Irene Campbell, GNP
A CDC-funded initiative to educate LTC nursing staff, medical providers, and family members onAsymptomaticBacteriuria(ASB) and UTIsInitiative Members: DPH; Mass Coalition for the Prevention of Medical Errors; MassPro; MassSenior CareAssociationGoals:Reduce theunnecessary testing and treating of AsymptomaticBacteriuria(ASB) in LTCReducethe prevalence of antibioticresistanceReducethe incidence ofCdiffColitis
TRUE OR FALSE
Infections are a serious problem in theelderly.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.Antibioticsare very safe drugs to use with theelderly.
What is an Infection? What is a UTI
An infectionis theinvasionof aperson’s bodily tissues by disease-causing organisms.AUTI is asystemicinfection of the urinary tract.
What is AsymptomaticBacteriuria
The presence of bacteria in the urinary tractwithoutspecificsigns or symptoms of urinary tract infectionPresent in up to 50% of elderly in LTCNot harmfulDoes not require antibiotics
Risk Factors for Getting UTI
Catheters in the bladderIncomplete emptying of the bladderConstipationProstate enlargementUterine ProlapseCertain medicationsImpaired Immune systemsPoor hygiene
Criteria forTesting for UTI (Non-Catheterized)
New burning or pain on urinationALONEORFeverPLUSone specific symptomORAt leasttwospecificsymptoms
Criteria for Catheterized Residents
At leastoneof the signs or symptoms below:Fever (new or increased)Costo-vertebralangle (CVA)tendernessRigors(shaking chills)Delirium (acute confusion)Flankpain (back, side pain)PelvicdiscomfortAcutehematuriaMalaiseor lethargy with no other cause
UTI: Specific Signs & Symptoms
Burningon urination (dysuria)Blood in urine (hematuria)Urgent need tourinate (urgency)Frequent need tourinate (frequency)Neworworsenedurinary incontinenceAbdominal painFlank pain
Antibiotics: Benefits & Risks
Combat infectionBUTMay cause allergic reactionsNausea/vomiting/non-infectious diarrheaMay result in severe, infectious diarrhea (Cdiff)May create mutant strains of bacteria, resistant to antibiotics
Organisms resistant to antibioticsA serious, growing problemDue to overuse andinappropriateuse of antibioticsCombined with patient’s allergies, may not be able to treat future infectionsAsymptomaticbacteriuriaoften treated with antibiotics unnecessarily
Non-specific symptomsConfusionLethargyPoor appetiteBehavior change: agitation, aggressionPLUSBacteria in the urine!ANDUnable to verbalize symptoms!!
Investigate other causesfirst:ConstipationNew medication or doseDehydrationPainUrinary retentionPneumoniaEnvironmental irritantsHaving a bad day!
Nursing assessment and monitoring:Vital signsBlood glucose level if diabeticFluid intakeBowel patternUrinary retentionRespiratory statusReview medicationsHunger, Thirst, PainEnvironmental precipitants
Other things for clinicians to consider
Drug levelsSeizure medication levels in the bloodDigoxinDepakoteComplete Blood Count (infection)Kidney Function testLiver Function Tests
And Then what?
Symptoms resolve with nursing measures , treatment of underlying conditions or spontaneouslyORSpecificurinary signs/symptoms or fever emerge → Test for UTI and Treat with antibiotic
Bacteriuriais very common in elderlyAntibiotics should be reserved for specific signs and symptoms of UTIAntibiotics are not harmless drugs for an individualAntibiotic resistance is a serious public health issueWe all need to change how we think about using antibioticswww.macoalition.org