Dr. V to the rescue..

... well that may be much more dramatic than it will actually be but we'll see. Dr. V stopped by yesterday and said what I was hoping he would say (even though I hadn't mentioned it here or to Katie.) That he wants to take Katie into the OR and use a cystocopy procedure to clean out her bladder from the inside. Since Katie's bladder is man-made and made of bowel tissue it produces mucuos. Since the transplant there has been more mucuos than normal, likely due to the fact that in order to implant the ureter from the new kidney they had to cut into the bladder, so it's not unexpected. But we're all thinking that all of this bacteria is hiding out in that mucuos and that the abx are clearing out what they can reach but that they aren't penetrating the thicker sections of mucuos. Then when the abx stops the bacteria grows up again. Dr. M wants to wait until we've gotten some good coverage with this round of abx so that there's less bacteria in the bladder that could get splashed around while he's in there so their current plan is to do the procedure on Friday afternoon. He said he thought we could likely go home after the cysto. I told him that Dr. M seemed to think we would have to stay for the full course of vincomycin because it's unstable. He said it could be monitored and if it seems as if it's going to stay stable it can be done at home. So when Dr. M came back I discussed that with her and she agreed. I think she was really relieved that he wants to clean out the bladder, as she seemed to lighten up quite a bit. She's a busy lady this week, there are 5 peds renal patiets that are inpatient right now, that's a lot, usually we're the only ones.

On a separate yet related note, the nurse came in last night and said she was going to be bringing in Katie's dose of Ceftriaxone but I said... "ummm, not without a resident explaining to me why we've added a new abx." I also told her to tell him/her that "because it was ordered" wasn't going to cut it as an explanation. So he came in and said that the culture from Monday morning grew ecoli. Now I know you all aren't as swallowed up in this stuff as I am so I'll recap for you. The first rehospitalization was for ecoli, the second one was for vincomycin resistant enterococcus, and this one was for coagulace negative staph as reported by a culture from last Tuesday. So I asked him if this culture from yesterday grew the staph too or just ecoli and he said just ecoli. I then reminded him (not that he knew but I like to pretend they do LOL) that that sample was given BEFORE we began treating the staph. If you think none of that makes sense, you're not alone. I told him that when the team comes through this morning I'm going to want some answers on why we're treating a bacteria that no longer shows up on culture, etc.

It's been impossible to get into this room to post. This morning I've snuck over in the morning before everyone gets up. It should be easier to update you over the next two days as I'll be at home in the evenings/overnights.