uti

 
one 72 year old male,hypertensive non diabetic non smoker, patient presented with sleepiness and confusion 5 years ago. On investigation he had urinary tract infection with pus cell count of over 100 per hpf. He also had elevated serum creatinine . Repeated ultrasound abdomen revealed slight prostatomegaly with pvr of 50 to 70 ml, no calculi. kidney normal.cystoscopy was normal. Following culture and sensitivity of urine specimen which revealed klebsella infection anti biotics were started which included septran , ciproflox, and others but to no avail. kidney failure worsened. Polymerase chain reaction for mycobacterium tuberculosis revealed a positive and a negative specimen. rifamcin isonex ethambutol and ciprofloxacillin were started and after long period he started improving. serum creatinine and urine parameters became normal. 
the problem was that on reducing ATT the urine started again showing 100 pus cells per hpf. Rifampcin had to be continued for 5 years . lately he started showing singns of agitation and it did not improve with dothiepin and larpose but improved with haloperidol . so a diagnosis of psychosis was made and rifampicin stopped. Again his urine is full of pus cells and shows resistence to most antibiotics. he is showing resistant klebsella infection. mri brain is normal
what should be the choice of antibiotics and should his prostatomegaly be operated.it only shows 50 ml pvr.
i shall be grateful. The case has been managed by many internists and nephrologist. quite a puzzle
is he resistant uti with compromised renal function. or prostatitis. or infection in seminal vescicles. urine also shows lots of rbc recurrently.or obstructive uropathy. or tuberculosis of lower urinary tract. bladder wall is thick

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