Update on Resin Cultures

[dbritts]

Hi,
Some of you have mentioned that resin cultures aren't available in your areas, so I thought I'd drop by the hospital and see what I could find out. I got to meet with one of the pathologists in our hospital. She was very nice and took me through the whole process at a level I could understand. The correct term is Fluid Resin Culture. They found out that they could use their Blood Culture System (Bactec 9240) to culture body fluids. They have culture vials which contain broth and resin beads. The resin picks up bacteria even if you're on antibiotics. They put the culture in the Blood Culture machine until a sensor lets them know it's ready. Then they use another medium and do a gram stain. She said this is an "unofficial" use of their Blood Culture machine because they'd never get funding to do the studies. I asked if our hospital would be the only one doing this. She feels others are doing it too because it works. They prefer a cathetered culture because less chance of contamination. I found out why I have to hand-carry it to the hospital because they want the urine as fresh as possible because if they can't culture it in about an hour, it has to refrigerated. We talked for awhile about enterococcus and she said it's one of the hardest bacteria to get rid of. I told her that I've had this since 2004, so she says it probably gone intracellular. She said an IC bladder would be a lovely place to seed and hide. Plus since I've got kidney and bladder colonization, she wasn't very hopeful. I know some of had success stories with antibiotics, but my IC didn't start with a bladder infection. I would just be guessing on how I got it. The Infectious Disease drs. said all I can do is stay on antibiotics. I just would urge everyone who keeps getting their infection back to ask your dr. to check for staph or enterococcus. If you've already been diagnosed, has your dr. done CTscans and actually done a cystogram and kidney reflux to make sure you have no structural problems. My bladder was doing quite well with Elmiron until I got the "never-ending" bladder infection. The pathologist suggested I find a dr. who is working on this specific problem. I've been looking for 2 yrs. Anyway if you feel like you have a bladder infection, ask your dr. if your hosptial does fluid resin cultures. I would love to hear that others are able to get tested by their own drs. You can also call your hospital lab and ask them. Best of luck to everyone who's having to deal with enterococcus!!!!! Hope this information helps.

Debbie

[ICNDonna]

I've been doing a bit of research as well and didn't find much on resin cultures, but I did learn that many hospitals (including the major hospital where I worked) require that urine specimens be delivered to the lab within one hour of obtaining the specimen and if it isn't processed immediately, the specimen must be refrigerated for no more than 24 hours. The strict time limits are in place to avoid contamination of the specimen.

Donna

[ads]

Have you called Mayo Clinic in Rochester, Minnesota? They will look at your records and respond back if they can help you or not. Mayo also has locations in Florida and Airizona, but Rochester, MN is the biggest clinic. When I went in 2001, they tested for many types of infections -- it was quite amazing.

http://www.mayoclinic.org/

ads

[dbritts]

Donna,

You're right. There are lab standards set for how to handle specimens of all kinds. I also found information that a lab shouldn't accept urine samples on Friday if they can't process them that day.

Since you work at a major hospital, could you find out if they do fluid resin cultures?

Debbie

[ICNDonna]

I'm retired from the hospital now, but did work there for 25 years. I can telephone and ask on Monday.

Donna

[dbritts]

Ads,

I went to Mayo in Jacksonville twice, but not for bladder problems or IC so I didn't get a urology workup. Thanks for the suggestion!!

Debbie

[dbritts]

Donna,

I would really appreciate that.

Thank you,
Debbie

[MarthaF]

I think Debbie's suggestion about checking for hospitals that will do resin cultures is an excellent idea. Like broth, it is probably an old technology that not many have bothered to use for urine. The mainstream seems happy with the agar plate that is quick and easy. But are we getting the best possible treatment by labs?? The EPIC study is showing that infection is a huge problem associated with IC.

As to contamination, nothing will grow in a specimen that was not there when the sample was taken from the body. Assuming the collection was done with care and cleanliness then what appears in the specimen is what was in the bladder. Flushing the urethra first by letting a stream spill out before the "catch" is important. But there is no such thing as spontaneous generation of bacteria, and if the specimen is placed in a sterile container and handled carefully, where does the contamination come from? There may be more growth over time but in the case of Gram positives like Strep, Enterococcus and Staph the count does not matter. So species don't just "show up" due to a few more hours or days. If it is very hot then there may be too much growth to identify the pathogen so in the summer an ice pack with the specimen is necessary if it is sent over a distance. But I have known patients from Poland, the UK, Hong Kong and other overseas locations who send specimens here for broth culturing and get accurate results.

