Q: My 84 years old father started getting chills followed by high fever two months back. He had Escherichia coli (E. coli) in the urine, which was thought to be urinary tract infection (UTI) and antibiotics were started. He continued to get chills and fever. After 18 days of antibiotic treatment, a patch in his chest appeared, which was diagnosed as right mid lobe pneumonia. The doctor suspected that my father had developed tuberculosis and put him on anti TB medicines. His hospital stay threw up Candida in sputum and BAL and Klebsiella in urine. After discharge from the hospital, he was given anti-fungal medicines and antibiotics. The course of medicine is over now and the patch has been resolved completely. However, a repeat urine and sputum culture revealed E. coli. He has been suffering from urgency in urination. He finds it difficult to withhold until he reaches the toilet. The doctor found that he had smegma collection. The doctor says the E. coli in culture is not from within but grown in the lab due to sample passing through infected smegma. Is he having another UTI? Is E. coli grown in bladder or was it due to passing urine through infected smegma? Is repeated UTI because of overactive bladder and sphincter dysfunction? Please advise.

A:Your father needs extreme caution and a balanced treatment. E. coli is unlikely to be from outside the system. However, it may not be necessary to treat E. coli, particularly so if he is on condom catheter. I think his urinary infection and urinary problem requires him to be under the care of a urologist. It is necessary to know how much residual urine he is holding. Condom drainage is only good for patients soiling bed. In case of retention of urine it is always inferior to bladder drainage with a regular catheter. If he has high residual urine he will be better of with a regular catheter. I would agree with you that as his age body will not have a strong resistance to infection and frequent antibiotics are also going to create problems. It is important that some one in the family should assist him in keeping proper hygiene and care of the penis and condom. You do not have to do much but be vigilant of what is happening.