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4 UTI's in 1 year

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    4 UTI's in 1 year

    I've been using an indwelling foley for approximately 12 years and had been fortunate to not have a UTI until 2017. I've gotten 4 UTIs in the last year and so many others in the past four years can't keep track of how many. Going back to the first two I had in the past year I needed to take ciprofloxacin. As some of you know that has to be some of the worst stuff to be on. Other than what I find very troublesome is a rarely have symptoms. This is what happened a year ago I woke up in the morning and I was shaking like I was in the ice bath. I guess you could call it septic shock since I had to be hospitalized.

    I think where my confusion is, who is more important, my urologist or an ID doctor. I'm only saying that from some of the threads I have read here. One other thing is should I always have another culture done 7 to 14 days after antibiotics are finished. It seems like my GP or my urologist has never done that FYI will never take another culture to my GP. You see in the attachments my last two cultures. I have to claim stupidity for July's infection since my urine smelled bad and I did not listen to my caregiver. As you can see by the October culture this is my point I had no symptoms at all. I had to use my own discretion to get a culture as the nurse was coming to change the foley. Click image for larger version

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    Wish I didn't know now what I didn't know then.
    Bob Seger

    #2
    I am not an expert in interpreting urinalysis (UA) or culture and sensitivity (C&S) data, but I know that GJ's doctors rarely prescribed Cipro. Cipro is a broad spectrum antibiotic that is very powerful and should be reserved for difficult to treat urinary tract infections (UTI). Possibly Levothyroxine may have been prescribed instead. UTIs in spinal cord injured are considered complex, not simple infections. Complex UTIs should be treated for 10 to 14 days with the selected antibiotic. Then about 3 days after the last dose of the antibiotic, another UA and C&S should be done to check that there is no residual bacteria present. If there is residual bacteria, the original course of antibiotics can be repeated or changed to an alternative antibiotic for another 10-14 days, and another specimen tested after the second course has been completed.

    I understand your comment about having few of the typical symptoms of a UTI. GJ rarely had a fever. But, he always had severe chills (shivering) and sweating, elevated blood pressure (all of these symptoms were AD - Autonomic Dysreflexia, likely caused by the pain he could not feel - flank pain, bladder spasms) and usually urine bypass either from the urethra or from around the supra pubic catheter. That said, his doctors rarely treated a UTI where the CFUs Colony Forming Units was below 100,000. Generally, without symptoms typical for you of a UTI, CFU below 100,000 indicate bacterial colonization in people using intermittent or indwelling catheters.

    As to the question of consulting a urologist, an infectious disease physician or your primary care to manage your UTIs...GJ had his primary care physician manage UTI treatment except when an infection became particularly difficult to treat. Then he consulted with an infectious disease physician. Rarely did he consult with a urologists about UTIs. He found that urologists weren't very interested in treating UTIs and infectious disease physicians were just more adept at managing antibiotics. GJ's primary care physician was very knowledgeable about spinal cord injury and managed UTIs skillfully.

    Hope this helps a bit.

    NL
    Last edited by gjnl; 28 Oct 2021, 1:28 PM.

    Comment


      #3
      I have had my sp for 30 years. Second best decision I ever made (colostomy is # 1). I have been using the Duette catheter for a couple years. Nothing compares to it. If I have a UTI I don't get a fever, chills or sweating but I do leak around my sp.

      Comment


        #4
        Posted on another recent thread about bladder management:

        GJ also used the Duette catheter whichis specifically designed for use with supra pubic stomas. The Duette catheter by Poiesis has two balloons with drainage eyelets between the two balloons. One balloon inflates with sterile water to retain the catheter in the bladder. The other balloon cushions against the bladder wall. With a typical foley catheter, the tip of the catheter can irritate the bladder wall, which can make bladder spasms worse. Poiesis has a good website: https://www.poiesismedical.com/medic...company-duette

        Comment


          #5
          Originally posted by gjnl View Post

          As to the question of consulting a urologist, an infectious disease physician, or your primary care to manage your UTIs...GJ had his primary care physician manage UTI treatment except when an infection became particularly difficult to treat. Then he consulted with an infectious disease physician. Rarely did he consult with a urologist about UTIs. He found that urologists weren't very interested in treating UTIs and infectious disease physicians were just more adept at managing antibiotics. GJ's primary care physician was very knowledgeable about spinal cord injury and managed UTIs skillfully.

          Hope this helps a bit.

