Battling UTIs - question

When my DH came home after 4 months of hospitalizations he had an ICU acquired superbug UTI which required him to be in isolation while an inpatient.

  He came home with it.It would be resolved briefly after prescription oral antibiotics, but would ultimately return. I could tell by the look on his face and his confusion that it was back again.

  It was a nightmare. I took him to several urologists with no resolution until I took him to chief of urology at Baylor who prescribed a compounded Rx to be irrigated daily into the bladder. It had to be filled weekly by a compounding pharmacist and cost a bundle. After doing this for several weeks it was gone.

Now for years I have give him an organic ginger tea with lemon and a splash of organic apple cider vinegar.I also make sure he drinks water throughout the day. He has never had another UTI.It has been eleven years now.

I remember your wife having had problems with this and am sorry to hear that it has once again become an issue.  For new readers; UTIs of can make significant changes in not only behaviors, but also can cause changes in function and somewhat even in cognition; mostly behaviors, which I am sure, Ed that you are experiencing with your wife as I have read in your Posts.

Being that your wife has become stool incontinent, that adds a significant risk for UTIs. However; there are things that can be done to help lessen this risk.

Postmenopausal women have a much higher incidence of UTIs due to the lack of estrogen and the drying/thinning of their tissues.  One thing that seems to help that physicians prescribe, is the use of Estrogen vaginal cream.  That has been effective for many women.  We have even had a Member with dementia here on this site who used this for her dreadfully persistent UTIs and shared that she had excellent results.   Something to discuss with your wife's doctor.

Being that there is fecal incontinence that significantly raises the UTI risk.  Most UTIs are caused by e. coli bacteria and there it is in large amounts.  Simply the wearing of incontinence diapers or incontinence pants also increases the risk due to harboring bacteria in a very warm and moist environment.

It is recommended that the incontinence supplies not be worn for an extended period of time.  Despite being an expensive item, they should be changed often and that the LO be monitored every two hours to ascertain whether or not the incontinence item is wet or soiled. If compromised, the item must be changed immediately with good hygiene cleansing being done whether it is a urine change or stool change.

Also recommended is that the LO drink at least six 8 ounce glasses of water a day minimum; compliance with this is another matter.   Also recommended is toileting the LO every two hours to get the bladder emptied so the bacteria gets flushed and does not have an opportunity to flourish.  Again, not always easy to accomplish due to resistance.

The cranberry substances are still questionable as to how much they help, but one effect can be is that cranberry is very high in oxalates and that is a substance that forms kidney stones.   Has your wife ever had a history of kidney stones?  If so; she may have a stone or stones that have formed but are not yet making themselves known; but what they will do is to harbor organisms and cause UTIs themselves. 

The female genital area is best kept very clean.  It is also recommended that the area be cleaned each time the incontinence item is changed.  That too can be difficult to get managed.   Did you decide to purchase the bidet seat for the commode that you were thinking about?  If it has not only a back nozzle for cleaning, but a front one, that may be helpful if there is cooperation for using it.

Sometimes, a patient is put on a low dose antibiotic for months; this of course has its own list of possible effects.

Another aid that I see discussed in helping to prevent recurrent UTIs, but know nothing about, is the use of  an oral probiotic; usually from the species of Lactobacillus.  I have not researched this, but you may want to do some reading and then discuss it with your wife's doctor. 

I wish I could be more helpful; it has to be so exhausting trying to keep up with all of this with a very resistive LO.   Hopefully, something as simple as an Estrogen vaginal cream (prescription) can be prescribed and will be effective in prevention of the recurrence of the UTIs.

J.

Ed--No it was done with a catheter and a liquid antibiotic solution daily.

dj

I applaud your being able to do electrical work.

Story;

Young mother raising two small children going to hang a light fixture. I get to the hardware store to get parts and they ask "is it male or female?" I replied with something like "very funny...give me a break...I am doing the best that I can". It ended with some chuckes and a much needed lesson concerning in electricity for me. 

Ed and Jo:  the reluctance to get cleaned up after an accident is likely the primary trigger for this new round of UTIs, I agree. This would negate any benefits of estrogen cream or cranberry supplements. 

I would likely prescribe daily low-dose antibiotic in this setting, until patient is less resistant to getting cleaned up. At some point the risk benefit profile and worst case scenario (urosepsis) align. I would stay away from cipro and other quinolones due to the CNS effects. 

I echo M1. 

Hurray for Marta seeing this and being so helpful.  Not only a respected Nurse Practitioner in the field of Internal Medicine, but she is also a highly experienced Caregiver of a husband who had a very complex journey with dementia until his death.  Thank you, Marta for your input.  And then, M1 is a physician; if I am not incorrect, is Board Certified in Internal Medicine and also presently an active Caregiver of a LO in a very difficult behavioral situation.  We are in good company and they also understand at the most basic level; they have lived, or are living it.

Well; the idea of the fecal incontinence with resistance to being cleaned and changed, we have all felt the same . . .  where to go from here, Marta has presented this well in her opinion.  It is as said, a challenge and I am truly sorry.   You are a person of action Ed, and willing to do whatever you can to deal with all situations as they arise.   Your wife is certainly blessed and if she was able, she would tell you how thankful she is for your loving care.

Talking with your wife's physician and taking it from the standpoint of chronic UTIs may perhaps lead to a good approach to vanquish this problem as much as can be possible.  Keep us Posted on how this is going and also let us know how you are doing.

J.

One bit of information that many people are unaware of, especially if a LO has dementia, are the effects  that  antibiotics can sometimes have on cognition, function and behavior for some people.

I take absolutely no prescription medication and only an occasional Tylenol for discomfort.  However, pver the years when I have had to have an antibiotic, there are several that I have a highly negative reaction to that affect my cognitive state to one degree or another.

My LO with dementia had a dreadful reaction to the antibiotic, Levaquin.  It caused complete fogging of reality and severe agitated fear as well as causing changes not only in cognition but in function.

Some years later, I was prescribed Levaquin . . . and . . . oh boy!  I went right over the moon; it was absolutely bizarre.  I had a terrible time trying to think, my mind was foggy to the point of feeling mutton headed.  Just could not think straight and could not help myself out of it.  Never, ever, ever will I ever take it again.

In fact, this effect of abx has been described in literature and sure wish more folks knew about this risk of abx for some people (not all); especially when dementia is present.  My wonderful Internal Medicine physician was telling me about a male patient in his 50's who was hospitalized . . . he suddenly became completely bizarre in behaviors and could not focus and was acting out.  Dr. said he was even wondering if there was a psychotic break when he remembered the initiation of Levaquin.  It was discontinued and voila!  The man regained his usual self.  This was when that particular antibiotic was first being used, so there was no "pattern" of this happening being discussed.

Anyway; off topic for this Thread, but always good to remember that even an antibiotic can cause problem issues with changes in cognition, behavior and function out of the ordinary for some individuals.

J.