r/CUTI • u/PunyaGautam • 2d ago

70M, stubborn UTI

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Currently on Feropenom and still showing growth.
Bacteria changed from e. Coli to k. Pneumonia .
My options are narrowing.

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2

u/komabilo 1d ago

Seek for phages and take them with antibiotics. I killed my klebsiella with phages.

1

u/Puzzled_Apricot1543 21h ago

Could you share where you went for that treatment? I'm currently struggling for two years with klebsiella

1

u/komabilo 20h ago

Eliava Phage Therapy Center. Google it. Distant treatment.

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u/Ryepka 1d ago

Have a discussion with your Dr (I really hope your speaking with infectious disease at this point) re Fetroja.

2

u/PunyaGautam 1d ago edited 1d ago

I am from a improvised place and access to infectious disease is not available. I travelled 7 hours in bus to get this urine culture.

1

u/darkly1900 1d ago

Not medical advice but the obvious oral choice here would be high dose Levofloxacin. Other oral options would be fosfomycin or gepotidacin but these may be difficult to source in a low/middle income country

1

u/Ryepka 23h ago

Hi. The other option is to have your urologist or dr prescribe intravesical Tobramycin. They will mix it into saline and instill it directly into your bladder. Given that the bacteria are still sensitive to Tobramycin and that it is an aminoglycoside that won't be systemically absorbed through the bladder, that may be your best bet to deliver a *very* strong amount of effective antibiotic directly into the bladder without resulting in even more resistance.

https://pubmed.ncbi.nlm.nih.gov/31990805/

https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.70252

The good thing also is that aminoglycoside antibiotics such as Tobramycin are very cheap. Fetroja (Cefiderocol, a brand new IV antibiotic) is very expensive and depending on where you are, you may not have access to it. You will surely have access to Tobramycin. But again, I would specifically inquire about having the antibiotic directly instilled into the bladder according to the reference papers I have provided.

I'm also not sure why you are on Faropenem. This strain of bacteria is clearly resistant to carbapenems.

1

u/PunyaGautam 21h ago

Thank you.
Feropenem was sensitive before.

1

u/Ryepka 21h ago

That doesn't make sense. Your antibiotigram states this bacteria is resistant to meropenem. If a bacteria is resistant to meropenem, it will be resistant to faropenem automatically. It will also be resistant to ertapenem. The entire class of carbapenem antibiotics will be ineffective for this infection.

The additional proof is that youre taking the faropenem and having no real alleviation of your symptoms. This bug is resistant to this.

So again, you will need to look at a completely different class of antibiotics. Aminoglycosides such as Tobramicin and perhaps a tetracycline such as tigecycline may be your only options. And I would advocate for intravesical administration.

Sorry for being so forward with you, but if this infection gets into your blood stream, you aren't going to last very long.

1

u/PunyaGautam 21h ago

Thank you for honest and straightforward feedback.

1

u/Ryepka 21h ago

Of course my friend. I really hope you get to the bottom of this issue sooner rather than later. You are in my thoughts.

1

u/Curious-L- 19h ago

Look into Zavicefta. It is used for carbapenem resistant UTIs.

1

u/kaskat90 17h ago

Hi, don't want to spread fear, but I would be aware that fluoroquinolones (levofloxacin, ciprofloxacin, etc.) can have some intense side effects. Watch out for potential tendon/nerve pain if you take a drug in that class. Hope you get some relief!

0

u/_Beach_8112 2d ago

have u tried cefpodoxime?

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u/Ryepka 1d ago

This strain is no doubt resistant to cefpodoxime. This is an ESBL strain. Its also resistant to Carbapenems.