Suggest treatment for UTI and blood in urine

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Posted on Tue, 29 Dec 2015 in Kidney Conditions
Question: I was diagnosed with ESBL positiive Klebsiella pneumoniae culture for a UTI. I took Nitrofurantoin for 7 days. After 10 days I had a urine check dip at my Dr. office and everything is clear. I just purchased an over the counter urine check because now 3 days after the clear I am having very cloudy, etc symptoms. It showed immediately positive nitrite and positive 500+++ leukocytes. I know if I go back to a walk in clinic (dr. office closed) again I am going to show the same, and as always, blood in my urine and more than likely again protein, and ketones, and hemoglobin. Those are usually positive. I am a type 2 diabetic. So, I am reading that maybe sometimes these UTI don't have to be treated. Do you think that I should see what happens if I don't take antibiotics. I get UTI all the time
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 1 hour later
Brief Answer:
Yes, it is ok to treat uncomplicated UTIs without antibiotics.

Detailed Answer:
Hello and welcome,

First, can you clarify the first sentence above? It says that you were diagnosed with "Klebsiella pneumonia culture". Is this a typo or do you also have pneumonia?

A lower urinary tract that is uncomplicated can be managed without antibiotics. If you have any symptoms of an upper UTI (kidney infection/pyelonephritis), then you definitely must take antibiotics. Symptoms of pyelonephritis are flank (kidney area) pain or aching, nausea, chills, and fever.

If you otherwise feel well, and if your sugars are well controlled, you can try to manage it with pushing fluids (water) and minimally sweetened cranberry juice or cranberry powder capsules.

If using cranberry juice, if you are willing you can make your own and use much less sugar than called for - apple juice is a possible replacement for the sugar. Or buy cranberry juice concentrate and mix it with water and a little unsweetened apple juice. Avoid Ocean Spray cranberry juice and other prepared type juices because if you drink a lot of it, as you need to do for a UTI, you will be getting a very large load of sugar.

There are also cranberry powder capsules and these might be a better bet for you given that you have Type 2 DM.

Has the cause of your frequent UTIs been explored? If these started sometime after menopause (or the frequency of UTIs increased in recent years), then you might benefit from topical estrogen cream applied on the outside or inside the vagina. A small amount of topical estrogen improves the health and integrity of the genitourinary tract. It is safer than taking oral estrogen - doesn't pose the same risks.

If you started having frequent UTIs after you became sexually active, and if this continues to be the case, be sure to urinate right away after intercourse and possibly shower to get off any bacteria that might make their way in.

I hope this information helps. Please let me know if I can provide further information or clarification.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 22 minutes later
this was not a typo. That is what the urine culture indicated. Also it is really important for you to know that additional culture test said that it was ESBL positive. That is a very dangerous as it is categorized worse than MRSA to treat. So even though I don't have any physical symptoms, I do have very cloudy urine and I don't have to go very often. I use the estrogen you are stating and I drink lots of water. I am worried that if I don't go on antibiotics that I could start getting a fever, etc. My dr. have never done any kidney work up or any bladder cystocopy. They did have me have kidney stones removed even though they werent giving me any pain. They didn't get all of the stones . However, it seems strange to me that I would continue to have lithotripsy if they didn't do some of the simpler things like more extensive blood work or cystocopy. Should I insist on further test and should I worry about this ESBL positive in the culture for the Klebsiella pneumonia? That culture seemed like a double whammy. thank you
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 41 minutes later
Brief Answer:
Some information info about testing and treatment.

Detailed Answer:
I am sorry, I did not read that first line carefully.

Given that you have (or at least had) ESBL positiive Klebsiella pneumoniae, and it cleared 3 days after treatment but you have a return of some signs of infection (or inflammation as increased leukocytes can be from either), and given that Nitrofurantoin is not reliably effective against this bacterial strain (see link to article below), I would suggest:

1. Ask your doctor if when your culture was done, if an antibiotic sensitivity test was also done. When a doctor orders a culture, he/she usually requests it as a "culture and sensitivity". The sensitivity test involves testing the isolated bacteria against a variety of antibiotics to see if it will grow in the presence of that antibiotic. The results are "sensitive", "intermediate", and "resistant". Sensitive is of course good - it will wipe out the causative bacteria. Intermediate (some labs use similar words other than intermediate) means it might get some or most of the bacteria. This can be a problem because the remaining few can multiply. Resistant antibiotics should not be used.

2. If a sensitivity test was done and Nitrofurantoin was listed as "sensitive", you may not currently be dealing with the same bacteria.

3. If the bacteria is not sensitive to Nitrofurantoin, it would be wise to be treated now with an antibiotic that is effective based on the test.

4. If no sensitivity test was done, even though you were clear 10 days after finishing the antibiotic, I suggest you have another culture (and sensitivity) done at this time, and take an appropriate antibiotic to clear the infection (i.e. if the current problem is from the previous infection) before it comes back.

Here is the article about treatment: http://medicine.missouri.edu/jahm/treatment-options-urinary-tract-infections-caused-extended-spectrum-β-lactamase-producing-escherichia-coli-klebsiella-pneumoniae/

You might also find the following article about recurrent UTIs useful:
http://www.aafp.org/afp/2010/0915/p638.html

You might want to see a urologist for discussion about the recurrent UTIs. Family practice management of recurrent UTIs is often to have the patient take prophylactic antibiotics. I don't know if this has been tried or how many infections you have been having in a year. But it would not be unreasonable to at least have a consult.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh 1 hour later
thank you this is very helpful! I will contact the office and see if they did the sensitivity with the culture and see if my primary care physician will refer me to a Urologist. Much appreciate the articles and your prompt response.
Sincerely,
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 29 minutes later
Brief Answer:
Your welcome!

Detailed Answer:
If you have no further questions, you can go ahead and close the discussion and if you wish, can rate and provide feed back.

Best regards,
Bonnie Berger-Durnbaugh, MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3131 Questions

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