Spectrum: Local Antimicrobial Stewardship, for Eastern Health

UTI - Nursing home

Note

There is a high prevalence of asymptomatic bacteriuria and pyuria in nursing home patients, which does NOT require treatment.

UTI should only be diagnosed and treated in patients with genitourinary symptoms.

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 atrophy

Cystitis Empiric Rx

Review previous urine culture data if recurrent UTI

Fosfomycin 3g PO once for women, and q72h x 3 doses for men

NOTE: NLPDP Special Authorization required

OR

Amoxicillin-Clavulanate 500mg PO TID

OR

Nitrofurantoin 100mg PO BID x 5days, unless pyelonephritis or eGFR<30

OR

Cephalexin 500 mg PO QID

E coli susceptibility in Eastern Health 2017 Antibiogram = 88%
(based on cefazolin susceptibility)