PERSISTENT URINARY TRACT INFECTION DESPITE TARGETED ANTIBIOTICS: THE ROLE OF SURGICAL INTERVENTION IN ENCRUSTED CYSTITIS CAUSED BY CORYNEBACTERIUM UREALYTICUM

Background: Corynebacterium urealyticum is a Gram positive, slow-growing bacterium that is a most commonly cause of encrusted cystitis. A major clinical problem is recurrent urinary tract infections with encrustation of the bladder mucosa especially for multimorbid individuals with weakened immune systems. Case report: We present the case of a 75-year-old male who was admitted to the urology department with perineal and urethral pain, dysuria, and macrohematuria. His medical history included complicated benign prostatic hyperplasia, vesical and splenic calculi, chronic cystitis, recurrent complicated urinary tract infections, and multiple prior urological interventions. Cystoscopy demonstrated nonspecific inflammation, incrustation of the bladder mucosa and prostatic area, and multiple bladder stones. Urine culture identified Corynebacterium urealyticum, which was susceptible to vancomycin. The patient received a 7-day course of vancomycin; however, no clinical improvement was observed. Surgical debridement of the urethral and bladder mucosa was subsequently performed, followed by a 2-week course of vancomycin. The patient’s clinical condition improved markedly after this combined approach. Conclusion: This case highlights the importance of considering rare infectious agents in patients with recurrent urinary tract infections, particularly in those with a history of multiple hospitalizations and broad-spectrum antibiotic exposure. Infectious calculi can act as a persistent source of infection and may not respond to systemic antibiotic therapy alone. In such cases, surgical debridement of the mucosa is essential to achieve effective treatment.