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Chronic urinary tract infection - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Urinary and Bladder Problems
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User :   The patient aged about 80 years is diabetic, has hypertension, enlarged prostate, small stones in gall bladder. The patient was admitted to the ICU of XXX hospital with UTI (E. Coli) with ARF recovered, Hyponatreamia, Hyperkalemia, Erosive Gastritis (H.Pylori) and BPH. The patient was treated with IV Fluids, IV antibiotic (Tazact), IV PPI (Neksium), IV antimetic (Emeset) and other supportive treatment. The patient was discharged from ICU and then from the ward after 8 days. On the 10th day Urine Culture revealed Klebsiella species and 40-50 pus cells, after that the patient was put on Meropenem 1 g twice a day for two days and then Meropenem 1 g once a day for 1 day. The Urine Routine revealed 10-15 pus cells. Meropenem was administered for four more days and a routine was done once again. The routine again shows 10-15 pus cells and 3-5 RBCs. Please tell me why are the Pus Cells not decreasing? Is the infection still there and the bacteria has become resistant. Please do let us know your views.
Doctor :   hi
User :   HI
Doctor :   I am Dr. XXX I reading ur query
User :   OK
Doctor :   Because of he is a diabetic, and had UTI and BPH, there are pus cells
Doctor :   He could have chronic UTI
User :   that is ok.
User :   so what could be administered after Meropenem
Doctor :   But 5-8 pus cells are normal in especially in elders
Doctor :   Where is he now?
Doctor :   ARe you there?
Doctor :   Does he has fever now?
User :   yes
Doctor :   Does his vitals stable now?
User :   right now there is no fever
User :   his vitals are stable
Doctor :   And he is at home
Doctor :   right?
User :   his pus cells are 10 - 15
User :   yes he is at home
Doctor :   We look at whole picture , and just do not go with one finding
Doctor :   I agree there are pus cells
Doctor :   He might have chronic UTI
Doctor :   He can be on antiobiotics for some months
User :   which ones?
Doctor :   You discuss with your doctor. I feel there is chronic infection.
Your treating doctor will decide which antibiotics are better.
Doctor :   Does he has trouble passing urine?
User :   no
Doctor :   Is he on in and out Foley catheter
User :   his urination problems have reduced to a great extent
Doctor :   OK
User :   he was on catheter after the infection and while he was on hospital'
Doctor :   He had Urosepsis and it was treated
Doctor :   it is resolving
Doctor :   Acute phase resolved.
Doctor :   He will have pus cell in urine
User :   but since the 12 days he is urinating on hiw own
Doctor :   Is it new or old?
User :   what is new or old? i didn't get it.
Doctor :   urinating on hiw own
Doctor :   You mean he is passing urine with out ny problems
User :   Yes
User :   not using the cathetra
Doctor :   OK
Doctor :   does he has incontinence of urine
User :   not as such
Doctor :   OK'
Doctor :   if he develop fever, nausea vomiting , uncontrolled blood sugars then it is an emergency and it could be sepsis especially urisepsis
User :   no, no such symptoms are there
Doctor :   usually patients on indwelling catheter has chonic UTI and they need antibiotics on chronic basis
Doctor :   But he is passing urine by him self , no fever not symptomatic , he do not need antibiotics
Doctor :   now
Doctor :   Did I answer ur querries/
User :   so for how long should be carry on with meropenem
Doctor :   Is he on intravenous medicine at hom,e?
User :   yes
User :   i told u meropenem 1g
Doctor :   What did your doctor advised u?
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