Asymptomatic Bacteriuria in Long-Term Care

What is asymptomatic bacteriuria? Can antibiotics help in ASB management? • Asymptomatic bacteriuria (ASB) is the presence of Current recommendations do not support routine bacteria in the urine without any signs or screening for or treatment of ASB in LTCF residents. symptoms of infection. Studies describing the effect of antibiotic treatment for ASB among LTCF residents have shown: Isn’t urine supposed to be sterile? • No effect on: • Even though bacteria are not normally present in o Risk for disease or death the urinary tract, bacteria can live in the bladder o Symptoms of chronic incontinence without causing disease. o Future episodes of urinary tract infection (UTI) • Negative effects on LTCF residents: What causes asymptomatic bacteriuria? o Increased drug side effects ASB is very common and is considered a harmless o Increased super bugs (bacteria resistant to condition among long-term care facility (LTCF) antibiotics) residents. Several factors contribute to ASB, including: o Increased cost of medication and healthcare • Indwelling urinary catheter Screening and treatment of ASB is appropriate for LTCF • Increased age residents under specific circumstances, as described by • Increased number of medical conditions the Infectious Diseases Society of America Guidelines for • Increased number of medications the Diagnosis and Treatment of Asymptomatic • Decreased ability to perform independent Bacteriuria in Adults activities of daily living (http://cid.oxfordjournals.org/content/40/5/643.full.pd • Decreased mental status f+html) • Decreased bladder emptying • Dehydration and poor fluid intake • Residence in a long-term care facility Bacteriuria without clinical symptoms of a UTI should not be treated with How should ASB be managed? antibiotics Caregivers • Regular, careful hand hygiene Is asymptomatic bacteriuria the same as a UTI? • Glove use by care providers before and after No. Even though bacteria in the urine is common to assistance with toileting, bathing and when there both UTI and ASB, what makes them different is that a is potential for contact with blood or bodily fluids UTI causes specific resident symptoms. Nursing plays an Resident care: important role in helping providers decide whether a • Frequent resident toileting opportunities UTI is present by carefully assessing, documenting, and • Good peri-care (wiping front-to-back) communicating residents’ symptoms. • Appropriate fluid intake, as determined by resident’s healthcare provider • Catheter use only when medically necessary ASYMPTOMATIC BACTERIURIA IN LONG- TERM CARE

What signs and symptoms of UTI should be present in If a resident experiences falls, mental status changes, or LTCF residents for initiation of antibiotics? other non-specific declines in status, does the resident have a UTI? • Resident WITHOUT indwelling catheter Falls, mental status changes, and other changes require evaluation, but are not symptoms specific Acute dysuria (pain with urination) to UTI. Current guidelines do not link these Note: Dysuria alone is an indication to start symptoms to a UTI that needs antibiotic antibiotics without any other symptoms treatment. OR Fever: >37.9°C (100°F) or a 1.5°C (2.4°F) increase above Does foul-smelling urine mean that a resident has a baseline temperature UTI? PLUS at least one of the following symptoms: • A resident’s urine can smell foul for several • New or worsening: reasons, including dehydration, diet, medication, o Urgency or when certain bacteria are present. Foul- o Frequency smelling urine without clinical symptoms of a UTI o Suprapubic pain does not require antibiotics. o Costovertebral angle tenderness o Urinary incontinence If a resident has pyuria (WBCs / pus in the urine) does it mean he or she has a UTI? o Gross hematuria • Pyuria is an immune response to bacteria present Resident WITH indwelling catheter in urine. The presence of pyuria alone does not mean that the resident has a UTI. Presence of at least one of the following symptoms: • Pyuria without clinical symptoms should not be • Fever: >37.9°C (100°F) or a 1.5°C (2.4°F) increase treated with antibiotics, according to current above baseline temperature guidelines. • New costovertebral angle (CVA) tenderness • Rigors (shaking chills) If a resident needs antibiotics, does it matter if urine is • New onset of delirium collected before or after antibiotics are started? • Collect a urine specimen prior to giving antibiotics in order to ensure an accurate test result. • Urinalysis (UA) or UC should be performed on Minnesota Department of Health residents with clinical signs or symptoms of a UTI. Infectious Disease Epidemiology, Prevention, and Control Division 651-201-5414 | 1-877-676-5414 References: www.health.state.mn.us Loeb et al. Development of Minimum Criteria for the Initiation of Antibiotics in Residents of Long-Term Care Facilities: Results of a Consensus Conference. Inf Control Hosp Epi. 2001 Material adapted from the Massachusetts Coalition for the Prevention of Medical Errors and the Minnesota Antibiotic Resistance Collaborative

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