Recurrent Urinary Tract Infection

[scadeleon]

Hi. I am a new Private nurse. I have a patient who has a recurrent urinary tract infection. Three to four weeks ago, my patient started to complain of severe low back pain and strong leg spasms (my patient is half paralyzed and has a long term indwelling foley catheter) so I figured to take his urine sample for urine C&S to a laboratory. The result reveals that he has infection caused by E. Coli and that in 15 antibiotics, my patient is only sensitive to 4 antibiotics only. The physician prescribed one antibiotic so I gave it to my patient and changed his catheter asceptically (I change his catheter every 2 weeks because his nurse before changed his catheter weekly and it caused bleeding and when the doctor instructed him to change it monthly, he had septic shock). After finishing the whole course of antibiotic, I, then again submitted my patient's urine sample to the laboratory to ensure that there is no infection. Unfortunately, my patient then again had an infection caused by a different microorganism. The same nursing care I did and another antibiotic was presribed by the Physician. I told the physician that it is my patient's second time to have such infection and asked if I should take my patient to the hospital already. The physician said that such scenario is common for a patient with long term IFC so I just had to give the antibiotic. Then again, after finishing the course of his 2nd antibiotic, he then again developed infection caused by ANOTHER microorganism (I found out just now). His current urine C&S reveals that there are only 2 antibiotics left sensitive. I asked my patient further if he felt pain at the sides of his abdomen and he claimed that he experienced pain. There was no blood in his urine all throughout the days that he had infection and his urine as always been bright yellow. He didn't experience or he's not having fever but yesterday he complained of feeling fatigue and feeling cold. All I know is the best way is to take hime to a hospital for consultation but the problem is my patient is hard to be convinced to go to a hospital. My question is, should I go to the physician again for another set of oral antibiotic or fully encourage him to go to the hospital? I'm really new to this kind of situation so if you could just please help me. Appreciate it :)

[CardiacKittyRN]

Is it possible to get a stronger, broad spectrum IV antibiotic ordered? That could perhaps be done at home or in an outpatient infusion center. It could also be possible that he has developed interstitial cystitis (IC) which is basically a chronic infection/inflammation of the bladder.. There are a few different drugs they use to treat this..

[scadeleon]

Is it possible to get a stronger, broad spectrum IV antibiotic ordered? That could perhaps be done at home or in an outpatient infusion center. It could also be possible that he has developed interstitial cystitis (IC) which is basically a chronic infection/inflammation of the bladder.. There are a few different drugs they use to treat this..

Thank you for the advise hollykristinxo. I didn't think of that. My patient once given a broad spectrum IV antibiotic before in an outpatient infusion center because he had septic shock. I asked a physician's advise regarding my patient's situation and asked if he could prescribe a broad spectrum IV antibiotic. He said the broad spectrun IV antibiotic is only needed if there's increased WBC count and if the same microorganism is found to have caused infection so he still prescribed the remaining 2 oral antibiotics that the micrroorganism seemed to be sensitive to. Follow up question, I thought of washing my patient's perineal area with betadine rather than the ordinary soap and water. Do you think that would be a good idea? I also put sterile gauze soaked in betadine around my patient's catheter near to his member just incase his urine leaks

[seppuku]

​I'd agree with the doctor and wouldn't send him to the hospital unless he became septic (fever, hypotensive, etc...) because other than positive cultures and pain (normal for uti), he seems okay. It's when the infection gets into the bloodstream that you should be really worried. Try ask the doctor if he wants him referred to an infectious disease doctor. They are specialists and usually know the best treatments for recurring infections like that. But given that he had so many infections with all different organisms though, my guess is he plays with himself without washing his hands >