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How to manage urinary tract infections in catheterised patients?

Q: My father (79 years old, about 55 kg weight, frail health) had tuberculosis of the spinal cord and was paralysed for some time, during which he had an indwelling catheter. He contracted E. coli infection in Dec. 2002 and inspite of antibiotics, he has not recovered from it. Additionally, the kidneys seem to have got affected also: Dec 2002 - urea 18, creatinine 0.8 (before infection) March 2003 - indwelling catheter removed May 2003 - urea 30, creatinine 1.3 (6 months after infection) November 2003 - urea 30 creatinine 1.7 His electrolytes are within the normal range but he has anaemia, there is trace albumin in urine and his feet are swollen. 1. How can the infection be cured? (he has been given many short spells (1-2 weeks) of oral antibiotics so far) 2. If the infection isn't cured, will the kidneys still keep deteriorating and ultimately fail?

A:Your father had neurogenic bladder secondary to spinal cord tuberculosis and had to catheterised. I am not sure if he is still catheterised. As long as catheter is in, there is colonisation with bacteria and there is no need to treat the positive culture unless patient gets symptoms of urinary tract infection in form of fever, chills and rigours. If there are no symptoms, no need to treat it even if urine culture is positive as it suggests colonisation and not infection. His albumin is low suggests that he may not be eating enough proteins as urine loss does not seem to be the reason for low albumin. I wonder if he could be suggested to do intermittent self catheterisation rather than continuous indwelling catheter. Urinary tract infections can cause kidney damage if there is infection of the kidneys which occurs in patients with high pressure bladder or lower urinary tract obstruction which may be revealed by cystometrographic study of the bladder.

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