best course of action for reoccurring URINARY TRACT INFECTION S

[shamrock88]

I just recently found this forum through Dr. Young s lecture in Boston recently. I'm a c4 injured in 1986 and reoccurring uti's have been a issue since my acute hospitalization 20 years ago. Drs. have had me on every antibiotic imaginable over the last two decades. I have taken them on their direction prophylaxisly and as treatment over all these years. Now suddenly I learn I never should have been taking antibiotics of this magnitude and could possibly be in serious trouble.

Recent cns on urine say I have pseudimonas (as usual,) but also --- enterrococcus, (sp?).

Anybody educated with this problem?

Thanks in advance

ps, if anyone newly injured or otherwise has any questions, I'd be happy to try to answer. Certainly not saying I have seen everything, but I have learned mostly the hard way over last 20 years, would like nothing more than 2 help others.

Best
shamrock

[SCI-Nurse]

How do you manage your bladder?

Are you actually getting UTIs (fever, chills, AD, malaise, etc.) or just having positive cultures (colonization)?

Prophylactic antibiotics don't prevent UTI in people with SCI, and they will significantly increase your risks for developing resistant strains fo bacteria chronically in your urine.

http://www.ahrq.gov/clinic/epcsums/utisumm.htm

Do you have a decent urologist who really knows SCI?

Do you get regular screening for stones and other potential problems (at least annually)?

More information would help us guide you better.

(KLD)

[shamrock88]

thank you for your quick response. I recently heard of this site from a dvd given to me of a conference at Boston Medical Center last year in which Dr. Young spoke. During his speech Dr. Young mentioned the history of sci patients and movement to treating infections less with antibiotics. This site looks to be a incredible resource.

To answer your questions, I both have had positive cultures of bacteria growth, and been incredibly sick (fever chills, increased spasms, decreased energy, lethargic, and finally septic). Again, these infections started virtually within the first 6 months of my injury. I was acutely rehab at Boston University Medical Center 1986, for 16 months. However after initial bladder tests and a bladder management plan was initiated, I was straight cathed 5x per day. Because I continually voided between catheter Times, which meant putting on external catheter after each straight cath, then removing before each straight cath etc. etc. 5x each day. I got what was then termed a spincterotomy (sp) while still under acute care at Boston Medical Center. So to answer your question I continually void, however infections have continually been a problem, which was managed primarily with antibiotics, alternating several different antibiotics monthly, mixing saline with Gent, or Tobra and using a catheter tip syringe to instill into bladder then using Cunningham clamp to keep solution in bladder usually 3x a week. Many strategies have been used, huge doses of vitamin C, cranberry, mandalamine etc. etc.

I'm sure you probably don't know, or maybe you do?? For many years now the Boston University Center (New England regional spinal cord center), has virtually been in disarray. After Dr. Reed passed in late '80s they lost their national credentials and funding most Drs. left, resulting in most patients like myself becoming involved with Drs. less experienced with sci patients. The Center seems to be getting revitalized presently and I have a appointment in June with one of their urology Drs.

I generally keep up with kidney & bladder scans etc., stones have never been a issue, just continual colonization.

Thank you for your time and knowledge
shamrock

[paramoto]

I am not a Doctor or Nurse, but it seems to me (if I understood your mail correctly) that your problem may be caused by residual urine volume left in your bladder. After six hours or so, bacteria begins to flourish in the bladder and if it is not emptied properly your chances of an infection increase greatly. I am not sure how a sphincterectomy affects this. I believe that many urologists not familiar with SCI overprescribe antibiotics. It happened to me. If my leucocytes were above 8-10, a culture was ordered and antibiotics often prescribed. Now I wait until symptoms develop to take antibiotics, and treat high leucocytes with a lot of water and cranberry juice (you would be surprised as to how the bacteria counts go down without resorting to antibiotics). Again, I am not in the medical field so my comments are strictly from personal experience.

