Editor- I read with interest the paper by Car et al and would like to raise the following points on this topic by presenting a case1. A 70-year lady with multiple sclerosis was referred for rehabilitation after undergoing nephrectomy of her left kidney for pyonephrosis. She was treated for recurrent lower urinary tract infection with several courses of antibiotic prior to admission. We were very keen to explore all means of preventing another urinary tract infection as she was on an indwelling long-term urinary catheter.
An adequate fluid intake was suggested as per body weight. This may prevent recurrence of infection and this has not been discussed in this paper2. Other possibly significant risk factors include poor hygiene and poor nutrition that results in decreased immunity2. It is worth doing a plain Abdominal X-ray (Kidney-ureter-baldder; KUB) to exclude stone in renal tract as 90% of renal stones are radio-opaque and can cause recurrent UTIs (Urinary Tract Infection), this was normal in our case. Patient’s medication needs careful reviewing. Our patient was on oxybutinin 5mg tds, which was started when she had symptoms of over-active bladder and continued taking since then. This was stopped as it could have been contributing to atonic bladder. Ranitidine was changed to a PPI (Proton Pump Inhibitor) as ranitidine has anticholinergic properties that too reduce bladder tone. She is now on prophylactic antibiotic and cranberry juice to prevent its recurrence1.
Urologist’s opinion was sought if suprapubic catheter insertion would reduce the frequency of infection, as urethral catheter may be prone to more frequent infection because of its proximity to perineum, which is a rich source of bacteria3, 4. This has been planned in a few months time. Antibiotic impregnated catheters have the potential to reduce nosocomial catheter related UTIs in comparison to silicone-coated Foleys catheter5. We are in the process of exploring if one type of catheter is better than another in a situation like this.
Shahid A. Kausar consultant physician/geriatrician
City Hospital,
Dudley road,
Birmingham
B18 7QH
1. Car J, Sheikh A. Recurrent urinary tract infection in women. BMJ 2003;
327:1204
2. MacMillan RD. Complicated urinary tract infections in patients with voiding dysfunction. Can J Urol 2001;8(1): 13-7
3. Dinneen MD et al. Urethral strictures and aortic surgery. Suprapubic rather than urethral catheters. Eur J Vas Surg 1990; 4(5): 535-8
4. Moore KN et al. Pathogenesis of urinary tract infection: a review. J Clin Nurs 2002; 11(5): 568-74
5. Al-Habden I et al. Assessment of nosocomial urinary tract infection in orthopaedic patients: a prospective and comparative study using two different catheters. Int Surg 2003; 88(3) 152-4
Competing interests:
None declared
Editorial note The patient whose case is described has given her signed informed consent to publication.
Rapid Response:
Recurrent urinary tract infection in women
Editor- I read with interest the paper by Car et al and would like to raise the following points on this topic by presenting a case1. A 70-year lady with multiple sclerosis was referred for rehabilitation after undergoing nephrectomy of her left kidney for pyonephrosis. She was treated for recurrent lower urinary tract infection with several courses of antibiotic prior to admission. We were very keen to explore all means of preventing another urinary tract infection as she was on an indwelling long-term urinary catheter.
An adequate fluid intake was suggested as per body weight. This may prevent recurrence of infection and this has not been discussed in this paper2. Other possibly significant risk factors include poor hygiene and poor nutrition that results in decreased immunity2. It is worth doing a plain Abdominal X-ray (Kidney-ureter-baldder; KUB) to exclude stone in renal tract as 90% of renal stones are radio-opaque and can cause recurrent UTIs (Urinary Tract Infection), this was normal in our case. Patient’s medication needs careful reviewing. Our patient was on oxybutinin 5mg tds, which was started when she had symptoms of over-active bladder and continued taking since then. This was stopped as it could have been contributing to atonic bladder. Ranitidine was changed to a PPI (Proton Pump Inhibitor) as ranitidine has anticholinergic properties that too reduce bladder tone. She is now on prophylactic antibiotic and cranberry juice to prevent its recurrence1.
Urologist’s opinion was sought if suprapubic catheter insertion would reduce the frequency of infection, as urethral catheter may be prone to more frequent infection because of its proximity to perineum, which is a rich source of bacteria3, 4. This has been planned in a few months time. Antibiotic impregnated catheters have the potential to reduce nosocomial catheter related UTIs in comparison to silicone-coated Foleys catheter5. We are in the process of exploring if one type of catheter is better than another in a situation like this.
Shahid A. Kausar
consultant physician/geriatrician
City Hospital,
Dudley road,
Birmingham
B18 7QH
1. Car J, Sheikh A. Recurrent urinary tract infection in women. BMJ 2003;
327:1204
2. MacMillan RD. Complicated urinary tract infections in patients with voiding dysfunction. Can J Urol 2001;8(1): 13-7
3. Dinneen MD et al. Urethral strictures and aortic surgery. Suprapubic rather than urethral catheters. Eur J Vas Surg 1990; 4(5): 535-8
4. Moore KN et al. Pathogenesis of urinary tract infection: a review. J Clin Nurs 2002; 11(5): 568-74
5. Al-Habden I et al. Assessment of nosocomial urinary tract infection in orthopaedic patients: a prospective and comparative study using two different catheters. Int Surg 2003; 88(3) 152-4
Competing interests:
None declared
Editorial note
The patient whose case is described has given her signed informed consent to publication.
Competing interests: No competing interests