Anyone With Success?

[Gspot]

I just read a very interesting reply to a thread that I posted about results of my broth culture. The question was: has anyone actually been cured after antibiotic therapy as a result of a positive broth culture?

[Anthrop42]

I just wrote about my success with antibiotics under your "Check This Out" thread.

Aline

[ICNDonna]

There are some people who feel they have been "cured" by one therapy or another, but I also know people who have had remissions for five, ten, or even fifteen years, only to find that eventually the symptoms return.

I read a message once about a person who said she had been in a remission for two years, at which point she is certain she is cured. I have had a remission that lasted almost two years, but the IC symptoms returned.

As far as I know nobody has yet come up with a cure, but there are treatments that will help keep the IC under control. I do well most of the time, but definitely have not been cured.

Donna

[PlainJane]

What was the reply you got? Was it from me?

[hollipop]

It's official. I've been symptom free for 15 months, and my URO just took the diagnosis of "IC" off my current medical conditions list. Thanks to the broth culture and being put on long-term antibiotics.

I'm still battling, but winning, my fight with the resulting PN/PFD pain, but with the help of my power plate and monavie (I do NOT recommend that for ICer's, because it may damage the bladder lining) I'm getting better and better every day.

If you want to hear more about my success story, feel free to PM me and we can chat via email/PM/phone, etc.

I really hope that others find their cure, and hope that my story is taken seriously, because I've researched my butt off to find my cure, and it's been a long road of recovery, since it took about 10 months for my bladder lining to actually "heal"....but I'm here and loving life again.

The broth culture and antibiotics saved my life, my marriage, my job, and my sanity. :bow:

[ICNDonna]

I'm really glad you are feeling better and I sincerely hope you continue to feel good. I know that after I was diagnosed, I went a full two years with no symptoms and I was so certain I was "cured" --- but my bladder knew I was not and the symptoms returned with a bang. At that time not much thought had been given to a diet connection so I wasn't following an IC diet at all (that was 1975).

Donna

[hollipop]

Well, you probably didn't try the same "treatment" plan as I did....a lot has been researched and discovered since 1975, so I am fortunate to have been diagnosed during a time that the cures are being investigated and found.

I really hope that people will not be discouraged from trying treatments that are medically known to cure people. My urologist is on the advisory board of two very prominent IC-focused non-profit organizations, so I really feel that her treatment should not be dismissed as a fluke.

I thought I was dying two years ago, and wanted to most of the time, but now I'm free of this horrible condition, and hope that I can help others by telling my story. Other organizations listen to me, but I still have to post in the "alternative" section here, so please take me seriously....my team of doctors do, including my urologist, hematologist, neurologist and gynecologist.

My story continues, and I hope to come back soon with my success story of PFD/PN pain. I'm not completely out of the woods, but gosh, those rays that shine through the leafy trees sure feel wonderful. :smile tee

[ICNDonna]

Please don't mistake what I said as me not having medical care since 1975. I have an excellent medical care team who are up to date on treatment options for IC --- it's why I'm able to live a normal life in spite of having an IC diagnosis.

As I said, I sincerely hope your symptoms are gone forever.

Warm hugs,
Donna

[jen74]

Holly, who is your urologist and where are you from? How did you go about getting the broth culture?

Jen

[mpizze619]

Please post your dr's names and where they are -
I would all like to work with a team of dr's that could make me symptom free. Thanks so much.

[PlainJane]

Hollipop,

I'm glad to hear that you're better! That is great news.

Erica

[dreamy]

Hollipop Im so happy for you that your better. I hope I will be the next to get better too! I hope we all get better fast.

[Vampireness]

Holly, who is your urologist and where are you from? How did you go about getting the broth culture?

Jen

Broth culture was sent to United Medical Lab. Her Urologist, doesn't do long distance consultation. Very understanding doctor though, how many doctors do you get these days, who take broth culture seriously?

I tried to get treated by her doctor, but she wouldn't do long distance. Ruth's care is good enough for me. I forgot where Holli lives, sorry Holli lol

Vampireness

[Vampireness]

Hey Holli,

I remember your struggle through this and I'm so glad you got through it, can't believe it's been a year actually. I don't remember you having Group D Strep, I remember some other bacteria but I have it now. How long were you put on antis for Group D Strep.

