Urogynecology Expert Forum
UTI after vag hyst - not responding to cipro or microbid
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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UTI after vag hyst - not responding to cipro or microbid

Two weeks ago I had a minimally invasive hysterectomy. This was a robot assisted (da Vinci) vaginal hysterectomy. I have had a very quick recovery and was able to resume many normal activities within one week. However, a week ago I came down with a UTI which I have since learned is quite common after vaginal hysterectomies.

Went to Dr and they put me on Cipro, hardly any improvement so I went back next day and asked for a culture and sensitivity test. (Why oh why do they not do this in the first place instead of guessing???)  The third day still little improvement so they switched me to Microbid. One test at urgent care and another a few days later through my internist showed no growth, but some blood/pus/white cells.

My major concern is that 5 years ago I was hospitalized for 10 days with an eColi ESBL and I don't want to go there again.

Questions:

1) Does having had an ESBL before make me more susceptible to it again?  I am under the impression that it is the bacteria that becomes resistant over a long period of time and through the general population.

2) Would trying a 3rd antibiotic make whatever bug I have become more resistant?

3) Assuming an infection the Microbid does not cure, how long after stopping it will I have to wait before a urine culture will grow bacteria?

4) Why in the world do they not do a urine culture and sensitivity test when you first come in with an infection?

5) Are there any antibiotics that can be taken orally for an ESBL? If not, is there any way to travel to a clinic several times each day to get the dose, rather than sitting in the hospital hooked up to an IV for 10 days?

Please help - I can't afford hospitalization....
1344197_tn?1392822771
Hello,  E. coli is the most common bacteria to cause UTI's .  Macrobid is usually effective in ESBL producing E. coli.  Other antibiotics that have been used are Fosfomycin and Mecillinam.  Your culture results should be your guide as to the antibiotic to use.  In your situation I would always request a culture be done.  I unusual instances where there are no oral agents that show effectiveness, I have used Invanz 1 gram IM for 7 days in patients with resistant bacteria.   J. Kyle Mathews, MD
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J. Kyle Mathews, MD, DVMBlank
Plano Urogynecology Associates
Plano, TX
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