Reintroduction of Antibiotics

I slept badly last night, woke up at 2am and merely dozed thereafter. At 5am I went up to see how Kay was doing. The answer was that she's slowly been getting worse during the night. When I arrived they were struggling with her O2 saturation, which was hovering around 90%, lower than when we went to bed last night. My worries increased further, but the doctor was already ahead of me.

After a while he came in and explained that he'd taken the time to review Kay's progress, or lack of it, over the last few days and that he'd concluded that she'd started going backwards from the moment that the broad spectrum antibiotics had been stopped on Friday afternoon. We'd been saying that most of yesterday that it seemed as if her reversal had started then. He thought that either she still has a bacteriaal infection or that she's picked up a new one. Her temperature seems a little high, although that's damped by the dialysis, her breathing is difficult, her CRP - infection indicator in her blood - had increased yesterday and she's generating a lot of mucus in her lungs which they keep having to suck out. The latter is something new, she wasn't doing it earlier in the week. So he planned to start her immediately on broad spectrum antibiotics again and take culture from all her lines and from the mucus to see if the infection could be identified.

If I understood correctly, the full results of Friday's lung examination are not in yet - it takes a few days to culture the specimens. Also, the full report of the lung specialist is not yet in, I guess waiting on the cultures. The primary conclusion was that she doesn't have PCP and nothing was visible in her lungs which, in combination with the discovery of aspergillus antibodies in her blood, was enough to lead to the conclusion that the problem's a fungal infection. That since this conclusion and the change to her meds Kay's condition has slipped backwards may indicate that there's something else as well as aspergillus.

The positive thing is that there doesn't seem to be anything else wrong (yet). Her BP is stable with a small amount of support, hugely less than she needed at the start of the week. The feeding directly into her small intestine is working well and the intravenous feeding has been stopped, which means that more fluid is being removed from her system by dialysis and the load on her liver is greatly reduced. She is visibly less swollen than a couple of days ago.

The road to recovery was never going to be smooth, so actually I felt quite reassured after my conversation with the doctor. His thinking seemed entirely logical to me and points to a specific cause for Kay's deterioration. This is much better than having no theory or idea why she's going backwards. The antibiotics will take a couple of days to reach their full effect, so I don't suppose that we'll see a dramatic improvement in the course of today.