The powerplate as you told me, seems like a really good idea, you do your research well!! I'm glad your PFD is under control.

Mpizzie619 - For someone to feel better from antibiotics therapy, there should be no further infections, like in my case, there seems to be multiple infections, so my nurse is asking me to keep my nutrition level up, so I don't get reinfected and able to fight off the current and future bacteria, so the bladder can heal.

You could get a broth culture done, because that's what Holli did, then her long term antibiotic treatment started.

Vampireness

[dbritts]

Hollipop, I'm glad for your successful treatment. I wish that every dr. in this country would culture for all organisms that can cause a UTI. Medicine changes all the time. As a librarian, any medical information over 5 yrs. old had to be weeded from our collection. Broth is a culture medium--it's used in hospital labs all over this country. My IC symtoms started in 1989--I was treated with antibiotics, dilations, silver nitrate, and a partial hysterectomy! I wasn't correctly diagnosed until 1994. I know how frustrating this is. Elmiron was a miracle for my bladder! I think everyone knows that my antibiotic therapy hasn't been successful--it's created a lot of additional problems because it colonized. I'm still fighting for enterococcus, staph and all the other organisms that cause complicated UTIs to be cultured for when symptoms occur and your regular culture is negative. Chronic bacterial prostatis is treated for 3-6 months and there's documented research to show that enterococcal infections deserve the same protocol. It's frustrating to have both conditions--we don't know what causes IC, but urologists know what bacteria cause complicated UTIs and they still refuse to order a culture that will find those bacteria. I know I'm way-off the original question, but this whole issue of "cultures" frustrates me--they're available in our hospitals and nothing is mysterious about broth. The urine from my kidney was cultured in broth at Gulf Coast Hospital in Panama City, FL while my urologist attempted to find the "host" organ for my infection. Hollipop--once again, very happy you're getting your life back.

Debbie

[MarthaF]

You bring up some good points, Debbie. I think Holly would say that her effective treatment was due to good culturing and an open uro (female).

On the subject of good culturing I would like to revisit the question of better culturing by the biggest lab corporations in this country. We have found that both Quest Diagnostics and LabCorp have better urine cultures listed on their menus than the "routine" cultures most doctors order. The doctors may not even know about these more extensive cultures. I have tried to find out more about them but the company lab personnel who are knowledgeable will not talk to anyone who is not professional medical person.

The Quest test is known as #3021A and a patient in Chicago asked her professional to order it. When the report came back it showed three species of bacteria, while a culture done in another lab a day later on orders from her gyn did not show any growth. So we are beginning to get some reports. Any of you who are wondering if you really do have bacteria could request your doctor to ask for more extensive culturing. You can look up tests offered by these big lab companies by going to their websites and searching for cultures and then zero in on urine cultures. If you find one you could suggest it to your doctor.

Otherwise the broth culture is available at United Medical Lab, a small independent lab that will accept specimens from the patient, herself, without a doctor's order. But hopefully some day the bigger labs will do better work for us.

I'm sure Holly will be adding more about her story on here later.

Martha

[marsi4]

Hi, I believe that for some ic may be bacterial, but for most of us it isn't. Inflammation and irritation I believe may be caused by other components besides bacteria. I like to compare ic to Crohn's or Colitis. These diseases are very similar to ic only they affect the intestines. Doctors don't know what the cause is and believe that they are autoimmune diseases like ic. Perhaps both these diseases have a bacterial and infectious etiology, but it is unlikely. If it was bacterial then why is it that sometimes only a part of the bowel is irritated or inflammed and not entirely. If it was bacterial the entire bowel would get affected. As far as I know Crohn's and Colitis can't be treated with antibiotics. I just want to caution those who think ic is bacterial to becareful with long term antibiotics. Sometimes it can be the antibiotics themselves causing other starains of bacteria and if you become resisistant and get an infection itwill be very hard to treat and dangerous.

