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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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My daughter is on multiple antibiotics after bone marrow transplant. Turned out she had a BK Virus infection in her bladder. So they told her to drink cranberry juice as well as take cipro. It helped. I did not know you could even get a virus in your bladder!
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probiotics+ antibiotics= no effect from both! I am wondering who prescribed both together? Besides, those probiotics are soo processed, just like the rest of food they serve in assisted living facilities...
Preventives: daily cranberry juice + cranberry pills, hygiene -
washing bottom every time she uses bathroom, make should she wipes herself from front to back, drinking a lot of fluids through the day (no, just offering water is not enough - making sure she DOES drink!).
Fermented food served 2-3 times daily. Not marinated, but pickled. That means it's useless if vinegar is one of the ingredients. Should be ONLY salt and sugar.
The sugar should be restricted to ONLY organic cane sugar, honey or agave nectar, all in very little quantities. Absolutely no GMO-food in her diet.
Fresh fruits and vegetables are a must!
Processed food to the minimum.
Considering that antibiotic/hormones filled chicken/beef will also depress good bacteria in the guts (which will help candida grow and prevail), the meat should be also restricted (organic or none).
The sours of protein would be: mushrooms, gluten free grains (non-GMO).
Yes, holistic life style = healthy lifestyle!
Any more questions?
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Keep your head high.... we opted for the cranberry juice as MIL did not want to take any more pills. Its amazing how quick she can get a UTI. When her daughter is there for the weekend, she refuses to give her the cranberry juice. It never fails, days later she developes a UTI after daughter was there. You are doing a good job!
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Thanks everyone for sharing your experiences. I've previously discussed all of these things with mom's doctor and the AI facility. Doc was on the fence about putting mom on preventative antibiotic but Dad insisted despite my concerns and the docs cautions. She is also on probiotics. Doc felt it might improve mom's overall quality of life and says it's sort of a wimpy antibiotic anyway. Neither the doc nor the AI had very reassuring answers to my question of "how will we know whether mom develops a resistant infection or one involving a bug the wimpy antibiotic is not effective against? How do we keep it from becoming a serious infection that can affect her balance, possibly become septic, etc.? They both said monitoring behavior, urine odor and appearance, etc. would be the keys. No regular testing due to clean catch challenges and risks of catheter use. I was advocating for redoubled efforts at prevention (hygiene, more fluids, etc.) but was essentially "outvoted" and told I can't expect too much given staff/patient ratios in AI. Now this fall. Mom fell while taking an unsupervised walk and must have fallen flat on her face. She has multiple broken bones in her face. I want to be sure AI is doing everything we can reasonably expect to prevent this from happening again. Emergency Room said the fall may have been due to the UTI. I could insist on a hospital bed with a rail but that will only help if her unsupervised walks only occur when she has been put to bed for the night. So frustrating. A.I. facility wants us to call with any concerns anytime, but the answer is always "we're doing everything we can". With one exception, I'v always felt my concerns are, in the end, dismissed. My Dad doesn't want to "rock the boat" because he uses mom's memory care A.I. facility as a refuge whenever he needs a break from living alone (won't accept any help at home and I live out of town). It's nice to have all of you to talk to here that is supportive of my efforts to keep mom safe instead of criticizing them. I know mom won't get better but i hope her final months or years don't HAVE to be punctuated with trips to the ER every few months. Its true that every episode takes more out of her physically even if her mental decline is at a lesser rate. Thanks for listening and sharing your ideas. I really appreciate it.
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The best answer so far is from "neveralone" about Candida infection. ALL seniors suffer from undiagnosed candida. That's one of the reasons why elderly people crave for sugar and bread -- the candida sends signal to the brain which is hard to resist.
And it's true that the only strict diet can help to control it: quite consuming process requiring a lot of knowledge. Unfortunately, there are very few doctors who are educated in holistic life style and sure your regular MD or OD will not even suggest it. Just goggle Candida symptoms and treatment, go extensive research and you might have luck to do the right thing for the person you care for. Remember that candida comes as a side affect from use of antibiotics! I saw old people being eaten alive by candida in the beginning of my carrier. Now it's the very fist adjustment I do for my every new resident: anti-candida diet!
