negative urinalysis, positive symptoms

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Specializes in Med-Surg, LTC.

We had a patient today who is extremely confused. Per the daughter, this is not her baseline, (Although the daughter deals with her in a way that makes me think it might be baseline). Daughter is convinced the confusion is from a UTI. the urinalysis shows NO WBC, NO leukocyte esterase, and 1+ bacteria. The culture did grow out >100000 colonies of ecoli. My question is this: Can you have symptoms (such as confusion) without having an active infection indicated by WBC? I had heard NO from some MDs, but this patient's wanted to treat (perhaps to keep daughter happy). I thought that alot of persons had asymptomatic bacteriuria and that the guidelines for treating was presence of leukocyte esterase and/or WBC in urine. (BTW, the lady's serum WBC weren't elevated, either).

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Specializes in Mental and Behavioral Health.

Does she have fever, flank or pelvic pain, pain or burning upon urination, or a change in the character of the urine. A UTI can cause confusion, but so can a host of other things

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Specializes in Med-Surg, LTC.

No fever or other symptoms. Diagnosis of dementia with a significant psych history, medical workup had been negative expect for the culture. My facility tends to jump on the UTI bandwagon every time someone can't remember what day it is. (I disagree with this, but get into hot water with the DON if I don't ask the doc for a UA C+S, different story). But I was just under the impression that the presence of bacteria in urine didn't always mean UTI.

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Specializes in Maternal - Child Health.

How was the specimen collected?

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Specializes in Med-Surg, LTC.

I don't know-the hospital collected it.

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in the absence of other symptoms, i'd be skeptical that it's uti.

but, would be considering other sources of confusion, i.e., new meds, sleep-deprivation, new environ, etc.

leslie

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Specializes in psych, addictions, hospice, education.

...hmmm....diagnosis of dementia...maybe this is worsening of symptoms of that diagnosis and the family isn't ready to accept it?

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Specializes in Med-Surg, LTC.

leslie-that was the origination of my post-the higher ups and physician even slapped on a diagnosis of UTI, and the daughter latched onto that, so any further discussion was moot. I'm the one thinking, guys, there's no indication of infection!

Whispera-I think you're right! (I also think the daughter needed a psych consult herself!)

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Specializes in Cardiac Telemetry, ED.

If the urine spec was a midstream sample or even a cath UA without sufficient disinfection of the meatus, then it could easily have been contaminated. With no leukocyte esterase or WBCs, it certainly is concerning for contamination.

Certainly polypharmacy could be an issue, or worsening symptoms of dementia r/t being in a different environment. It's not at all unusual for people to compensate for dementia quite well so long as they are in familiar surroundings with a predictable routine. It's only once the person is removed from that environment and their normal routine is disrupted that symptoms of dementia become pronounced. Family members can be resistant to accepting this for a host of reasons.

I know all this is Nursing 101 that you probably are well aware of. I'm just more confirming your train of thought than anything.

One more thought; is she being treated for UTI with a flouroquinolone? I've heard that this class of ABX *can* cause confusion in the elderly.

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