Marsi4:angel:

[dbritts]

Martha--There is no doubt that enterococcus is a urinary pathogen. I have no idea if anyone else's dr. has gone into their bladder and kidneys and cultured specimens from them. My enterococcus and staph started 14 yrs. after I developed IC. For me, they are two distinct conditions. I feel the most accurate cultures available are at hospital pathology and research labs. I'm glad that Holly was able to get an early diagnosis because IC feels pretty much like a bacterial infection--and without proper diagnostic tests to include accurate cultures, there is no way to tell the difference in the beginning. Based on current information on the Center for Disease Control website, I feel it's very important to be able to distinguish between e.faecalis and e. faecium. I've had both strains. I want to thank you for sending me Dr. Reid's DVD. I e-mailed him and he responded with the probiotic protocol that he has had some success with in the lab.
Marsi--you made excellent points because overuse of antibiotics has created a problem outside of the hospital.
I've always compared my IC to a condition like lupus. I've got more specialists than family, plus conditions that aren't the standard IC-related conditions. Based on my own situation, I would like to see drs. who are knowledgeable about finding and treating complicated UTIs--risk of colonization is a real possibility. Not to mention C.Diff and overgrowth of yeast because of long-term therapy. I'm 4 yrs. into this and no one can identify the host. I try to present both sides of the picture because I have it and it hasn't been "curable" for me--everyone is different and we need more funding for research.
Debbie

[Vampireness]

Not every hospital in US know about broth culture, doctors have asked what's that or they don't provide that service when it's mentioned.

If labs over there did testing, patients wouldn't be finding low count bacteria that was previously dimissed or undetected. Which is why United is helpful.

Over here, in Singapore, no one knows what broth culture is and there has been several occasions where they have stated low bacteria count and considered that as "no infection". I know that I feel better once infections are promptly treated.

Vampireness

[hollipop]

Sorry guys, went out of town for my class reunion.

I just did a clean catch at home and Fed-Exed it to the United Medical Lab, but talk to MarthF, because I she has another lab (Quest) that is even more sensitive. They found Strep D infection, and by that time it was so bad, I developed kidney stones around the bacterial colonies, so the "colony" theory was proven in my case. Also, I have a blood disorder called, cyclic neutropenia, which means I don't have the white blood cells that are needed to fight UTIs or sinus infections. This was just made official this year after many tests, including bone marrow biopsy. The Strep D doesn't produce nitrates, so all my previous urinalyses were false negatives, because they were only looking for nitrates and white blood cells, when I never had those to begin with.

I live here in Houston, where we are lucky to have some of the best doctors, but even they are human and make mistakes. There is so much to learn about IC, and it appears they are just now getting the clue that IC may be bacterial....they just have to find the bacteria to know how to treat it. Karen Delhey is a very compassionate doctor and will bend over backwards to treat her patients effectively. She is very open to new ideas that I've researched, and right now, I think I'm the only person (guinea pig) that is using Monavie and a Power Plate to treat my PFD, but it seems to be working. I'm just one of those people who refuse to be told no, and luckily found Delhey who has always taken me seriously. Another URO (male) told me to have a laproscopic gynecological exam w/possible hystrectomy...glad I went with my gut instinct on that one and ran as fast as I could.

My point here is just to say that all of my tests came back negative, but with the help of all my doctors working together (actually, I left out the most important one, my allergist is the one who came up with the idea that I may have a white blood cell/immune system problem because I couldn't kick a sinus infection either), we were able to not only figure out if the chicken or the egg came first, but a battle plan to prevent future problems from happening.

[ICNDonna]

If a culture is done, it will identify streptococcus. So if your doctor is ordering urine cultures, the strep will be identified. My children were forever getting strep throats and all it took was a smear and a culture to identify it positively.

Donna

[dbritts]

Holly--
I'm glad you had smart drs. who caught this disorder early. When you say Strep D, I'm assuming that you mean enterococcus that requires a very different culture than strep throat because they don't have the same DNA. Sounds like you have some great drs.!

Best wishes,
Debbie

[Vampireness]

None of my urine culture ordered by doctors, in Singapore showed Strep or any gram positive bacteria. It was E.Coli and Klebsiella that were detected.

Vampireness

[hollipop]

Yep, enterococcus was the main culprit, although they found trace E.Coli and yeast, too. Enterococcus isn't the same Strep as what they find in the throat is it? I thought throat Strep was Strep B - or called streptococcus. (?) Martha???

Not all Strep are the same thing: http://en.wikipedia.org/wiki/Streptococcus

[ICNDonna]

There are actually three types of streptococcus --- alpha, beta, and gamma.

Donna

[hollipop]

Yes, but what I had wasn't streptococcus at all. I had enterococcus. Maybe we can suggest a doctor talk or write an article about the differences here???

