[NP-Clinical] UTI

[David or Diane Dito]

Well, if it were my mother, Christine, I'd probably do the culture. Sounds
like this is what you'd really like to do, right? If her orthopedic surgeon
is going to be that strict, it'd be better to make sure that she doesn't
have a resistant organism floating around in there that the Bactrim or Cipro
"nearly cured," but flares back after she finishes the Cipro. And she may
have resistance, given her history. If the cx is negative, I guess the next
thought would be to put her on prophylactic dosing until the surgery.

 

Diane Dito

 

From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Christine Smith
Sent: Saturday, January 13, 2007 6:10 PM
To: NP Clinical
Subject: Re: [NP-Clinical] MRSA UTI

 

I have no thoughts on this, and certainly you are our women's health
resident expert so I hope someone has some ideas that you have not
considered. However, I have another UTI problem. 

 

My mother, 69 yo, has frequent UTIs ever since a bladder rupture, S/P
motorcycle accident about 10 years ago (my parents were Harley lovers).
Anyway, she had severe urge and stress incontinence - was urinating nearly
every hour and was always unresponsive to Detrol, Ditropan etc.. She has
seen multiple urologists and they felt a cath would be the best option until
she did find a female urologist in Portland who did some sort of
bladder/urethral repair last Spring.  The incontinence resolved but she has
continued to have urgency and was ultimately learning to live with it. 

 

NOW, she is scheduled for a knee replacement 1/31. Her orthopod is adamant
no infections, including UTIs, or no surgery. She had her pre-op last week
and was found to have another UTI and the Pre-op NP put her on Bactrim. No
culture was done, and I don't think my mom was clear to the NP on just how
bad and frequent her UTIs get. She is now down here in California with me
for one week and has worsened. Peeing every hour - driving her nuts, and
driving me nuts too. I took a urine sample to work and spun  it - only RBCs.
No leukos, nitrites or bacteria. I had switched her to Cipro and after
seeing the results of the UA opted to just have her finish the Cipro anyway.


 

 No pain, just urgency and frequency. No CVAT. Feels otherwise well. Only on
Lipitor and Fosamax and was just started on Atenolol 25mg for  very mildly
elevated BP - 136/84. No other health issues except the bladder and DJD.

 

With just RBCs it seems I should not need to do a urine culture, right? I
can order one for her so she has the results by Tuesday or so - she does not
return home until next Monday and so I want to do as much as possible. 

 

Thoughts?

 

Christine Smith, NP

Antioch, CA

----- Original Message ----- 

From: Pat Camillo <mailto:looking-glass at worldnet.att.net>  

To: NP Clinical <mailto:np-clinical at nurse.net>  

Sent: Saturday, January 13, 2007 6:53 AM

Subject: [NP-Clinical] MRSA UTI

 

Recently saw a woman who had been having 2-3 UTI's a year, ran a culture -
came back MRSA.......tx with cipro which was found to be sensitive.......she
also complains of vulvar burning .....tx with terazole thinking it was yeast
following multiple antibiotic therapies......some relief but not gone. I'm
beginning to wonder if perhaps the vulvar complaint might be related to the
MRSA.....

 

Any thoughts would be appreciated :)

 

Pat

 

Pat Camillo PhD,RN,APN,C
Certified Nurse Practitioner in Women's Health,
Gerontology and Menopause
Carmenta Health
1 Kalisa Way Suite 103
Paramus, New Jersey 07652
(201) 265-9042


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