UTIs, Bacteriuria & Antibiotics

1. UTIs, Bacteriuria & Antibiotics Irene Campbell, GNP

2. The Project • A CDC-funded initiative to educate LTC nursing staff, medical providers, and family members on Asymptomatic Bacteriuria (ASB) and UTIs • Initiative Members: DPH; Mass Coalition for the Prevention of Medical Errors; Mass Pro; Mass Senior Care Association • Goals: • Reduce the unnecessary testing and treating of Asymptomatic Bacteriuria (ASB) in LTC • Reduce the prevalence of antibiotic resistance • Reduce the incidence of Cdiff Colitis

3. 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.

4. 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.

5. What is Asymptomatic Bacteriuria The presence of bacteria in the urinary tract withoutspecific signs or symptoms of urinary tract infection Present in up to 50% of elderly in LTC Not harmful Does not require antibiotics

6. 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

7. Criteria for Testing for UTI (Non-Catheterized) New burning or pain on urination ALONE OR Fever PLUS one specific symptom OR At least two specificsymptoms

8. 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

9. 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

10. 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

11. 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

12. What if?? Non-specific symptoms • Confusion • Lethargy • Poor appetite • Behavior change: agitation, aggression PLUS Bacteria in the urine! AND Unable to verbalize symptoms!!

13. Now What? Investigate other causes first: Constipation New medication or dose Dehydration Pain Urinary retention Pneumonia Environmental irritants Having a bad day!

14. 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

15. 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

16. 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

17. 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 www.macoalition.org