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There is a high prevalence of asymptomatic bacteriuria and pyuria in nursing home patients, which does NOT require treatment (leads to resistance).
UTI should only be diagnosed and treated in symptomatic patients
Avoid catheterization
For patients with nonspecific symptoms (falls, change in mental status) without signs of sepsis, improving hydration often resolves symptoms - suggest withholding ABx 24hrs and reassess
Contributing factors to UTI should be assessed and managed where possible: i.e., cystocele, incomplete bladder emptying, vaginal trophy
Beta-lactams including cephalexin, cefuroxime, cefixime, amoxicillin, and amoxicillin-clavulanate may be used if susceptible but require 7d of therapy
Nitrofurantoin (5-7d, only if eGFR>60) and TMP-SMX (3d) are preferred agents when susceptible
Fluoroquinolone (3d) may be used for isolates with very limited susceptibility to other agents, but should be reserved for other uses
The microbiology lab can set up fosfomycin testing for organisms with limited susceptibility