Found in the link I previously indicated, Strep D has been reclassified and isn't considered streptococcus anymore. So the same culture that was done on your childrens' throats would not help for Strep D Enterococcus. Plus, Enterococcus can form in biofilms/colonies like in my case. So there is proof that this can happen. When my kidney stones were broken open, the Strep D colonies were found there, too.

Beta-Hemolytic Streptococci

[edit] Group A
S. pyogenes (also known as GAS) is the causative agent in Group A streptococcal infections, (GAS) including strep throat, acute rheumatic fever, scarlet fever, acute glomerulonephritis and necrotizing fasciitis. If strep throat is not treated, it can develop into rheumatic fever, a disease that affects the joints and heart valves. Other Streptococcus species may also possess the Group A antigen, but human infections by non-S. pyogenes GAS strains (some S. dysgalactiae subsp. equisimilis and S. anginosus Group strains) appear to be uncommon.


[edit] Group B
S. agalactiae, or GBS, causes meningitis in neonates and the elderly, with occasional systemic bacteremia. They can also colonize the female reproductive tract, increasing the risk for premature rupture of membranes and transmission to the infant. The American College of Obstetricians and Gynecologists, American Academy of Pediatrics and the Centers for Disease Control recommend all pregnant women, who are between 35-37 weeks gestation, should be tested for GBS. Those who test positive should be given prophylactic antibiotics during labor which can prevent transmission to the infant.[4] In the UK, clinicians have been slow to implement the same standards as the US, Australia and Canada. Only 1% of maternity units test for the presence of Group B Strep.[5] Some groups feel that as a result over 75 infants in the UK die each year of GBS related disease,[6] however this is yet to be substantiated by RCT in the UK setting.[7]


[edit] Group C
Includes S. equi which causes strangles in horses,[8] and S. zooepidemicus which causes infections in several species of mammals including cattle and horses. This can also cause death in chickens and moose. Many mountaineers from Canada have found corpses of moose lying in the middle of the road. Post-mortem tests have found group c streptococcus in their blood.


[edit] Group D (Enterococci) *variable in hemolysis
Many former Group D streptococci have been reclassified and placed in the genus Enterococcus (includes S. faecalis, S. faciem, S. durans, and S. avium).[9] For example, Streptococcus faecalis is now Enterococcus faecalis.

The remaining non-enterococcal Group D strains include Streptococcus bovis and Streptococcus suis.

[Vampireness]

Yeah, many people seem to think Group D Strep is Enterococcus but the reclassficiation is what I point them to. Gotta love Wikipedia!

Vampireness

[dreamy]

Okay Im real confused and need some help please. All of my urine tests from er rooms, and urologists have come back with rbc, or just wbc, strep b or both rbc and wbc, or none of the above, the latest said no infection but over abundance of strep b. I have been having urinary issues for 2 months so my idea is to get that broth culture done beause it may be a bacteria somehow cauing these ic like issues. Should I send it to uml? Quest? What to do? I got the specimen cups ready to go, I havent taken any antibiotics or pyridium type meds for 2 days now so I can do the test. Is this different than my uro's urine test where she found strep b? I am not sure if they can do in office culturing thats why Im asking about that. Basically Im hoping that whatever the bacteria is if its bacteria can be treated and I can get better faster bc Ive only had this for 2 months, maybe I wont need a year of antibiotics to get better.

[glenda]

Dreamy,
Hi!:) I have had the strep b, as well. The broth culture will show it if you have it, but don't expect any doctor to consider it as an infection. Mine wouldn't. I have gotten better with long-term antis. good luck! :)

[Vampireness]

Dreamy - I think it won't take too long of antibiotics to treat you, since you been having this for two months like you said. I think you should send to United Medical but I don't know how different Quest is and if it's something you can afford. Maybe ask Martha, she knows but I think United Medical Lab broth culture is pretty stable. Also, wbc and rbc are indications of an infection if I'm not wrong. The white blood cells usually try to fight off infection but die and then they're appear in the urine.

GLENDA!!! I haven't seen you in forever!!! I sent you an email sometime ago. Nice to see you around! You're feeling better??? AWESOME!

Vampireness

[glenda]

Hi, Vamp:

I have not checked my emails in a couple of weeks, so that could be why I have not gotten your message. Sorry.

