The IV antibiotics that Drew was on for the past two weeks did not get rid of the bacteria that he is growing in his lungs. We knew there was only a chance that it would work, as the bacteria is antibiotic resistant to just about everything, but we had to try anyway. We found out last weekend that it didn't work and decided to move on to an inhaled antibiotic that is more or less the only thing that this bacteria isn't resistant to. You may be wondering why we didn't start there, and the answer is because of the reaction that Drew has had to inhaled antiboitics in the past. Because of his tracheomalacia, his already floppy airway is just made floppier with an inhaled antibiotic and it seems to cause a degree of collapse in his airways. Luckily (knock on wood), he seems to be tolerating this drug just fine. I'm not sure if its just the time that has passed that has allowed his airways time to grow and strengthen or the fact that its a different antibiotic, but regardless, he's tolerating it so we'll take it.
I don't know if he will ever get rid of achromobacter. Even with these inhaled antibiotics going right to the source, he may simply just not ever be able to get rid of it completely. Our CF docs (and I think most CF docs) treat based on both what people are growing and their symptoms. Sometimes, despite their best efforts, stubborn and clever bacteria find places to hide in the lower airways and just never go away. They might not cause any problems most of the time, but every now and then they will start to grow and thrive and wreak havoc on the lungs causing a pulmonary exacerbation and needing attention and treatment to get it back at bay.
And the big question on everyones mind is "What does this mean?. I don't know really. It's not going to kill him tomorrow, or even later this year. It's unlikely that it will kill him in the next 5 years. And frankly he may live with this bacteria being a pain in my ass here and there for the next 60 years. I just don't know, and neither does anyone else. Here's what we know:
-Achromobacter is a multi-drug resistant bacteria
-It is known to cause inflammation
-It may be a contributor to lung function decline in people with CF, but not enough people have it for researchers to be able to reliably report its short and long term effect.
So there you have it. I don't know what it means if we don't eradicate it. I would love to have it not show up on a culture ever again, or at least for a while, but I don't know how likely that is. For now, we will continue the inhaled antibiotic and see where that takes us. Thank you for the continued thoughts and prayers. We'll keep you posted!