Pyelonephritis - E. Coli Kidney Infection
What Is Pyelonephritis
Before last week, I’d never heard about Pyelonephritis. Since then, I’ve done a lot of research about this potentially serious urinary tract infection. What is Pyelonephritis? It’s a kidney infection – a specific type of nephritis, which is the term used to describe inflammation of the nephrons. Nephrons are the tube-like structures in the kidneys that remove waste and water from the blood and create urine. Located at the center edge of each kidney is the pyelum, or renal pelvis. The renal pelvis is shaped like a funnel, and urine flows from the kidney and into the ureter via the pyelum. When the pyelum becomes inflamed, the condition is called pyelonephritis. How did I become so interested in this particular type of kidney infection? I’m trying to learn as much about it as I can because my daughter, Shannon, has it. She was diagnosed last week and had to spend several days in the hospital. And her fight’s not over yet, as it took her doctors a couple of days to find an antibiotic that the infection would respond to. This infection has made her very ill, and I was shocked to discover that in extreme cases, Pyelonephritis can be fatal.
Urinary Tract Infection
A urinary tract infection is a viral or bacterial infection of any part or parts of the urinary system: the urethra, the bladder, the ureters, or the kidneys. Urinary tract infections are pretty common, especially for women. That’s because they have shorter urethras, making it easier for bacteria to enter the bladder. A urinary infection can be introduced to the urinary tract through sex, improper bathroom hygiene, spermicides and other irritating substances, and the use of catheters. Sometimes germs in other parts of the body, especially in the lymph system and the blood, can travel to the urinary tract and cause infections.
The most common type of urinary tract infection is cystitis, an infection of the bladder. When I was a kid, I used to get this type of UTI infection when I used bubble bath too often. Cystitis isn’t usually serious if it’s treated promptly, although it can be painful. When the bacteria isn’t killed, however, the infection can spread to the kidneys and cause a kidney infection, which is much more serious.
A kidney infection typically starts in the urethra or in the bladder. If not treated properly, the urinary infection spreads to one or both kidneys. If you have an infection anywhere in your body, there’s a chance that it can spread to the kidneys. This works the other way around, too. Kidney infections can spread the invading bacteria to other parts of your body and can even lead to blood poisoning. Symptoms of kidney infection include painful urination, fever, dark or bloody urine, nausea, vomiting, and pain in the back, lower abdomen, or lower side. Someone with a kidney infection might also have to urinate much more than usual.
If you think you might have a kidney infection, seek medical attention as soon as possible. Your doctor can test your urine to find out. If your suspicions are confirmed, you’ll most likely be prescribed an antibiotic to help your body fight the bacteria. Please be sure to take the antibiotics as directed. It’s important to take all the medication, even after you begin to feel better. If you don’t finish your antibiotics, there could still be some bacteria surviving.
Shannon was surprised to find out she had pyelonephritis. She had been feeling bad for a couple of weeks. She’s a nurse, and she felt sure she had a urinary tract infection. It wasn’t her first UTI infection – she’d had them in the past. She had some antibiotics on hand, so she self-medicated. I think nurses often do that. She didn’t get better, however. In fact, she got worse. It got to the point where every day included nausea, vomiting, and pain in her back and sides. When her fever spiked, she finally sought help from a physician, who admitted her to the hospital.
Shannon’s urine was dark reddish brown. A urinalysis showed she had a urinary tract infection, along with blood in the urine. A CT scan revealed that she had acute pyelonephritis in both kidneys. This condition can result in kidney failure, urosepsis, and even death. Urosepsis can result in shock, causing shaking, dangerously low blood pressure, rapid breathing, and delirium. In some rare cases, xanthogranulomatous pyelonephritis can develop from chronic pyelonephritis, and part of the kidney might have to be removed.
Once Shannon’s medical team diagnosed her with acute pyelonephritis, they had to discover what they were fighting – what virus or bacteria was the cause. They ran a C & S, a culture and sensitivity test. A culture was grown, and the culprit was identified – E. coli. And this wasn’t just any E. coli, either. It was a strain that was very resistant to antibiotics. I’ve never had a kidney infection, so I didn’t really know much about them. I asked how E. coli wound up in a kidney. The health care team believes that Shan probably had diarrhea a few weeks ago, and that some of it splashed from the toilet up onto her urethra, causing a urinary tract infection. Because the infection wasn’t treated properly, it expanded to the kidneys.
The attending physician shared some frightening news with us. He believes that in ten years, there will be strains of E. coli that antibiotic drugs won’t be able to control at all. The bacteria is getting stronger because so many patients don’t finish their round of antibiotics. The weakest bacteria are killed first, and the stronger ones are able to survive longer. Sometimes when patients start to feel better, they stop taking their antibiotics. When that happens, the stronger bacteria are often allowed to survive, and they’ve gained resistance.
Pyelonephritis treatment can prove challenging. The E. coli causing Shannon’s for example, would not respond to the antibiotics first prescribed. Only a specific antibiotic, Invanz, worked, and it had to be delivered through IV. They placed a PICC line in her inferior vena cava for administration of the drug. PICC stands for peripherally inserted central catheter, and the inferior vena cava is the large vein that brings blood from the lower body back to the heart. The line runs from her right arm, where the port was placed. Once a day, every day, the antibiotic has to be administered through the port.
Invanz is the brand name for ertapenem, a strong antibiotic that works against numerous strains of aerobic and anaerobic microorganisms, including E. coli. The drug is considered pretty safe, but it’s not completely without negative side effects. Invanz side effects can include nausea, headaches, diarrhea, constipation, confusion, swelling, and feminine itching. It might also cause some serious side effects in some patients: convulsions, rash, stiff or painful muscles, and blackouts. In rare cases, a patient might have an allergic reaction to Invanz that could result in breathing difficulties, hives, or swelling of the face, tongue, throat, or lips.
After Shannon had been hospitalized for five days, her physician wanted her to stay for another two weeks. She really didn’t want to do that. She has four small children, and she didn’t want to miss that many days of work, either. Her doctor agreed to release her from the hospital, and a home health nurse would visit every day to give the Invanz – at first.
The first day after going home, a nurse came to Shan’s house to give the dose of Invanz. The next day the nurse came, she explained and displayed how the drug should be given. The next day, the nurse watched Shannon do the job on her own. The nurse was satisfied that Shan was capable of giving herself the antibiotic. The drug is in powder form, and it has to be mixed with saline, in a small bag. Once mixed, the solution is fed into the PICC port. It takes about thirty minutes.
Shan isn’t on any other pyelonephritis treatment drugs. She’s getting better, although it’s a gradual improvement. She’s still nauseous every day and has lost a significant amount of weight. Ironically, she’s one of the few family members who don’t need to lose at least a few pounds. Nausea is one of the symptoms of pyelonephritis, and it’s also a side effect of the antibiotic, so we’re not sure which is causing the nausea and vomiting. Maybe it’s a combination of the two. I worry about her getting enough protein and calories, so I bought her some Muscle Milk. She’s usually able to keep that down. She also feels physically exhausted most of the time, even though she sleeps a lot. Her mother-in-law has the two younger kids, and the two older kids are at school all day. Shannon’s husband, Justin, is really helping out at home, too. I’m just glad my precious daughter finally found out what was making her so ill and that she’s on the road to recovery. Kidney infections like pyelonephritis can be extremely serious.