Needing Intravenous IV for Bladder-UTI Infection

[KyleP2112]

Unfortunately because of the presence of two strains of strong bacteria in my bladder I have been receiving intravenous antibiotics (Meropenem) which is being delivered by a picc line as I write this post.

This issue has been going on for two or three months or more. About two weeks ago after being prescribed the antibiotic Bactrim buy my urologist for a UTI/bladder infection I felt somewhat better but as soon as the antibiotics were stopped, the symptoms of a bladder infection returned...pain, bladder spasms and voiding of my bladder especially when I?m sitting up in the chair. After finishing the seven day course of oral antibiotics I submitted another urine culture to be tested. Unfortunately The culture came back with not one, but two strong strains of bacteria as I said before. The urologist said this is the best approach as taking two antibiotics to deal with the two different strains would be harsh on my stomach. I am scheduled to have a Botox procedure on my bladder done on September 16, So the intravenous antibiotics better work.

This is a first for me and hopefully this will help me turn the corner and not have so many bladder problems. Anyone else have similar experiences?

[SCI-Nurse]

The strains of bacteria out there are vicious at times. It sounds like this is the case for you. IV antibiotics are helpful, when used appropriately and it does sound like this is the case right now.
I am surprised a little that your urologist is going ahead with the botox injections. I question that because any urologic invasive procedure opens you up to infection. Given the rough course that you have had recently, I would ask about the risks right now vs the benefits. Please don't get me wrong - botox is llife changing for some people. I just question the timing of the procedure.

ckf

[annev308]

I had three prolonged hospitalizations for full blown sepsis from multidrug resistant UTIs this spring and summer and spent close to 15 weeks on IV antibiotics at home. It was miserable and I am still pretty run down and feeling not-great.

FWIW, I strongly encourage you to find a urologist and/or infectious disease specialist with expertise in/experience with neurogenic bladder. Had my local urologist or PCP listened to me, read my history prior to becoming their patient or reached out to more knowledgeable urologists and/or ID folks, things would’ve stopped at the first round of sepsis.

[Art454]

I had problems with uti from 2013 to 2015. lost 30 pounds due to uti. Everytime I had a uti it was a different medicine I needed. Finally after this they tried Keflex 500 mg twice a day. It would go away 3 days later it returned again and needed the same Keflex again for 15 days. Again after about 3 days it came back. Needed the same thing again Keflex and they put me on a low dose 250 mg and it went away. So now I take 250 mg a day just for it not coming back and have not had any problems in 3 years. Had epididymis 3 times and spent 2 times in the hospital for 10 days each with iv over the last 40 yeras. After a lot of test they said once you get epididymis it like to get coming back for me. Very painfull ordeal I can tell you that. So far the low does of Keflex has stop it from coming back. I feel the best I have in years. Urologist said sometimes it can be a real problem but he said if Keflex worked he put me on the low does. They don't like to do that but it was killing me. He said it works so I take one a day. They don't like to put you on a medicine but he said if it works for you its better than uti all the dam time.

[KyleP2112]

You two have been through a lot over the years dealing with stubborn, resistant UTIs and bladder infections. It is really scary that the bacteria that causes these infections seems to be outsmarting and is increasingly resistant to antibiotics. I need to find out from my urologist office what two strains of bacteria caused this.

What tips and strategies do people out there used to help keep infections from happening as often? I use a supra pubic Foley catheter which I know unfortunately tends to bring out more bacteria infections. One of the SCI nurses talked about the closed system for the leg bags and catheters. Any other methods?

The Doctor Who is doing the Botox procedure was OK with going ahead with that procedure when I called the urology office to doublecheck if the Botox injections should go ahead or wait…

[SCI-Nurse]

You should take a look at the microcyn postings. That seems to have worked miracles for some people on this forum. Also, make sure that you keep your fluid intake up - I know you probably do that and keep the fluids more towards water than other drinks. The closed system also seems to help many.

