CDIff vs Sepsis risk with Chronic UTI treatment

Patient

Q: My father is late 80s advanced stages of Parkinsons. He constantly gets UTIs (almost monthly) despite clean safeguards put around his care. Till now we have cultured and treated each of these UTIs with antibiotics. We are now considering discontinuing this practice because of CDiff risk, but would like to understand if UTIs can ever go away on their own, and if left untreated there is a high risk of sepsis.

Symptoms:  Chronic UTIs , elderly
Doctor

A:   Hi.
Thanks for your query.
Read and understood the history about your father of age 80 having Parkinson's, getting recurrent UTI in spite of clear safeguards. You have cultured and treated each UTI with antibiotic.
UTI may not go away permanently unless the original cause that has caused this problem gets solved.
The commonest cause can be the obstructing lesion like an enlarged prostate, taking less liquid intake as goes on normally with most of the elderly people with Parkinson's.
I would advise you the following:
Take an opinion of a Urologist for clinical evaluation and examination of the prostate and the per rectal examination, PSA, ultrasonography of the abdomen particularly for the uro-genial system.

There is definitely a very high risk of sepsis if you keep UTI and the original cause.

I hope this answers your query and may give you and your Doctor an idea how to go about the whole problem
Please feel to ask for further relevant questions if you need to or if you feel that there is a gap-of-communication.

Comments / Follow Ups

Patient: Hi - Thanks for the response.

So a few other pieces of information. Over the past couple years we've done a lot of follow up with urologists and infectious disease specialists, have worked on ensuring catherization, etc. is a sterile procedure, and ensureda lot of (thickened) liquid intake, but have been unsuccessful in finding the root cause or staving off the infections. And in fact, a lot of the cultures have come back as different bacteria, indicating that there might be several root causes. We're in a state right now where we're accepting that he will get UTIs.

So I really want to focus in on the actual risk of getting CDiff from continually treating with antibiotics, vs the risk of getting Sepsis from leaving one untreated. And the prognosis of both of those.

And to confirm: your response seemed to indicate a possibility that an untreated UTI will actually go away on it's own?
Doctor: HI.
Thanks for your feedback.
Yes, your thoughts are absolutely correct.
Some factors like repeated antibiotics, old age are contributory factors.
The C diff occurs due to disturbed gastro-intestinal flora of bacteria and can be tackled to an extent by giving appropriate pre and probiotics.
Once we know that there is an infection anywhere including that of urinary tract, antibiotic cover should be given as per the clinical picture and culture and sensitivity reports.

Although the chances of C diff are there, we can not allow the sepsis to grow.

Since many Specialists have already seen him, they would have definitely tried to see the cause of recurrent infection, catherization is one of , another cause may be inadequate treatment of the previous infection.
Please discuss with your Specialist about the role of Doxycyclin, as it may be given for weeks together and possibly cure the infection.

Untreated UTI does not go away on its own.

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