I have ordered abx through the net. Thank goodness for that, or I'd still be struggeling with ignorant doctors.

Also, I have not been around anyplace much because I've been swamped with assignments. I don't think I've talked to you since I began taking classes, so you might not have known this. I appologise for being so absent. I've been taking classes on-line for the past five months. So far so good! I currently hold a 4.0 GPA. Yippy! :) It has kept me very busy.

Hope you are doing well. I will check for your email. K?

[Vampireness]

Hey Glenda,

That's okay, I thought you're busy or unable to get access to the internet. But, it's good to finally hear from you!

I have ordered abx through the net

Abx? What is that? How are your symptoms?

Thank goodness for that, or I'd still be struggeling with ignorant doctors.

Yeah, I remember your whole struggle, I'm glad you don't have to deal with that anymore.

Are you getting treatment for Lyme?

I don't think I've talked to you since I began taking classes, so you might not have known this. I appologise for being so absent. I've been taking classes on-line for the past five months. So far so good! I currently hold a 4.0 GPA. Yippy!

Oh this sounds GREAT! Congrats!

I look forward to your email response.

Vampireness

[PlainJane]

If a culture is done, it will identify streptococcus. So if your doctor is ordering urine cultures, the strep will be identified. My children were forever getting strep throats and all it took was a smear and a culture to identify it positively.

Donna

I think this statement is a little misleading. As far as I understand the labs won't report streptococcus in the urine culture unless the bacteria count comes back at a certain number. So for example if the cut off for reporting is 10 but you score a 9 they don't report it. That is my understanding.

It is also my understanding that the standard urine culture a urologist does best detects ecoli infections and not infections like strept (i can't remember if strept is gram positive or gram negative).

So when your child gets strept and they do a swab they report "yes strept is positive" or "no strept is negative" but with the bladder they don't report yes or no the bacteria must be in high enough number to be deemed worth reporting. Who decides that number and how is anyone's guess I really don't know enough about this.

I did many routine cultures with my g.p. and they always came back as having no bacteria. Then i did a broth culture and they found i had enterococcus. once i started treating the enterococcus and was re-tested they found klebsiella. I'm sad to report that after many months (almost a year of biclllin) of treatment my bladder symptoms aren't better. my bladder still drives me up the wall. However, after I started treating the bladder infections i looked into the possibility that i have chronic lyme disease and i saw 2 separate specialists who said yes i have lyme disease. after almost a year of treatment for that i'm not any better. however i don't want to discourage anyone from trying antibiotic therapy.

there is no cure for IC as someone pointed out in this thread. i just want to point out that in my opinion the medical system is incredibly flawed. conventional medicine picks apart symptoms and focuses on specific body parts that trouble the patient.

so you go see a urologist and they do a urodynamics test and it doesn't show anything helpful (as was the case with me) and they say "nope no problem here" but they never mention to you the fact that a systemic problem such as lyme disease can cause bladder symptoms. perhaps because they don't know it can cause bladder symptoms but also because they aren't looking for systemic causes. it's not a holistic approach is what i'm saying.

in some cases i think the medical system works just fine for certain people. some people go to urologists and find they have x,y,z and that is the cause of their symptoms. however, obviously there are many people who don't have x,y,z as the cause of their symptoms (otherwise these boards wouldn't exist). for us on these boards the problem is more complicated than x,y,z.

i personally am not so worried about antibiotic resistance. i have been on longterm antibiotic treatment for lyme disease and i am of the opinion that it is worth the risk because at this point i have no quality of life whatsoever. i think the biggest problem when it comes to antibiotic resistance comes from feeding our livestock antibiotics. this is a crazy approach to farming in my opinion. it is not humane; it is very unhealthy. if we all refused to eat antibiotic fed livestock i think that would greatly decrease antibiotic resistance.

[Vampireness]

Yeah I agree with you, it IS misleading. It's not as simple, otherwise alots of our bacteria would have gotten detected. Strep is a gram positive bacteria.

I think PlainJane, the reason your antibiotic therapy didn't go so well, could be because of the lyme disease.

When are you going to do a reculture to see if you have different bacteria in your bladder?

Vampireness

[ICNDonna]

If you ask your physician, you will be told if anything shows on your culture. At least mine always has.

Donna

[Vampireness]

Throughout a fifteen to thirty minutes consultation, I'm sure alots of us ask the doctor if we have an infection.

