MEDiscuss • Fever and Related • Urinary tract infection

One of my elderly relatives was told to have urinary infection. She is 76 years old and has diabetes. In the begining, they took sample of usine for testing and told to check after a few days for the report.

Today, she was called for getting admitted as she would need an injection.

Does a urinary infection need admission for treatment? Can't some antibiotic tablets work?
If admitted, how long does she have to stay?

Chris, welcome to MEDiscuss.

She certainly has indications for inpatient care - elderly, diabetes and an infection. The combination can be life threatening if not treated promptly. However, you mention that they suggested admission after a urine report that took a few days.

If it was a urine culture report and they suggested injections after checking that, probably the culture (a method where microbiologists see if any bacteria grows from blood/urine etc in an incubator) of the urine showed an infection that was sensitive to injectable antibiotics...

There is an entity called ESBL (extended spectrum beta-lactamase) producers. If she has an infection due to these organisms, she will certainly need immediate admission and treatment using higher antibiotics like piperacillin+tazobactam or imipenem/ meropenem.

If you can check the report itself, we will be able to discuss clearly... Her blood glucose levels are also important.

Wow, that was quick. I don't have the reports now, will check with the hospital and get back here. Yes, I will take her to the hosp now

Urine culture showed E. coli >10^5 CFU... (yes, ESBL) microscopy 15-20 WBCs and 2-3 RBCs/HPF. Her blood glucose was 237mg/dl (Had to struggle a lot to get these).

She was given some injections after admission and another culture sample was taken, this time from blood.

She has a significant infection. The organism grown in culture is an ESBL (Extended spectrum beta lactamase) producer. Which means that the antibiotics that worked in the lab may not work in the patient. Usually the patient is given one the following three antibiotics:

1. Meropenem or Imipenem
2. Piperacillin + Tazobactam
3. Cefoperazone + Sulbactam

When any one of these is used, the success rates are >90%.

Her blood glucose is also high and the doctors would have controlled it by now, preferably using insulin. How is she now, by the way?

Prevention of UTIs
The best way to treat UTIs in the elderly, or anyone for that matter, is to try to prevent their occurrence. UTIs can be prevented or their recurrence minimized by:

• Not using douches or other feminine hygiene products
• Not drinking fluids that tend to irritate the bladder, such as alcohol and caffeine
• Drinking cranberry juice or taking cranberry supplement tablets, but only if you or your family does not have a history of kidney stones
• Drinking lots of water
• Keeping the genital area clean. If wearing adult diapers see that they are changed regularly. Wear cloth undergarments
• Always wiping from front to back (for women).