UTI VS. Asymptomatic Bacteriuria

Posted By Chris on

Situation: One of the nurses tells you she has an elderly, asymptomatic female patient who has been diagnosed with three urinary tract infections in the past three months. The physician orders Levaquin each time he is called with positive culture results and orders repeat cultures when the antibiotic is completed. The cultures usually come back positive for E. coli.

What should you as the Infection Preventionist, do in this situation?

Confirm the nurses who have placed the calls to the physician have assessed the patient completely before calling and also confirm they have reported in detail, the fact that the patient is not exhibiting any signs and symptoms of UTI such as dysuria, flank pain, frequency, etc.

In-service the nursing staff on Urinary tract infection; use Mcgeer’s Definitions of Infection for surveillance in long-term care facilities (A. Mcgeer, MD, et all, 1991) this is the standard used in most long-term care facilities. McGeers

The document can be found under resources on this site. Point out the differences between infection (positive signs and symptoms) and bacteriuria (the presence of bacteria in the urine with no signs and symptoms of infection). Remind nurses of the association between inappropriate use of antibiotics and C. difficile disease.

You as the nurse,could call the patient’s physician, discuss the facts with him, ask if the patient could have bacteriuria and ask if he wants to continue current antibiotic therapy. If there is no resolution to the problem you should contact your facility’s Medical Director and ask for their expertise and possible intervention. See Pub Med.org

About the author

Chris

Hello, my name is Chris Walter. I am a Registered Nurse with experience in several nursing specialties including Surgery, Case Management, Legal Nurse Consulting, Community Health, and Infection Prevention and Control. I have a BSN, a California Public Health Nursing Certificate (PHN) and I am also Certified by the Certification Board of Infection Control and Epidemiology (CIC). My hope is to facilitate the sharing of knowledge and resources with Health Care Workers who have an interest in the specialty of Infection Prevention and Control in Long-term Care. Please feel comfortable contacting me at icpreventionist@aol.com and share your comments with The Preventionist as well. I consider myself a perpetual student, rather than an expert. My intent is to provide information based on recommendations from the masters of infection control and prevention such as; •The Association for Professionals in Infection Control and Epidemiology (A.P.I.C.) •The Centers for Disease Control and Prevention (CDC) •State Department of Public Health All information contained within The Preventionist site is strictly for informational purposes only. None of the statements on this site are to be considered a recommendation for treatment of any particular disease or health related condition.

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