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Since antibiotics can cause their own problems, caution should always be given to their excessive use. Antibiotics (anti-bio = "anti - life") kill the healthy "bugs" in the intestines where their job is to provide over 1/2 of a person's immunity. It is wise to follow the use of antibiotics with Probiotics ("pro-life") to restore the intestines to health, so they can contribute to a fully-functioning immune system. Using antibiotics as a "preventive" is increasingly being questioned - and blamed for - creating ever-tougher bacteria, that no current medications can destroy.

Some of the previous suggestions for hygiene and checking with a urologist etc are worth following up on. In the meantime, consider cranberry tablets or capsules. The cranberry in these forms is much more concentrated than cranberry juice, and does not contain the sugar that yeast (Candida) grows and thrives on.

Good luck. It sounds like you are being very cautious and responsible - raising questions, seeking answers, attempting to do the best thing for your Mom. She's fortunate to have you actively looking out for her.
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There are 2 ways to test a urine speciman. One is the lab dipsticks it for a urinalysis The other is they do a culture and hopefully test to see what antibiotics will work. If a culture is not done the correct antibiotic may not be presribed. It is quite common to see ecoli which originates from the stool getting into the urinary tract. That is my mother in laws case.(Try to tell a stubborn woman to wipe from front to back does not help... She says I've been wiping this way all my life) The other common bacteria seen is Strep. We give my MIL cranberry juice 3 times a day as preventative, This kills the bacteria which can cause the UTI's.
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We go through the same thing here. Seven UTI's in 9 months. How did they obtain the specimen in the ER? It seems the only way to obtain a non contaminated sample from my mom is to catheterize her. Mom's chronic diarrhea also causes problem with clean catch. In mom's case improper cleaning after going is also a problem. These UTI's cause all sorts of new symptoms, one did put her in the hospital with stroke symptoms.
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back when my dad was having prostate issues and we ended up in ER about 1 time a month, every time he tested positive for a UTI, but the doctor himself said that ER's do a "quick test" which will sometimes say they have a UTI when they really don't. so make sure they are not given antibotics un-necessarily. good luck
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I can speak to this from personal experience and the advice assisted living is giving you sounds like a bunch of hooey to me. My mom has suffered from chronic UTI's as well, for a couple of years at least. She finally went to see a urologist who put her on long-term antibiotics. She did great for several months and then she got another UTI. In the ER the doctor changed her to a different antibiotic for a week then we followed up with the urologist. She had another urinalysis before that your urology visit and she was negative for UTI. So what had happened was the antibiotic she was on was working but those insidious bugs found a way around it and caused an infection with a different type of bug. I do not believe in false positives when it comes to UTI and I don't think someone with chronic UTI's will always test positive. That makes no sense to me either. Best of luck to you.
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My mother was suffering from the same thing and we were told the same advise. Thankfully we found a Naturopath who told us we should treat her for a Candida obeegroo. Sounded weird to me and it required a very restrictive diet, but it has worked so far. It is slow going, depending on how long your mom has been sick, but it has made a complete difference in the way my mom acts and feels. We also had to work on her hygiene, which was probably contributing tothe problem. I would highly recommend that you check into if you could treat her for Candida if her assisted living is willing to work with you.
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My mother was suffering from the same thing and we were told the same advise. Thankfully we found a Naturopath who told us we should treat her for a Candida obeegroo. Sounded weird to me and it required a very restrictive diet, but it has worked so far. It is slow going, depending on how long your mom has been sick, but it has made a complete difference in the way my mom acts and feels. We also had to work on her hygiene, which was probably contributing tothe problem. I would highly recommend that you check into if you could treat her for Candida if her assisted living is willing to work with you.
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To start with, who at al is giving you this info about utis? M.D.? As in you mom's MD? It seems to me as though your mom should be seen by a urologist in the hospital to figure out what is going on. Also, my mom kept getting utis while in independent living. My sister-in-law and I realized that my mother had stopped washing her hands after using the bathroom. We had her doctor tell her about the need for washing her hands with soap and it solved the problem. She dismissed us when we told her it was necessary but once the doctor told her....!
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