5.3 Treating UTIs

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Del curso dictado por The University of North Carolina at Chapel Hill

Infection Prevention in Nursing Homes

119 calificaciones

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The University of North Carolina at Chapel Hill

Infection Prevention in Nursing Homes

119 calificaciones

Learn about the role of environment in disease transmission and how to implement standard and transmission-based precautions to prevent the spread of antibiotic resistant bacteria and other infections in your facility.

De la lección

UTI Prevention in Nursing Homes

The goal of this module is to describe the risk factors, symptoms, and prevention of urinary tract infections. To obtain CE Credit for this module: Take the Quiz and complete the evaluation at the end of the module, you will be directed to your course completion certificate.

5.1 Epidemiology of UTIs10:51

5.2 Diagnosing a UTI11:06

5.3 Treating UTIs3:49

5.4 Prevention of UTIs9:01

Conoce a los instructores

Evelyn Cook
Associate Director
North Carolina Statewide Program for Infection Control and Epidemiology (SPICE)

We already know that up to 40% or more of residents without an indwelling catheter,

have asymptomatic colonization of the urinary tract, and

that a positive culture is a common and expected finding at any time.

When localizing and systemic symptoms or signs such as fever or

shaking chills, painful urination, blood in urine, pain or

tenderness along the urinary tract and a new or increased frequency, urgency or

incontinence are also present, diagnosis and treatment of a UTI is appropriate.

In residents without any signs or symptoms who have a positive urinalysis and

positive culture, there are often benign findings and

should not be treated, as this can be harmful to the resident.

Prescribing antibiotics is the subject of increased scrutiny due to the overuse of

antibiotics, and resulting resistance to antibiotics that many organisms develop.

The upward trend of C Difficile diarrhea cases and

increasing antibiotic resistance has led to the positive practice

of shifting from broad to narrow spectrum antibiotics.

The use of narrow spectrum antibiotics is based on the need for

accurate diagnosis, and the importance of obtaining cultures

in the elderly population before starting antibiotics.

Local antibiotic resistance patterns are increasingly utilized for

aiding in the prescribing of antibiotics to ensure that the infecting bacteria and

available antibiotics are appropriately matched up.

When clinicians are selecting antibiotics for treating UTIs,

they should follow evidence-based clinical guidelines, such as those published by

the Infectious Disease Society of America, or other professional societies.

Clinicians faced with the decision to treat with antibiotics or employ monitor

and observe, often opt for antibiotics due to the concerns over missing an infection,

delaying treatment, or not meeting a resident's or family's expectations.

In doing so, physicians overvalue the benefits of antibiotic therapy,

while undervaluing the strong likelihood of negative outcomes related to treating

asymptomatic bacterial colonization such as Clostridium difficile,

adverse drug events, and antibiotic resistance.

The appropriate choice is to monitor and

observe the resident, which is called watchful waiting.

The example observation order set,

shown here, ensures that the resident is receiving supportive care,

provides reassurance that the resident is being adequately cared for, and

emphasizes prompt communication for changes in condition.

The goal of treatment for

UTI is to alleviate symptoms, not to create a sterile bladder.

If the resident appears to be responding to the therapy,

it is not necessary to re-culture after a course of antibiotics.

Polymicrobial bacteriuria often persists after a course of antibiotics and

does not mean the treatment has failed.

A urine test alone does not provide sufficient information.

Increases the risk of treating asymptomatic bacteriuria,

as well as the risk of adverse drug events, C difficile infection, and

antimicrobial resistance.

To sum up, a positive urinalysis and or urine culture only tells you that bacteria

are present in the bladder, and does not necessarily indicate an infection.

For a UTI to be present, the resident must have systemic and or

local signs and symptoms and a positive culture.

Only then should an infection be treated.

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