[shamrock88]

thank you para

[SCI-Nurse]

I agree. One of the most common problems for men who use reflex voiding and externals is that over the years the bladder can eventually decompensate or literally wear out. This is due to voiding with high pressures. This causes increasing amounts of residual urine as well as potential reflux. The combination causes more and more problems with high levels of bacteria in the urine without infection (colonization) and if it refluxes, it is likely to cause a kidney infection, which is what causes the true UTI with fever, chills, AD, etc.

I would strongly encourage you to cath at least 2X daily now until you can see a urologist. See if you can determine how much residual you have (cath immediately after voiding). Do you trigger or tap to void? Try that and see what amount is left over. Once you get a good urologist, you should have urodynamics to really find out what is happening to your bladder. You may need another sphincterotomy, which can help if your bladder is not completely decompensated. I have seen men with SCI who have had to have their sphincterotomy repeated as many as 5-6X over the years, as it tend to scar and cause stricture, which prevents good emptying again.

If you are not a candidate for another sphincterotomy you may need to consider an indwelling catheter, as it is unlikely you would be a candidate again for intermittent cath due to the sphincterotomy you had.

The instillations, and so-called "prophylactic" antibiotics, etc. are probably totally ineffective, and put you at risks for more infections. As noted above, do not take antibiotics for a positive culture or even cloudy urine unless you have kidney infection symptoms (fever, chills, bad AD, malaise, etc.). I would try to talk your physician into stopping these until you see a urologist. Don't you get AD with the Cunningham clamp? I have seen some pretty bad urethral strictures using these. Be very careful.

You should also be evaluated for possible urinary stones, which are much more common with high residual urines.

You might also want to look into care through Spaulding Rehab. They are not a Model System SCI Center, but I know they do quite a bit of SCI rehab. They should be able to refer you to a competent urologist as well.

(KLD)

[shelley]

KLD ~ my husband gets all the other symptoms ~ i.e. increased spasms, cold feeling in his legs, very nauseous, sometimes headache ~ but he never seems to get a fever.

Should he just be trying to stick it out without going on antibiotics? How long do you go feeling sick without taking antibiotics?

As soon as he finishes antibiotics all the symptoms come back again.

And yes, he has had all the testing, and yes we always take a culture and test for sensitivities.

Still trying to figure this out.

Thanks

[SCI-Nurse]

If he feels bad like this, he should also have his blood tested for signs of systemic infection (elevated WBCs). If this is the case, they may want to presume a UTI and treat.

Again, has he been evaluated for stones? What is his bladder management technique and routine?

(KLD)

[shelley]

He had blood work done ~ it was okay.

He's just finished 6 days of IV cipro. Infection appears to be back again ~ I just took another urine sample in to see if it pseudomonas again.

He has been evaluated for stones ~ none. We do 2 IC's a day and he wears a condom cath all the time. His risidual is small (approx 100 cc).

It's a perpetual cycle for him. Even when he was cathed every 4 hours he had just as many infections.

We just cannot find a way to get this under control. He has an appointment with a specialist next week, but I'm worried he will be too sick to sit in the van the hour it will take to get there.

Very, very frustrating.

[shamrock88]

kld, thank you for your efforts & knowledge. I'm a c4 so I can't do any tapping, but do have my aides crede' several times a day.

I had my spicterotomy surgery evaluated last year, and surgeon said it was fine, although he said he opened the bladder neck somewhat so it was wide open & residual urine shouldn't be a issue. They did some pressure tests as well, and because of the wide open surgery pressures were extremely low. However I sometimes can crede still about 50-75 cc.

Are you suggesting to straight cath twice daily even with the surgery?

I tried using Foley catheter last winter, but had problems leaking around the balloon because of bladder surgery. Not sure what to inflate balloon to, tried many volumes 20 cc, 30 cc, still had periodic leaking. Even try these special silver catheters that are supposed to act against bacteria. ---