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smjpain posted:
hI Jane well my Christmas was spent in the ER and they did a Cath UA because I still have a bad yeast infection been on Diflucan for 23 days already. Well the cath UA was sent off to be cultured anyways I will talk about that later well I also had to go to the ER the next day then thursday was Iowa City Immuneologyst she thinks I could have Luhkemia because of my white blood cell count since before I had my HISS has been slightly lower, and I have had a total of 325 infections since that time also. She is running blood test and on the third I will have more lab work done and possibly spinal tap well then yesturday I went in to see my GYN because of the amount of pain I was in and having to go to the ER well the UA cultures came back positive and now I have a really bad UTI/Bladder infection which could be causing my abdominal pain. He put me on Amoxicillin-POT clavul 500-125mg twice a day for 7days but if by monday I am still hurting alot I probably will have to have IV meds because my Body can't fight anything and also I still have a yeast infection. I am so scared when two Doctors say possibly two different types of cancer that isn't good.
Jane Harrison Hohner, RN, RNP responded:
Dear smjpain: Dang, that is a shocking supposition, and reason, for the multiple infections with poor healing. Please let us know how the blood work comes out from the Immunologist. I pray that there is some other explanation for your blunted immune function.

So glad you got the cath UA for a culture and sensitivity done rather than just getting some random antibiotic treatment for UTI symptoms. Hopefully you won't have to go to IV meds as an option. If you are very immune compromised, every procedure is another opportunity for skin bacteria to enter.

Alas, it is hard to know how to prevent worsened vaginal/vulvar yeast with this new round of needed antibiotics. A lit search of the topic fluconazole resistant candida vaginitis yielded 72 citations. Here is the most recent:

Obstet Gynecol. 2012 Dec;120(6):1407-14. doi: http://10.1097/AOG.0b013e31827307b2.
Fluconazole-Resistant Candida albicans Vulvovaginitis.
Marchaim D, Lemanek L, Bheemreddy S, Kaye KS, Sobel JD.

Division of Infectious Diseases, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.

: As a result of high recurrence rates of Candida albicans vaginitis, successful suppressive fluconazole is widely used, and drug resistance is considered rare. We report increased occurrence of secondary fluconazole resistance, analysis of risk factors thereof, and describe management of fluconazole-refractory vaginitis.

: Patients referred to the Vaginitis Clinic at Wayne State University with clinically refractory fluconazole-resistant (minimum inhibitory concentration [MIC> 2 micrograms/mL or greater) C albicans vaginitis from 2000 to 2010 were enrolled. Patients completed a questionnaire pertaining to demographics, comorbidities, behavioral characteristics, exposure to antimicrobials and antifungals, fluconazole consumption in defined daily doses in the previous 6 months, management received, and outcomes. With patients not located, data were extracted from charts. Susceptibilities to antifungals were determined by broth microdilution.

: Twenty-five women with fluconazole-resistant recurrent C albicans vaginitis were identified, and 16 returned filled questionnaires. Study cohort consisted mainly of married, insured white women with more than 12 years of formal education and average or above average socioeconomic status. Median fluconazole MIC was 8 micrograms/mL (range 2-128 micrograms/mL). Risk factors for mycologic failure included increased fluconazole consumption (P=.03) with 16 of 25 women exposed to low-dose weekly fluconazole maintenance therapy. All patients were clinically controlled successfully, although treatment was difficult and often prolonged.

: Fluconazole-resistant C albicans vaginitis was previously considered rare. We report 25 cases over an 11-year period, indicating an emerging problem. All patients had fluconazole consumption in the previous 6 months. Management of fluconazole refractory disease is extremely difficult with limited options, and new therapeutic modalities are needed.


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