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What Does This Urine Culture Report Indicate?

Posted on Tue, 12 Sep 2017

Question: Hello Doctor:
I have questions about my recent UTI.
I'm a 53 year old Male.
History:
1) 07/14/2017 - I had cystoscopy and trans-rectal ultrasound. The procedure was done to figure out the enlarged prostate problem.
2) 07/28/2017 - I started to feel FLU-like symptoms (Fever(101.7), Chills, Body Ache, Weakness) with burning and pain during urination. I went to the ER and they did the Urine Culture.
3) 7/31/2017 - Doctor started me on antibiotic - Augmentin (amoxicillin and clavulanate potassium) 875/125 mg twice a day for 10 days.
4) Urine culture report found the E. Coli organism and resistant to many antibiotics but SUSCEPTIBLE to Augmentin and finished the antibiotic course on 8/10/2017.
5) 08/14/2017 - I started having UTI symptoms - burning and pain during urination but NO fever.
6) 08/16/2017 - Restarted Augmentin (amoxicillin and clavulanate potassium) 875/125 mg twice a day for 30 days.
7) 08/18/2017 - Report for the Urine culture received (Urine was collected on 08/15/2017).
The urine culture report found again E. Coli organism (ESBL).
RESULT: 50,000-1000,000 CFU/mL
Most of the antibiotics are resistant:
AMOX/Clavulanate - Intermidiate - MIC = 16
ERTAPENEM - S - MIC = <=0.5
IMIPENEM - S - MIC = <=0.25
NITROFURANTOIN - S - MIC <=16
PIP/TAZOBACTAM - S - MIC = <=4
8) 08/20/2017 - I started having little burning and pain with or without urination today. But, NO fever or chills yet. Also some sour throat.

I have following questions:
1) Based on my history and recent urine culture report, what will be the next step?
2) Do I need to be on different antibiotic? If so, which will be the safer and most effective choice?
3) It is Sunday evening here and I don't have access to my doctor. I am worried and concerned about sepsis. Do I need to go to ER (emergency room) now or can wait until tomorrow morning?
Thanks for your time and expert advice!
Best Regards

Can we please expedite the urgency of this question and get a quicker response?

Answered by Dr. Dr. P. T. Patil (2 hours later)

Brief Answer:
There is no harm in waiting till Monday

Detailed Answer:
Hello
Thanks for query Based on the facts that you have posted it seems that you have UTI due to E-Coli organisms which were sensitive to Augmentin and you have completed a course for almost 10 days However You are facing similar problems and your recent urine culture has revealed UTI due to E-Coli which are sensitive to Carbazepam group Of antibiotics.

It is common and natural finding that bacteria always change their sensitivity pattern hence one has to change the antibiotic as per culture report.

In view of your recent cultures report I would suggest you to start Imepeum twice daily It is in Injectable form.

This would work for you.

Hope I have answered your query Please feel free to ask if you have more questions I shall be happy to help you

Thanks and Regards
Dr.Patil

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. P. T. Patil (14 minutes later)

Hello Dr. XXXXXXX -

Thanks for your response.

Looks like Imepeum may not be easily available in USA. Not sure though.

What is your opinion about Zosyn or Ertapenem to treat this condition?

Is it possible to do allergy test before the use of the antibiotic to be on the safe side? Because I'm concerned about the possible side-effects and bad reaction of the drug.

Thanks again for your help!

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
Imepenem,Ertapenem.and Meropenem

Detailed Answer:
Hello
Thanks for follow up .

All these antibiotics thlike Irtapenem.,Imepenem,Meropenem belong to same group of drugs called Carbapenem and easily available all over the world .

These are most effective against all the organisms and are being used in serious and complicated infections.

You have to take it twice daily intravenously for 5-7 days.

Thanks and Regards.
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (4 hours later)

Hello Dr. XXXXXXX -

Thanks for your answer.

I never had UTI in my life. I did have prostatitis 12 years back and I was on Cipro for a month.

1) What could be the possible cause for UTI in my case? Could the procedure I had few weeks back cystoscopy and trans-rectal ultrasound be the cause for UTI?

2) What are the chances that I have a prostate infection? Is there a test or something to rule out the prostate infection now?

Thanks again for your help! I appreciate it!

Best Regards

Answered by Dr. Dr. P. T. Patil (12 minutes later)

Brief Answer:
The precise cause for UTI can not be ascertained

Detailed Answer:
Hello
Thanks for follow up .

The possibility of infection being introduced from outside during Cystoscopy can not be ruled out

however there is every possibility of having UTI from a Prostate infection (Prostatitis) can be thought for .

Getting swab test and culture of Urethral discharge obtained after doing prostate massage will help to confirm or rule out active prostate infection (Prostatitis)

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (10 hours later)

Hello Dr. XXXXXXX -

Thank you very much for your detail answer.

I talked to my Urologist office today regarding the urine culture report.

The Urologist also sent my urine sample for the culture few days back too.

1) 7/31/2017 - Emergency Room sent urine culture:
Result: E. Coli organism (Sensitive to Augmentin and few other antibiotics)

2) 08/17/2017 - Urologist sent urine culture:
Result_1: Klebsiella Pneumoniae (Sensitive to many antibiotics)
Result_2: Methicillin Resistant Staphylococcus aureus (Sensitive to few antibiotics)

3) 08/15/2017 - Primary Care Physician sent Urine culture:
Result: E. Coli organism (ESBL) (Resistant to most antibiotics)

I have following questions:

1) I'm now very confused that how come two culture just 2 days apart have totally different infections? (BTW, results from 7/31 1nd 8/15 both confirms E. Coli)

2) I'm still on Augmentin and my Urologist still have not started me on a Carbapenem group of antibiotics. Is it taking too long? BTW, I have an appointment with Urologist tomorrow (8/22/2017) and he will come up with a treatment plan. Should I wait again one more day or go to the ER tonight?

3) Is the UTI with E. Coli organism (ESBL) contagious? If so, what can I do to prevent it from spreading?

Thanks you very much for your help!

Best Regards!

Also, Is it a good idea to repeat the urine culture test now?

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
Repeat Urine culture in different laboratory .

Detailed Answer:
Hello
Thanks for follow up .
Though confusing the authenticity of different report from two different laboratories can not be challenged .

Repeat your urine culture and Swab test of urethral discharge done at third laboratory .

Continue taking Augmentin till you get the fresh report and then take a call to take antibiotic as per new report .You can certainly wait for 2-3 days .

Thanks and Regards.
Dr.Patil.

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Above answer was peer-reviewed by : Dr. Yogesh D