Pneumonia and pseudomonas

My husband has severe COPD and was admitted to hospital on 28 November with pneumonia. He seemed to have recovered and was discharged on 16 December. Four days later he had relapsed and was readmitted with severe breathing problems. He had various blood tests and sputum lab tests which finally resulted in him being diagnosed with pseudomonas. It took several days before any doctor actually named the infection and my research suggests it is primarily hospital infected.

He has had several days of IV antibiotics and is still in hospital under supervision - they are waiting to see if he relapses without any other medication. Obviously, having spent so long in hospital, he is fed up, but I am concerned that he will just revert to the severe infection as it had not completely cleared up - the last test on Wednesday suggested his infection level at 100, which is when they decided to stop ABs. His phlegm was never clear as it is when he is well (as well as he can be!) - more brownish - but now is brownish green (sorry for the graphic detail).

Only one registrar has actually named this bug - all the other medics look blank when he mentions it by name and as soon as my husband asks about how long it will take to go away they skirt around it.

He is due to have lung reduction surgery in April and I am very concerned that this will impact on his chances.

Has anyone else experienced this sort of cloak and dagger reaction to this "superbug"?

Many thanks

Ros

[Damon1864 Volunteer]

Hi Hart's sorry to hear the trouble your husband is having, I really hope he gets well very soon. Keep asking the Doctors for answers you have a right to know. Please let us know how your husband is doing, and how you yourself are coping. Thinking of you both 😊 Bernadette xx

[Hidden in reply to Damon1864]

Hi Bernadette, thank you for your kind thoughts. The most difficult part is actually seeing a doctor who knows what he/she is talking about - most do their best but are not specialists and do not understand COPD. It really is a cruel disease which robs not just the patient, but the families of the patient, of a normal life. I will update when we get any further forward. Ros x

[Damon1864 Volunteer in reply to Hidden]

Thank you.😊xx

[Hidden]

There are quite a few of us on here who have lived many years with pseudomonas in our lungs. It seems to me that because your husband was an emergency admission you have come up against medics who are used to treating emergency acute infections but have little knowledge of long term lung disease. You say that your husband is due to have lung reduction surgery. This suggests to me that he is under the care of a consultant.That consultant should be familiar with treating pseudomonas in lung patients. I would suggest that you call their secretary and tell them what has happened. Ask to see the consultant asap. He/she will then be able to decide how to treat your husband. In addition, they will want to get him as well as possible before the surgery. Good luck, I hope that you get it sorted out.

[Hidden in reply to Hidden]

Hi, thank you for your input. Your reply suggests that pseudomonas does not go away but lurks in the background - is that the case for everyone who contracts this bug? I was just very surprised at how secretive all the medical staff, bar one, were in divulging the cause of his infection - particularly as it manifested so soon after being discharged following the pneumonia. Yes, my husband has a consultant dealing with his COPD but he is based in another hospital 50 miles away. I suspect my husband will not want me to contact his secretary until he is out of hospital in case it impacts on his future surgery. He tends to put his head in the sand and deal with things after the event, whereas I want to know everything as soon as possible. I just have to remember that it is his life and try not to take control, however much I want to. Thanks again. Ros

[Hidden in reply to Hidden]

I don’t think that the medical staff were being secretive, rather that they do not know anything about it as it is not their specialism. Their usual experience of pseudomonas would be as a hospital aquired infection, which, given that your husband has copd, is probably not the case. It is more likely that the pneumonia set off an exacerbation of the pseudomonas which may have been lurking in small numbers in his lungs for some time. Then hospital lab tests would have picked it up.

I’m afraid that your husband’s consultant will have to know in order that they can get the numbers down to an acceptable level before the surgery. It usually takes at least two weeks IV to achieve this when a bad exacerbation has taken place. Also, I am pretty sure that they will want to check that the pneumonia has gone. All this would be to ensure your husband’s safety and give the surgery the best possible chance. It is better that the experts be dealing with this rather than doctors who who do not know your husband and obviously do not know how to deal with his condition.

[Hidden in reply to Hidden]

Hi, thanks once again for your valued experience. If two weeks' IVs is the yardstick, then I am not certain that he will have had enough to knock it on the head - I suspect that is why they are having this monitoring period without medication. Ironically, he had a mild infection which put paid to planned surgery at the end of September - only discovered at the pre-op appointment two days' before admission date - prior to that he had been infection free for more than a year!! He was then told he had to wait 6 months without infection - sadly, he has had two much more serious exacerbations since so we are unsure where we stand now.

