UTI - Nursing home

Change the catheter if present >2wks, and remove if not indicated

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

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 atrophy

Review previous urine culture data if recurrent UTI (patient specific antibiogram) to better inform empiric choice

E. Coli isolates from Calgary nursing homes have reduced susceptibility to TMP-SMX (60%) and fluoroquinolones (50%), and higher prevalence of ESBLs