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Long Term Care Medicine-2010


B39 - Treatment of Bacteriuria without Urinary Signs, Symptoms, or a Systemic Infectious Illness [mnemonic-S/S/S]


Mar 12, 2010 11:00am ‐ Mar 12, 2010 12:00pm

Standard: $24.00

Description

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates
this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™.
Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of 1 Clinical credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
The most contentious reason antibiotics are prescribed for BTU is "Geriatric Manifestations" (confusion, falls) in the absence of urinary signs/symptoms or a systemic infectious illness. This session presents information regarding the futility and dangers of this practice as well as an alternative approach.

Learning Objectives(s):

  • Examine the danger of antibiotics for bacteriuria in the absence of urinary Signs/Symptoms or Systemic Infectious illness.
  • Describe the assessment of localizing urinary signs and symptoms or a Systemic Infectious illness.
  • Describe an alternative approach to antibiotic treatment of bacteriuria in the absence of urinary Signs/Symptoms or Systemic Infectious illness.
  • Review management of the Urinary Catheter to prevent infectious complications.


Speakers(s):
Paul Drinka, MD, CMD

Disclosure(s):
Paul Drinka, MD, CMD has no disclosures to report.

References:
1 Nicolle LE, Bradley S,Colgan R, Rice JC et al IDSA Guidelines for the Dx and Treatment of Asymptomatic Bacteriuria CID 2005;40:643-54
2 Wegenlener FME, Pilatz A, Naber KG, Weidner W Theraputic challenges of urosepsis Eur J Clin Invest 2008;38:45-9
3 Nordenstam GR, Brandberg CA, Oden AS, Svanborg Eden CM et al Bactriuria and mortality in an elderly population NEJM 1986;314:1152-6
4 Nicolle LE, Mayhew WJ, Bryan L. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. Am J Med 1987;83:27-33.
5 Abrutyn E, Mossey J, Berlin JA, et al. Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women? Ann Intern Med 1994;120:827- 83
6 Nicolle LE, Bjornson J, Harding GKM, MacDonell JA Bacteriuria in elderly institutionalized men NEJM 1983;309:1420-5
7 Boscia JA, Kobasa WD, Abrutyn E, Levison ME et al. Lack of association between bacteriuria and symptoms in the elderly. Am J Med 1986;81:979 -982.
8. Ouslander JG, Schapira M, Schnelle JF, Uman G et al. Does eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residents? Ann Intern Med 1995;122:749 -754
9 Drinka PJ. Complications of chronic indwelling urinary catheters. J Am Med Directors Assoc, 2006; 7:388-392
10 Darouiche RO, Goetz L,Kaldis T, Cerra-Stewart C et al Impact of StatLock securing device on symptomatic catheter-related UTI: A prospective, randomized, multicenter clinical trial Am J Infec Control 2006;34:555-65
11 SHEA Position Paper: UTI in LTCFs Infec Control Hosp Epidemiol 2001;22:167-75
12 Pop-Vicas A, Tacconelli E, Gravenstein S, Lu B et al Influx of multidrug resistant gram negative bacteria in the hospital setting and the role of elderly patients with bloodstream infection ICHE 2009;30:325-31
13 Loeb M, Bentley DW, Bradley S, Crossley K et al Development of minimum criteria for the initiation of antibiotics in residents of LTCFs: results of a consensus conference ICHE 2001;22:120
14 McGeer A, Campbell B, Emori TG, Heirholzer WJ et al Definitions of Infection for Survalence in LTCFs AJIC 1991;19:1-7
15 Orr PH, Nicolle LE, Duckworth H, Brunka J et all Febrile urinary infection in the institutionalized elderly Am J Med 1996;100:71-7
16 Nicolle LE The chronic indwelling catheter und UTI in LTCF residents 2001;22:316-21
17 High KP, Bradley SF, Gravenstein S, Mehr DR et al ISDA Guidelines: CPG for the evaluation of fever and infection in older adult residents of LTCs Clin Infec Dis 2008;48:149-71
18 Tenke P, Kovacs B, Johansen TEB, Matsumoto T et al European and Asian guidelines on management and prevention of catheter assoc UTI Int J Antimicrob Agents 2008; 1:S68-77