In any case the person reading the results of the culture must be very trained. That is key. The combination of symptoms and bacteria indicates an infectious cause should be considered.

Martha

[dbritts]

The ICN has been a great source of information for me and I thought I might have something useful to offer because enterococcus was discovered by my own dr. through a resin culture. No one seemed to have heard of it, so I decided to find out why. My information is correct, but I didn't know that it's officially a Fluid Resin Culture. Before I posted again, I decided to search using the proper wording. I came up with several hits. I found research going back to 1998. After reading a few journal articles from major University Hospitals, I'm sure my pathologist is right and it's probably available at most hospitals. It's used to test all kinds of body fluids not just urine. The resin is special because it identifies the bacteria even if a person is on antibiotics. My only intent was to provide people with information about a culture that my dr. uses. I won't post anymore about this because I've given all the information I have and I hope it helps.

Debbie

[mich2604]

thanks debbie for the info.

[ads]

Debbie,
I found your posts to be extremely informative and educational, please keep us updated on your journey. It would be wonderful if they could find a cause other than IC to your symptoms and treat to make you better.

Your posts made me want to pull out all my labs and rethink them. Again, please let us know how you are doing in the future. Thank you for sharing.

ads

[Anthrop42]

Debbie,

Thank you very much for posting your information. It is very helpful, especially to those of us living in small towns and/or who don't have access to hospitals and specialists who know anything. Please post again if you encounter any new situations. For a lot of us, the Internet is our only link to any people who have a clue.

Best wishes,
Aline

[dbritts]

Thanks to everyone for all the nice comments and support. My IC started 18 yrs. ago with only 1 documented UTI in my life. Like many of you, I've developed a lot of other conditions. I still think that Enterococcus started because my bladder lining is damaged, and I've got a lot of immune-system related disorders. There's an old saying "Be careful what you wish for". When I was flaring, I used to wish they would find bacteria and give me antibiotics!! Now I've got IC and a bladder infection. Enterococcus used to be found in hospital patients with long-dwelling catheters, but a lot of these germs have moved out of the hospital because of overuse of antibiotics. At least the medical world is finally recognizing that there is a problem. It just makes sense that an IC bladder wouldn't handle enterococcus like a healthy bladder. My urologist is very good about getting second opinions and he's sent me to 4 Infectious Disease doctors. They all say the same thing--it's colonized and not curable at this time. Not giving up yet on getting rid of it!!!!

Thanks everyone,
Debbie

[mich2604]

did they say how they could tell it was colonized?


It is just recently that dr are recommending probiotics to replace the good flora that is killed while taking antibiotics. I often wonder if this is how the enteroccous takes a hold of some of us and becomes the dominant gut flora?

For me strep was found in my gut as a potential pathogen....due to lyme disease my imune system is very supressed.

thanks again for your informative posts, looks like you have a great Dr.

[dbritts]

My urologist wanted to make sure I didn't have any kidney or structural issues that could cause problems. He did a cystogram with a kidney test to check out how my kidneys were working. While he was doing the procedure he took specimens from my kidneys and bladder. Both cultures came back positive for enterococcus faecilis colonies in the kidneys and bladder. No retention, stones, or structural problems--everything was normal. The Infectious Disease docs said that some people have colonization and no symptoms. Drs. never use to recommend probiotics when you took antibiotics and that disrupts your gut flora. I have a depressed immune system too and took endless rounds of antibiotics for sinusitis. It's just been the last couple of years that drs. tell you to take probiotics. I've been taking Culterelle GG, Femdophilus, and added VSL#3 thinking maybe that would make a difference. I used to be a librarian so I've read a lot of studies on colonization and enterococcus in general and I haven't seen any suggestions about getting rid of it after colonization. My brother-in-law has pseudomonas colonized in his sinuses so he's going through the same problem. He also has a lot of immune system problems. He started having bladder problems years ago, and they've given him tons of antibiotics, but his bladder never felt better. I told him that men can get IC, but his urologist said that was highly unlikely and wouldn't do a work-up for IC. He's got a high ANA and sed rate, joint problems, but they don't think a man can have IC or lupus for some reason. He lives in Atlanta and has gone to Emory. He's just as frustrated as we are. How do they treat your Lyme and the strep in your gut?

Debbie

[Anthrop42]

According to an article on the Enterococcus Research Site at the University of Oklahoma ((http://w3.ouhsc.edu/enterococcus/lynn_revirew.asp), enterococcus will grow and colonize if its treated with the wrong antibiotics. It can also migrate to other organs in the body.

