@rosemarya Rosemary, are the UTIs due to having a weakened immune system from the immunosuppressants? I do not generally use the hot tub at my health club because I am afraid of UTIs. I spoke to my surgeon about it and told him I only use it when I have been in the pool for a while and the hot tub has been unoccupied so I figure the chemicals would have killed any bacteria by then. He left it up to my discretion on whether I used it or not.
When I had my first HE episode and went to the outpatient part of the hospital on Christmas Eve, 2013, part of my diagnosis was that I had a UTI and apparently in some older people UTIs can cause confusion, similar to HE episodes. Now they realize though that urine is not sterile (they used to think it was) so if the bacteria count is low it may well not actually be a UTI. I doubt it was then, nor a couple of more times after that when I showed a low level of bacteria. Still, I worry about UTIs now due to the immunosuppressants. Do you use a pool or hot tub that could cause yours?
JK

@contentandwell and @rosemarya I also have a history of frequent UTIs. My physicians have explained that: 1-My frequent loose stools may set the stage for bacteria to migrate into the urinary canal. 2-The bladder is never completely emptied and because of immunosuppressant's and my other gastric issues the residual urine may be over-colonizing with bacteria. 3-If I don't drink enough water to urinate every two hours I increase the probability of bacterial overgrowth in my urine. and 4-Make sure to wipe front to back after toileting (I know, but they always say this, lol). Despite all that info and following those practices I still developed UTIs and am now on a prophylactic antibiotic to reduce the amount of my UTIs. I am not drawn to water so I do not sit in hot tubs and rarely take a bath. I can't get past the thought of all those germs waiting in the bottom of the tub to climb all over my body. lol I can attest to the fact that UTIs in the elderly can cause confusion. My mother had an extended UTI last year and ended up in the hospital in full-blown dementia. Once the infection was cleared she returned to her usual state of cognition. She does not even remember that hospitalization.

@2011panc Reading your post I am amazed that I have managed to avoid UTIs since my liver transplant. My stools are loose, for which I am taking metamucil twice a day but I still have problems, I have incontinence problems and I know that my bladder does not totally empty. I do drink a lot of water though, something stressed to me to keep my kidneys flushed and keep my creatinine level down. The last cause of course is something we have all been warned about for many years.
Interesting that your mother did have a confusion episode from a UTI. I guess they were right but when I think that they thought they thought that was causing my confusion problems for so long it boggles my mind that combined with my lowering platelet count no one had a light go off in their head that maybe they should look at my liver! I realize now how many symptoms I actually did have.
As I said, I very rarely go in the hot tub at my health club. Many of the people in the classes do go in afterward and that becomes a social thing but I avoid it, go and take a shower, and use the sauna. I would enjoy the sociability but it's not worth it.
JK

@contentandwell, I do not use pools or hot tubs. I suspect that the immunosuppression has some effect on it - or maybe it is my alertness to any physical change from what I consider to be normal for me.

@2011panc, We observed similar UTI / cognition issues with my mother-in-law. Nursing home noticed the unusual behavior, and after treatment, she improved.

@rosemarya if a hot tub is well maintained there should not be a problem. At my club they test the water about every two hours but of course things can happen between testings and if there is any bacteria present, being on immunosuppressants will impede your defenses from rejecting them. I would never use one at a hotel now, but as I mentioned, if I see that the hot tub is vacant for a long time while I am in the pool I do occasionally take a dip, it is so relaxing and after the colder water of the pool the hot water in the tub feels good. Most of the time I just get warm in the sauna though.
JK

@rosemarya Although my doctors did consider that to be a possibility they felt that I was too young for that to be the probable cause. Anything is possible though.
JK