My doctors said, I have no infections and I believed them, knew nothing about low colony count and I knew nothing about culturing methods, took their word for it but just couldn't understand why the test would tell otherwise, when I felt like I still have an infection.

I had to get all my results back, years later from the hospitals and realised, bacteria was available in low count in all results. I was just told I don't have any infections.

Vampireness

[PlainJane]

I am not sure about the re-culture for bladder infection. My primary focus is the Lyme disease treatment right now.

[Vampireness]

Oh I see, I thought Ruth would have adviced you to recheck if the Group D is gone.

Vampireness

[PlainJane]

i actually haven't been in touch with ruth since the lyme disease diagnosis.

[Vampireness]

Oh I see. Strep D and cause alots of problems, from what I read that's why I asked if you're going to check if it's gone.

Vampireness

[PlainJane]

I don't know what to do. i have so many health problems I don't even know where to start.

[Vampireness]

I would think to recheck to see if you have further infections, so that you don't leave one untreated and wait till your Lyme doctor's appointment and see what he has to offer.

Vampireness

[boukie]

what is a broth culture and the anitbiotics helped with what? bacteria in the bladder?

[MarthaF]

A broth culture is a more extensive method of looking for bacteria in a urine specimen. This is a method that has been known for a long time but fell out of use and the current lab method involves using agar plates to isolate bacteria. This is less labor intensive and faster but often bacteria do not grow on agar. Broth encourages the growth of some fastidious bacteria or bacteria that are slower growing. There is only one lab that we know of that will do broth cultures for patients - United Medical Lab. You can look them up at: unitedmedicallab.com. You can send a specimen on your own and do not need a doctor's order. If they find bacteria they will send you the report showing antibiotics that the bacteria are sensitive to.

[boukie]

I found the number thanks so much! I hope this helps me. I can't bear to think to live with this for the rest of my life.

[massagedoula]

I just wanted to respond to the posts about group B strep (not about enterococcus or any other bacteria.) Group B strep is a bacteria that is a normal part of many people's gut flora. About 1 in 3 to 1 in 4 people have this bacteria living in their body. It becomes a concern in pregnancy, which as a student midwife about to graduate from school, is where I have had much experience with this bacteria. Is is routinely tested for in pregnancy with a vaginal culture, because if a woman has group B strep at the time of childbirth and the baby gets exposed to it, it can infect the baby (since babies are born with a low-functioning immune system.) So all women have a vaginal culture for this bacteria, and if positive, we treat them with IV antibiotics (usually penicillin G) during their labor. Is is VERY common for women to have this bacteria in their vagina, but sometimes they are so heavily colonized that it can show up in their urine. In that case, it is possible to have a UTI with group B strep, and women are also treated with antibiotics during their pregnancy, because it is considered a pathogen that causes UTI. I have seen it show up on more than a few urine cultures.

And, as a matter of fact, about 70-75% of all urine cultures we take from our pregnant clients have a result of anywhere from 3,000-100,000 mixed gram positive bacteria. (a UA is routine at the first prenatal visit to check for asymptomatic UTI--which can quickly lead to pyelonephritis in pregnant women). In these women it is all considered "normal vaginal flora" or "contamination from external genitalia". And not treated. Only when there is a specific bacteria isolated (e. coli, GBS, klebsiella, etc.) does the client get treated. So my point is that there are huge amounts of women running around just fine with no IC that have mixed gram positive bacteria show up in repeated UAs. Is it contamination? Enterococcus? We may never know. But my point is that it is REALLY common to see any number of mixed gram positives show up on a UA in obstetrics. No-one blinks an eye about it!

[MarthaF]

I agree that mixed flora on a urine culture is contamination. These
women also aren't symptomatic, don't have damaged bladder walls, and
their immune systems are working well and can handle a certain level of
bacteria without problems.

IC patients have damaged bladder walls, have impaired immune function,
and are symptomatic.

I don't know of a study of extensive culturing of healthy women. Maybe urine is not sterile after all. But it usually takes a very extensive culture to find certain bacteria that are not easy to grow. Or maybe labs dismiss some low growth since they consider it "contamination" when in fact it should be reported if there are symptoms. I was always told I did not have any bacteria until a broth culture found Enterococcus that my uro treated.

Martha