URINARY TRACT INFECTIONS WITH INDWELLING CATHETERS:
Dear Sumner:
I would like your opinion about a 45 year old paraplegic male who has worn an indwelling catheter for the past 12 years (since his initial injury). He prefers to change his catheter monthly, rather than to do intermittent catheterization. He complains that his urine has a foul odor and suspects there is an infection. Should I treat him with antibiotics?
Dear John:
It is near impossible to sterilize the urine in the presence of long term catheter drainage. It is important to distinguish between bacilluria and a clinical urinary tract infection. (Bacilluria refers to the presence of the organisms in the urine. A clinical infection is when these organisms cause manifestations of a disease process) If the only problem is an odor of the urine, there are medications on the market which can control that problem. If your patient is not having any undue distress, then antibacterial medication is not only unnecessary its use may be contraindicated because of the likely emergence of resistant organisms, which could impede the treatment of subsequent clinical infections. However, since there can be silent damage to the urinary tract organs and/or the formation of stones, it might be wise at some point to get some radiological evaluation of the urinary tract: e.g. renal ultrasound or intravenous pyelogram; if there is evidence of renal damage, a voiding cystourethrogram should be obtained as well. Assuming no obvious problem is revealed on these studies, active urological intervention is not necessary at this time.
