Urinary tract infection, a humble disease, made me go back to hell | Guokr Patient

When I gave birth, I was one month away from turning 38, and my health was still pretty good. I was in the United States at the time, and American obstetricians didn't treat pregnant women any differently. They told me to walk every day, swim if I could, and not eat raw meat or fish. I could do anything else. So I walked more than 5,000 steps every day, and my weight was always within the standard range.

At 38 weeks, my blood pressure was high and I had slight edema, so the doctor at the clinic sent me to a cooperating hospital to see if it was eclampsia and whether I should have a cesarean section.

The hospital checked everything and found that I had a urinary tract infection except for one indicator. The obstetrician prescribed me some medicine. When I went to get the medicine, the pharmacist told me that I couldn't take that medicine after 37 weeks because it would harm the fetus. The obstetrician was not happy and asked me to go back to the clinic to collect urine again. Maybe it was because I had drunk a lot of water at that time, or maybe the clinic's test was not professional, but the result was that I didn't have a urinary tract infection. So I followed the doctor's advice and continued to drink more water and exercise more.

There seemed to be signs before the onset of this disease

Urinary tract infection has always been a lingering shadow around me. Whenever I am busy, tired, or forget to drink water for a few days, it will occur, especially in summer. In the past, I would take some medicine and drink some water, and the symptoms would disappear. When I was 24 weeks pregnant, the pregnancy test also found a urinary tract infection. I went home and drank water for three days, and it was gone.

At 40 weeks, there was still no movement in my belly. The doctor told me to go to the hospital for induction after the weekend. Thinking that I would soon lose my freedom, my husband and I climbed a small hill on the weekend. At that time, I didn't think about how to get down if the baby started to move halfway up. Fortunately, everything went smoothly. I had spotting at 3 a.m. on Monday morning. I went to the hospital and was only six fingers dilated until 4 p.m., so I went to the operating room for a caesarean section and gave birth to the baby.

In the next two weeks, everything went smoothly. Except that my blood pressure was a little high when I was discharged from the hospital, but it returned to normal after a few days. My milk supply was also good, and my cesarean section wound didn't hurt at all. It seemed that everything was on the right track.

One day, I suddenly felt very cold and wanted to drink hot water. I covered myself with the quilt and shivered for a while. I took my temperature and it was 38 degrees. But in less than ten minutes, my temperature returned to normal. I didn't pay much attention to it, thinking that it might be a normal reaction after giving birth. In the afternoon, I shivered again and had a fever again - the temperature was 38.5 degrees. In the evening, I took my temperature again and it was 39 degrees. I left my husband at home to take care of the baby and took a taxi to the hospital emergency room alone.

The nurses in the hospital ignored me.

At the triage desk, the nurse took my temperature and found that I didn't have a fever. I explained that I had a fever when I just left the hospital, but it's gone now. The nurse said she would send me home as usual, but considering that I had just had a caesarean section in this hospital, she agreed to let me stay for a while.

Later I learned that the hospital emergency department does not follow a first-come, first-served basis, but rather a severity-based one. I was classified as the least severe. There seemed to be quite a few seriously ill patients in the emergency department that night. The ambulance brought in a little girl with a broken arm and an adult on a stretcher. I was left alone in the emergency room for nearly three hours. Whenever I went to the triage desk to ask, the answer I got was that there were more serious and urgent patients, and I had to wait a little longer.

There was a water dispenser in the emergency room, but I didn't think of drinking it during these three hours. Suddenly, a severe chill hit me, and I suddenly felt dizzy. After enduring for a few minutes, I walked to the triage desk and told the triage nurse that I was dying. The nurse took my temperature, immediately asked someone to push a wheelchair, and gave me a Tylenol. I only remember being pushed into the emergency room and climbing onto a bed. Two nurses surrounded me, talking while preparing to give me an infusion, and then I knew nothing.

Someone told me, come in and you won't feel uncomfortable

When I woke up, the nurse looked terrified: "You just fainted. That's scary." My body was covered with ice cubes at this time, and she continued, "Your blood pressure is very bad."

A lady in casual clothes and glasses came to my bedside with a pile of documents and sat down: "I am the lawyer of the hospital. Your condition is very critical. We need your signature to authorize the hospital to act as your medical agent and make necessary medical decisions on your behalf. We have contacted your insurance company, so you don't have to worry." I signed a few words in confusion. Some people came and went around. I suddenly felt very uncomfortable and couldn't help but scream. Several nurses ran towards me.

A terrifying scene appeared before my eyes. Not far away, a white moving door was half opened, and a dazzling white light shone through it. It was very hot on my body. A voice said to me, "Come in, come in, and you won't feel uncomfortable."

I felt pain all over my body. That voice made me feel terrified. I screamed desperately: I don’t want it! I’m only in my thirties, I just gave birth to a child, I’m still young!

After struggling for a while, I suddenly came back to reality. I saw the face of a black female doctor with pigtails, who was saying, "Oh my God, she's not responding!"

Suspected pyelonephritis plus severe dehydration

I realized then that I should say something, so I hummed. The black female doctor almost jumped up with joy, "Great!" She pointed to the screen above my head and said, "This is your heartbeat. You need to focus on breathing now, don't think about anything else, breathe in - breathe out - breathe in." Then I was pushed into the emergency room.

