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Suggest Treatment For Recurrent UTI And Delirium In An Elderly Person
Question: My mother is 77 years old. She keeps getting UTI. They are causing severe delirium. She has been cultured with ESPL, VRE are the superbugs. They are telling us that she is colonized and will always show some type of bug in her urine. She has had over 12 UTI since XXXXXXX 28th to present. The infectious disease doctor and urologist don't believe she has an active infection with all the antibiotics she has been given. They say the confusion is advanced dementia which she did not even have dementia before this so hard to believe but I guess possible. She seemed to improve on IV antibiotics but when they switched her to pills the delirium seemed to get worse.
Questions:
Should they not be able to tell why she keeps getting these UTI?
They did do a CT scan and it did not show anything.
Because of the delirium/dementia she has had to be placed in a nursing home and they are going off the recommendation of Infectious Disease and not treating or testing her urine tell she shows major signs of infection. She has never run a fever in the past with her UTI but has always presented with the same symptoms. How do you know when to treat and when not to treat.
Is there anything we can do
Questions:
Should they not be able to tell why she keeps getting these UTI?
They did do a CT scan and it did not show anything.
Because of the delirium/dementia she has had to be placed in a nursing home and they are going off the recommendation of Infectious Disease and not treating or testing her urine tell she shows major signs of infection. She has never run a fever in the past with her UTI but has always presented with the same symptoms. How do you know when to treat and when not to treat.
Is there anything we can do
Brief Answer:
sometimes it's difficult to tell
Detailed Answer:
Hello,
there is no simple answer to your question but I'll try to describe her current situation and the difficulties in medical decisions.
It is a fact that a urinary tract infection (even a simple one, like cystitis - without fever) may cause worsening of pre-existing dementia. I doubt that it's the drugs or the 'infection' that caused this condition for the following reasons:
- if her mind was in perfect shape (no dementia), then she wasn't expected to show signs of dementia particularly without fever.
- her doctors should have detected signs of serious inflammation (fever, elevated inflammatory markers and white blood cell count) if she had a more serious infection.
I'll take for granted that she did have dementia although the symptoms were not clearly evident until recently. So here comes the next question... does she really have an infection? Culturing pathogens is not enough data to document an infection. Symptoms are required. Since she's delirious, she can't provide credible information about her symptoms, so you can't really tell whether a positive culture means infection or not. It doesn't matter whether a pathogen is found or how many colonies it formed. Cystitis requires symptoms otherwise it's called asymptomatic bacteriuria... Upper urinary tract infection (pyelonephritis) requires fever (high fever with rigor usually) for the diagnosis.
In cases like hers, the decision to treat is not a straightforward one. A doctor may try to treat her if no other explanation for her condition can be documented. A trial of antibiotics sounds reasonable but if - after adequate treatment - the symptoms do not resolve, then another explanation (dementia probably) has to be considered and further treatment should be withheld.
If it's indeed an infection then her state of mind could be contributing to it in many ways. Less than adequate cleanliness, urine retention in the bladder, inadequate functionality of the bladder may increase the risk for infection. A clear CT scan makes sure that no anatomical disorder contributes to it (an obstruction, a stone, etc).
If her doctors decide that there is no infection, then she can take cranberries' extract which prevents urinary tract infections but is not adequate for treatment. If she develops a real infection then antibiotics would be required.
So in conclusion I believe that her doctors are probably right. It's a pretty common scenario actually. I would have treated such a patient once, as a trial to see her response. If there was no adequate response then I would have withheld further treatment and would have focused on prevention (cranberries) and close monitoring (monitoring of her temperature, white blood cell count, C-reactive protein levels, etc).
I hope it helps!
Kind Regards!
sometimes it's difficult to tell
Detailed Answer:
Hello,
there is no simple answer to your question but I'll try to describe her current situation and the difficulties in medical decisions.
It is a fact that a urinary tract infection (even a simple one, like cystitis - without fever) may cause worsening of pre-existing dementia. I doubt that it's the drugs or the 'infection' that caused this condition for the following reasons:
- if her mind was in perfect shape (no dementia), then she wasn't expected to show signs of dementia particularly without fever.
- her doctors should have detected signs of serious inflammation (fever, elevated inflammatory markers and white blood cell count) if she had a more serious infection.
I'll take for granted that she did have dementia although the symptoms were not clearly evident until recently. So here comes the next question... does she really have an infection? Culturing pathogens is not enough data to document an infection. Symptoms are required. Since she's delirious, she can't provide credible information about her symptoms, so you can't really tell whether a positive culture means infection or not. It doesn't matter whether a pathogen is found or how many colonies it formed. Cystitis requires symptoms otherwise it's called asymptomatic bacteriuria... Upper urinary tract infection (pyelonephritis) requires fever (high fever with rigor usually) for the diagnosis.
In cases like hers, the decision to treat is not a straightforward one. A doctor may try to treat her if no other explanation for her condition can be documented. A trial of antibiotics sounds reasonable but if - after adequate treatment - the symptoms do not resolve, then another explanation (dementia probably) has to be considered and further treatment should be withheld.
If it's indeed an infection then her state of mind could be contributing to it in many ways. Less than adequate cleanliness, urine retention in the bladder, inadequate functionality of the bladder may increase the risk for infection. A clear CT scan makes sure that no anatomical disorder contributes to it (an obstruction, a stone, etc).
If her doctors decide that there is no infection, then she can take cranberries' extract which prevents urinary tract infections but is not adequate for treatment. If she develops a real infection then antibiotics would be required.
So in conclusion I believe that her doctors are probably right. It's a pretty common scenario actually. I would have treated such a patient once, as a trial to see her response. If there was no adequate response then I would have withheld further treatment and would have focused on prevention (cranberries) and close monitoring (monitoring of her temperature, white blood cell count, C-reactive protein levels, etc).
I hope it helps!
Kind Regards!
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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