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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 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
Review previous urine culture data if recurrent UTI
Fosfomycin 3g PO q72h x 3 doses for men
OR
Amoxicillin-Clavulanate 500mg PO TID x 7 days