Bacteriuria in older adults triggers confusion in healthcare providers: A mindful pause to treat the worry

Abstract

The evidence base for refraining from screening for or treating asymptomatic bacteriuria (ASB) in older adults is strong, but both practices remain prevalent. Clinical confusion over how to respond to a change from baseline, when to order a urinalysis and urine culture, and what to do with a positive urine culture fuels unnecessary antibiotic use for ASB. If the provider can take a mindful pause to apply evidenced-based assessment tools, the resulting increased clarity in how to manage the situation can reduce overtreatment of ASB.

Fig. 1.

A mindful pause in diagnosis and treatments of UTI in long-term care residents. This decision aid can be employed by providers who are facing one of these clinical situations: a nursing home resident has a change from baseline, the provider is considering ordering a urinalysis or urine culture, or the provider receives a positive urine culture result. Each of these clinical situations can result in confusion. However, the provider should take a mindful pause and then follow the arrow to the recommended next steps for work-up and management in that clinical situation. These next steps are organized by patient symptoms, objective findings, and external factors.

Fig. 2.

Agency for Healthcare Research and Quality (AHRQ) decision aid for suspected urinary tract infections in long-term care residents.