Recurrent Urinary Tract Infections

[Rings]

My mother now 78 began to suffer from Alz Dis 7 years ago and started to become incontinent and suffer from UTI's and seizures. Then mod stroke. Bed ridden for the past six years. Since incontinence, she experiences constant recurrent UTI's.This whole time we have been culturing urine = infected including symptoms(lethargic)and as I couldn't deal with her lethargic state (very uncomfortable)and making it difficult to get her to eat/drink - including risk of pneumonia / possible aspiration in lethargic state, we would treat the infections with the antibiotics based on the C&S.Retest after antibiotics,sometimes clean,then infected 1-2 weeks later.For years, main bacteria was e-coli with a few others here and there. Been on antibiotics constantly for years. Always worried about the overuse of antibiotics (even though they appear to always be necessary to keep out of lethargic state.Oct 2003,hospitalized, WBC's in blood >20000,urine bacteria =Kliebsiella Pneumonia. Treated w/antibiotics and then started Macrobid daily 100mg and Pomogranite juice as recommended by a friend. She was doing excellent - UA's clean.Then,late Dec 2003, became ill again and hospitalized - WBC's in blood again >20000; however, both the blood and urine cultures came back = no growth. I was and still am puzzled on this one. Antibiotics again and got better. Tests performed with a Urology consult during hosp visits: Oct = Urogoly consult report = Bimanual not done at this time, Deep right CVA tenderness - slight wince, that was it.Renal Ultrasound - mild left pelvicaliectasis in pelvic region, kidneys atrophic and small, irregular cortex. KUB - no definite renal calcification yet mildly underpenetrated, lumbar scoliosis, small calcification low pelvis likley phleboliths. Limited Pelvic Untrasound - No polyps, no stones, bilateral jets present = normal bladder US. Dec 2003 thought infection may be diverticulitis of bowel. CT Abdomen - left renal cyst small is appreciated, left peripelvic cysts noted, kidneys bilateral irregularity, infrarenal abdonminal aortic aneuysm, common duct dialated. Recently, I have been concerned as Kliebsiella has been primary bacteria and we have had to use IV antibiotics due to resistance. Consulted another Urologist, discussed all history and further explained post void retention (result of stroke). He recommended we prevent retention by doing i/o cath 4 times/day. Did this and we now have infection with e-coli and Psuedonomas Aurigonosa. I am really worried now - we are on Gentimicin. What should I do ? Thoughts include: Intraveneous pyleogram, cystourethrogram (VCUG same thing?), CT Scan Urinary tract, Cystoscopy, Blood factors test (P1 Group, Lewis B Group, Def in HBD-1),collidial silver,acidophillus,Maj earth liq classic nutri, highfiber, bethanechol/urecholine,pyridium,uriced,foley catheter with macrobid l00mg or ofloxacin, hyprex,stent,stretch urethra,Estrogen Cream ?  

Pls Help
















  

[Kevin Pho, MD]

Cases such as these are difficult, since the use of many antibiotics are promoting more resistant and dangerous bacteria.  Prophylactic antibiotics have already been tried.  The issue with constant catheterization is the reintroduction of bacteria from the catheter itself.  

One consideration would be the placement of a suprapubic catheter.  This may help with the neurogenic bladder and possibly reduce the incidence of recurrent infections.  

If this is not an option, then you may want to consider a referral to an ID (infectious disease) specialist who can recommend an appropriate course of prophylactic antibiotics that may not have been tried.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.