Afterwards, I looked through the long medical records of that night. My blood pressure was 60/90, my heart rate was 170, I was extremely dehydrated, my consciousness was confused, and there was a small shadow in my renal pelvis. My memory of the emergency room was extremely vague. I only remember that I was talking loudly. Later, the nurse said that I kept asking, "Where is my husband? Where is my baby?"

When I woke up again, I was already in the ICU. The nurse said in a serious tone that it might be sepsis and that they were still waiting for the final blood test results. Fortunately, the results showed that it was not sepsis, and I was moved to a general ward.

The next morning at nine o'clock, my husband sat in front of the bed, and my arms were full of tubes. The doctor came and patted my lower back and asked if it hurt or if I felt sore. I said no, I didn't feel anything. He also asked if I had urinary urgency or frequency before, and I said no. Then the doctor explained to me that at first it was suspected to be sepsis, and everyone was almost scared to death, but fortunately I was young and recovered quickly. Now it is suspected to be pyelonephritis plus severe dehydration.

The doctor said he was infected with multi-drug resistant E. coli.

I was then hospitalized, while my husband took care of the baby at home and fed her formula milk. I pumped milk regularly and then dumped it out. There was a bowl in the toilet in the ward. Every time I wanted to go to the toilet, the alarm would go off as soon as I left the bed. The nurse would come to help me go to the toilet. I repeatedly said I didn't need it, but the nurse said that the red bracelet on my hand meant that I was at risk of slipping. After going to the toilet, the nurse would record the amount of urine and then empty the bowl in the toilet. The attending physician came to see me and said confidently that it was not serious and I could be discharged the next day. But I had a fever again at night and was told that I needed to stay in the hospital.

The next day, I changed my antibiotics from vancomycin to norfloxacin, and I was given many bottles of what I thought was saline solution. I still had a fever at night. On the third day, the attending doctor said that the results of my urine bacterial culture came out, and it was a multi-drug resistant E. coli that none of them had ever seen before. The bacterial sample had been sent to the Atlanta CDC. Then he asked me if I was living in a long-term nursing home? Or was I from China?

The doctor changed my medicine and said it was the highest grade penicillin. That night I didn't have a fever anymore. I was discharged on the fourth day, which was already January 2. I spent the New Year of that year in the hospital ward. Before I was discharged, the doctor prescribed 12 days of medicine and asked me to go to the outpatient clinic every day to infuse a small bag of it. He also put a catheter in my right upper arm so that I didn't need to get an injection every day for infusion. I just had to wrap the area with plastic wrap when I took a shower.

The infusion did not affect breastfeeding, and I started breastfeeding day and night again after I was discharged from the hospital. Sometimes I secretly miss the time in the hospital. The day when the indwelling needle was removed after 12 days of infusion was exactly my 38th birthday.

Looking back now, the cesarean section with a catheter, the fatigue after giving birth, the low immunity, and the fact that I had plenty of milk but didn’t remember to drink water in time could all be the cause of the urinary tract infection. It could also be that I was too focused on taking care of the baby and didn’t notice the urinary urge symptoms, so by the time I had a fever, it had already turned into pyelonephritis. And I didn’t drink any water during the three hours I waited in the emergency room, which led to extreme dehydration. I went to the emergency room with a high fever and had a near-death experience.

Doctor's comments

Ma Hong | Associate Chief Physician, Department of Urology, Beijing Hospital

This is a very interesting and typical case.

Pregnancy is a common time for young patients to have urinary tract infections. For patients with mild symptoms, the first choice is generally to drink more water and maintain local hygiene. In order to avoid affecting the fetus, antibiotics will not be used at this time. For patients with more severe symptoms, cephalosporins with relatively small effects can be tried for symptomatic treatment.

Postpartum lochia is a high-incidence period for infection, so patients are encouraged to drink more water and increase urine output to promote the disappearance of inflammation. The author of this article considers pyelonephritis combined with toxic shock, and the risk of death is very high. More serious toxic shock is generally more common in infections such as Escherichia coli, Enterococcus faecalis, and Staphylococcus aureus. In this case, better antibiotics should be used routinely, and vital signs should be monitored and symptomatic fluid replacement should be given.

It is best to stop using antibiotics when the patient's temperature is normal and the urine culture is negative for two consecutive weeks. The author's treatment was relatively timely and accurate. Because many people in China abuse antibiotics, multidrug-resistant bacteria are relatively more common in China. Compared with American doctors, most Chinese doctors are more relaxed when dealing with these diseases.

To quote the author's summary, "Catheterization during cesarean section, fatigue after childbirth, low immunity, and my ample breast milk but not remembering to replenish water in time may all be causes of urinary tract infection." The development into pyelonephritis was mainly due to low immunity after childbirth and the failure to deal with the infection in time. Finally, it developed into infectious toxic shock, not only because of dehydration, but also because the infection caused a large amount of blood volume to enter the third space, resulting in insufficient effective circulating blood volume.

In summary, urinary tract infections are very common, especially in women, and drinking less water and fatigue are the main causes. It is necessary to moderately increase the amount of water you drink, pay attention to local hygiene, and avoid excessive fatigue.

Author: Anne

Editor: Muyi Yangyang