To all those that wished us well for littleun’s first appointment at the RBH on Monday, I just wanted to let you know the outcome. Her fev1 was down to 47% and she very helpfully brought up some disgusting, blood streaked sputum, at which point our new named consultant phoned the bed manager in front of us and arranged for her to come in on the Wednesday. We had a few hiccups over the first couple of days, but she is now on a full compliment of treatment including IV colomycin (as a result of the concerns over whether she has ototoxicity from aminoglycoside use), IV aztreonam, oral septrin (to cover the s.maltophilia she cultured in July, just in case), and oral fluconazole just in case there’s a fungal element, or the Candida she’s routinely cultured for the last 2 years is actually in her lungs rather than being a contaminant from her throat or mouth. They also tend to throw in an antifungal where patients aren’t responding to treatment as they would expect or would normally, and given this is our 4th course of IVs since Feb, we all agree she definitely fits that bracket.
The consultant isn’t convinced about the possibility of an MDR strain of pseudo, but they haven’t had any resistance profiles from our old tertiary team yet (despite asking repeatedly), and the sample from Monday was still processing as of yesterday. She did concur that it’s looking extremely likely that bod has developed resistance to cipro, though, given her repeated lack of clinical response when growing this particular strain, which is something our old team refused to entertain despite the lab results also showing resistance. We’ve basically agreed to take it day by day and see how she responds, but we’ll definitely be in until at least the 30th. They’ve also agreed to get a number of other things done that should have been done previously but haven’t, including the genetic screening for ototoxicity, a dexa scan, an up to date CT, and a couple of other bits. I’m already incredibly impressed with the team here; there might have been a couple of issues, but if nothing else they at least acknowledged them and apologised rather than just shrugging and going ‘oh well’.