So What Next?

[mustang3]

After months of re-occuing infection following urethral surgery in April the Doc had me wear a foley. It got to the point where cathing was very difficult due to the amount of stricture. Right on schedule I finished my last round of meds for a pesky E-coli bug last friday and the symptoms returned yesterday.

Only somewhat bearable this time..fever in the 101 range then it dropped, it was normal all day today but as the evening progressed it started to rise again but not as hight as last night...this is along with the usual aches and pains.

Is this what I have to look forward to, is this colonization? I'm drinking a crazy amount if water (one good thing about the indwelling cath) My urine is clear, no odour. I'm using Vetericyn VF morning and night. I ended up dropping off a culture this afternoon just to see if anything grows.

I'm really not looking forward to putting up with this type is discomfort on a daily basis.

Thoughts?

[thehipcrip]

Sorry to tell you this, mustang, but this isn't colonization. Colonization is the presence of bacteria without having any symptoms of a full blown infection (e.g. fever, flank pain, malaise, leaking between or around caths, elevated white blood cell count, blood in your urine, etc.). You've got a full-blown infection again.

The answers to the following questions might help us figure out why the infections are recurring so quickly after you finish treatment.

Were the antibiotics prescribed based on the results of a C&S?
How long was the course of treatment?
Has e.coli been the culprit behind all these recurring infections?
Have you taken the same antibiotic for every e.coli-based infection?
Are you cleaning your meatus and the base of the foley catheter at least once a day?

The Vetericyn should help prevent further infections *if* you can get to a point when you are infection-free.

[SCI-Nurse]

You are likely to be colonized constantly with any indwelling catheter. A positive culture without symptoms should generally not be treated. Symptoms that are significant and should lead you to call your physician to get a culture and sensitivity (C&S) done are one or more of the following:

• Fever
• Chills
• Flank pain
• Autonomic dysreflexia
• Severe leaking around the catheter or between catheterizations
• Severe malaise

Have you considered a suprapubic catheter rather than a urethral? There is a small amount of benefit for this related to UTI but a huge amount of benefit for lack of risk of urethral damage and for sexual activity.

Both urethral and SP indwelling catheters have increased risks for infection, stones, and bladder cancer vs. intermittent catheterization.

Also, if you are having recurrent infections with the same bacteria over and over, then other problems such as urinary stones and (in men) chronic prostatitis should be ruled out.

(KLD)

[mustang3]

Originally Posted by thehipcrip

Sorry to tell you this, mustang, but this isn't colonization. Colonization is the presence of bacteria without having any symptoms of a full blown infection (e.g. fever, flank pain, malaise, leaking between or around caths, elevated white blood cell count, blood in your urine, etc.). You've got a full-blown infection again.

The answers to the following questions might help us figure out why the infections are recurring so quickly after you finish treatment.

Were the antibiotics prescribed based on the results of a C&S?
How long was the course of treatment?
Has e.coli been the culprit behind all these recurring infections?
Have you taken the same antibiotic for every e.coli-based infection?
Are you cleaning your meatus and the base of the foley catheter at least once a day?


The Vetericyn should help prevent further infections *if* you can get to a point when you are infection-free.

I woke up this morning feeling "normal" if that ever exists, No fever..nothing out of the ordinary. Any time I've been treated it has been following a C&S and it's always been Ecoli. This bug is now resistant to Cipro, I'm allergic to Sulpha and Macrodantin. I was put on a daily dose of Trymethoprime however the last culture was resistant to that. The last two infections where treated with Gentamicyn for 5 days and following 14 days of no symptoms what so ever the infection returned, it was treated with 10 days of Clavulin/amoxi. I finished that round 9 days ago. It was this past Friday that things appeared to have returned.

As for cleaning, I'm doing what I can I think. Shower in the AM and clean my penis and catheter area thoroughly. In the evening I wipe the end of the Cath and tubing with an alcohol swab. I inject the Vetericyn and let it sit for 30 mins prior to connecting my night bag. Once I do that I clean the end again with a new swab connect the bag and spay the area with Vetericyn.

[mustang3]

Originally Posted by SCI-Nurse

You are likely to be colonized constantly with any indwelling catheter. A positive culture without symptoms should generally not be treated. Symptoms that are significant and should lead you to call your physician to get a culture and sensitivity (C&S) done are one or more of the following:

• Fever
• Chills
• Flank pain
• Autonomic dysreflexia
• Severe leaking around the catheter or between catheterizations
• Severe malaise

Have you considered a suprapubic catheter rather than a urethral? There is a small amount of benefit for this related to UTI but a huge amount of benefit for lack of risk of urethral damage and for sexual activity.

Both urethral and SP indwelling catheters have increased risks for infection, stones, and bladder cancer vs. intermittent catheterization.