Sometimes it is a combination of a few changes but only change one thing at a time. That way you know if the thing that ou changed made a difference.

ckf

[annev308]

I am now doing gentamicin bladder flushes. Local urology and infectious disease had never heard of such a thing - they were startled to be handed a stack of peer-reviewed research indicating they are not exactly current with their fields. SCI experienced urologist was *appalled* that local urologist, in a practice big rehab routinely refers to, had not started gentamicin protocol long ago. My comfort level with local providers is pretty much eradicated and I am considering relocating altogether.

Since we began gentamicin I am orders of magnitude better. I am still not in great shape but it’s the kind of weakness that comes from having been sick for a long time (+3 ICU stays and lots of IV ABs), as opposed to the kind of weakness during stupid sickness. There are a number of threads about bladder irrigation with microcyn, gentamicin etc.

[ChesBay]

I am now doing gentamicin bladder flushes. Local urology and infectious disease had never heard of such a thing - they were startled to be handed a stack of peer-reviewed research indicating they are not exactly current with their fields. SCI experienced urologist was *appalled* that local urologist, in a practice big rehab routinely refers to, had not started gentamicin protocol long ago. My comfort level with local providers is pretty much eradicated and I am considering relocating altogether.

Since we began gentamicin I am orders of magnitude better. I am still not in great shape but it’s the kind of weakness that comes from having been sick for a long time (+3 ICU stays and lots of IV ABs), as opposed to the kind of weakness during stupid sickness. There are a number of threads about bladder irrigation with microcyn, gentamicin etc.

I have had tremendous success with instillation Annnev. About 12 years ago I thought recurring UTI's were going to be the final chapter of my SCI journey. Instillation / irrigation has made a world of difference. I do it with IC, it's a bit of work but well worth it,imo.

Wishing you success and relief from UTIs.

[beckman]

Needed the same thing again Keflex and they put me on a low dose 250 mg and it went away. So now I take 250 mg a day just for it not coming back and have not had any problems in 3 years.

Thats great. I had a recurring ecoli UTI that Keflex was one of the few antibiotics the bug was sensitive to. The doctor eventually put me on Keflex daily as well. Worked great for a year no UTIs, felt great then got c.difficile and its ugly aftermath. I’d been on a higher daily dose so hopefully it continues to work for you, but keep an eye out for c.diff symptoms.

I am now doing gentamicin bladder flushes. Local urology and infectious disease had never heard of such a thing - they were startled to be handed a stack of peer-reviewed research indicating they are not exactly current with their fields.

Could you post the links to the research please? The young urologist I’m dealing with says he will only prescribe according to Canadian Urological guidelines. Says someone else might order it but not him. Next week I have an appointment with an infectious disease doctor. Maybe he’ll be more open especially if I can show positive research results.

[KyleP2112]

To help prevent UTIs why is your fruit and vegetables… Found out something that everyone susceptible to UTIs should know. After the Doctor Who did my Botox procedure today came in to see me, He stated that the type of bacterias causing my infection ( pseudomonas aueringosa) were most frequently found in the southern part of the United States and is often ingested with fruits and vegetables. This made sense since we were in South Carolina and North Carolina due to a death in the family for about three weeks this summer. After this time in the south I started having major bladder problems.

The simple way of preventing acquiring Pseudomonas is to Watch all fruits and vegetables in water and even better in vinegar or apple cider vinegar. If you do a search on the Internet for Pseudomonas aueringosa and UTIs you will see how this superbug is responsible for a lot of major infections, UTI infections , It is resistant to many types of antibiotics and causes about 13,000 deaths a year. The urology surgeon I saw today said another way to help prevent UTIs is to wash or rinse the leg bag in my bag either with vinegar or 10% bleach solution and didn’t really recommend that closed system approach as bacteria can really take off inside the leg bag when it’s not washed in anyway for two weeks or three weeks. Oh yeah and I was also prescribed gentle myosin for bladder flushes.

There should probably be another post about washing fruits and vegetables and being wary of eating vegetables or salad at a restaurant in order to help prevent UTIs.

