Assisted Living says Mom will always test positive for UTI's at ER. Is this true?

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Mom has had many UTIs since moving to Assisted Living. Two months ago her doctor recommended daily antibiotics as a preventative measure. Despite the risks of C-Diff, etc. Dad agreed. A few days ago, Mom had a bad fall that required an ER visit. She was diagnosed with a UTI. Assisted Living says it's a "false positive" because "she always has a UTI... that's why she's on the preventative antibiotic". That doesn't make sense to me.

We know the preventative doesn't always work. I understand mom may always have some bacteria in her urine. But how do we know if the bacteria have become resistant? Antibiotic on top of antibiotic doesn't sound like a good solution. Who do we believe... ER or AI? Has anyone been down this road?

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Ah well...it is hard...for the bladder issue in particular, none of your options are very good :(

I think you've done a lot regarding this issue...more than many! Pat yourself on the back! There may be some other areas in which it's a little easier to make headway keeping your mother as "healthy and comfortable" as you can under the circumstance.

And don't forget to take a rest every now and then.
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Thank you for your clarification. I'm so discouraged. Mom's doctor reluctantly put her on daily antibiotics due to her frequent UTI diagnoses (that were most definitely correlated by behavioral changes... mom can't speak) despite the risks of developing C-Diff and another lung issue he worries about. Dad pretty much insisted on the daily antibiotics. It was his idea. I advocated for redoubled efforts at prevention for a while longer instead (more frequent changes of briefs, monitoring her fluid intake which I'm worried isn't enough, religious assessment of peri-area irritation, cleanliness, etc.) I'm feeling like we'll never really know whether they are working or or continue to be worth the risk of what sounds like a much worse condition and quality of life to me. Really starting to feel hopeless about keeping mom "as healthy and comfortable as possible" knowing she'll never get better. I do appreciate the information.
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hi KeepYourHeadHi,

Actually, a urine culture with that much bacteria means there is definitely bacteria living there (as opposed to just a little contamination), not that there is a clinically significant UTI.

If you look up "asymptomatic bacteriuria," you'll find lots of expert references that explain that older adults are often "colonized" with bacteria in the urine; in women aged 80+, over 20% of them have colonized bladders. (Higher rates in nursing homes.)

If your urine is usually sterile (which is the case for younger adults, and many older adults), then a positive urine culture generally correlates well with a clinically significant UTI. If your bladder is colonized, then you can no longer rely on a positive urine culture to tell you if you need treatment for a UTI. So I would disagree with your doctor friend. (sorry!)

UTI means urinary tract infection. The key word here is "infection," which means the body develops inflammation and symptoms in response to the bacteria's presence and activity. As you know, we live with bacteria on us -- and inside us -- all the time, and it doesn't necessarily mean infection. (Although the immune system tends to get weaker w/age, and it makes it easier to develop bad infections.)

For the bladder, infection typically causes pain with urination, but in frail older people it can just mean confusion and weakness. As I said earlier, I think in your situation it will be very difficult to know for sure whether a clinically active UTI caused your mother's fall.

I think it's reasonable to try treating whatever grows from her urine. But since it sounds like she has a colonized bladder, it's probably worth your while to try to learn more about asymptomatic bacteriuria versus UTI.

Re how to tell the difference in a frail older woman: again, it's often very difficult! You may face this quandry repeatedly, and there will not be an exact right answer, but at least you'll be better informed about the uncertainties at hand.

I don't usually link to my own work here, but I did write some practical tips on this topic for caregivers a few months ago:


Good luck!
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Thanks everyone for their support and ideas. I've come to accept that in an Assisted Living setting, a clean catch isn't reasonable to expect and therefore, mom's initial UAs will always appear as if she has a UTI. The silver lining of her ER visit is that apparently, they got one and cultured it.

drkernisan, I should hear the results of the culture tomorrow. I discussed this with a doctor friend yesterday who said any result exceeding 10 to the 5th bacteria count would be a red flag for a UTI that is significant and a threshold for me to be a very squeaky wheel on her behalf. He was pretty sure they would be reporting any antibiotic resistance too.

Thanks again. Hugs to all.
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hi KeepYourHeadHi,
Seems to me you have 2 questions: 1) how do you know if the bacteria in your mother's bladder is resistant to her antibiotic, and 2) how do you know if a clinically symptomatic UTI caused her fall.

For Q1, if someone gets a good sample of urine (clean catch or by cath in the ED) and it's cultured, the culture results usually test the bacteria for antibiotic resistance.

The harder issue in people like your mom is figuring out when they have a clinically significant UTI. In frail older people, sometimes the only outward sign is weakness or new confusion...so was that fall triggered by the UTI, or by something else? Hard to say.

I do hope they let you know what her urine culture showed, regarding antibiotic resistance. After such a fall, if you suspect UTI it would be reasonable to treat the bacteria with something that the culture shows they are susceptible to.

Otherwise, you can try cranberry, probiotics, and many of the other suggestions, to see if that reduces your mom's bacteriuria (chronic bacteria in the bladder without UTI) or clinical UTIs.

You can also ask a urologist, but often they aren't well-versed in the practical health questions of eldercare, which is "Is this problem a sign of a UTI that needs treatment?"

Good luck!
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I'm so glad people posted for you to take her to a urologist. Or outside doctor. Why trust this? And if they are lying is it wise to keep her in such a place? The next question..... Best of luck to you.
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I was just going to post what PJRuby did, about the fact that it may be time for a higher level of care. Your mom has made the transition into having ongoing medical needs and a higher level of vigilance is needed. Talk to her doctor about what her needs are now and what they are going to be in the future.
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In addition to long term antiobotics, my mom uses a cream twice a day for candida and takes cranberry tablets three times a day.
Her infections were so relentless, they seemed like a single, continuous infection. Her diabetes increases her risk for UTIs. Something aggressive had to be done. So far she's doing well.
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I am so happy to share what Dr. Oz recommended the other night, and that is two cranberry supplements (NOT the cranberry juice - too much sugar which allows the bacteria to grow). Health food store and get some prebiotics and probiotics as well since antibiotic destroy the natural flora on the intestines and that just creates a viscous cycle of more UTIs. Let us know how they work on your mom! I'm buying some on pay day!
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I suggest considering a higher level of care for your mom. Nursing home...start looking now it will take a considerable time to locate one you are comfortable with. It sounds like she might need someone to change her diaper, pads several times a day. She also needs to get adequate hydration, less sugars. Cranberry juice/sugar free, can prevent but not cure UTI. You need to use antibiotics to kill UTI bad bugs, then live culture yogurt/sugar free to rebuild her guts and cranberry juice.

Make sure the MD is not connected with the care facility which makes divided interests a consideration. Also, consider a 24 hr aide if mom remains in assisted living.

Good Luck with all of this.
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