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    Shivani PDF

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    deepukumar
    The document provides guidelines for diagnosing and managing urinary tract infections (UTIs) in long-term care residents over 65 years old. It states that a UTI diagnosis requires both clinical signs and symptoms as well as a positive urine culture. Urine testing or cultures should only be done on symptomatic patients, not based on urine appearance alone. Routine antibiotic prophylaxis is not recommended to prevent UTIs. Empirical antibiotic treatment may be considered for symptomatic patients pending culture results, and treatment should be modified according to the culture.

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    Shivani PDF

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    The document provides guidelines for diagnosing and managing urinary tract infections (UTIs) in long-term care residents over 65 years old. It states that a UTI diagnosis requires both clinical signs and symptoms as well as a positive urine culture. Urine testing or cultures should only be done on symptomatic patients, not based on urine appearance alone. Routine antibiotic prophylaxis is not recommended to prevent UTIs. Empirical antibiotic treatment may be considered for symptomatic patients pending culture results, and treatment should be modified according to the culture.

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    The document provides guidelines for diagnosing and managing urinary tract infections (UTIs) in long-term care residents over 65 years old. It states that a UTI diagnosis requires both clinical signs and symptoms as well as a positive urine culture. Urine testing or cultures should only be done on symptomatic patients, not based on urine appearance alone. Routine antibiotic prophylaxis is not recommended to prevent UTIs. Empirical antibiotic treatment may be considered for symptomatic patients pending culture results, and treatment should be modified according to the culture.

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    © All Rights Reserved
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    162 views3 pages

    Shivani PDF

    Uploaded by

    deepukumar
    The document provides guidelines for diagnosing and managing urinary tract infections (UTIs) in long-term care residents over 65 years old. It states that a UTI diagnosis requires both clinical signs and symptoms as well as a positive urine culture. Urine testing or cultures should only be done on symptomatic patients, not based on urine appearance alone. Routine antibiotic prophylaxis is not recommended to prevent UTIs. Empirical antibiotic treatment may be considered for symptomatic patients pending culture results, and treatment should be modified according to the culture.

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    Diagnosis&ManagementofUrinaryTractInfection(UTI)

    inLongTermCareResidents>65years

    KEYMESSAGES

    DiagnosisofUTIinresidents>65yearsrequiresacombinationofreliableclinicalsignsandsymptoms

    ANDapositiveurinecultureresult.

    Onlyperformurinedipsticktestingorsendurineforcultureinpatientswhoaresymptomatic.Donot

    performurinedipsticktestingorsendurineforculturesolelyonthebasisofurineodourorappearance

    Residents in long term care facilities have high rates of abnormal dipstick and urine test results
    WITHOUT infection necessarily being present. Antibiotic therapy in these cases does not reduce
    mortality or prevent symptomatic episodes, rather it increases side effects and leads to antibiotic
    resistance.


    DONOTROUTINELYUSEANTIBIOTICPROPHYLAXISTOPREVENTURINARYTRACTINFECTION

    1:SIGNSANDSYMPTOMSOFUTI
    DiagnosisofUTIshouldbebasedonafullclinicalassessment.

    Symptoms&signssuggestiveofurinarytractinfectioninclude:
    Dysuria FrequencyUrgency Newonsetincontinence
    Fever>38CSuprapubictendernessHaematuria
    Inpatientswithaurinarycatheterloinpainandfever>38CaresignificantindicatorsofaUTI.
    ***DONOTSENDURINEFORCULTUREIFTHEREARENOSIGNSANDSYMPTOMSOFUTI***
    DipstickurinetestingisNOTareliablewaytodiagnoseUTI.Donotperformdipstickurinalysisif
    patientsareasymptomaticorifaurinarycatheterispresentasfalsepositiveswilloccur.

    EmpirictreatmentmaybeconsideredinaSYMPTOMATICpatientwithapositivedipstick.Aurinesampleshould
    besenttothemicrobiologylaboratoryforcultureandantimicrobialsusceptibilitytestinginthesecases.

    Apositiveurinedipstickresultinanasymptomaticpatientisnotsignificantandshouldnotbetreated.
    2:HOWTOINTERPRETURINECULTURERESULTSINRESIDENTSWITHOUTAURINECATHETER
    Microscopy
    WhiteCells Nowhitecellspresentindicatenoinflammationthereforecultureresultisunlikely
    toindicateUTI.
    Whitecells100/lareconsideredtorepresentinflammation.
    Epithelialcells/mixed Presenceindicatesperinealcontaminationandthereforecultureresultisunlikelyto
    growth indicateUTI
    Redcells MaybepresentinUTI,patientswithpersistenthamaturiapostUTIshouldbe
    referred
    Culture
    Singleorganism10,000(104)colonyformingunits(CFU)/mLOR
    5
    100,000(10 ) mixedgrowthwithonepredominantorganismOR UsuallyindicatesUTIbutonlyin
    3 patientswithsymptoms
    EscherichiacoliorStaphylococcussaprophyticus1,000(10 )CFU/mL

    Positive culture/microscopy result and no symptoms = bacteriuria, not infection


    and does not require antibiotic treatment.
    3:HOWTOINTERPRETAURINECULTURERESULTINRESIDENTSWITHAURINARYCATHETER
    LaboratorymicroscopyshouldnotbeusedtodiagnoseUTIincatheterisedpatientsasurinewhitecellsare
    oftenelevatedduetothepresenceofthecatheter
    If the urine culture result is positive (see section 2) treat only if the resident has symptoms or signs
    suggestiveofUTIandnoothersourceisidentified.
    Inthepresenceofaurinarycatheterantibioticswillnoteradicatebacteriuria
    4:EMPIRICALTREATMENTOFUTIINRESIDENTS
    OnlyconsiderempiricantibiotictherapyinSYMPTOMATICpatientspendingurinecultureresult.
    Choiceofempiricaltherapyshouldbeguidedbylocalresistancerateswhereavailable.
    Modifytreatmentaccordingtocultureresultwhenavailable.

