UTIs?

[ohbet]

An elderly patient has chronic UTIs, and she has one now, so I was going to call the doc. with the lab results when another nurse said that infection control told her "that if some one with frequent UTIs,has a lab that says there is a UTI but the bacteria are colonized,and they are asymptomatic,then its not necessary to treat the UTI."

Can someone explain to me the scientific reasoning behind this statement?

[aimeee, BSN, RN]

Asymptomatic bacteriuria is common in the elderly. In a nutshell, the studies don't really show any long term benefit from treating it and in fact, show that this is one of those cases where the cure is worse than the condition. The patients are subjected to the side effects of the antibiotics, yet the bacteria tends to return within a short time period anyway, and often in a more resistant form.

"In 50 institutionalized elderly women randomized to treatment or no treatment and followed for one year, morbidity from urinary infection was similar in treated and non-treated groups. Antimicrobial therapy, however, was associated with significantly more adverse medication effects, increased reinfections, and a tendency to emergence of resistance. Mortality was 4 (18%) for untreated and 9 (39%) for treated subjects. Thus, these studies in the institutionalized elderly support the non-treatment of asymptomatic bacteriuria."

"One characteristic of the institutionalized bacteriuric elderly is the rapid recurrence of bacteriuria following antimicrobial therapy. In most individuals, treatment of asymptomatic bacteriuria is followed by an extremely short period free of bacteriuria, with over 50% recurring within 2-4 weeks of discontinuing antimicrobials. "

http://www.ctfphc.org/Full_Text/Ch81full.htm