasix and low dose inotropes.
Here i would like to specify one new antibiotic k/a Dalbavancin which is usually given as a single dose of 1gm IV once weekly.
This drug is extremely effective against MRSA and was recently approved by USFDA in may 2014.
I wish you discuss this with your doctor as an option for complete removal of infection from contaminated defib leads.
Yes TEE is definitely the option to look for any infection associated with defib leads especially in the setting of previous attacks of infective endocarditis.
TEE has an excellent resolution to pick up vegetations(foci of infection) from the heart.
Gallium scan has high risk of damaging the kidney ,hence it is absolutely not recommended in your case as an investigative tool at any stage.
There is certainly a definite protocol to ask for medical records in order to have a 2 nd opinion from another doctor.
You have all ethical rights to do so.
This protocol is hospital governed and changes from hospital to hospital.
You can post your request to the hospital authorities who have treated him earlier requesting for a another doctor's referral in a written format seeking a duplicate of required medical records.
Hope i have answered all your queries.
Thank you.
TEE is an excellent tool.
Detailed Answer:
Hello XXXXXXX XXXXXXX
Welcome back.
If the contamination of defib leads is the occult/recurrent source of infection,then the patient in his condition will be able to tolerate antibiotics for a period of approximately 30 days,provided the renal function is closely monitored with low dose oral lasix and low dose inotropes.
Here i would like to specify one new antibiotic k/a Dalbavancin which is usually given as a single dose of 1gm IV once weekly.
This drug is extremely effective against MRSA and was recently approved by USFDA in may 2014.
I wish you discuss this with your doctor as an option for complete removal of infection from contaminated defib leads.
Yes TEE is definitely the option to look for any infection associated with defib leads especially in the setting of previous attacks of infective endocarditis.
TEE has an excellent resolution to pick up vegetations(foci of infection) from the heart.
Gallium scan has high risk of damaging the kidney ,hence it is absolutely not recommended in your case as an investigative tool at any stage.
There is certainly a definite protocol to ask for medical records in order to have a 2 nd opinion from another doctor.
You have all ethical rights to do so.
This protocol is hospital governed and changes from hospital to hospital.
You can post your request to the hospital authorities who have treated him earlier requesting for a another doctor's referral in a written format seeking a duplicate of required medical records.
Hope i have answered all your queries.
Thank you.
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Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Answered by
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