    FortreatmentofuncomplicatedUTIinpatients<65,pleaserefertopage9oftheNationalGuidelinesfor
    AntimicrobialPrescribinginPrimaryCareinIreland(2011)1
    4a:EMPIRICALTREATMENTOFUTIINRESIDENTSWITHOUTAURINARYCATHETER

    UncomplicatedUTIi.e.nofeverorflankpain,first Acutepyelonephritis
    presentations/lowriskofresistantorganisms
    Coamoxiclav500/125mgTDSfor14days
    Trimethoprim200mgBD ORCiprofloxacin500mgBDfor7days
    ORNitrofurantoin*50100mgQDS
    (*Avoidinrenalimpairment) Ifnoresponsewithin24hoursconsiderhospital
    For7days referral


    UseofCephalexin500mgBDorCoamoxiclav

    500/125mgTDSmayalsobeconsideredbasedon
    local resistance rates

    4b:EMPIRICALTREATMENTOFUTIINRESIDENTSWITHAURINARYCATHETER



    Firstpresentations/lowriskofresistantorganismsPreviousresistanceto,orriskof,trimethoprimor
    nitrofurantoinresistance
    Trimethoprim200mgBD Cephalexin500mgBD
    OR OR
    Nitrofurantoin50100mgQDS* Coamoxiclav500/125mgTDS
    (*Avoidinrenalimpairment) (Considerbasedonlocalresistancerates)


    Durationoftherapy

    Promptresolutionofsymptoms:7days

    Delayedresponse(regardlessofwhetherpatientremainscatheterisedornot):1014days


    Ifanindwellingcatheterhasbeeninplacefor>2weeksattheonsetofUTIandisstillindicated,thecatheter
    shouldbereplaced.

    5:ANTIBIOTICPROPHYLAXIS

    DONOTROUTINELYUSEANTIBIOTICPROPHYLAXISTOPREVENTURINARYTRACTINFECTION

    AntibioticprophylaxisisnotrecommendedforthepreventionofsymptomaticUTIincatheterisedpatients.


    Antibioticprophylaxisisnotrecommendedforurinarycatheterchangesunlessthereisadefinitehistoryofsymptomatic

    UTIsduetocatheterchange.

    Antimicrobialprophylaxismaybeconsideredinpatientsforwhomthenumberofurinaryinfectionsareofsuchfrequency

    orseveritythattheychronicallyimpingeonfunctionandwellbeing.


    1:Availableathttp://www.hpsc.ie
    REFERENCES

    AbrutynE,MosseyJ,BerlinJA,BosciaJ,LevisonM,PitsakisP,KayeD.Doesasymptomaticbacteriuriapredict
    mortalityanddoesantimicrobialtreatmentreducemortalityinelderlyambulatorywomen?AnnIntMed1994:827
    33.

    Diagnosis,Prevention,andTreatmentofCatheterAssociatedUrinaryTractInfectioninAdults:2009International
    ClinicalPracticeGuidelinesfromtheInfectiousDiseasesSocietyofAmericaClinicalInfectiousDiseases2010;
    50:625663

    EuropeanUrinalysisGuidelines.Eds.KouriT,FlogazziG,GantV,HallenderH.HofmannW,GuderWG
    ScandJClinLabInvest2000;60:196.

    HPA.InvestigationofUrine.HealthProtectionAgency.NationalStandardMethodBSOP41.2009http://www.hpa
    standardmethods.org.uk/documents/bsop/pdf/bsop41.pdf(Accessed6thAugust2011)

    HPA.DiagnosisofUTI.QuickReferenceGuideforPrimaryCare
    http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947404720(Accessed6thAugust2011)

    Jointconsensusstatementontheinitialassessmentofhaematuria.RenalAssociation&BritishAssociationof
    UrologicalSurgeons.July2008.

    NicolleLE,MayhewWJandBryanL.Prospectiverandomizedcomparisonoftherapyandnotherapyfor
    asymptomaticbacteriuriaininstitutionalizedelderlywomen.TheAmericanJournalofMedicine1987;83:2733.

    SARI.GuidelinesforAntimicrobialPrescribinginPrimaryCareinIreland2011http://www.hpsc.ie/hpsc/A
    Z/MicrobiologyAntimicrobialResistance/StrategyforthecontrolofAntimicrobialResistanceinIrelandSARI/Communityan
    tibioticstewardship/File,3334,en.pdf(Accessed6thAugust2011)

    SIGN.Managementofsuspectedbacterialurinarytractinfectioninadults:anationalclinicalguideline.Scottish
    IntercollegiateGuidelinesNetwork.2006http://www.sign.ac.uk/guidelines/fulltext/88/index.html(Accessed6th
    August2011)

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