Jun 29, 2021
Bladder Infections: To Treat or Not to Treat in Older
Adults?
“Asymptomatic bacteriuria in long-term care is more common than
actual Urinary Tract Infections. About 35 to 40% of men and about
50% of women in long-term care have it—that's even higher for women
with urinary incontinence.” -Jamie Smith, MSN, FNP
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When someone is aged and frail, the risk of a bladder infection is
higher, raising the chances of delirium, hospital admission, or
even death.
In this episode of This Is Getting Old: Moving Towards An
Age-Friendly World, Jamie Smith, a Family Nurse Practitioner in
geriatrics and nursing home care, describes bladder infections and
things you and healthcare professionals should know about helping
the older adults decide whether or not to treat with
antibiotics.
Part One of 'Bladder Infections: To Treat or Not to Treat
in Older Adults?'
What Is A Bladder Infection?
A Urinary Tract Infection (UTI) a bacterial infection within the
bladder. It's an acute illness that affects the genitourinary
system and is commonly known as a “bladder infection” - and means
you have an infection of your genitourinary system, so your
bladder, kidneys, ureters or urethra with a “positive urine” with a
urine sample.
The typical symptoms include: burning sensation with urination,
abnormal urgency and frequency in urination. In addition, you may
have severe pubic pain or “gross hematuria” (where your pee turns
different colors like pinkish or reddish).
Asymptomatic Bacteriuria (ASB), also known as a colonized state.
ASB is where you have a positive urine sample, but lack the typical
genitourinary symptoms that go along with a UTI. The presence of
bacteria in ASB is in quantitative counts of ≥ 100,000
colony-forming units/milliliter (CFU/mL) or ≥ 100 CFU/mL in a
catheterized specimen. Thus, in the absence of urinary tract
symptoms, asymptomatic bacteriuria is determined by white blood
cells in the urine.
"It's critical to differentiate between UTI and colonized state
because when you give antibiotics to older adults, that increases
their risk of antibiotic resistance, drug to drug interaction, and
increased health care cost." - Jamie Smith, MSN, FNP.
To Treat or Not To Treat?
Telling the difference between a UTI and ASB is tricky in older
adults, especially those in long-term care facilities because
localized genitourinary symptoms are far less pervasive in them.
Consequently, there have been differences in treatment protocols
from place to place regarding a bladder infection.
✔️ Differences in Protocols For Treatment at ER/ Hospital vs
Long-term care settings
Whenever a family member requests a patient to go out because
they're confused about whether it's a UTI or ASB, one of the first
things the ER does is check a Complete Blood Count (CBC) and a
Basic Metabolic Panel (BMP). Even if the urine has trace amounts of
bacteria, let's say the patient is confused that they can't tell if
there are any genitourinary symptoms, the ER will typically go
ahead and prescribe an antibiotic.
✔️ Protocols for Treatment at Skilled Nursing Facilities or at
Home
Bladder infection treatments are different in long term care
facilities or at home because the staff or family members can tell
if the older adult is having symptoms. If the older adult is not
having any symptoms associated with the urinary tract, that's
classified as colonized. We don't treat colonized states because we
look at Loeb's or McGreer's Criteria, and if they don't qualify, we
don't treat them because of the risk of harm by giving them an
antibiotic.
Risks of Harm in Older Adults
It's imperative to differentiate between UTI and ASB (colonized
state). Because when you give antibiotics to older adults, that
increases their risk of Clostridium difficile (C. diff), antibiotic
resistance, a drug to drug interaction, and increased health care
cost.
Part Two of 'Bladder Infections: To Treat or Not to Treat
in Older Adults?'
Role of Cognition in Treating Asymptomatic
Bacteriuria
Remember that treating ASB is not always straightforward. Long term
care patients sometimes will have a cognitive impairment, and they
can't always tell you if the symptoms are there.
There are several tools that you can use. The AMDA Watchlist, for
instance, is a urinary tract infection flip manual. This one-pager
watchlist can be used by staff or family members, and it helps care
providers figure out if it's a UTI or colonized state.
Read the full article at www.MelissaBPhD.com/podcast-blog