[annev308]

Gentamicin/tobramycin instillation articles:

This is Canadian Urological Assoc study re: gentamicin instillation - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798439/

Lit review of instillation research - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097067/

Urotoday video & notes - https://www.urotoday.com/video-lectu...-17-09-07.html

Univ of Michigan urology dept instructions for instillation - http://www.med.umich.edu/1libr/urolo...Indwelling.pdf

instructions for home compounding and instillation, Seattle Children’s - https://www.seattlechildrens.org/pdf/PE1769.pdf

university of Louisville is currently running a clinical trial of instillation for SCI folks.

P Aeruginosa articles, etc.

Merck manuals overview on pseudomonas aeruginosa - https://www.merckmanuals.com/home/in...nas-infections


CDC info sheet on Pseudomonas - https://www.cdc.gov/hai/organisms/pseudomonas.html - most common source in community is poorly maintained swimming pools and hot tubs.

More pseudomonas - https://www.cdc.gov/hai/organisms/pseudomonas.html

research from *1974* - pseudomonas in 24% of soil samples, only 0.13% of vegetable samples - https://aem.asm.org/content/aem/28/6/987.full.pdf.


I strongly encourage anyone with c diff or p aeruginosa to find an experienced and SCI knowledgeable infectious disease doctor. I had a lot of super nice, very comforting and not at all knowledgeable urologists and ID folks in the first 18 months post-injury discharge and the consequences of that misplaced trust have been pretty miserable.

[ChesBay]

Gentamicin/tobramycin instillation articles:

This is Canadian Urological Assoc study re: gentamicin instillation - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798439/

Lit review of instillation research - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097067/

Urotoday video & notes - https://www.urotoday.com/video-lectu...-17-09-07.html

Univ of Michigan urology dept instructions for instillation - http://www.med.umich.edu/1libr/urolo...Indwelling.pdf

instructions for home compounding and instillation, Seattle Children’s - https://www.seattlechildrens.org/pdf/PE1769.pdf

university of Louisville is currently running a clinical trial of instillation for SCI folks.

P Aeruginosa articles, etc.

Merck manuals overview on pseudomonas aeruginosa - https://www.merckmanuals.com/home/in...nas-infections


CDC info sheet on Pseudomonas - https://www.cdc.gov/hai/organisms/pseudomonas.html - most common source in community is poorly maintained swimming pools and hot tubs.

More pseudomonas - https://www.cdc.gov/hai/organisms/pseudomonas.html

research from *1974* - pseudomonas in 24% of soil samples, only 0.13% of vegetable samples - https://aem.asm.org/content/aem/28/6/987.full.pdf.


I strongly encourage anyone with c diff or p aeruginosa to find an experienced and SCI knowledgeable infectious disease doctor. I had a lot of super nice, very comforting and not at all knowledgeable urologists and ID folks in the first 18 months post-injury discharge and the consequences of that misplaced trust have been pretty miserable.

Great post. A lot of good info. Thanks

[beckman]

I strongly encourage anyone with c diff or p aeruginosa to find an experienced and SCI knowledgeable infectious disease doctor

Yes that would be ideal, unfortunately SCI knowledgeable specialists seem to be in short supply especially in smaller centres like mine. Thanks for posting the articles, hopefully they will be willing to listen.

[KyleP2112]

Its now been 4 days since I finished the 7 days of the antibiotic mirepenem via IV a Pseudomonas infection of my bladder. I have been feeling much better the past few days with far less bladder spasms and pain.

As I write this I am concerned the infection isnt gone and is coming back to torment me. some of the symptoms of a bladder infection I had before are returning like bladder spasms and emptying of my bladder but not quite as bad, at least not yet. I read of other people?s experiences where they need more than 1 course of IV antibiotics to treat some infections. I did have two cultures taken this morning so I will update when I find out if I still have the infection or am cleared.

[annev308]

I had multidrug resistant pseudomonas for 6 years. I spent at least 14 months on IV antibiotics to “manage” the infection -no one ever encouraged me to think we might be rid of it. It was basically a juggling act of trying to control the population so that I could still have a life with the infection. It is a highly adaptive organism and the biofilm it forms can make treatment very challenging.