UTI for 4 months plus blood in urine

[teapot1000]

I’ve been on antibiotics for the last three weeks for an UTI and on and off for the last 4 months. At the urologist office today the urine sample came back with couple + bacteria 50 to 75% white blood cells and 100% red blood cells. Then a cystscope  was performed to determine where the blood was coming from because this was the major concern with all the urine samples. Blood was showing up in all of them. I was told that there was a red line in my bladder. I was told that the red line was due to the infection however I have been on medicine for three weeks should this have not cleared up the infection. What does all of this mean and especially the red line in the bladder? I have no other diseases such as diabetes or lupus.

[Dr Smitha Mathews]

Hi,

If you are still having bacteria in the urine after 3 weeks of antibiotics, It implies that the infection has not responded to antibiotics. This happens because the infection-causing organism would have developed resistance to that particular antibiotic.

You will need to have a culture sensitivity done for the bacteria that have been detected, and start a course of antibiotics to which the bacteria is sensitive.

The report for the culture sensitivity should be available 48-72 hours after you provide the sample.

The red line indicates that the bladder lining has been damaged from a persistent infection. This infection will need to be treated adequately for the bladder to recover and heal.

Such kind of damage to the lining predisposes individuals to the development of chronic bladder conditions such as interstitial cystitis.

Additionally, increase your intake of fluids to over 2000 ml per day, avoid caffeine and alcohol, and add citrus fruits to your diet. You can also drink cranberry juice as this helps clear the bacteria from the tract.

Do keep us posted.
Regards.

[teapot1000]

A culture was done prior to this visit. I was told at this appointment that the culture did not grow anything. The urologist has switched  antibiotics from macrobid to cephalexin to levaquin over the past three weeks. However, over the past 4 months I have been one cipro, keflex and levaquin one time before this medicine came from the PCP before an appointment was made with an urologist.
1. Why is the infection not respond to the antibiotics
2. Why is the culture not grow anything
3. What else can be done

[Dr Smitha Mathews]

Hi,

If there are bacteria detected in urine, they should be growing on culture media as well.

Usually the bacteria are identified in the gram stain done during urinalysis and an appropriate growth media is selected for them to grow on.

Some bacteria grow quite slowly and some others do not grow in media that are not conducive to their growth.

If you were on antibiotics earlier do you remember whether you completed the entire course for all the antibiotics or did you stop after a few doses or miss any doses?

Did the urinalysis state what bacteria was isolated?

If the infection is not responding to the antibiotics it could be because the bacteria are resistant to all the antibiotics you have been on as you were taking them even earlier.

Do check with the lab about the type of organism that caused the infection and post here.

Meanwhile follow the general measures posted in my previous post.

Regards

[teapot1000]

Yes, I finished the course of antibiotics no I did not miss any doses.

However, today, which is 3 days past cystoscope procedure I have been in terrible pain. The best way to describe this pain is like I have giving birth again, which I have not.
I called the doctors office went in to give them an urine sample. I was told that the culture that was done on the day of the cystoscope procedure had no growth. Remember this sample had 3+ bacteria, 50 to 75 WBC and 100 red blood cells. I still don’t understand why it had no growth. Today sample (which is 3 days post procedure) had 1+ bacteria, 0 red blood cells but 50 to 75 WBC.
1. I don’t understand why there is no growth if bacteria are present.
2. I don’t understand what is causing the WBC to be there. This is has been the main concern from the start along with blood in the urine.
3. Why am I in this much pain.

I do know that there is an urachal cyst and inflammation in my bladder

Thanks for all your help

[Dr Smitha Mathews]

Hi,

Cramping lower abdominal pain is not normal if the UTI is resolving.
Also in view of the presence of a urachal cyst, it would be better to seek evaluation of the source of infection.
A urachal cyst can occur between the umbilicus and bladder and infection of the same can result in inflammation of the overlying skin.
Since the cyst also predisposes to frequent infections, it may be worthwhile to consider having it removed surgically once the current infection has been resolved.

The current test results seem to indicate that the infection is resolving even if the inflammation is persisting.

You can take an anti-inflammatory drug like acetaminophen  singly or in combination form as tylenol.
Since you have completed your course of antibiotics, try conservative measures such as adequate hydration, citrus fruits and juices, application of heat over lower abdomen and back, etc., for a day or two.

If the symptoms still do not clear up, call your doctor and have an ultrasound done to check for infection within the cyst.

Regards,

[teapot1000]

First of all I want to thank you for all of your help. Then I would like to keep you updated. I wanted back to have another urinalysis done. This time it showed 100 WBC 25 to 50 RBC and 1+ Bacteria. I did not get a chance to talk with the doctor since this was a nurse visit but I had the nurse to ask the Dr. if the cyst was causing this his answer was no. Also he said that he did not know what was causing the WBC. He told the nurse to have me come back to see him.  Can you give me futher advice on what is causing this and what to do?

Thanks a bunch

[Dr Smitha Mathews]

Hi,

It would be simpler if the bacteria is identified on urinalysis. Bacteria detected in urinalysis are stained with a gram stain and organisms are classified into gram-positive and gram-negative groups and antibiotic treatment changes based on which type the organism is. Also most bacteria have a typical appearance and can be identified on the basis of this appearance.

Please let me know what the urinalysis says about the gram-positive or negative organism.

The culture medium changes for some bacteria as they do not grow in the standard culture media. This is determined based on what bacteria is detected in the urine.

Also an ultrasound would detect whether there is any damage or infection in the kidney that could be causing the WBCS and blood in urine even though the infection in the bladder could be the cause of these findings in urinalysis.

Antibiotic resistance or partial sensitivity can be factor in prolonged infections and this can be ascertained on culture sensitivity.

Do post the type of organism detected.
regards,