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UTIs, Bacteriuria & Antibiotics
IRENE CAMPBELL, GNP
The Project
o A CDC-funded initiative to educate LTC nursing staff, medical
providers, and family members on Asymptomatic Bacteriuria (ASB)
and UTIs
o Initiative Members: DPH; Mass Coalition for the Prevention of
Medical Errors; Mass Pro; Mass Senior Care Association
o Goals:
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Reduce the unnecessary testing and treating of Asymptomatic
Bacteriuria (ASB) in LTC
Reduce the prevalence of antibiotic resistance
Reduce the incidence of Cdiff Colitis
TRUE OR FALSE
 Infections are a serious problem in the elderly.
 Bacteria in the urine is always a sign of an active
Urinary Tract Infection (UTI).
 Mental Status changes are a strong indication of UTI
in the elderly.
 Antibiotics are very safe drugs to use with the
elderly.
What is an Infection? What is a UTI
An infection is the invasion of a person’s bodily
tissues by disease-causing organisms.
A UTI is a systemic infection of the urinary tract.
What is Asymptomatic Bacteriuria
 The presence of bacteria in the urinary tract
without specific signs or symptoms of urinary
tract infection
 Present in up to 50% of elderly in LTC
 Not harmful
 Does not require antibiotics
Risk Factors for Getting UTI
 Catheters in the bladder
 Incomplete emptying of the bladder
 Constipation
 Prostate enlargement
 Uterine Prolapse
 Certain medications
 Impaired Immune systems
 Poor hygiene
Criteria for Testing for UTI (Non-Catheterized)
 New burning or pain on urination ALONE
OR
 Fever PLUS one specific symptom
OR
 At least two specific symptoms
Criteria for Catheterized Residents
At least one of the signs or symptoms below:
 Fever (new or increased)
 Costo-vertebral angle (CVA) tenderness
 Rigors (shaking chills)
 Delirium (acute confusion)
 Flank pain (back, side pain)
 Pelvic discomfort
 Acute hematuria
 Malaise or lethargy with no other cause
UTI: Specific Signs & Symptoms
 Burning
on urination (dysuria)
 Blood in urine (hematuria)
 Urgent need to urinate (urgency)
 Frequent need to urinate (frequency)
 New or worsened urinary incontinence
 Abdominal pain
 Flank pain
Antibiotics: Benefits & Risks
 Combat infection
BUT
 May cause allergic reactions
 Nausea/vomiting/non-infectious diarrhea
 May result in severe, infectious diarrhea (Cdiff)
 May create mutant strains of bacteria, resistant to
antibiotics
Antibiotic Resistance
 Organisms resistant to antibiotics
 A serious, growing problem
 Due to overuse and inappropriate use of
antibiotics
 Combined with patient’s allergies, may not be able to
treat future infections
 Asymptomatic bacteriuria often treated with
antibiotics unnecessarily
What if??
Non-specific symptoms
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Confusion
Lethargy
Poor appetite
Behavior change: agitation, aggression
PLUS
Bacteria in the urine!
AND
Unable to verbalize symptoms!!
Now What?
Investigate other causes first:
 Constipation
 New medication or dose
 Dehydration
 Pain
 Urinary retention
 Pneumonia
 Environmental irritants
 Having a bad day!
Then what?
Nursing assessment and monitoring:
Vital signs
 Blood glucose level if diabetic
 Fluid intake
 Bowel pattern
 Urinary retention
 Respiratory status
 Review medications
 Hunger, Thirst, Pain
 Environmental precipitants

Other things for clinicians to consider
 Drug levels
 Seizure medication levels in the blood
 Digoxin
 Depakote
 Complete Blood Count (infection)
 Kidney Function test
 Liver Function Tests
And Then what?
 Symptoms resolve with nursing measures ,
treatment of underlying conditions or spontaneously
OR
 Specific urinary signs/symptoms or fever emerge
→ Test for UTI and Treat with antibiotic
Summary
 Bacteriuria is very common in elderly
 Antibiotics should be reserved for specific signs and
symptoms of UTI
 Antibiotics are not harmless drugs for an individual
 Antibiotic resistance is a serious public health issue
 We all need to change how we think about using antibiotics
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