[MarthaF]

Mich,

Enterococcus is one of the predominant bacterial species in the gut. So is E. coli. These should be there and finding them in the gut is normal. For some reason when they get to the bladder they can be pathogens for [U]some[U]. We don't know why some of us are susceptible, but it could be certain strains of these species that carry what they call virulence factors. More research needs to be done.

Probiotics, on the other hand, contain good bacterial species and are meant to replenish the gut after something like antibiotics have reduced the level of these. It is my understanding that the gut represents the major part of our immune system so its contents are very important. Also, the vagina should contain good bacteria, like Lactobacilli, since the gut bacteria are in the vagina before getting into the urethra on their way to the bladder. FemDophilus is the new urogenital probiotic that repopulates both the gut and the vagina with good Lactobacilli. They have found it helps with bacterial vaginosis for one thing. In the vagina good bacteria should predominate and can prevent the bad from adhering to the wall. Urogenital problems have been well-studied by Dr. Gregor Reid who is a well-known microbiologist from Canada. He has many articles published on the web.

Prevention Magazine, in its June issue, had an article about probiotics and named 6 or 7 of the best. Culturelle and FemDophilus were both on the list. The title of the article was something like "Europe's Best-kept Secret".

Martha

[dbritts]

I would like to say that I found the information on the University of Oklahoma Enterococcus Research site extremely informative. Unless I'm misreading, it appears that some strands of enterococcous are bad in the G.I. Tract. I've always been told it's normal flora. Only bad when it leaves the intestinal area. I took tons of antibiotics for chronic sinusitis, developed colitis, and then enterococcus faecalis and faecium among others. I also read if you have multi-species of bacteria it's usually an abdominal source. Has anyone successfully gotten rid of it where it didn't reoccur? If so, what did you do? If you keep having infections, I would urge to call your hospital lab and find out if they do Fluid Resin Cultures. They are so specific that you can't get put on the wrong antibiotic. But enterococcus can colonize with ampicillin and other antibiotics that we commonly use for it. They suppress it not kill it and that just makes it stronger. Thanks so much for some new research to read.
This was the first article that gave me a good overview of the bacteria"
http://www.emedicine.com/MED/topic680.htm

Debbie

Thanks

[mich2604]

Debbie,

do you know what actually kills this bacteria? with my broth culture it showed amoxy as one of the few antibiotics i could use for it. but that really burned my bladder.

[mom_in_ma]

Martha,
If ic is related to bacteria, how come IC goes into flares and remissions for some people? I had a two year remission that came about without antibiotics. Just curious.

[MarthaF]

Hi Mom-in-Ma,

That is a really good question and I am in no way qualified to answer it. We can speculate that it could be due to one or more of many things - like stress, condition of the immune system, change in hormone levels. some kind of trauma, etc. Since we don't know why some of us are susceptible to UTIs it is hard to answer. But the same thing happens with regular UTIs - some have recurrent ones for no apparent reason.

Maybe you haVe heard of the work of Scott Hultgren at Washington U. His lab found (in mice bladders) that E. coli form "pods" or biofilms where the bacteria can hide, only to re-emerge later. The antibiotics can eradicate the bacteria that are floating in the urine but can't penetrate the biofilms, or "intracellular bacterial communities" as the lab calls them.

They were only looking at E. coli but, in the case of many of us diagnosed with IC, our study (which used a molecular test) found 67% had Enterococcus. It is a form of Strep and an entirely different species than E. coli. Dr. Fugazzotto theorized that it invades the tissue. Could be but it could also form biofilms. A Japanese study found Enterococcal biofilms in a group of hosptialized patients. Most Enterococcal infections are diagnosed in hospitalized patients and the bugs may be more virulent. But we want the research community to know that Enterococcus is also out in the community in much larger numbers than anyone has suspected. One Canadian study found it is second only to E.coli as a cause of UTIs in a community of women tested. Most labs do not isolate it very easily since it is slow-growing and does not always show many colonies, so some dismiss it as a contaminant.

There is still much we don't know and I would like to see a study of Enterococcus from IC-diagnosed patients wherein they were tested to see if there are biofilms in the bladder. We know it does damage to many bladders, ulcers being the most evident. The biofilm theory makes sense which could account for flares and remissions - the bacteria are hiding - but the two microbiologists I have asked have said they don't think there are biofilms or someone would have seen them. (They know bacteria in the case of BV are in biofilms). There is still so much more to be done, but a start would be the recognition that at least a subset of IC patients have bacteria that can be pathogenic in some settings.

