merca

[josie]

I have been on NxStage home hemo for almost two years now with no problems. The last six months,however, have been a nightmare. I had both of my kidneys removed in May, with no compicatiions, but shortly after I started experiencing some discharge from my buttonhole sites that was pretty much clear after treatment. My doctors kept saying it looked insignificant because the sites were not swollen and the discharge was clear. Well, then I developed chills, fever and loss of appetite, and cultures revealed merca infection in my blood. They prescribed vencomycin for two weeks, I felt better, but about a week later I Had the symptoms, only worse. So back in the hospital I went and a brand new drug, daptomycin was prescribed. After several doses, I test negative for the infection. But now I'm put back on dialysis unit for six weeks, because this drug cannot be given at home due to insurance regulations and it must be given after dialysis so as not to be removed by that process. So now my treatments are five hours totaL for six weeks, and I have been temporarily been pulled off the transplant list for six weeks. I have been on that list for just under three years, so I'm feeling kind of bummed and I miss my home hemo. I would love to hear from others that have experienced issues from merca.

[greg10]

Welcome to the forum and I am sorry to hear about your ordeal.  Do you think you were infected in the hospital after the surgery?  Hospitals are such dangerous places to be.  We are always careful to body wash completely after a stay.

Did you mean MRSA instead of merca?

It appears that daptomycin can be infused at home, perhaps at the end of treatment, usually reconstituted in saline and iv drip for 30 minutes.  Our Nxstage training center mentioned that antibiotic iv can be done through the t-line for the saline, but we weren't taught how and we never had to use it (thank god).  I think it may be more for billing and insurance purposes that daptomycin is not available to you at home.

http://www.homeinfusionreports.com/Partners/Article.aspx?id=64

[Zog]

Are you still using that infected buttonhole?  Its a good time to start a backup set of buttonholes if you haven't gotten some made already.  Are they chain sticking you incenter?

Do they keep you isolated incenter?  My wife never had MRSA but she did have staph infection from a catheter exchange that sent her into septic shock.  If your blood pressure starts to go really low and/or you have a high fever, GET TO THE EMERGENCY ROOM.   

[josie]

Yes, I did mean to say MRSA. I'm pretty sure I contracted it in the hospital, as I have been on NXStage for two years now with no problems. It really messed with my bloodwork levels, which have always been wonderful. My hemoglobin is down to 8.0 and is just now starting to come back up. Now that my cultures have come back negative to the MRSA, I use my buttonholes. The first week I had to go back in center they used sharps and infiltrated my venus access and left my arm a black and blue mess. The buttonholes are great, and my fistula is very strong. The reason for my not being able to use the antibiotic at home for the six weeks is absolutely insurance related. Thanks for your replies, it has been a very tough couple of months for me. When I was diagnosed with MRSA, I was two days away from starting my second year at community college, so I've got tons of time on my hands, when I'm used to go,go,go. NxStage is soooo wonderful, I can't wait to go back on!!!

[greg10]

Josie, I am glad things are back to near normal and you are feeling better.
Bigsky had posted a link to a good webinar on the use of the buttonhole.  It is good and very comprehensive.  40 minutes into the 1 hour webinar it talks about the cleaning of the buttonholes and scabs, basically it is 1)Prep 2)Scab removal with tweezer and not needle 3)Re-prep 4)Cannulate.

Strategies to Improve Complications Rates with the Buttonhole Technique

https://ifmcevents.webex.com/ifmcevents/onstage/playback.php?FileName=http://www.nwrenalnetwork.org/QI/wrfs/F-ESRDSTRATEGIES111709.wrf

[kitkatz]

MRSA sucks.  It took out my graft in April and I have struggled ever since in trying to get a fistula back into my arm and recover.   They tell me MRSA sticks around and is very energetic in getting into anywhere you have an opening on your skin and can rear its ugly head again and again.  So keep antiseptic wipes nearby and be as clean as you can.

[RightSide]

Yes, I did mean to say MRSA. I'm pretty sure I contracted it in the hospital, as I have been on NXStage for two years now with no problems.

I'm glad to hear you're feeling better.  Though I've never had MRSA, I've had other nasty antibiotic-resistant bugs and I know what a mess they can be.

I'm sure you picked up MRSA in the hospital:

"In the United States, the Centers for Disease Control and Prevention estimates that roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year. In Europe, where hospital surveys have been conducted, the category of Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year."

http://en.wikipedia.org/wiki/Nosocomial_infection

But thank goodness, you fought off the hospital-acquired infection and survived.  I'm glad.  Thousands of other patients weren't as lucky.

[josie]

Well.ot out of the woods yet. My cultures are now positive again, so they upped the dapdomycyn to 800 mg adn added an oral antibiotic.. My blood pressure is great again, pulse is good and I feel weel. However, last week as a result of the infection my hemogloblin dropped to 7.9. I had two blood transfusions, lots of iron rich foods. and take my iron supplement twice a day, and within twenty four hours it was 9.9. Which is great, but if they cannot completely rid my body of the MRSA it will just slowly drop again. I have an  appointment with the infection specialist today and a cat scan again tonight, so here we go again. The specialist is worried that now I have developed a resistance to the daptomycin now. Here we go again!!!!! But sso far I feel great: no fever, chills, etc like last time I was hospitalized. 

[casper2636]

Josie, I had MRSA for some many years, but it was  just colonnaded in my nose (meaning no symptoms), but most nurses have it (I was a nurse). Then one day I had an incredibly painful knee. It was so painful I could not move without screaming with pain...don't know how you did with it in your body! They had to take me to surgery to flush it out but ugh!!!What an ordeal! The up side is that you'll always get a Private room with the knowledge that you have a history of MSRSA

[kitkatz]

I gt a private room now because of the MRSA in the dialysis graft in April.  My arm hurt like the dickens and I was running a fever.  It came on fast. One minute I was at work and fine and within hours in the ER with a temp of 102.

[casper2636]

Kitkatz - Yes MRSA happens hard and FAST! More people should be aware that the symptoms can come on very quickly and with seemingly no reason what-so-ever. Just let it be known that if you all of a sudden just start feeling ill, are in severe pain, or running a high fever don't take it lightly. Our (kidney patients) systems are very fragile, and immune systems can be very weak. Just a word for the wise.