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Abstract: Wang, 60 years old, presented with “recurrent frequent and painful urination” and occasional fever. Self-report: She had long-standing type 2 diabetes mellitus without regular blood glucose monitoring and regular glucose-lowering treatment. He was diagnosed with “urinary tract infection and type 2 diabetes mellitus”, and was recommended to be admitted to the hospital based on his medical history and symptoms. After hospitalization, through strict blood glucose management and antibiotics and other symptomatic treatment, the body temperature was normalized, urinary urgency and painful urination were relieved, and blood glucose reached the standard.
Basic information】Female, 60 years old
Disease Type】Urinary tract infection, type 2 diabetes mellitus
Hospital】Associated Hospital of Fujian Medical University
Date of Consultation】June 2022
Treatment Plan】Medication (Levofloxacin Hydrochloride Injection, Glycine Insulin Injection)
Treatment period】Inpatient treatment for 15 days, outpatient follow-up after 1 week
Treatment effect] Temperature normalized, urinary urgency and pain relieved, blood glucose reached the standard
I. Initial consultation
Ms. Wang came to our hospital in June 2022 with “recurrent frequent and painful urination for six months”. Self-report: Recently, she had occasional fever with a maximum temperature of 37.6℃. After detailed medical history, he learned that he had long-term type 2 diabetes mellitus without regular blood glucose monitoring, regular glucose-lowering treatment, or even diet control, and had been in a coma with diabetic ketoacidosis once.
Urine routine suggests: leukocytes 3+, urine sugar 3+, urine nitrite +, urological ultrasound: no special except for a few crystals in both kidneys. Consider “urinary tract infection, type 2 diabetes mellitus”. We recommended hospitalization to strengthen anti-infection and strict control of blood sugar.
II. Treatment process
After hospitalization, she was given empirical levofloxacin hydrochloride injection for treatment. After two days of use, she still had occasional fever, with a maximum temperature of 37.3℃, which was lower than before admission. Urine culture results: Enterobacter aerogenes infection, according to the drug sensitivity test to select sensitive antibiotic levofloxacin hydrochloride injection for anti-infection treatment. At the same time, the endocrinology department was asked to assist in the consultation. Initially, the blood glucose was too high to be measured, and glycine insulin injection was given for continuous blood glucose control. The family initially refused to use insulin for fear that it would not stop after the injection, but they were told that if the blood glucose was not controlled, the infection would easily recur and would not be easily cured.
(Interruption of urine bacterial culture + drug sensitivity)
III. Treatment effect
After the endocrine consultation, she was instructed to control her diabetic diet and use appropriate medications to control her blood sugar and prevent infection, her body temperature was normal for several days and her blood sugar gradually reached the standard. On the 15th day of hospitalization, the urine routine was rechecked: the white blood cells were negative, the urine sugar was also negative, and the symptoms of urinary urgency and pain were relieved compared with those before admission, so she was discharged. Before discharge, she was instructed to review her condition in 1 week, continue oral medication and pay attention to blood sugar control.
(Review of urinary routine)
IV. Notes
We are glad that Wang’s condition is stable after medication, her blood sugar is more stable than before, and her urinary urgency and pain are relieved than before admission. However, after discharge, she should pay attention to the fluctuation of blood sugar, pay attention to regular monitoring, and use insulin or hypoglycemic drugs regularly for control. Usually pay attention to rest, three regular meals, and avoid foods with high sugar content, such as moon cakes and cakes. Participate in exercise properly, drink water to promote urination and do not hold urine. Change underwear regularly and pay attention to personal hygiene and cleanliness. Urinary tract infections are prone to recurrence. If symptoms such as frequent urination, painful urination, fever or even coma appear again, promptly visit the outpatient clinic for review and consultation.
V. Personal insight
Postmenopausal elderly women with long-term uncontrolled diabetes mellitus are often susceptible to urinary tract infections, as in the case of Ms. Wang. Therefore, strict control of blood sugar while treating urinary tract infections will help improve Ms. Wang’s systemic and local symptoms, in addition to controlling the infection. The treatment should be administered strictly according to medical advice and the dosage should not be changed at will. In addition, urinary tract infections are prone to recurrence, so in addition to anti-infection treatment, paying more attention to hygiene habits and regular review can also reduce the incidence of urinary tract infections.