All of the above is only speculation at this point, but I think the fact that many respond to the RIGHT antibiotics indicates there should be more research on this front. We know the EPIC study at the U of MD found 50% of IC patients said their's started with a UTI. So maybe there will be more focus on bacteria which was the original thinking, but then dismissed when they could not find a consistent species of bacteria. Now we have found one.

Hope this isn't TMI, but as long as no other explanation for IC symptoms has been found I don't think bacteria should be overlooked.

I would love to hear from others who believe their symptoms could be due to infection. Some on here have been treated and are well. Then they tend to move on and don't post any longer.

Martha

[dbritts]

Mich,

I wish I could tell you which antibiotic will kill it. I was a librarian for years so I thought eventually I would find some way to kill it by doing my own research. I've lost count of the studies that I've read over the last 3 yrs. The problem is that enterococcus has what is called an intrinsic resistance to antibiotics--it's built into the bacteria. There is tons of research about enterococcus -- amoxicillin used to kill enterococcus pretty easily years ago, but now when people get sinusitis or anything that could possibly be viral, they'll go ahead and put you on antibiotics like Zithromax or Cipro, something broad-spectrum so they don't culture and see if you've really got an infection, and it's creating antibiotic resistance. This is causing "supergerms"! There are tons of articles about enterococcus and research is showing that drugs like Amoxicillin, and Cipro seem to only be suppressing enterococcus--not killing it. Then the stuff colonizes and you're stuck with a big problem. Amoxicillin bothers my bladder also, but usually Cipro is a better choice on my cultures and I can tolerate that. You take one for awhile and the bacteria gets used to it and you're switched to a different one. Amoxicillin might not even be the best choice for your infection right now if you've been on it a long time. One of the recommendations based on culture results is if it's still fairly susceptible to amoxicillin to combine that with Macrodantin. Mine is totally resistant to macrodantin, so that didn't work for me. Because I had methillin-resistant staph and e.faecalis on one culture, I was prescribed Zyvox which is reserved for methillin or vancomyacin resistant bacteria. It's one of strongest antibiotics we have. They could only do 2 weeks because my platelet count started dropping, but my bladder felt great--that lasted all of two weeks and it was back. That kind of gives you an idea of how strong enterococcus is. If you've got it and you don't treat it, then not only are you miserable, but you might end up with a kidney infection or worse. I've tried not taking antibiotics and I'll end up with a fever and blood in the urine, so it's a true infection, not just bacteria irritating an IC bladder. I know some people have been diagnosed with IC, used antibiotics and they are cured. I don't have an answer for that. I think there are too many variables. It's a shame we have to do our own research, but that's the way it's always been for me. Urologists should know more about enterococcus because it's now the 2nd leading cause of UTIs. Is your dr. doing your cultures now? Also I noticed your doing PT, I had to stop PT therapy because my PT has a strict policy, no PT when you have an infection because it can make it worse if they're doing anything internally. Sorry so long. Debbie

[dbritts]

Hi everyone,

I've been in a lot if denial about life-time antibiotic therapy and colonization of enterococcus. My neighbor is a head surgical RN at our hospital. I decided to pick her brain because she usually knows more than our local MDs. I thought this is important enough to share with anyone posting on this board and then you make up your own mind about the information. She said hospitals have been using resin cultures for quite a few years because resin is the only substance that pulls out bacteria even if you're on antibiotics. Her further comment was "I would be shocked to find a hospital not using resin in their cultures". I know a lot of you are mailing urine to Virginia, but she said that urine is very easily contaminated and you will not get an accurate result. She also said you will only find Fluid Resin Cultures at hospital labs because of the Infectious Disease problems. Her advice was to call your hospital labs. She said most of them will be probably be willing to talk to you about urine samples and resin cultures. She confirmed what the drs. have already told me that I won't have any choice to be on antibiotics and I need to hope the enterococcus doesn't beome vanco-resistant. In my situation I've had this so long and it's not been contained she said it's wiser to have frequent cultures, stay on antibiotics rather than start and stop because that just makes it more stronger. She said nurses cringe when mothers come in demanding antibiotics for their children because of the huge problem created by overuse of antibiotics. I'm not asking you to take my word for any of this. I encourage you to talk to your doctors, and your hospitals. It's true that enterococcus forms biofilms and colonizes and becomes intracellular, but it's important to realize that you're dealing with something that could potentially be life-threatening. This is a problem that goes beyond whether it caused your IC. My neighbor is a breast cancer survivor and she told me to urge you guys to be proactive. I think most would agree that we live in a world where women's health problems are still horribly underfunded, particularly things like IC, lupus--anything that mostly affects women. I've actually gained more information talking our female pathologist and her than I have my male drs. I was told I could stay on antibiotics full-time or start and stop, but no dr. explained which would be better. This is information for you who are struggling with this problem and no offense is meant to anyone. Please check it out with your own medical professionals.

