LAS VEGAS – Prudent use of catheters, cultures, and antibiotics are three keys to proper urinary tract diagnosis and management, according to a speaker at this year’s annual meeting of the Society of Hospital Medicine.
“We have not done very well with decreasing catheter-associated urinary tract infections,” said Jennifer Hanrahan, DO, an assistant professor of infectious disease medicine at Case Western Reserve University in Cleveland, Ohio, and an infectious disease physician at MetroHealth Medical Center, where she is the medical director for infection prevention. “The main reason is people don’t really think of i
t as a serious problem, but it’s actually causing serious problems for our patients.”
The main way to reduce catheter-associated urinary tract infections is to avoid catheters, she said, noting “that’s obvious, but unnecessary catheters get put in all the time.”
Dr. Hanrahan recommended only putting them in when absolutely necessary, doing so in a sterile manner, and then continually monitoring whether the patient still needs the catheter.
Knowing when to obtain a urine culture is key to ensuring proper diagnosing and treatment for UTIs. A person who is asymptomatic does not need a culture, Dr. Hanrahan said during the well-attended, rapid-fire session. Those who do need a culture include septic patients with no apparent cause for their symptomatic presentation, despite a careful history taking and physical exam. Also, patients with pelvic pain, or flank tenderness for whom no cause can otherwise be determined should be cultured. It is also appropriate to screen for asymptomatic bacteriuria for pregnant patients, since it can be a sign of premature labor, and for patients about to undergo any invasive urologic procedure, Dr Hanrahan said.
“An awful lot of people have asymptomatic bacteriuria all the time,” she added, “and it doesn’t mean anything.”
Reasons to not culture include urine that smells “off” or that is cloudy or has sediment. “Anyone who has eaten asparagus knows that, after you eat it, your urine smells weird. It doesn’t mean you have a UTI,” she said.
She recommended against “pan culturing” in sepsis, and culturing “just because” when there is a clearly identifiable cause for the fever.
Once a diagnosis is made, Dr. Hanrahan urged physicians to avoid the overuse of antibiotics, suggesting that, whenever possible, the shortest possible course should be used. In order to help preserve antibiotic resistance, she also recommended using antibiotics that are not as prevalent, in order to help preserve antibiotic resistance. These could include nitrofurantoin and fosfomycin.
Dr. Hanrahan had no relevant financial disclosures.
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