It’s no secret that I work with a lot of geriatric patients. These things have been on my mind lately about the management of UTI’s, so just wanted to share them.
- With rare exception, asymptomatic bacteriuria (ASB) should not be treated. ASB is defined as “isolation of a specified quantitative count of bacteria in an appropriately collected urine specimen from an individual without symptoms or signs of urinary tract infection” via Uptodate.
- Cloudy urine alone is not a reason to get a urinalysis. I see this frequently from nurses who are legitimately trying to do the right thing, but it leads to increased risk of adverse effects from medications as well as risking increasing problems with future resistance. A few other potential signs of infection include fever, pain in the abdomen or back, change in cognition (especially in the elderly), or painful urination.
- About once or twice a year I see an order for a routine UA to be performed to detect bacteria in the urine. A positive result in this situation again leads to potential overuse of antibiotics and put patients at risk of increased resistance as well as adverse effects and drug interaction. No symptoms of infection, no treatment!
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Eric: I work with paeds but I had a bad experience with my mother who is 86. She had an urinary infection without symptoms. Then I learned that this is very common in the elderly, many of them end admitted in hospitals because they are very ill, as the infection is detected too late. The home where she lives perform an urine analysis twice a year, taking into account this lack of symptoms.
Fever in the elderly is very rare due to urinary infections. My mother never had, despite this threatening infection. Maybe if it had been detected earlier she could have avoided being admitted and treated with i.v. ATBs
Appart from this comment, some quizzes about pediatric pharmacy would be wellcome!
In your practice are doctors actually following this practice? I wonder about liability issues and a pt being sent home only to get worse because they didn’t have symptoms!