Also, if you are having recurrent infections with the same bacteria over and over, then other problems such as urinary stones and (in men) chronic prostatitis should be ruled out.

(KLD)

I do have an ultra sound schedule to look into stones, as for the prostate that is something i will bring up.

At this point the foley was the first line of defence to see if there would be any change in the sequence of infections. We'll move forward I guess once we move passed a the next couple of week and see what happens. The results of the C&S will be available Monday morning and i have a Doc's appointment Monday as well.

I know there is a lot of damage to my urethra already and I don't know if the foley is the best thing...will this not only cause more trauma?

[McDuff]

Bettin' on stones. I went from almost no uti's to one after another, got checked and had an infected kidney stone, antibiotics never cleared it up, just the outer layer I guess. went back to normal after getting it removed.

[mustang3]

Originally Posted by McDuff

Bettin' on stones. I went from almost no uti's to one after another, got checked and had an infected kidney stone, antibiotics never cleared it up, just the outer layer I guess. went back to normal after getting it removed.

I can only hope it's that simple but I don't think it will. i was fine until i had that urethral diverticulium repaired ever since that surgery it's been a shit show with infections

[gjnl]

If you don't have stones and the urine culture comes back indicating yet another e.coli urinary tract infection, you may need to get an infectious disease doctor involved in your treatment.

I went through a similar set of events when I had to stop intermittent catheterization (frequent infections and having to cath every 2-3 hours instead of every 4-6 hours). I transitioned to an indwelling urethral foley catheter and went through a couple courses of IV antibiotics under the care of an infectious disease doctor.

Meanwhile, I consulted with a couple neuro-urologists who proposed major surgeries. I decided not to jump right into the major surgeries, but instead try the simple procedure of placing a suprapubic catheter. That was two years ago. That is also when I started using Vetericyn. For me, the suprapubic catheter was a good decision.

On the subject of Vetericyn. How much Vetericyn are you instilling into the bladder?

All the best,
GJ

[mustang3]

Originally Posted by gjnl

If you don't have stones and the urine culture comes back indicating yet another e.coli urinary tract infection, you may need to get an infectious disease doctor involved in your treatment.

I went through a similar set of events when I had to stop intermittent catheterization (frequent infections and having to cath every 2-3 hours instead of every 4-6 hours). I transitioned to an indwelling urethral foley catheter and went through a couple courses of IV antibiotics under the care of an infectious disease doctor.

Meanwhile, I consulted with a couple neuro-urologists who proposed major surgeries. I decided not to jump right into the major surgeries, but instead try the simple procedure of placing a suprapubic catheter. That was two years ago. That is also when I started using Vetericyn. For me, the suprapubic catheter was a good decision.

On the subject of Vetericyn. How much Vetericyn are you instilling into the bladder?

All the best,
GJ

Im doing rounds of 60ml morning and night and leave it in for about 30mins.

At this point I have no fever, feel good (went to the gym for an easy work out) I've been drinking so much water that I needed to empty the bag into a clear water bottle that I had in my truck while I was out doing errands. It was so clear I'd drink it if I had too??? normally when i empty into the toilet bowl you can never really see how clear it is, I haven't seen my urine this clear in months...not even any floating particles. My Uro suggested the MAJOR surgery thing if this continues and I'm not ready to go down that route yet

I'll be interested in what the C&S has to show on Monday. I did see and infectious decease doctor and what she suggested for starters if this was persistent was a 14 day run of Genta and see what that does. The first time I went on the Genta is was only for 5 days, my uro was reluctant in anything longer than that being concerned with my kidneys.

[gjnl]

Originally Posted by mustang3

Im doing rounds of 60ml morning and night and leave it in for about 30mins.

At this point I have no fever, feel good (went to the gym for an easy work out) I've been drinking so much water that I needed to empty the bag into a clear water bottle that I had in my truck while I was out doing errands. It was so clear I'd drink it if I had too??? normally when i empty into the toilet bowl you can never really see how clear it is, I haven't seen my urine this clear in months...not even any floating particles. My Uro suggested the MAJOR surgery thing if this continues and I'm not ready to go down that route yet

I'll be interested in what the C&S has to show on Monday. I did see and infectious decease doctor and what she suggested for starters if this was persistent was a 14 day run of Genta and see what that does. The first time I went on the Genta is was only for 5 days, my uro was reluctant in anything longer than that being concerned with my kidneys.

I've got my fingers crossed for a no bacteria present outcome from the C&S for which you will get results on Monday. Since you have seen a change in the urine to very clear and you are feeling good, your urine may be infection free now, but when you took the specimen, it may show some bacteria. You may want to hold off on taking any antibiotics (if prescribed, again) and take in another specimen later in the week for a retest.

All the best,
GJ