Asymptomatic Bacteriuria: Treatment (Nursing)

00:00 Now let's take a look at the population and we'll compare them. How likely are you able to see asymptomatic bacteriuria? Well, if the population is pregnant women, we're going to compare them to nursing home residents and to patients who've had an indwelling catheter for greater than a month. Remember that's the urinary catheter that we put into the urethra, it goes up into the bladder to drain urine, and they've had it for longer than a month. So, the 1st group, pregnant women, that's going to happen in about 10% of the patients. The treatment plan for a pregnant patient with asymptomatic bacteriuria is a short-term treatment, usually 3 to 7 days. Now we may consider amoxicillin or cephalexin. Also we've got some other options but they're dependent on the place or the progress of the pregnancy. So, 1st and 2nd trimester, we may go with something like TMP-SMX. Yes, I used that shortened version because that is a mouthful to say that antibiotic combination. The other option is nitrofurantoin. In the 2nd trimester, we can use this medication but not within 30 days of delivery. So there's very specific antibiotics recommended. For pregnant patients, it's short-term, and the antibiotic of choice may depend on how far along the pregnant patient is in their pregnancy. So we're going to treat it but we'll only see this in 1 in 10 pregnant women patients. Now, our odds are going up. Look at nursing home residents. Almost half of them, 40% to 50% of nursing home residents are going to have asymptomatic bacteriuria. So if you have a nursing home client, you have a urinalysis done, you're not going to be surprised that you see bacteria in their urine. So it's not recommended to treat that unless the patient is undergoing some urological procedure. So, if the patient is going to go for some type of invasive urological procedure, so like a cystoscopy, we don't treat asymptomatic bacteriuria in a nursing home client. Now, look at the estimate of incidence in that group of patients who have a catheter for greater than 1 month, 100%. You don't often see that, but we know if you've had a catheter for more than 1 month, you're going to have bacteria in your urine. So treatment is not indicated. Now, removal of the catheter leads to spontaneous elimination of the bacteria in most of the patients. So, pregnant women, 1 in 10; nursing home residents almost half and we're not going to treat them unless they have some invasive urological procedure; and chronic or long-term indwelling urinary catheters, absolutely they're going to have bacteria in their urine and we're not going to choose to treat them.