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Urinary Disorders

Persistant E Coli UTI in Elderly Female

07/13/2009

Question:

My mother, 76 y/o has had a persistant UTI with e coli singled out as the culprit. The urine has been cultured more than once and she has been on several antibiotics that have yet to kill the bug. She is still experiencing pain from the UTI after several months. She has taken Macrobid, Augmentin and Cipro which have come back as "sensitive" on the culture but have yet to kill it. She is at her wits end and is tired of being in pain. She would like any information she can get as to how to get rid of this infection.

Answer:

Recurrent UTI evaluation requires "ruling out" causes that may increase her risk for recurrent infections including urinary tract stones, urinary retention, anatomic abnormalities (pelvic floor relaxation, poorly draining kidney, etc.). In general, UTI persistence (same bacteria, same array of sensitivities) makes one suspicious of foreign body (such as stone).

Typical evaluation includes CT scan without and with contrast if kidney function permits followed by cystoscopy. This will usually be sufficient to provide necessary information to identify cause. Treatment options if no causal factor is noted include suppressive antibiotics or antibiotics provided on an "as needed" basis. Your mother should be evaluated by a urologist to manage this issue.

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Response by:

James F Donovan, Jr, MD James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati