Treating asymptomatic bacteriuria

[Hi2Jenn]

I work in acute rehab, but I don't think that makes a big difference. That being said, I was taught that you do not check for a UA C&S if a patient is NOT having s/s of a UTI. However, every facility wants to check a urine everytime a patient is slightly more confused. I tried to discuss this with the psychiatrist the other day. She basically said that if she is not allowed to check a urine on her patients and treat them then she risks misdiagnosing them. I found a concensus paper from the Infectious disease society of america stating that it is not recommended to treat, but doesn't say about testing. However, I am meeting resistance at every turn. So the facility waits until I am not on call and gets my on call to give the order. They are all hospitalists so they do urines routinely and think nothing of it. I guess I just want to vent, but does anyone have any other resources or suggestions?

[Goldenfox]

I found a concensus paper from the Infectious disease society of america stating that it is not recommended to treat, but doesn't say about testing.

What I remember about this is that you generally don't treat it---unless the patient is pregnant or pre-op for invasive uro/gyn type procedures. I once had a discussion about a slightly different issue with an infectious disease doctor who told me that, when it comes to old people and suspected UTIs, don't treat empirically with any antibiotics---wait for a positive urine. And the powers that be still don't recommend treating if the count is less than 100,000. They might have new evidence based guidelines now. I don't know. The textbooks and medical journals used to all say that you should do a culture since it is still the gold standard to rule out, but the bean counters don't like it when you order cultures for everybody because it is cost more than a UA with micro, so I usually order the latter first.

[traumaRUs, MSN, APRN]

And depends on their renal function. If they have chronic kidney disease, a dip UA is of no use

[lmccrn62, MSN, RN]

This is a daily occurrence in the facility I am in. I have them increase fluids and I may order some labs. I don't treat anyone for UTI unless they meet criteria. I do the same thing for URI unless they have underlying pulmonary disease. I am anti-antibiotic!!!

I do find the attendings don't care so order abx to shut them up.