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Muneeb Ali
Muneeb Ali, Emergency Medicine
Category: Urology
Satisfied Customers: 7453
Experience:  MBBS,MD,ECFMG certified. Have dealt with urological emergencies in the ER on a regular basis
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Research discrepancy treating false positive urine culture;

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Research discrepancy treating false positive urine culture; If contamination of urine is mostly always the case even though a patient wipes using special germ clothes prior to collecting a sample, I have read that there is always bacteria lining the urethra even so really the only way to get a true specimen is to use a cathetar. SO when elderly women provide samples of urine, even if there is no bacteria showing on the urine culture test, does the little bit that is found in the urine stream or on the body, going to grow into a positive population of ecoli or other bladder located bacteria in the lab? As well as a urine test strip coming out negative, but then if the urine sits out long enough, will that sample begin to grow the bacteria that would have otherwise tested negative because there was so little. And why does some literature say to NOT treat a UTI on an elderly woman. WHy is that?

Welcome to JA and thanks for this question. Actually while it is true that you have bacteria lining the urethra, when we geta urine sample we always ask for a mid stream sample, the reason being the initial part of the urine sample can be contaminated and once those contaminants are passed in the urine, the mid stream sample should represent the true bacteria which are present inside the urinary tract.

Secondly, the small amount of bacteria which are present on the urinary tract usually do NOT grow into a large population which can cause an infection and usually e.coli is not found in that sample. The e.coli which could be present normally is a variety which does not cause an infection as there are thousands and even hundreds of thousands of strains of each bacterium, some of whom can cause an infection while others may not.

The urine left out of the body would NOT grow bacteria unless the conditions are ideal, the temperature needs to be correct and they need a host of factors in order to propagate and grow and that is why most bacteria would not grow on a simple urine sample left outside.

Lastly, the recommendations to treat a UTI is when you actually have symptoms OR if the colony count of the bacteria is greater than 50,000 CFU/ml. The reason for this is because it has been seen that if the colony count is less than this number and there are no symptoms, the bacteria would usually be cleared by the body itself however if symptoms occur then that would indicate that the body has failed to clear out these bacteria and thus would need treatment. Numerous studies have indicated that a count of less than 50,000 would be more consistent with simple colonization and that would not lead to any issue in most patients. Only in diabetics or patients who are immunosuppressed would treatment be necessary in this case.

Do you have any more questions?

Please leave a POSITIVE rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

Customer: replied 2 months ago.
Well, what does it mean if using cranberry or mannose results in negative nitrates and leukocites for a few days and then positive again? Or even an antibiotic creating negative test strips for approximately 3 weeks and then the urine dip stick becomes positive again.
Customer: replied 2 months ago.
I'm referring ONLY to elderly women that have bladder prolapse
Customer: replied 2 months ago.
Do you have a lot of experience with this group and have witnessed successful management that prevents or restores or maintains negative nitrate and not compromising mental or digestive health as happens in that group (Alzheimer's dementia Parkinson's)

If you use cranberry for a few days, and the test becomes negative then that means that the initial test showed colonization of bacteria which were cleared out and they regrew again on the next test OR the more likely possibility is that MANY a time, urine cultures can be negative despite you having bacteria in the urinary system. This could be because of sampling issues or inability to grow the bacteria on the culture broth because of various issues. This is a common problem faced in the clinical setting.

If antibiotics caused a culture to be negative then the bacteria were killed and due to the presence of a bladder prolapse you may have gotten colonized/infected again.

One last thing, a urine culture is a much more accurate test as compared to dipsticks, while dipsticks are good easy ways to determine if there is an infection, a culture is definitive always.

Yes i have managed patients who have had chronic UTIs and treatment has not resulted in any problems associated with digestive or mental health.

Customer: replied 2 months ago.
In the population of elderly women who flip flop with behavior health issues AND sluggish bowels, have you been able to stabilize their behavior and create bowel regularity while the prolapse bladder creates the challenge of re-infection because of feces accumulating and the bladder NOT being able to empty completely ? The antibiotic use for bladder bacteria apparantly disrupts the microbiota and contributes to neurological deficeits?
This is my simplistic understanding of things I've read regarding these overlapping health challenges.

