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Urine culture showed positive for providencia stuartii. Reduced renal function. History of repeated UTI. Remedy?

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Yes my mom is in the hospital due to a urine culture that showed positive for providencia stuartii. She is elderly with reduced renal function, is incontinent, and does not ambulate. Also she has had a history of repeated UTIs including one that went into sepsis They are treating her with cefepime IV but has only had 4 doses of cefapime and they are talking about discontinuing it tomorrow. Is this standard? I thought the usual dose is 1 gram we Rey 12 hours for 7 days? XXXXXXX
Posted Mon, 12 Aug 2013 in Urinary and Bladder Problems
Answered by Dr. Aditya Bhabhe 1 hour later
Thanks for your query.

The usual duration of antibiotics to treat recurrent UTIs is 7 to 10 days. The choice of antibiotic depends on the sensitivity of the bacteria which can be ascertained in the urine culture report. The dose of antibiotics varies as per the renal function (depends on patient's serum creatinine/ age/sex).

So you can discuss with the treating physicians if they have any particular reason for discontinuing the antibiotic.

The following steps might help in reducing the frequency of UTIs:
1) If she has diabetes, then the blood sugars need to well controlled.
2) An Ultrasound of kidneys and bladder to see if there are any structural problems and treat them appropriately.
3) use of pills containing cranberry extract.
4) Use of low dose oral antibiotics on a long term basis, depending on the sensitivity report, after discussion with your physician.

Hope this helps.
Good luck.

Above answer was peer-reviewed by
Follow-up: Urine culture showed positive for providencia stuartii. Reduced renal function. History of repeated UTI. Remedy? 45 hours later
Well it kind of helps but we do all those things. The antibiotic she takes as a preventative measure is not effective against the bacteria she has now. She does take cranberry capsules. She does not have diabetes. She does have a prolapse and reduced renal function but there is nothing we can do about those things as she is 82 and they do not warrant surgery. Do you have any other suggestions?
Thank you XXXXXXX They are continuing the antibiotic for a 7 day regimen.
Answered by Dr. Aditya Bhabhe 37 minutes later
Thanks again for the query.
As I did not know the complete background I suggested the measures which are effective and commonly work. However looks like you have tried most of them.

One of the main routes through which the bacteria gain entry into the urinary tract of females is by migrating there from the vagina which is often colonized with harmful bacteria. This problem increases with age.

So the following measures have been tried to decrease the harmful bacteria in the vagina:
1) Use of local (intra-vaginal) estrogen cream in postmenopausal females. This helps in replacing the harmful bacteria with the harmless ones. However this has to be done after consulting a gynaecologist.
2) Use of probiotics (orally as well as locally) which helps in replacing the harmful bacteria with the harmless lactobacilli. This measure has been shown to be helpful in a small number of patients.

Apart from this I can also suggest the following:
1) If there is ANY oral antibiotic to which the bacteria are sensitive then it should be tried on a long term basis (say 8-12 months) at low doses.
2) Another suggestion would be to see a urologist who could do a cystoscopy as elderly women often have underlying urological issues like meatal stenosis which can be corrected. However if your mother does not want a surgery then this option will not work.

I hope you would be able to apply some of my suggestions for your mother's ongoing health problem which I can imagine must be quite frustrating to deal with.

I hope this was helpful.
Regards and best wishes.

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