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Discussion

Protocol for treating Uti

Hello everyone. Just wondering what is your protocol for treating uti's in ob patients? Have a patient that continually shows ecoli on her urine culture from 5000-9000 even after a round of macrobid. Keep in mind it was greater than 100,000 at first. So this new colony could was after 2 rounds of abx....and was the same count after a third round. Since it is considered sub clinical with this count....what are your thoughts? Patient is uncomfortable with so many rounds of antibiotics. And MD next step is probably prophylactic macrobid and I know the patient is not going to be happy.

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    Are you certain it's a clean specimen? Perhaps a one time sterile technique straight cath specimen for C&S might be more prudent than stacking prophylactic antibiotics

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    Yeah....probably not the best specimen....I believe the ua showed many epithelial cells.

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    Yeah....probably not the best specimen....I believe the ua showed many epithelial cells.

    Then a proper clean catch is needed before treatment. Sounds more like a contaminated specimen

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    Will definitely have that done.....but also....if in fact that if the count is still the same....what do you feel is the next best step?

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    The way we handle it is after 2 treatments of the same organism, the patient gets put on suppression therapy for the duration of the pregnancy - Macrobid 100mg qhs. We then do UAs at every prenatal visit, and a C&S once per trimester.

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    After 3 subclinical specimens I'd probably I'd straight cath. If it's 100,000 or above the doc would put her on suppressive therapy.

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    Our policy is >10,000 for CCUA, or >1,000 for straight cath. In OB patients, our providers tend to treat any single identified organism >1,000, though.

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