The simple answer is YES, not ALL antibiotic use will contribute to worsening of behavioural issues or even change in the bowel habits. Some antibiotics may effect the behaviour specifically fluoroquinolones which can effect behaviour most commonly in this age group and these sort of patients but there are MANY other antibiotics which dont effect the behaviour. Similarly yes the intestinal flora would be affected to a degree in some patients but NOT all patients experience this sort of side effect. Not all patients develop constipation after antibiotic use. And even if they develop issues with the bowels, medications can be used to regularize the bowel habits and also adjusting their diet. It is a complex process but patients are stabilized with adjustment of the medications and the infection is controlled without significantly affecting behaviour and digestive issue.

Would you like to know anything else? Any clarifications or additional questions that you might have, i would be happy to answer them for you. If done for now, please remember to leave a positive rating as that is the only way we are compensated for our time spent helping you. You can continue to ask follow-up questions even after the rating.

Customer: replied 2 months ago.
Well I understand the meds can then play with preventing constipation but those meds are also implicated as disrupting gut microbiota or balance. Miralax, mineral oil, laxatives, even bulking up with psyllium disrupts digestive health. Now I learned that artificial sweeteners still raise insulin levels and Alzheimer's is being called diabetes 3.
The antibiotic the dr prescribed is Ciprofloxacin. HCL 500mg. 2 x day for 3 days.
I was able to get negative nitrites for a week using mannose silver colloidal oregano oil and 90 billion probiotic multi strain per day. So why can't I try that route again?

You can certainly try that route again if that works for you, but we physicians tend to go for evidence based medicine, the evidence for use of mannose silver is not robust enough for us to recommend using it routinely for management of UTI's, while it may work for you, there is a lot of evidence saying it does not. When we talk of evidence we are talking about trials which are done is a last segment of the population which produces statiscally significant effects. However these trials dont focus ona single individual so if this treatment protocol works for you, you can certainly try it.

Customer: replied 2 months ago.
Do you know WHY the positive nitrite reading came back after one week doing the alternative uti protocol? And is the antibiotic the dr prescribed one of the bad ones for people with Alzheimer's?

Reinfection is a possibility, if the initial test was negative and then it came back as positive after using the protocol. If you are colonized, reinfections can occur.

Regarding the antibiotic, ciprofloxacin can cause transient issues with confusion and altered behaviour in patients above the age of 65 or those with pre existing diseases like alzheimers, it can worsen the effects of the alzheimer's for a short period of time but not permanently worsen the disease, the effects would fade after the antibiotic leaves your system if they occur at all in the first place

Customer: replied 2 months ago.
Ahh That's amazing how antibiotic creates a disruption. But only momentarily? It's extremely important that I understand this. Can it be determined if the cause of rienfection is due to thinning tissue, lack of protective mucous lining, hydration, not enough good bacteria to balance the bad bacteria (which apparantly is also necessary, or simply the dropped bladder resulting in urine retention. How do I know if there's urine retention because 16 oz of water can be held for 2 hours . If I recall correctly, a true uti causes someone to pee every 10 minutes doesn't it?

It is NOT necessary that every patient with a UTi will have urinary frequency, infact many patients would have urinary retention or only burning urination and no urinary frequency so the only way to determine if there is urinary retention would be to get an abdominal ultrasound done or a bladder emptying study. That is the most accurate way to determine the residual urine volume and that can determine if it is cause for your recurrent UTIs.

The cause can be determined by simple examination and testing in most cases, the thinning can be determined on an examination, absence of good bacteria on a culture and so on.

And yes some antibiotics can cause transient confusion and delirium like symptoms in patients with pre existing dementia etc.

Also would you mind leaving a rating as we have been talking for over six days without a rating. thanks.

Customer: replied 2 months ago.
I will add bonus and rate I promise you . This is just so important and doctors don't have time to explain in person. Can you clarify this last point you wrote in the first response;
"however if symptoms occur then that would indicate that the body has failed to clear out these bacteria and thus would need treatment. "
Can you describe some physiological symptoms and behavioral symptoms in an 80 year old woman with a cistocele ?

