For the bot: Female, forties, obese but steadily losing weight, average height

Medical history: complicated. Biggest issues are mitochondrial disease, dysautonomia, gastroparesis dystonia, neurogenic bladder, Hashimoto’s, diabetes related to the mito. Reliant on central line for IV hydration (due too mild but persistent lactic acidosis, chronic dehydration, lack of a sense of thirst, frequent urosepsis, etc). Diagnosed with juvenile systemic lupus at age 11, diagnosis now uncertain.

Medications: So. Many. Relevant would be the nightly Trimethoprim, and two recent rounds of additional antibiotics (Bactrim and Keflex) prior to hospitalization. No immune compromising medications.

At the beginning of this month I was hospitalized with bacteremia from two different bacteria commonly found on the body (multiple positive blood cultures over several days) and an ESBL UTI (also multiple positive cultures). They suspect the bacteremia was from my PICC line even though it tested negative when cultured after being removed. I am exceedingly careful as is home care, but this was my third line infection in 14 months.

I received 14 days of IV Vancomycin plus both Rocephin and an antibiotic for the ESBL E. coli over the 8 days hospitalized. My lab reports were remarkably normal - my white count never elevated nor did any of the expected markers for infection. I had a low fever, just over the 100.4 cutoff, and felt awful but it’s like my body made no real effort to fight the infections. I have been told that I am considered immunocompromised due to the mitochondrial disease, but no work up has been done regarding anything immunologic since I was a young adult (college aged). Does this indicate a need for further work up by Immunology? There may not be an immunologist accessible to me, so what would be the most important things to have primary care look into? My primary doctor is wonderful but a bit unsure about this given how complicated I am, but always willing to learn and consider additional opinions.