OpenHealth Q&A

Mom's UTI: Improvement in Urine but Deterioration in Blood Tests After 5 Days of Antibiotic Treatment

**Patient Overview:** - Age: 56 years - Gender: Female - Height/Weight: 5 feet 6 inches, 71 kilograms - Ethnicity: Indian - Duration of Symptoms: Recurrent UTI for approximately 5 weeks - Location: India - Medical History: Prediabetes (HbA1c 5.8%), hypothyroidism, iron deficiency anemia - Current Medications: Nitrofurantoin 100 mg twice daily, Fosfomycin 3 g (completed), Metformin 500 mg twice daily, Thyroxine 62.5 mcg, iron supplements **Primary Concern:** My mother is currently facing a challenging recurrent urinary tract infection that has shown resistance to multiple antibiotics. Initially, she experienced a high fever (103°F) with her first infection in mid-January; however, she has not had a fever during subsequent occurrences, despite indicators suggesting the infection might be worsening. The confusion arises as her urine analysis appears to have improved while blood test results indicate a decline. **Timeline of Events:** **January 11, 2026:** - Diagnosis: E. coli UTI (100,000 CFU/mL) - Treatment initiated using antibiotics. - Symptoms recurred one week later with fever (103°F). **February 8, 2026 (New Infection):** - Urine culture revealed Citrobacter koseri (>100,000 CFU/mL) – indicating a different pathogen. - Urine pus cells: 60/HPF (elevated level). - Presence of blood in urine. - CRP level: 8.81 mg/L. - eGFR: 89 mL/min/1.73 m². **February 9, 2026:** - Medical advice included: - Nitrofurantoin 100 mg twice daily for 14 days. - Fosfomycin 3 g pouch for 3 days. - Clinical notes suggested possible pyelonephritis. - Blood Pressure: 146/80. **February 13, 2026 (Following 5 Days of Antibiotics):** - Urine examination showed positive trends: - Pus cells: Decreased to 6/HPF (from 60). - Bacteria: Not observed under microscopy. - Blood: Absent. - Leucocyte esterase: Still detectable. Despite improvements in urine analysis, blood results showed a concerning turn: - CRP: Increased to 17.47 mg/L (previously 8.81) - signifying a doubling of inflammation. - ESR: 60 mm/hr (normal range <30) - a new test result indicating inflammation. - eGFR: Dropped to 84 (from 89), suggesting declining kidney performance. - Hemoglobin: 11.4 g/dL (down from 11.9). - Sodium level: 134.6 (mildly decreased). **Key Questions:** 1. What could explain the significant reduction in urine pus cells (from 60 to 6) while the CRP levels have doubled (from 8.81 to 17.47)? Does this indicate a potential progression of the infection from the bladder to the kidneys? 2. Is the absence of fever a notable factor? With the first infection accompanied by a fever exceeding 103°F, her current lack of fever alongside rising blood markers is perplexing. Could her prediabetic state be concealing symptoms? 3. Are the prescribed antibiotics sufficient? While I acknowledge that Nitrofurantoin is effective in targeting the urinary tract, it may not adequately penetrate kidney tissues. Should alternative antibiotics be considered? 4. Does this clinical pattern suggest confirmed pyelonephritis? Considering: - Improvement in local urine parameters - Deterioration of systemic blood markers - Decreasing kidney function - Absence of fever amidst elevated CRP/ESR. 5. How immediate is the need for intervention? Should we consult the doctor without delay, or is it acceptable to wait until she completes the current antibiotic regimen? 6. Is hospitalization necessary? Given the concerning increase in CRP and declining renal function, would intravenous antibiotic treatment be warranted? **My Concerns:** Initially, the doctor raised the possibility of pyelonephritis, and the observed improvement in urine combined with the decline in blood tests seem to strengthen that suspicion. The absence of fever raises doubts about her true health status, especially with kidney function decreasing from 89 to 84 within just 5 days—this development is quite alarming. I appreciate any insights or advice on how to proceed further.

Answers (1)

2/13/2026, 3:40:59 PM

OpenHealth AI

Main Points:

1. Improvement in urine analysis despite worsening blood tests raises concerns, potentially indicating pyelonephritis.
2. The absence of fever does not rule out a serious infection.
3. Immediate consultation with a doctor is essential, given the concerning trends in blood markers and kidney function.

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Explanation: Your mother’s situation is complex. The significant decrease in urine pus cells suggests that the antibiotic treatment is effective at the bladder level. However, the increase in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), alongside a decline in kidney function (eGFR), indicates ongoing inflammation and potential progression of the infection, possibly to the kidneys (pyelonephritis). The absence of fever could be attributed to her immune response. In some cases, particularly in individuals with prediabetes or diabetes, fevers may not present as prominently, masking the severity of the infection.

Next Steps:

1. Immediate Consultation: It is critical to contact your mother’s healthcare provider as soon as possible. This is to discuss the worsening blood markers and the potential need for reevaluation of her treatment.

2. Consideration of Further Testing: Ask the doctor about the need for additional imaging studies (such as an ultrasound or CT scan) to evaluate the kidneys, which may indicate whether pyelonephritis or another serious condition is present.

3. Review Antibiotic Therapy: Request a discussion regarding the effectiveness of Nitrofurantoin, given that it primarily targets the bladder. If pyelonephritis is suspected, the doctor may consider alternative antibiotics that penetrate kidney tissues better.

4. Monitor Symptoms: Keep tracking her symptoms closely over the next few days. Note any new symptoms like back pain, changes in urination patterns, or worsening fatigue.

5. Evaluate Hospitalization Needs: Be prepared to discuss whether hospitalization is warranted based on her symptoms, blood test results, and overall health status.

Addressing these questions with her physician promptly is essential to ensure any necessary actions can be taken without delay. Reassure your mother that with proper care and management, many complications can be effectively addressed.