That statement means that if the symptoms occur an active infection has developed, colonizing bacteria dont always cause an infection and sometimes the body is able to get rid of the bacteria on its own but sometimes due to various factors infections would develop like immune system weakenind, age etc

Regarding the phsyiological and behavioural symptoms, symptoms due to which condition? Can you clarify that

Customer: replied 1 month ago.
In the case of a urinary tract infection as occurs in the elderly female population. I have read that amongst this population, it seems to be almost normal to have positive urine culture that the nih has recommended NOT to test anymore for UTI, so that is confusing to me. If there is weakness, if there is confusion or if there is cognitive type dementia symptoms, how much of these symptoms are hydration issues or low iron or low electrolyte imbalances Folate, or B12 deficiencies or directly caused by bacteria in the urine? I need some markers because apparently ALzheimers and neurological issues are also connected to overuse of antibiotics in some way because the neurotransmitters depend on enzymes and probiotic good bacteria. SO my desire is to NOT liberally rely on antibiotics if in fact the bladder has colonizing bacteria which as you stated above, that dont always cause an infection and we are keeping it in check. What symptoms would appear to reveal if the bladder has bacteria that is causing infection? What are signs and symptoms of infection of a true UTI in an elderly senior woman with a dropped bladder?
Customer: replied 1 month ago.
This is so helpful... i will tip fairly i promise because this is valuable to understand this for me once and for all.
Actually there is a difference between the colonization and infection, if the colony count is less than 50k/ml then it is less likely to be an infection and anything above it is usually treated. Secondly symptoms like burning, frequency, change in color, change in smell or lower abdominal pain. This would be indicative of an active infection.
In this age group based on the experience of many physicians, most of the time that IA about 30% of cases, hydration is the cause and then another 20-30% is uti an issue
Customer: replied 1 month ago.
When you say hydration.... do you mean water or a deficiency of vitamins or minerals or salt that is OFF balance? Or do you mean simply that there is lack of fluid volume in the body or bladder or kidneys so bacteria can fester within the bladder itself and multiply? I find that giving lots of water does absolutely nothing... A person can drown in drinking. I think there is something else that is an issue aside from having enough water.. YES? no? THis is where i am confused...

Hydration primarily refers to lack of water however once that happens usually there are mild electrolyte imbalances related to the sodium and potassium. In some situations a person may be dehydrated but have low sodium and in that case it would be counter productive to drink water and here saline would be needed.

Customer: replied 1 month ago.
Are the symptoms similar to symptoms of UTI and how to differentiate between the two?

Differentiate between UTI and lack of hydration? Lack of hydration and electrolyte imbalances are diagnosed on labs mostly but the symptoms would be similar , that confusion would occur in both but in UTi there would be urinary symptoms as well.

Customer: replied 1 month ago.
In the elderly, what symptoms would need to be present in order to differentiate between a true UTI where sepsis is soon to manifest or kidney issues or what ever symptoms might be diagnosed as a true dangerous UTI vs a UTI which colonizing bacteria is OVER 50k/ml just the same but doesn't cause an infection.. I am understanding from what you are saying that a person might have NO infection yet has received positive results of over 50k/ml, yet no dangerous symptoms.

A count of greater than 50k CFU/ml is an indication for treatment of a UTI even in the ABSENCE of symptoms. This is the general guideline which is followed.

You can predict whether a UTI is going to lead into sepsis on the basis of symptoms alone, that is determined on the basis of symptoms PLUS clinical examination as well as lab findings. You cant simple predict that a patient is going go into sepsis based on symptoms alone.

The danger signs which MAY predict worsening iof an infection and possible onset of symptoms (but not always) include,


Low blood pressure less than 90/60

Increased heart rate usually greater than 130/min

Shortness of breath

Decreased urine output

Persistent temperature above 102 F or below 96 F

Also would you mind leaving a positive rating, it has been three WEEKS since we started this conversation and i would appreciate it if you can leave a positive rating and a bonus as i have spent a significant amount of time helping you.

Customer: replied 1 month ago.
Can I ask more questions regarding this topic after I rate and add a bonus? There are more things to understand on this topic. It seems like hours of dialogue but I just read the whole thread slowly in 10 min and skimmed it in 7. Should I open a new question related to this? The reason I drag it out is because I don't have time to stay here . I stop and start and multi task throughout the day and my questions dissapear from being visible if I am speaking with multiple experts about various topics so I apologize. So the questions get pushed off the front page.
Customer: replied 1 month ago.
Your communication with me is beyond valuable and I appreciate your patience .
You can open a new question related to this after leaving a rating and we can jump back in to the same conversation.
Customer: replied 1 month ago.
But if the question seems related, justanswer might not allow it. I can try tho.....

They will allow it as this conversation is now 3 weeks old, do remember to rate it

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