Pneumonia Update

Dear Son is doing better. Since I last wrote, they continued to have issues controlling his fevers and when the fever rose, his oxygen saturation deteriorated and he had great difficulty breathing. My concern was that if the antibiotics were effective in controlling the infection, then I shouldn't be seeing the fever spikes and hence the difficulty breathing. They consulted with Infectious Diseases and they looked at where the pneumonia presented itself in the lungs and then the types of bacteria associated or rather that present in that location. There was some discussion with changing his antibiotics from Ceftriaxone and Vancomycin, to the next level antibiotic that is typically used for Vancomycin Resistant Pneumonias, however they decided against it. Instead, they changed his antibiotic to Zithromycin (this is a much lower level antibiotic). They determined that he had an atypical pneumonia and probably not an aspiration pneumonia, although they can't really rule it out. (This is good news and it was probably community based which essentially means it's a less serious pneumonia than say a MRSA.)



Once he was on Zithromycin, he began to wake up and open his eyes at times. He improved on that but continued to have issues with oxygen saturation; yesterday they changed the antibiotics again to one that covered a broader based spectrum. In addition, they took him off the mouth tent (he was at 100%) and put him on a nasal cannula at 5 liters. Dear Son ran into oxygen saturation issues again at around 2:15 a.m. this morning and his oxygen saturation had dropped to 84%-87%. They made some changes again and it's becoming more stable, and is now in the early nineties. (Dear Son is a mouth breather and that makes the nasal cannula a little less effective for him (in my opinion) and makes him work a little bit harder.) We have yet to get through the night without any issues. He is experiencing some slight issues with vomiting in the last twenty four hours which make it more difficult since it increases the risk of aspiration. Normally, Dear Son is unable to roll over and chokes on his saliva when he is on his back. He is having a more difficult time now since he is weaker and can't manage many changes in position (like for diaper changes) without heaving. I have yet to meet with the ENT. Prior to the pneumonia, we had experimented with some drying agents prior to surgery and I had been in contact with the ENT. Our next step will most likely be a Nissen (to control reflux) and botox injections into the saliva glands.


Today, they'll do another chest xray today and are re-evaluating his oxygen needs as well as increasing his respiratory treatments. Overall, not a serious pneumonia like he has had previously.


As you are aware, Dear Son has MRSA, which he most likely acquired from his multiple hospital stays (versus community based). While he does have MRSA, this is not a MRSA pneumonia-it would only be considered a MRSA pneumonia if he had MRSA in his lungs (that's where it presented last year). In addition, they shared with me that patients like Dear Son who have had "two" MRSA pneumonias, have much weaker lungs than others. They also indicated, that although he had an atypical pneumonia, it could turn into a MRSA pneumonia. At the present time, I am not concerned about this happening since I think he is fairly stable.


In summary, an atypical pneumonia. I spoke with our Pediatrician today and he will remain here until he can sleep through the night and breathe room air. We have a ways to go before we get there since he doesn't seem to be able to manage decreases in the oxygen just yet. His normal baseline is fairly weak to begin with so I suspect we'll be here a few more days since I don't see that happening in the next day or so.


Thank you for your concern and your thoughts and prayers.