Take care,
Debbie

[Anthrop42]

Debbie,

Thanks for all the info. You have really good contacts. Don't give up!!!!

My own personal theory is my "IC" was created by a string of UTIs - at least one or maybe all were caused by entero but it was never properly diagnosed or treated. Doctors kept prescribing antibiotics to me purely on the basis of my symptoms. Of course the drugs were either not effective against entero or not a high enough dose for a long enough period. So the entero happily grew & got stronger. You're right -- if you search the Internet for articles on UTIs, almost all site that entero is a major cause of complicated UTIs. But no doctor in my life has ever mentioned it!

Anyway, a German doctor told my fiance (who's German) that amoxicillin is getting much, much weaker against many types of bacteria. He didn't know anything about IC, but said European docs made the mistake of prescribing it like it was candy. Now they prescribe very large dosages (3000-6000 mg/day for up to 20 days for strong infections). US docs still prescribe some miniscul amount, like maybe 250 mg 2 or 3 times a day. Maybe this would be enough if you got entero for the first time & caught it immediately. If its grown for a while, amox at a low dose may be too weak. American docs are scared of resistant bacteria, & rightly so, but giving out tiny little doses for a few days is also making the bacteria stronger.

My problem was, when I was have recurring UTIs last year, I had no insurance. So I usually went to one of those family clinics that accepts anyone. Several times I was on a trip & had to find clinics in other cities, or countries. Doctors in these clinics know nothing!!! They do a little test strip, maybe look under a microscope, often don't find anything & then they'd give me cipro for 3 days or maybe bactrim for a week. It is to the point where I think these clinics are being negligent. I feel bacteria-caused IC is going to continue to rise in this country because of it.

Aline

[dbritts]

Aline,

Y

[dbritts]

Aline,

Sorry, hit the wrong button by mistake. You're right that most drs. assume that all UTIs are caused by e.coli and antibiotics have been passed out like candy for everything. In my case, when my symptoms started I never responded to antibiotics, but I did respond to elmiron. I think that's what makes "IC" so hard to figure. In my case, I believe all the years of Cipro, Augmentin and Amoxicillin for sinus infections may have been the trigger in my damaged bladder lining. I believe mine is intracellular at this point and all research says drugs like amoxicillin and Cipro can only suppress it. We're talking about a bacteria that has built-in resistance antibiotics. And you're exactly right about how it gets stonger. I really think people seem to have different triggering events for IC and UTIs is one cause. But we'll never know how many had enterococcus because our drs. weren't looking for it and apparently most of them still aren't looking for it. You are right, it's going to continue to grow as a problem and I don't understand the reason for that when research calls enterococcus "the rising problem of Infectious Disease". I found some interesting stuff last night about probiotics and enterococcus, but it wasn't the strains that I'm familiar with, so thought I would do some research on those strains. Also found stuff about the antibiotics that they use in animals are contributing to our problems. All these facts, but no answers. We can't afford to give up because we live in these bodies!!!! Maybe resistant bacteria are why women are being diagnosed with IC younger and younger these days.
It's frustrating---I've always said "I wish every male dr. could have IC or UTI symptoms for a month" and I bet their attitude would change in a hurry.

Debbie

[dbritts]

Forgot to mention My last CT scan says my "prostate" is normal, so guess I can rule that out as a cause!! lol

Debbie

[Anthrop42]

Debbie,

So glad your prostate is healthy! Really bad when it gets enlarged & then our clitoris's go flacid. :lmao: Back when I was 18 (many yrs ago), had my first pap smear & the gyno in training checked for my prostate. :bonk:

Aline

[Anthrop42]

Unfortunately no one in the town I live in knows what a resin culture is (I'm in a small town). There's a little hospital here that's called a death trap by the locals. Other than simple tests, they mail most body samples to other cities for testing. The clinic at the Air Force base outside of town also mails out their samples.

So, if I need a culture done, I'll continue to use United Medical Labs for broth culturing. I'd rather take my own sample & send it myself with dry ice than trust the clinics here.

Aline