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  • Writer's pictureDavid S Klein, MD

Chronic Urinary Tract Infections: What I've learned as a physician

Nothing makes for better education than experience, and my family has had some interesting insights that I'd like to share.


  1. The typical dip and read urinalysis, performed for many decades is outrageously inaccurate. It relies on 50 year old technology. Performed in an enormous number of physician's offices, emergency rooms, and there are home kits for the 'do it yourself' customer, the test is a quick way to get affirmation of an infection. That is, if it is positive, you probably have an infection.

  2. The problem is that the test is inaccurate and will detect a UTI between 50-60% of the time, that is, it is wrong nearly as often as it is correct.

  3. Manufactured in China, these strips will miss urinary tract infections, perhaps as frequently as 50% of the time.

  4. Urinary tract infection leads to urinary sepsis (blood poisoning, to some) and is a leading cause of death. Do you really want to rely on a $15 dip stick if your life or kidney function depended on it?

  5. A problem in the senior population, it is also a real problem with children. Missing almost 50% of UTI's in young children with fevers.

  6. Missing Chronic Urinary Tract Infection can result in preventable death and kidney damage.


 

Natural, non prescription treatments will follow in the next UTI Blog Post


 


Note Well: If someone close to you starts feeling oddly, for no other apparent reason such as stroke or heart attack, consider urinary tract infection as a possible cause. Ignoring this, it nearly cost my wife her life in July of 2023.


IT WENT SOMETHING LIKE THIS: My wife and I were enjoying our 5th wedding anniversary by taking a trip to Portugal. A marvelous vacation it was, right up until the day before we were to return home. She had an unfortunate fall, fractured her right ankle, and became somewhat immobile. The following day, she started having 'morning chills,' thinking that it might have been a reaction to the previous nights' dinner. Resolving quickly, we thought nothing of it.


The next day, we flew home, believing all was well. The next day she felt normal at 8:00 a.m. but became febrile with a temperature of 102 deg. blood pressure dropped to 80/palpable and she was in and out of consciousness. Oxygen saturation was down to 82%.


When we arrived in the emergency room 30 minutes later, she was in shock. Treated with fluids, quickly, and given intravenous hydrocortisone to treat her adrenal failure (Addison's Disease) she 'bounced back,' delirious, but communicative. I had mentioned to the ER internist that my wife had darker urine than baseline, fever, chills, and a change in consciousness. I insisted that they treat her for urinary tract infection.


Evaluation was rapid, including chest CT and abdominal CT, but her blood work was pending and her 'urinalysis' was negative. Informed by the ER physician that UTI was effectively ruled out, I insisted that they look a little closer at UTI as her problem. When her White Blood Cell count (WBC) returned at 33,000 with a decrease in kidney function to an eGFR of 27, they took a closer look at the abdominal CAT scan and found that she had pyelonephritis on the right kidney (infection of a highly significant nature) and started her on intravenous antibiotics. Five days in the hospital, she recovered. Her infection, however, was not gone........


The Monday following her hospitalization for a 'cryptogenic' bacterial UTI, I took her to my medical office, did a repeat urinalysis with a much higher quality screen, and it was NEGATIVE! On suspicion that the technology was flawed, I sent the urine to be analyzed by PCR, and we found that she had large amounts of a bacterium called 'enterococcus.' I had already started her on doxycycline, and she seemed to improve even more.


We repeated her urinalysis weekly, it was negative for 3 weeks in a row, with positive PCR each time. She had a mixed infection with E. Coli and E. Faecalis, and I added amoxicillin to her mixture.


Referred to a urologist, she is scheduled for cystoscopy with ureteroscopy to see if there is an anatomic issue with the right kidney and/or ureter.


 

This little recent bit of personal history has changed my medical practice significantly. Urinary Tract Infection is not easily ruled out with a simple $15 dip stick test. In the past month, I have sent samples for PCR if the patient had even trace WBC in the urine, and 50% of the time, the PCR was positive for E. Coli or one of the less frequently encountered pathogens. I am now performing PCR on negative dip stick evaluations, if the patient is showing mild to moderate mental status changes, and if the symptoms are severe, they go straight to the emergency room.


The number of patients found to be walking around with mildly symptomatic urinary tract infections was astounding. What was eye-opening was the fact that when we found infection, the patients all reported confusingly mild symptoms that in retrospect, were suggestive of UTI.


I have picked up almost a dozen 'occult' urinary tract infections in the past 3 weeks. One very fortunate patient had become wheel chair bound, and it was blamed on her Parkinson's Disease. I sent her to the ER with the diagnosis of urinary sepsis, and following IV antibiotics (started before the PCR results returned as positive) she is now walking again and in physical rehabilitation to regain strength.


The commercial insurance companies do not routinely cover urine PCR unless it is done to rule out sexually transmitted diseases. For the practitioner, if you include an STD panel with the urine PCR, it has a high likelihood of being covered, if not, the test can cost $600 or more. In the future, it is my hope that the insurance carriers will follow the lead of Medicare, and cover this service.


I am fortunate in that I own a laboratory that has the capability of performing the testing, but for my patients that do not, the laboratory owners have agreed to reduce the price to a more affordable level of $240. The commercial diagnostic laboratory can be reached at:


I will update this blog post, as more information becomes available. I will add published references and such, for validation of the data mentioned above.




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