clinical focus
Frequent testing and administration of
antibiotics for asymptomatic bacteriuria
can cause side effects for the consumer
being treated. The use of antibiotics also
increases the risk of antibiotic resistance,
with resistant bacteria able to be
transmitted to other consumers and staff.
Some other implications identified in this
case history include:
• Potential for missed diagnoses –
dehydration and other causes for
confusion could be missed.
• Resident, family distress – sometimes
an in/out urinary catheter was inserted
to obtain the urine sample. For this
consumer, who had a very private nature
and strong Catholic faith, the loss of
dignity and modesty during an in-out
catheter procedure is likely to have been
distressing for her. Furthermore, there
is the potential for the introduction of
infection during this procedure.
• Increased workload for the staff – staff
were required to undertake/assist not
only the urine specimen but also extra
documentation, liaise with the general
practitioner and pharmacy (when
antibiotics were prescribed) with extra
visitation time and workload required
from the GP.
• Cost to service and health system – the
cost to the healthcare system includes
the cost of extra care provision, the cost
of equipment required for the collection
(dipsticks, specimen containers, bed pan,
and in-out catheters) plus pathology
costs and costs of the antibiotics.
Diagnosis of a UTI in older women with
dementia and non-specific symptoms can
be demanding and a challenge.
When chronic urinary incontinence,
nocturia, increased frailty or a
general sense of lack of wellbeing is
present, routine urine studies are not
recommended.
A persistent change in behaviour and
a change in the characteristics of their
urine which is not responsive to other
interventions (e.g. rehydration) suggests
the need for further investigation.
For this consumer, antibiotics did
not improve her incontinence or other
symptoms, which is suggestive that
she had asymptomatic bacteriuria rather
than a UTI.
Changes to policies, procedures
and culture in long-term aged care
may reduce testing for UTI, resulting in
Bacteria can and do
live in the bladder of many
women without causing
symptoms.
reduced unnecessary antibiotics and
improved consumer care and antimicrobial
stewardship in the future.
It is important to assess consumers using
validated criteria and to treat a validated
infection using the Australian Therapeutic
Guidelines. ■
Barry Lowe lead nurse – antimicrobial
stewardship – at Southern Cross Care (SA &
NT), and has been seconded to the Drug and
Therapeutics Information Service (SALHN).
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