A quick response after a positive test for a bacterial lung infection
My care team jumped into action to protect my post-transplant health
I was diagnosed with idiopathic pulmonary fibrosis (IPF) in January 2017 and subsequently received a bilateral lung transplant in July 2021. With IPF, whether you’re pre- or post-transplant, one of the things you learn quickly is that the growth of bacteria in the lungs can be deadly.
My journey has involved regular bronchoscopies, during which doctors conduct a bronchoalveolar lavage to take a sampling of my lower respiratory tract. During this procedure, a small amount (5 mL) of saline is released into the lungs and then collected and monitored for bacterial growth.
This practice was used during my most recent bronchoscopy on Jan. 24. The difference this time was that the culture produced an unwanted result.
I received an email from my care team that opened with the following sentence: “Your last bronchoscopy was positive for Klebsiella oxytoca/Raoultella ornithinolytica (only one colony so very light growth).”
You have my attention
That was a first for me. None of my previous lavages produced positive results. Within minutes, I was researching these bacteria and how the infection is treated.
A word of caution when conducting your own research: Seek out reputable sources of information. What I write here for you each week is my perspective as a patient, though every factual statement in my columns is tied to a reliable source.
When I began researching Klebsiella oxytoca/Raoultella ornithinolytica, I made sure to focus on reputable, peer-viewed publications.
First, I learned that R. ornithinolytica was initially classified as Klebsiella ornithinolytica, and later reclassified when the genus Raoultella was created in 2001. Although K. oxytoca and R. ornithinolytica are distinct types of bacteria, they share similarities, with the latter sometimes misidentified as the former. I decided to focus my research efforts on K. oxytoca, which was listed first in my results.
A 2016 article published in the Medical Journal Armed Forces India notes, “Klebsiella oxytoca is emerging as an important bacterial isolate causing hospital-acquired infection in adults and having multiple drug resistance to commonly used antibiotics.”
That’s a lot of information in a single sentence, but “hospital-acquired infection” caught my attention immediately. I want to be clear that this alert is in no way a criticism of any part of the health system. In fact, it’s just the opposite. My care team looks for a variety of indicators with each lavage sample they collect. As soon as the culture began to show signs of bacteria, they addressed the issue.
I also was concerned to read that this type of bacteria has a “multiple drug resistance to commonly used antibiotics.” Over the course of my IPF journey, the only antibiotic I have used is amoxicillin, primarily before dental procedures. To treat my bacterial lung infection, my care team prescribed Augmentin (amoxicillin and clavulanate).
According to the National Library of Medicine’s DailyMed database, Augmentin “should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria.” This medication was prescribed to me as one tablet (containing 875 mg of amoxicillin and 125 mg of clavulanate) that I’d take twice daily for 10 days.
What is the risk?
K. oxytoca is not spread through the air. As I mentioned, it’s often spread in healthcare settings, where IPF and post-transplant patients tend to spend a lot of time. Coupled with the level of immune suppression a post-transplant patient requires, this bacterium can be particularly troublesome for our community — and it’s not the only invader that can cause problems. Pseudomonas aeruginosa, cytomegalovirus, and aspergillus also pose a significant risk to lung disease patients.
Quickly identifying the bacterial lung infection gave my care team time to reduce the threat. They decided to treat me with antibiotics because they knew that my wife, Susan, and I plan to leave next month for our first international trip since 2019. We will fly to Amsterdam and board the AmaLucia river-cruise ship to see the tulips bloom.
Sharing my journey with you is how I can make every breath count.
Note: Pulmonary Fibrosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Pulmonary Fibrosis News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to pulmonary fibrosis.
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