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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), improving hydration often resolves symptoms - withhold ABx 24hrs and reassess
The choice between the following agents should be made based on the acuity of illness, previous culture data from the same patient, risk factors for drug resistant organisms, and appropriate antibiogram data (i.e. community vs hospital)
PO: TMP-SMX DS 1 tab po BID x 7-14d
OR
PO: Ciprofloxacin 500mg po BID x 7-14d
Cystitis only: Fosfomycin 3g po q3days x 3 doses (not recommended for pyelonephritis and prostatitis)
IV: Ceftriaxone 1g IV daily
IV: Gentamicin 5 mg/kg IV daily (trough <1mcg/mL)
IV: Ertapenem 1g IV daily - If known to be colonized ESBL, consider if multiple risk factors
ESBL RFs
Healthcare: prolonged hospitalization, ICU stay, percutaneous feeding tubes, nursing home residence, urinary catheterization
Travel within 6-12 months to area of high prevalence (i.e. South Asia), especially when received medical care while abroad Antimicrobial exposure