[NP-Clinical] MRSA UTI

[Pat Camillo]

Hi Christine,

Here are some thoughts about your mom.......

First of all, I think it was inappropriate for her provider to treat her recent and assumed UTI without a culture - esp since she has so many..........in the dhort term, I would keep her on antibiotics through the surgery and immediate post op phase and make sure the culture is clear.

In the long term, I would explore why she is having so many UTI's. Something that few people ever consider is a woman's estrogen effect. Contrary to older beliefs, it is a HIGH estrogen effect that can contribute to problems with incontinence. High endogenous estrogen also makes DJD worse and is perhaps even part of the pathology. I am thinking that if she had a bone scan, it is unlikely that she has osteopenia or osteoporosis......I am also thinking that she is likely overweight and this may be the cause of her increased estrogen. If she doesn't fit this profile there are other possibilities......let me know. 

Good luck! 

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

  ----- Original Message ----- 
  From: Christine Smith 
  To: NP Clinical 
  Sent: Saturday, January 13, 2007 7:10 PM
  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 
    To: NP Clinical 
    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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