Urinary tract infection with Serratia fonticola
November 6, 2010 | 20,00 EUR | answered by Dr. med. Olaf Stephan
Hello,
Background: Recurring urinary tract infections since June 2010 - have been infection-free for maybe 2 weeks since then. Initially treated as an outpatient with 4 different antibiotics (Cotrim, Nitrofurantoin, Ciprofloxacin), without success. Then treated inpatient with IV Cefuroxime, also without success. After antibiotic sensitivity testing, switched to IV Imipenem for 5 days, followed by oral Nitrofurantoin for another 14 days - then infection-free for about 2 weeks. During a bladder examination, a stone was found and removed, further stones were not found.
New infection in early September, again with e. coli, treated with Ciprofloxacin for 2 weeks after sensitivity testing. Still no success.
After a new sensitivity test, switched to Nitrofurantoin. Urine was never sterile, always some leukocytes and sometimes erythrocytes in it, nothing was detected in a culture in mid-October, so medication was stopped.
Afterwards, more leukocytes and erythrocytes again, new culture. My urologist said that nothing had grown in the new culture, but he still sent it in. Laboratory findings:
1,000,000 bacteria/ml
1. Bacteria: Serratia fonticola
2. Bacteria: Enterococcus sp.
Only Gentamicin is sensitive to the first bacteria. In the hospital, they told me that they would prefer not to give me this medication because it needs to be dosed according to body weight, and at my weight of 160 kg, it would be overdosed.
However, my urologist wants to go ahead with it, with a daily dose of 160 mg for 5 days. I am afraid that this dose may be too low and only promote resistance. I have been having infections for 5 months now, and constant antibiotic treatment has not led to freedom from infection.
Urine tests in September and last week were unremarkable.
I have a slight pressure in the lower abdomen, no other complaints. Occasionally a very slight burning sensation. I drink about 3.5 liters of water daily.
However, there are always leukocytes in the urine. Is it absolutely necessary to treat the infection?
I sought a second opinion, the second urologist does not want to do anything, just wait.
But I am worried about urosepsis. On the other hand, I am worried that this last medication will not work if something really serious happens.
What to do?
Dear Inquirer,
The germ you mentioned in the first place (Serratia fonticola) is a rod-shaped bacterium from the Enterobacteriaceae family, which also includes the second germ (Enterococci). The preferred habitat of these bacteria is the environment of the intestinal flora. These bacteria rarely play a role as pathogens, but they are increasingly being found in nosocomial infections (infections acquired in the hospital with specific pathogens that are often resistant to many antibiotics, such as pneumonia, wound infections, or urinary tract infections). It is quite possible that you acquired this germ during a hospital stay. Normally, the urinary tract and urine are sterile, meaning no bacteria are detected. A bacterial urinary tract infection, possibly with an existing urological condition (such as kidney stones, prostate disease, or chronic infection), can escalate to a severe infection with the risk of urosepsis (your concern is valid) and should therefore be treated if possible. A bacterial count of 1,000,000 is highly pathological, and leukocytosis (increase in white blood cells in the urine) indicates an existing urinary tract infection. Therefore, I would definitely recommend antibiotic therapy. Surely, the test for the effectiveness of various antibiotics against the detected bacteria was also conducted in your case, hence the decision for Gentamycin. Additionally, attention should be paid to an antibiotic combination that targets both germs, in case the second one is not sensitive to Gentamycin. Gentamycin therapy is also feasible in the urinary tract, as the medication has good efficacy in this area. However, Gentamycin is only available as an intravenous infusion, meaning you would need to receive a short infusion every day from your urologist. The dose of 160 mg daily is appropriate, with a maximum daily dose of 240 mg. Gentamycin can have toxic effects primarily on the kidneys, ears, and vestibular system. Therefore, a prerequisite for the therapy is that your kidneys are functioning properly, you drink plenty of fluids, and the therapy is medically monitored. Based on your information, it seems that all prerequisites are met, so I recommend following the therapy proposed by your treating urologist. After completing the treatment, it can be checked if the urine is finally free of germs. I wish you a speedy recovery. Best regards, O. Stephan.