[Hidden in reply to Hidden]

If they knew anything about pseudomonas they wd be treating it not sitting back whilst it has a party. Given what you have just told me I really think that he needs to be treated and monitored by his specialist team as soon as possible. He cannot pull the wool over their eyes and as they already picked up an infection at a pre op they will certainly pick this up. I'm sorry but there is no more advice I can give if he refuses to do the sensible thing

[Hidden]

Pseudomonas is an extremely common infection in cystic fibrosis (which my daughter has), and bronchiectasis too as I understand it. It’s also a risk to some with COPD; whilst in those without a lung condition many cases are indeed hospital acquired (often via ventilation in ICU or other equipment for respiratory difficulties) it’s a bacterial family rife in the natural environment and therefore quite difficult to avoid. Like many bacteria, there are several different strains within the family, the one of most concern in lung disease being pseudomonas aeroginosa: My daughter first cultured it at two, and efforts are intensive to try and fully eradicate it with cf. The options are either 3 months of cipro with nebulised colomycin, or two weeks of IVs (two antibiotics, one of which will almost certainly be tobramycin), often followed by a few months of nebs. We successfully eradicated with IVs and nebs, but she picked it up again a year later, and by the age of 5 she had a chronic infection i.e. there’s a constant colony of it living in her lungs that we’ll never be able to clear. I don’t know if this applies to other conditions, but in cf, the criteria for being considered colonised is 4 positive cultures for it in a twelve month period. The issue then becomes about long-term management and suppression, which is usually done via nebbed antibiotics on a daily basis and utilising cipro as the first line treatment for exacerbation, and some (like my daughter) have planned admissions for IVs 3 or 4 times a year, but it can be very successful - prior to October, littleun hadn’t cultured it since March 2017.

As this is the first culture for your husband, the important thing is to make sure they do their absolute best to eradicate it: you need to make sure that the doctor in charge of his care is experienced in respiratory medicine, by which I actually mean a respiratory consultant. I don’t know enough about COPD to tell you whether treatment needs to be comparable to what they do in cf, but I can tell you that it’s known to be a bugger of a bacteria generally, and that when littleun was really ill with a pseudomonal pneumonia in 2017, it took a full month of IVs and intensive physio to get it under control. If his sputum is still nasty colours, then odds are he still has an active infection, so I would be very wary of anyone wanting to stop antibiotics on that basis alone, regardless of whether they had an underlying lung condition or not. Also, a negative culture does not necessarily mean that the infection is cleared, so don’t let them fob you off with that if you’re not happy with how he is.

Hope that’s been at least a little bit helpful and that hubby is feeling better soonish.

[Hidden]

Thank you for your very detailed response. He has a respiratory consultant looking after him during this admission and he is the one who suggested this IV downtime. The consultant is only available two days each week, though, which makes it difficult to discuss anything. His registrar seems to be inexperienced in dealing with such issues and does not seem that pro-active - rather "wait and see what Dr X says in a couple of days". The surgical consultant overseeing the planned LVRS will not talk to me without my husband's permission and that is difficult whilst he is in another hospital. Hey ho - I will see how he is later today and take it from there. Really appreciate your reply though, and I hope your daughter continues to be as stable as she can be - must be so difficult so see a youngster cope with such a rotten condition.

[Tugun]

Hi,

On top of all the antibiotics also try to increase his immune system through vitamins and minerals. With all the antibiotics, he will also benefit from some probiotics. His system will have taken a beating and will need strengthening. A good naturopath or nutritionist may be able to help in this area. Wishing you both the best.

[Hidden]

Thank you. I will try that once he is released!!

[Wadeyboy]

Please guys don't take cirpo unless it's a matter off life and death they are the worse

[Hidden in reply to Wadeyboy]

Not the case for everybody Wadeyboy. I have been taking cipro since 1986 because it is the only oral ab which will tackle my pseudomonas. I have never had a tendon problem.

[Hidden]

After four days off antibiotics my husband's phlegm reverted to green again and they finally decided to restart IV antibiotics with meropenem - suggested 10 - 14 days more in hospital. The consultant says the pseudomonas may just be masking another underlying bacteria which they need to eradicate. Not very happy but at least they are trying.