19 Fish DN, Piscitelli SC, Danziger LHD Development of resistance during antimicrobial therapy: A review of antibiotic classes and patient characteristics in 173 Studies Pharmacotherapy 1995;15:279-91
20 Pop-Vicas A, Mitchell SL, Kandel R, Schreiber R et all Multidrug-Resistant Gram- Negative Bacteria in a LTCF: Prevalence and Risk Factors JAGS 2008;56:1276-80
21 Maslow JN, Lee B, Lautenbach E Floroquinolone resistant E coli in a long term care facility Emerg Infect Dis 2005;11:889-
22 Crnich CJ, Zimmerman DR, Drinka PJ, Maki DG Differences in risk factors for colonization with MRSA and fluoroquinolone resistant bacteria in NH residents ICHE 2009
23 Marcus RJ, Post JC, Stoodly P, Hill-Stoodly L et al Biofilms in Nephrology Expert Opin Biol Ther 2008;8:1159-66
24 Prince AA, Steiger JD, Khalid AN, Dogrhamji L, Reger C, Eau Claire S, Chiu AG, Kennedy DW, Palmer JN, Cohen NA. Prevalence of biofilms-forming bacteria in chronic rhinosinusitis. Am J Rhinol 2008;22:239-245.
25 Gander S. Bacterial biofilms: resistance to antimicrobial agents. J Antimicrob Chemother 1996;37:1047-1050.
26 Psaltis AJ, Weitzel EK, Ha KR, Wormaid PJ. The effect of bacterial biofilms on post-sinus surgical outcomes. Am J Rhinol 2008 22:1-6
27 Kilty SJ, Desrosiers MY The riole of bacterial biofilms and the pathophysiology of chronic rhinosinusitis Current Allergy and Asthma Reports 2008;8:227-33
28 Smith K, Hunter IS Efficacy of common hospital biocides with biofilms of MDRO J Med Microbiol 2008 57:966-73
29 Thomas JK, Forrest A, Bhavnani SM, Hyatt JM, Cheng A, Ballow CH, Schentag JJ. Pharmacodynamic evaluation of factors associated with the development of bacterial resistance in acutely ill patients during therapy. Antimicrobial Agents and Chemotherapy, 1998; 42:521-527
30 Rodrigues RMJ Antibiotic resistance profile of the subgingival microbiota following systemic or local tetracycline therapy J Clin Peridontal 2004;31:420-7
31 Feres M Antibiotic resistance of subgingival species during and after antibiotic therapy J Clin Peridontal 2002;29:724-32
32 Wiener J, Quinn JP,Bradford PA,Goering RV multiple antibiotic resistant Klebsiela and E coli in NHs JAMA 1999;281:517-23
33 Smith PW, Seip CW, Schaefer SC, Bell-Dixon C Microbiologic survey of LTCFs AJIC 2000;28:8-13
34 ACOG Practice Bulletin: Treatment of UTI in nonpregnant women Obster Gynecol 2008;111:785-94
35 Mandell LA, Wunderink RG, Anzueto A, BartlettJG et al IDSA/ATS Consensus guidelines on the management of community acquired pneumonia in adults CID 2007;44:S27-72
36 Schechner V,Nobre V, Kaye KS, Leshno M et al et all Gram neg bacteremia upon hospital admission: When should Pseudomonas aeruginosa be suspected? CID 2009;48:580-6
37 Datta R, Huang SS Rissk of infection and death due to MRSA in long term carriers CID 2008;47:176-81
38 Drinka PJ, Faulks JT, Gauerke C, Goodman B. A comparison of previous antibiotic therapy following isolation of MRSA versus MSSA in nursing home residents. J Am Med Dir Assoc 2002; 3:356-359.
39 Arpi M, Rennberg J The clinical significance of Staphylococcus aureus bacteriuria J Urol 1984;132:697-700
40 Ibrahim EH, Sherman G, Ward S, Fraser VJ et al The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU Chest 2000;118:146-55
41 Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jeminez-Jeminez FJ et al Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the ICU with sepsis Crit Care Med 2003;31:2742-51
42 Loeb M, Brazil K, Lohfeld L, et al. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: Cluster randomised controlled trial. BMJ 2005;331:669
43 Gross PA, Patel B Reducing antibiotic overuse: A call for a national performance measure for not treating asymptomatic bacteriuria Clin Infec Dis 2007;45:1335-7
44 Lesse AJ, Mylotte JM Clinical and molecular epidemiology of NH associated Staphloccus bacteremia Am J Infect Control 2006;34:642-50

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