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