Canine Bladder Wars and Antibiotic-Resistant Bacterial Infections
The good news? A total of 7 weeks of antibiotics (2 different kinds) wiped out Lilly’s e coli bladder infection. The bad news? Now she has an antibiotic-resistant bacterial infection called staph pseudointermedius. People get MRSA infections. Dogs sometimes get MRSP infections, like this one. All of this stems from her treatment for rabies vaccine-induced meningoencephalomyelitis (and the resulting incontinence). The drug chosen for this next canine bladder war is a doozy.
Canine Bladder Wars Backstory
For those catching up, Lilly first got sick with brain and spinal cord inflammation after receiving a routine rabies vaccine in January 2012. We’ve been in a life / death battle ever since.
Her treatment includes, among other drugs and supplements, 3 different immune squashing medications:
- Steroids (dexamethasone)
- An immune mediator drug, given to people after organ transplants, (cyclosporine)
- Cytarabine, a chemo drug used to combat the specific kind of white cells they found in Lilly’s spinal cord fluid
Some 50% of dogs on long-term steroids will get bladder infections. Cytarabine is also pretty doggone hard on the bladder.
Lilly become totally incontinent (both ways) in June 2012, and it has been unrelenting since then … though, the recent addition of veterinary acupuncture has helped some.
In January 2013, Lilly suffered her first seizure in a year and began peeing blood. That’s when we found the e coli bladder infection was causing emphysematous cystitis (air in the bladder and bladder wall from the off-gassing bacteria).
We fought and won that battle, even though the infection was probably in there since at least September 2012.
But, then a few days after getting the news that Lilly’s latest bladder ultrasound showed all clear, we got the urine culture news telling she now battles staph pseudointermedius.
Canine Bladder Wars Theory
The best guess is that this is NOT a “new” infection. Our veterinary team hypothesizes that this bacterial infection has been going on for a while, but oddly enough, they think the e coli won the battle for resources inside Lilly’s bladder and kept the staph pseudointermedius at bay.
Now that the e coli infection is gone? The staph pseudointermedius is going wild.
On a Scale of 1 to Scary
On the How-Much-to-Worry Scale, we’re at a 7. This is a bad, bad antibiotic-resistant infection. On the plus side, according to our veterinary neurologist who joked last night about being “pathologically optimistic”:
- At least there is a drug we can use
- At least this drug isn’t prohibitively expensive (about $75 for 3 weeks’ worth)
- Maybe Lilly’s incontinence and overall status will improve once we beat this staph pseudointermedius
The Dog Gods Must Be Crazy
Now, the CRAZY-@$$ news. The chosen antibiotic (chloramphenicol) is great for dogs — NOT so great for people. Chloramphenicol can cause irreversible bone marrow damage in some people (even if they merely touch the drug).
It’s a slim chance (1 in 10,000), but considering how Lilly’s Medical Miracle Tour started with an adverse vaccine reaction probably rarer than that, I’m being BEYOND careful. This crap CAN happen, and unfortunately … it seems to happen to ME.
Alas, I have to treat our sweet canine heroine like she is a HAZMAT hazard. I’m supposed to wear medical gloves anytime I:
- Give Lilly her chloramphenicol (twice a day for 3 weeks, to start)
- Change her diapers
- Help her potty
- Clean her up
- Do her laundry
There isn’t much of a zoonosis risk (catching her infection), but between the bacteria she sheds via elimination and the concentrated chloramphenicol potentially in her mouth and eliminations, we’re being VERY careful.
Let’s just hope she doesn’t suffer the common chloramphenicol side-effects of vomiting and diarrhea since those, too, would require containment / safety protocols.
Why this particular drug? Chloramphenicol hasn’t been used much in the last 20 years, so bacteria hasn’t had the chance to become resistant to it. We’re lucky that our neurologist had some in stock — apparently, it’s hard to find.
For some reason, though, he has seen 3 cases needing chloramphenicol recently. All of them border collies. Wild!
Canine Bladder Wars Re-checks
We’ll do another urine culture at 10 days and again at a week after she finishes taking 3 weeks of chloramphenicol.
Other Adverse Vaccine Reaction Treatment News
You may recall that I ditched her cytarabine treatments for 7 weeks while Lilly battled the e coli infection. That withdrawal of treatment brought us near the brink, where Lilly easily could have suffered a major brain and spinal cord inflammation relapse — and, we probably would have ended the fight there.
We will postpone her next set of cytarabine injections by 1 week as we test to see if a 4-week cycle works OK. If so, then she’ll get 4 cytarabine injections over 2 days, every 4 weeks — instead of every 3 weeks. Our veterinary neurologist feels that Lilly is stable enough to give a longer treatment timeline a try.
How Does Lilly Feel?
- Lilly is tanking up on water more than she had been.
- She is a little subdued and tired.
- After nearly a week, where Lilly nearly peed on her own at least once a day … that has stopped.
- We’re seeing more standing potty accidents, which had stopped when we began treating the first bladder infection.
- Today (Tuesday 4/2) she is in pain — crying when I try to help her pee. So, I’m just letting what happens happen, rather than risk hurting her.
I’m worried and discouraged, but hopeful. I knew we’d face more immune-suppression troubles. I just hoped we would get a little springtime reprieve first.
I had a good talk last night with our veterinary neurologist. Even though he’d just gotten back from vacation, even though he’d just worked probably 14 hours, even though he has a terrible cold, he called to give me context on both Lilly’s antibiotic-resistant staph staph pseudointermedius infection and the relative danger to me of using chloramphenicol.
He talked me down off the ledge, as it were.
It’s snowing hard on the mountain (again) tonight, so I’ll end with a photo of yesterday’s sunrise.
Tomorrow is Lilly’s survival day # 435. She is a bundle of love in a tough, miraculous package.
Thanks, as always, for your interest and concern.