The Tentative Long-Term Plan

Annie and I have just been hanging out in her hospital room this morning waiting for her surgery later.  We had a rather eventful night last night, with not much sleeping going on, by Annie or myself.  Strangely, Annie hasn't been very tired lately.  We are all amazed at how she can stay awake for two nights in a row now, and still not nap any during the day either! ...and still remain perfectly happy!

A blood culture was drawn this morning, I think mostly for a baseline before surgery.  Annie's BMs are getting more frequent and loose, which isn't a good sign.  Once the infection was discovered in her back, everyone attributed all her problems to that, but I still believe that she has a whole other issue with her colon.  Some people are telling us that this kind of diarrhea is expected with all the antibiotics she is currently on, but her calprotectin level wouldn't be elevated if that were the case.  So I've requested a consultation with GI to see what their opinion is about why her calprotectin is elevated.  But they probably won't do anything until a few more days after Annie's surgery.

The infectious disease team came by this morning and gave me their tentative plan for the next year of antibiotics.  So far the cultures from Annie's fluid in her back haven't grown anything and they honestly don't expect them to grow anything because of the antibiotics she's been on for over a week now.

So if nothing grows in the cultures, the plan is to put her on the following drug therapy for the next year:

1. Daptomycin by IV once a day for a year, for gram positive coverage.
2. Ertapenem by IV once a day for a year, for gram negative and anaerobic coverage.
3. Rifampin by g-tube for a year, to help with bacteria that tend to adhere to implants.
4. Vancomycin by g-tube for a year, to help prevent the development of c-diff that all the other antibiotics can cause.

If pseudomonas grow in her culture, they will switch out the Ertapenem with a different gram negative drug that will also cover pseudomonas.  But they don't plan on changing any of her current antibiotics until much later this week, just to give the cultures more time to grow something that would point them in a more definitive direction.  So until then, she'll continue on her zosyn and vancomycin by IV and her oral vancomycin as well.

There was talk earlier about placing Annie's long-term central line during her surgery today, but since the procedure on her back will stir up so much bacteria and contaminants, they will take her back to the OR later to have the central line placed in a more sterile environment.