Question: Hello
This deals with my XXXXXXX mother who has a history of chronic ecoli bladder infections.
She has been on preventative antibiotics, topical estrogen.
Recently - she was 8 months uti free with being on 2000mg mannose sugar daily.
Her EGFR -was 65 in XXXXXXX
I reduced the sugar down to 1500mg.
About a week ago, she developed faint uti symptoms.
Historically - she would get incontinence, urgency and a distinctive radiating pain shooting up torso when she peed. However this week, she had only this symptom lightly once two days in a row.
Otherwise, she had no other symptoms.
This began Monday night and Tuesday a urine sample was submitted - see attached.
I also have urinalysis strips which I have taught myself to use.
On the day of the lab sample, mine was positive for nitrites but nothing for rbcs or leukocytes.
I increased her mannose to 3 grams for two days and then the last three have been 2grams.
By Thursday, my dipstick test showed leukocytes, nitrites and rbcs 200.
On the positive, by today - two tests showed traces or negative nitrites (3hours bladder retention).
However the rbcs are still high at 200 and the urine sample showed a pink tinge.
I have been given approval by a urologist to give my mother fosfomycin but also know my mothers ecolis in the past have shown resistance to Bactrim, amocillin, ampicllian etc.
She has no symptoms at this point other than being more tired but she is 90.
Someone told me if nitrites are getting less, she might be be able to get over this incident without a formal antibiotic. She does take 15mg xarelto daily, It was ceased last night but taken today again - whether that has any bearing. She also used to take estrogen cream more regularly but now once a week if she remembers it. She had spot bleeding on her underwear a few months ago - once or twice - an ultrasound showed nothing. SHe has an ovarian cyst.
Only drinks 1 to 1.25 litres daily .......
Just trying to guage the significance of the blood in the urine - thanks
A urologist or gyna specialist would be best.
If a general doctor answers - you better know your stuff

Are you inferring that a blood thinner would worsen bleeding while fighting a uti.
She has had historical ecolis with bleeding. Another doctor stated that a blood thinner would not influence this?

Also the reason the fosfomycin hasn't been used yet - as she had no true historical symptoms to date, her nitrite/leukocytes were negative the last day.

So hopefully - she is on the mend than taking an antibiotic which may increase the chance of even a stronger ecoli emerging.

How conversant are you in these specific urinalysis test parameters?

You have a young face Dr T
You are also a gyna rather a urologist.
I could not convince to take my mother to a local urgent care clinic today
as its 3 hours wait with young interns who dispense antibiotics like candy.

What is your clinical experience in uti mgt exactly?
My main concern today was the significance of the lingering rbcs.
She had higher rbcs last April with a symptomatic ecoli.
So I paid today for three answers on different sites
One stated no connection between xarelto and bladder bleeding with a uti
Another stated it was caused strictly by the xarelto not the uti
I do biweekly urinalysis strips and only this week was the bleeding there
when the ecoli showed up.
So I shall have to take your advice that bleeding might increase with ecoli while on a blood thinner.
I shall continue to do the daily urinalysis strips.
Fosfomycin is one of the last tolerable antibiotics for her.
The mannose sugar has helped her to be 8 months uti free - the longest in 7 years. And hopefully this is the mildest episode.
Though she has post urine void - her spinal arthritis has resulted in poor hygiene
as she lives with me and I do the laundry.
Anyhow, hopefully the information you have provided is the most accurate of the sources sought today.
One shouldn't have to be online....

I just checked my mothers urine just now.
It has a trace of nitrites again with leukocytes and 200 RBC's

So in absence of any obvious symptoms - she also had pink staining in her underwear

I shall give her the fosfomycin XXXXXXX this evg
I should have followed your direction yesterday but she never had any symptoms

So my mother took the course of today 1000mg mannose - twice

1 hour after taking the second dosage of mannose - she took the 3 grams of fosfomycin.

It was only decided then because of the re-appearing nitrites/leukocytes
and steady rbcs and pink stained underwear.

She also took 0.5gram estrogen tonight
---
No xarelto was taken this evg either.

So this is the first ecoli episode -she had no real symptoms
thus the reluctance of taking the fosfomycin too hastily.

So even in absence of discomforting symptoms - her tests for continued rbcs
and re-appearing wbcs and nitrites required an antibiotic - that was your primary point yesterday

I attempted to call the urologist but he hasn't returned my phone call.

She takes xarelto for atrial fib. She has been given the reprieve 3 days at a time.

However, I am not comfortable to date with the magnitude of the blood loss with what is coming out of the bladder. Its not ketchup red nor even a cola but you can see there is pink. This appears to have gotten worse since Thursday just viewing the daily urine sample.

What else can be done at this point from a medical intervention if any?

Or what would dictate I would have to take her to the hospital?

Thankyou for your contd answers
Public healthcare is horrible in Canada.
I phoned twice today to review the situation regarding my mother - no response.

I doubt her cardiologist will want to do anything such as vitamin k injection - she will expect the urologist to followup.

I shall have to contact the family doctor after tomorrow.
A cardiologist once stated missing three days of xarelto would not be a huge issue.

You made a general statement about ceasing the blood thinner til the rbcs have passed. So you assume it would only be a few days regardless.

A urologist stated there is only a small chance that the blood thinner is contributing to the bloodletting created by the ecoli.

I had to be conservative and thus ceased the xarelto

Anyhow, thanks for your insight. Its not grand I have to be online to seek help for a 90 year old woman

Phoned the urologist today twice - he is a surgeon so this doesn't interest him much

Dr Tayal:
Thankyou for your insight.
My old test strip showed yesterday 80 RBCs
and another test strip today showed 10 Ery/uL
So I imagine that is a trace of blood.

She has been off 3 days of xarelto and I shall give my mother either today or tomorrow the 15mg xarelto.

You appear to be a competent lady as a gynca but I am still deciphering and getting differing opinions on the significance that the xarelto played here.
Was it the asymptomatic ecoli or the xarelto which contributed to the blood.
Also it was almost a week into the episode where the blood thinner was stopped