          NL
          Thank you for your input but I would never go back to my GP for UTI's. This is the first time I looked into the records of a culture. It doesn't seem that hard to understand. For the second time urologist gave me nitrofurantoin. I would have to believe the S means sensitive. One thing I cannot understand is why my GP gave me ciprofloxacin twice. I'm just wondering is there more to it than just looking at these culture tests.
          July culture nitrofurantoin S 16 mrsa e.coli R 16
          Oct. culture nitrofurantoin S 16 e.coli

          I guess either way I have to go back and see my urologist, I trust him. The past two times I never got to go see him because it was transportation problems or PCA's. problems. The question I need to ask is why I keep getting these UTI's. I've done everything think of. I've gone to a closed loop system and changed to a silicone catheter. And I have to force myself to drink 6 quarts of water a day.

          I guess only time will tell if I'll ever be infection free for at least six months or a year.

          Wish I didn't know now what I didn't know then.
          Bob Seger

          Comment


            #6
            I know that bringing up the subject of Microcyn product instillations to help prevent urinary tract infections is a land mine subject on this site. Just saying...try a search, read, ask questions and make decisions for yourself based upon what you read.

            Comment


              #7
              First of all I'm sorry about the recurrent infections you've had of late

              1. I first recommend a Urologist consult for a cystoscopy - look inside the urethra passage, prostate and bladder lining.
              If you've had an indwelling foley for 12 years, it is very likely, you could have scar tissue or small fissures in the lining of your urethra. Scar tissue and small fissures can hold onto bacteria.

              2. once you have determined the cause of the recurrence, then focus on prevention. There are many different type of catheters that are available -for example one that I am thinking of has an ultraslick coating that can easily pass around scar tissue, prostate (if enlarged) etc.
              Or you could use Urojet 2% lidocaine - specifically for pain with urination/catheterizaiton.

              3. How often are you getting your catheter changed at this time?

              pbr


              The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

              Comment


                #8
                Originally posted by SCI-Nurse View Post
                First of all I'm sorry about the recurrent infections you've had of late

                1. I first recommend a Urologist consult for a cystoscopy - look inside the urethra passage, prostate and bladder lining.
                If you've had an indwelling foley for 12 years, it is very likely, you could have scar tissue or small fissures in the lining of your urethra. Scar tissue and small fissures can hold onto bacteria.

                2. once you have determined the cause of the recurrence, then focus on prevention. There are many different type of catheters that are available -for example one that I am thinking of has an ultraslick coating that can easily pass around scar tissue, prostate (if enlarged) etc.
                Or you could use Urojet 2% lidocaine - specifically for pain with urination/catheterizaiton.

                3. How often are you getting your catheter changed at this time?

                pbr

                I have the same thoughts about the cystoscopy and I will ask my urologist when I see him. As a matter of fact, I'm gonna copy some of what you said and bring it to him. I think you gave me some good information on something that I was always afraid to hear of. That would be the day when I would be told my urethra was damaged and would have to go to a suprapubic. I don't like the thought of having a hole put in my stomach.

                By the way, I always used 16f all 12 years. But recently they (hospital and visiting nurse) kept on sneaking 18f and with me not even knowing. One more thing I might add. The last UTI had was in the urethra oozing out of the end of my penis for over 4 weeks. The catheter has always been changed between 28 and 30 days. I rarely ever had a problem with encrustation.

                I also brought it to the attention of the urologist receptionist, but I believe she was speaking for him. There was a prostate operation 11 years ago. (https://www.lifespan.org/centers-ser...eenlight-laser) maybe the prostate is enlarged again? Just one more thing I need to point out. I had two appointments lined up with him but could not make it due to an incompetent PCA or transportation.

                OK good, I'm done thank you. Goodnight Austin TX wherever you are.
                Wish I didn't know now what I didn't know then.
                Bob Seger

                Comment


                  #9
                  I'm asymptomatic with Uti's too, my usual "tell" is when I start peeing blood, so usually well along by then.

                  I've posted it before, but a few years back, I had Uti after Uti after Uti, the antibiotic would knock it back, but then reappear after done with script. They sonogrammed my kidneys and found a small "hidden" infected kidney stone, that was bad enough the antibiotics couldn't kill it. They went in and laser zapped it out, and boom, my Uti's were gone.

                  Just saying to make sure they check your whole urinary system. Good luck dude.
                  "a T10, who'd Rather be ridin'; than rollin'"

                  Comment


                    #10
                    I had the same problem but it went on for years. I ended up on 400 mg a Bactrim daily and it's kept them away for years. Also try silver-coated catheters
                    Brought to you by: atrophied&twitch

                    Comment


                    • SCI-Nurse
                      SCI-Nurse commented
                      Editing a comment
                      Definitely it is not recommended to use a prophylactic antibiotic routine (such as the Bactrim you mention) as invariably you will develop bacteria that are resistant to this antibiotic, and there can be side effects of long term use as well.

                      Silver coated or impregnated catheters also have not been shown to be effective in preventing UTIs in chronic long term catheter users; the studies have all been done on short term acute users who had their catheter for less than 20 days. (KLD)
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