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A 90-year-old Asian female who lives in a nursing home is noted to have >100,000 Escherichia coli on a urinalysis performed because her urine œsmelled strong. She is afebrile and is asymptomatic. Which one of the following is most appropriate?
A. Antibiotic treatment for 3 days
B. Antibiotic treatment for 10 days
C. A repeat reculture and treatment if positive
D. Foley catheter insertion
E. No treatment
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Older Patients with Asymptomatic Bacteriuria
Studies of asymptomatic bacteriuria in pre- and postmenopausal women report similar outcomes regardless of age.28,29 A study of ambulatory women in a long-term care facility who were assigned to receive antimicrobial therapy or placebo for bacteriuria showed a decrease in prevalence of asymptomatic bacteriuria at six months among those receiving antibiotics, but no significant difference in symptomatic episodes.30 Adverse outcomes attributable to asymptomatic bacteriuria were not observed in a cohort of ambulatory male veterans older than 65 years at several years' follow-up.10
Clinical trials of older residents in long-term care facilities have shown no benefits from screening for or antimicrobial treatment of asymptomatic bacteriuria.31-33 Although antimicrobial treatment does not decrease symptomatic infection or improve survival, there is an increased incidence of adverse antimicrobial effects and reinfection with antibiotic-resistant organisms. Thus, the IDSA does not recommend screening for or treatment of asymptomatic bacteriuria in older patients.2
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if wbc r greater than 15-20 in urine we need to treat otherwise not
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E-no treatment for asymptomatic bacteriuria. I knew this and still got wrong, because I thought that the bad smell is already a symptom!
Ref:Antibiotic treatment of nursing-home patients with asymptomatic bacteriuria is not beneficial. Chronic incontinence is not improved, subsequent episodes of symptomatic urinary tract infection are not reduced, and there is no decrease in overall mortality
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> 100, 000 that is not asympotmatic bact. that is the definition of infection
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usmleology,
that's why it's asymptomatic ie
urine is showing >100 K colony forming unit of single bacteria (here E. coli)
but pt doesn't have any symptioms of infection like fever, chill, frequency, urgency, burning.
hope i'm right and it will help.
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and also, >100 k bacteria in urine is a work-up finding, not a symptom.
