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Thread: colonization vs infection

  1. #1

    colonization vs infection

    Would antibiotic be warranted for a specimen with a colony count of 10 to 50,000 and a culture that isolated Enterobacter Cloacae?

    I don't have fever, but my urine has turned quite demonstrably foul with quite a bit of what is presumably inflammatory debris. I typically always have chronic pelvic pain, so that piece of symptomatology isn't always a good diagnostic indicator. I do hydrocleanse once per day or twice per day if I think I have a problem.

    My local urologist, who while competent, isn't quite in tune with all of the clinical management complications of neurogenic bladder (such as chronic colonization) and left it up to me whether to treat or not. It's been this way for about two weeks. I presume the colony count will only increase, until such time that it probably becomes an infection.

    I try very hard not to overuse antibiotics, so I'm not sure how to proceed on this one.

    Does the augmented section of bladder contain bowel bacteria? Or do they tend to die out over the years, once disconnected from the bowel proper?

    Thanks for your input.

  2. #2
    Rarely is it appropriate to treat colonization without other signs of a true UTI in a person with a neurogenic bladder, regardless of the colony count. There are a few exceptions, such as prior to invasive bladder or kidney procedures, or prior to surgeries.

    Colonization is characterized by a positive urine culture and colony count, sometimes WBC in the urine, severe malaise, and sometimes cloudy or foul smelling urine.Most colonizations do NOT proceed to infection. Increasing fluid intake, and continued routine use of your Hydrocleanse would be indicated.

    A true UTI would include fever, chills, flank pain (indicating kidney involvement), elevated WBC in the blood, significant increased spasticity or AD, or leakage of urine around indwelling catheters or between intermittent catheterizations. Significant bloody urine may also occur.

    Initially after an augmentation you may have bacteria from the bowel in your urine, but that should not continue for months or years afterwards. You may continue to have significant amounts of mucous, which can be foul smelling, and can make the urine look cloudy.

    Have you had recent screening for urinary stones? Prostatitis?

    How do you manage your bladder?

    (KLD)

  3. #3
    I intermittent cath, but definitely over cath because my bladder retains very strong contractility once I hit 400 mL. I do Botox once a year, typically that only gets me through six months or so. Until my next Botox I have resumed my Ditropan instillation, typically in the evening before bed to help get me through the night. I have done this on and off for years, but I think this time around, it does have a quieting effect.

    The only way I can go four hours around the clock between caths is with pretty substantial fluid rationing. All I drink is water. In order to keep the colonization counts down, as well as all the mucus crap, it's pretty important to push a lot of fluids. I generally consume a minimum of 2 L per day, probably more close to 2 1/2 to 3.

    I have long thought I had prostatitis (perhaps the chronic bacterial or inflammatory types), but it's very hard to diagnose, much less treat. It seems to be more of a negative diagnosis, whereby if you can't identify some other source of the problem it may be the prostate. I do have an enlarged prostate and had it biopsied due to positive MRI findings. I have been on finasteride for quite some time to help reduce the size since I was chronically bleeding out of my urethra after bowel care which required digital stimulation and necessarily irritates an enlarged (or any) prostate. The bleeding has since been reduced to next to nothing. The biopsy was also negative. I do semiannual renal ultrasounds, which have been clean, but they haven't been doing the bladder. Perhaps I'll ask them to do so the next time.

    We decided to not use antibiotic at this time but we will repeat the ua/cs in about two weeks to check on the colony count and again, the type of bug.

    I see that there is information for acetic acid irrigation of the bladder. But that seems to be applicable towards those with indwelling catheters. Would not have applicability for general neurogenic bladder care as well?

    Thank you.

  4. #4
    Acetic acid bladder instillation is a very old treatment for stones. It is rarely recommended any more...in fact at the hospital where I worked we had it removed from our drug formulary as the evidence for use was so poor.

    How is your PSA level? That can be elevated in prostatitis as well as prostate cancer.

    (KLD)

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