Here’s an interesting case of recurrent UTI we see all the time in urgent care, but could have had a better outcome:

Patient is 82 y.o. female with previous history of pelvic wall/floor collapse/prolapse requiring bladder mesh surgery. 

History of frequent and chronic recurrent UTI since that time. 

Presented to Urgent Care and UTI was confirmed in early July 2020.  Given broad spectrum antibiotic and C and S ordered.  

Hospitalized after 3-4 days on antibiotic with fever, worsening symptoms and another urinalysis done via indwelling catheter confirming persistent, recurrent UTI.

Creatinine was high on admission to hospital.  Another C and S was ordered.  Results of both C and S were inconclusive

Patient was treated with systemic antibiotics, hydration, etc. and released after 5 days.

At that time creatinine came back down to normal. 

5 days in the hospital

In early September, patient again became symptomatic with recurrent UTI. 

Urinalysis was positive and patient was again started on an antibiotic, Cephalexin. 

Symptoms did not improve and PCR testing was performed.  It was confirmed that recurrent UTI was a result of E. coli.  Antibiotic resistance to cephalexin was reported so patient was put on twice daily nitrofurantoin. 

Patient’s symptoms resolved.

This hospitalization could easily have been prevented

Real Time Polymerase Chain Reaction (RT PCR)

Real Time Polymerase Chain Reaction (PCR) infectious disease testing offers
higher accuracy and broader detection than culture.

▪ Detects the presence of infection by amplifying pathogen RNA and DNA
▪ Pathogen and antibiotic resistance information in 24 hours
▪ Increased sensitivity and specificity
▪ Unaffected by concurrent use of antibiotics
▪ Identifies polymicrobial infections

Identifying cause of infection on the first test is important especially in immunocompromised patients, including the elderly.

Here's what you need in your practice:

  • PCR testing that provides causative microbe coverage for up to 99% of syndrome-related
    microbes, some of which are not detected by traditional culture and sensitivity.
  • The test panels that offer information on the antibiotic resistance genes found in an individual sample. This information can help the clinician choose the best possible anti-infective therapy for the patient.

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Your patients want an answer.  "What do I have?" 

Especially when point of care testing is not available, inconclusive, or doesn't give you an actual treatment decision, as well as for confirmation, rapid turn-around PCR testing (24-36h) will keep your patients safe, out of the hospital, and your reputation intact. 

"The urgent care mis-diagnosed me" is not something you want to see on your online reviews.

Let's get this set up in your practice: