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Suggest Treatment For Recurring UTI

Posted on Mon, 3 Aug 2015

Question: Hello, I'm XXXXXXX XXXXXX
I'm a 60 year old male and 22 years post-injury C-6 Quadriplegic (complete injury). I've had numerous UTI's over the course of my injury. These infections seem to be getting worse, getting more frequent and getting more resistant to most antibiotics.
I had a urinalysis with bacteria sensitivity done 2 weeks ago - results were enterococcus faecalis gram positive >100,000 colonies. I was prescribed Nitrofurantoin (Macrodantan) for 7 days. After completing the course of Macrodantin, I waited 5 days and rechecked the Urinalysis results. The bacteria was still there at the same colonization level >100,000. >

Answered by Dr. Rakesh Madhyastha (1 hour later)

Brief Answer:
Asymptomatic bactiuria

Detailed Answer:
Hello

Thanks for the query

In order to answer your question I need a few more details from you

1. How are you currently voiding urine? on your own? is there a catheter, cic?
2. Do you have symptoms like burning while passing urine? difficulty in passing urine?
3. do you have fever ?
4. do you have diabetes ?

Please get back to me, I am awaiting your reply

Regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Rakesh Madhyastha (1 hour later)

In response to your questions Dr. Madhysdtha;

1. I do an intermittent self catheterization with assistance from my wife (as my hands neither move nor feel anything below the C-6 level). I do the self-catheter "clean technique" procedure four times per day. There are no other tubes / ostomy in my body.

2. As I mentioned; as a complete injury quadriplegic, I have no feeling at all below the C-6 level (approximately 2 inches above the "nipple line" on my chest). However, when I feel pain below my level of injury spasms and blood pressure will both increase and I have general feelings of malaise as opposed to specific feelings as to were it hurts. I do not have any burning sensations or problems passing urine.

3. I am not running a fever (My temp is currently at 97.7 F).

4. I am not diabetic.

I anxiously await your thoughts, ideas and recommendations on how to deal with this situation. Thank you for taking the time to review the information, urinalysis and bacteria culture which I uploaded.

Regards, XXXXXXX XXXXX

Answered by Dr. Rakesh Madhyastha (12 hours later)

Brief Answer:
Asymptomatic bacteriuria

Detailed Answer:
Hello

Thanks for getting back to me with all the details.

Here are my thoughts

1. It is common to have significant bacterial growth in patients on CIC
2. If the patient is not running any temperature then we leave it alone and not necessarily treat it as it is impossible to get rid of the bacteria however much you are careful with the CIC
3. So you question would be, when would you consider treatment. If the urine growth is associated with fever, loss of appetite and more importantly associated with renal impairment in the form of elevated serum creat then only I would consider treatment
4. I usually put my patient on long term prophylaxis with Tab TMP+Sulfmethaxazole double strength, once at night after treating symptomatic urinary tract infection.

Please approach your doctor with my recommendation, I am sure he will agree with me as well.

I hope I was of help, if you have any further queries please get back to me

Regards

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj