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What is the cause for reoccurring urinary infections post total knee replacement?

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Practicing since : 1980
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I have had reoccurring urinary infections for several years. I had an MRI and nothing wrong. They put me on vagifem 10 mg 3 times a week and it helped for awhile then stopped. Mu urologist put me on 500 mg penicillin one per night. That worked for two years then stopped. I had at least two episodes a year. The problem is I had a total knee replacement so do not want to get a UTI infection. I developed C-Diff and it would not improve even with flagyl until I stopped the penicillin entirely. What do I do now?
Posted Fri, 3 Jan 2014 in Urinary and Bladder Problems
Answered by Dr. Rakesh Karanwal 58 minutes later
Brief Answer: Recommended course of action is given below Detailed Answer: Hi Ma'am, Thanks for your query. There are several causes of recurrent UTI, such as:- # an abscess in the kidneys, # stone(s) in the kidneys or urinary bladder, # a growth in the bladder, # a distant infection spread to the kidneys through the blood, # contamination of urine pipe opening by anal bacteria or # transmission of chronic vaginal infection (bacterial, yeast, trichomoni or chlamydia) into the urine pipe opening; # other structural causes, such as, a fistula (abnormal connection between rectum and bladder; between vagina and bladder. Further, an underlying undiagnosed diabetes too predisposes to frequent UTI. Other possibilities are, inadequate duration of treatment of UTI; use of an antibiotic which is resistant to the offending bacteria; or, fungal (yeast) infection which is not treatable by antibiotics but by an anti-fungal drug. Ideally, whenever UTI occurs, urine examination + culture and sensitivity test should be carried out to firstly, isolate the causative organism (bacteria or yeast) and secondly, to short-list the antibiotics/antimicrobials which are most lethal to the offending bacteria. Use of one of the most effective antibiotic FOR AN ADEQUATE DURATION (ideally, until no bacteria are grown on urine culture) IS THE MOST EFFECTIVE METHOD OF COMPLETELY ERADICATING THE INFECTION. Partially treated UTI or use of ineffective antibiotic always leads to frequent recurrences of UTI. If yeast is isolated in the urine, an anti-fungal drug, such as, Fluconazole is the drug of choice. Hence, I would recommend that:- * Blood sugar test be done to exclude diabetes * Ultrasound of kidneys and bladder to rule out abscess/stones/growth * Gynecological examination to rule out structural defects, such as, fistulas as described above * All relevant investigations to be carried out to rule out/diagnose the likeliest cause of recurrent UTI, as described above * Lastly, in case of subsequent UTI, insist on getting urine examination + urine culture and sensitivity test done, so that the most sensitive antibiotic is prescribed by your doctor. As far as your C.diff infection is concerned, if it has not improved with flagyl, oral vancomycin powder, 125mg every 6 hours for 2-4 weeks, should cure the infection. Consult your doctor and apprise him of my opinion. I am certain that he will agree with my opinion; order required tests, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment as advised. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards and have a nice day, Dr. Rakesh Karanwal
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Follow-up: What is the cause for reoccurring urinary infections post total knee replacement? 59 minutes later
I want to thank you for your answer, but all of the issues that you raised have been ruled out with an MRI, blood tests, etc.
Answered by Dr. Rakesh Karanwal 7 hours later
Brief Answer: Need more information Detailed Answer: Hi Ma'am, Please don't lose heart : I would like to go to the bottom of your problem and diagnose the exact cause. May I assure you that I would not rest till I diagnose the exact cause of recurrent UTI. Firstly, I would like to re-analyze the symptoms. Therefore, kindly provide the following information:- 1. Your symptoms or UTI in detail. Did you have urinary urgency, urinary frequency, waking at night to urinate and, pain in lower part of abdomen? Have you noticed UTI symptoms aggravated with certain foods? 2. Was the urine culture done during each episode of UTI? Did the culture show growth of any bacteria? 3. have you been passing through chronic mental stress/chronic anxiety? 4. Are you suffering from chronic back pain? 5. Vaginal problems such as dryness, itching, burning, soreness, pressure, white discharge, foul-smelling discharge due to infection, painful sexual intercourse, bleeding after intercourse. 6. Any other problem which you thought is trivial or unrelated and, have not informed me. Since all investigations carried out so far, were inconclusive, the only possibilities that have not been explored so far, are (a) Interstitial Cystitis- in which there is chronic inflammation of the bladder wall. This condition mimics UTI symptoms. (b) Involvement of nerves which supply the bladder, due to osteoporosis induced vertebral collapse or disc herniation. I am eagerly awaiting additional information. Fond regards, Dr. Rakesh Karanwal
Above answer was peer-reviewed by
Follow-up: What is the cause for reoccurring urinary infections post total knee replacement? 14 hours later
Thank you for your kind help. I think you have given me enough information to continue with my own doctors now.
Answered by Dr. Rakesh Karanwal 9 hours later
Brief Answer: You're welcome Detailed Answer: You are most welcome, Ma'am. It would be a great pleasure answering further queries, if any. Wish you good health Dr. Rakesh Karanwal
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