To Treat or Not to Treat: UTI or Bacteriuria?

Reflex urine culture grew 100,000 colony-forming units (CFU)/mL of E. coli. a. Start ciprofloxacin for E. coli UTI b. Start broad-spectrum antibiotics pending infectious work-up c. Restart the higher dose of quetiapine and give Haldol to calm the patient down d. Hold antibiotics, hydrate and continu...

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Bibliographic Details
Published inMedicine and health, Rhode Island Vol. 103; no. 2; pp. 31 - 35
Main Authors Macias-Gil, Raul, O'Neill, Emily, Gaitanis, Melissa M
Format Journal Article
LanguageEnglish
Published Providence Rhode Island Medical Society 01.03.2020
Subjects
Antibiotics
Antimicrobial agents
Bacteria
Catheters
Drug dosages
E coli
Intubation
Long term health care
Nosocomial infections
Pathogens
Patients
Polypharmacy
Urinary tract infections
Urine
Urogenital system
Women
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Summary:Reflex urine culture grew 100,000 colony-forming units (CFU)/mL of E. coli. a. Start ciprofloxacin for E. coli UTI b. Start broad-spectrum antibiotics pending infectious work-up c. Restart the higher dose of quetiapine and give Haldol to calm the patient down d. Hold antibiotics, hydrate and continue a careful workup for metabolic issues and medication side effects. [...]many patients like the one described above end up receiving unnecessary antibiotics. ASB is more prevalent in men and women living in a long-term care facility (up to 50%) followed by elderly persons (>70 years old) living in the community (10.8 to 16% in women and 3.6 to 19% in men).3 Persons with spinal cord injury requiring intermittent catheterization and sphincterotomy/condom catheter was as high as 69% and 57%, respectively45 One study has even reported a 100% prevalence of asymptomatic bacteriuria in persons with indwelling catheters.6 The risk of developing bacterial colonization in patients with indwelling catheters is directly proportional to the length of time the catheter will remain in place. More than 50% of these patients were considered to have bacteriuria but 32% of these received inappropriate treatment.11 Another observational study found that the average length of inappropriate treatment for ASB was around 6.6 days, resulting in two cases of C. difficile infection and one case of QT prolongation.12 Treating patients who do not need to be treated could result in colonization with increasingly resistant urinary bacteria, untoward patient adverse events or hospital-acquired infections.
ISSN:2327-2228