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New Grad NP

Treating Asymptomatic Patients

Published November 23, 2012 9:51 AM by Kelly Wolfgang

I wrote a blog much earlier this year discussing the importance of abstaining from treating asymptomatic UTIs while making a feeble attempt to include a Harry Potter reference. This past week, a favorite patient of mine, an older woman who has been hospitalized repeatedly for an ESBL UTI and bacteremia called our office in a panic.

She was scheduled for a cystoscopy and her urologist requested that she have a urine culture performed in advance of the procedure. Her urine culture revealed an Enterococcus species that was resistant to everything except for Vancomycin. This is a problem.

Vancomycin can only be administered intravenously in the setting of treating Enterococcus. Plus, she was totally asymptomatic: no dysuria, frequency, urgency, supra-pubic pressure, pyuria, hematuria, fevers, rigors, nada. This means quite simply that her bladder is colonized with Enterococcus. While not optimal, this is not a problem that warrants treatment.

Do you treat an asymptomatic octogenarian with multiple comorbidities with a potentially nephrotoxic medication? The answer is no, unless the goal is to insure categorical antibiotic resistance.

2 comments

Thanks for the thought provoking post.  Hopefully she is not going to be treated for the ABU.  I would think she is having a cysto to investigate the repeated ESBL UTIs.  Hopefully, you and her urologist will be collaborating.  I love looking up what the literature has to say about the subject.  Here are two resources I found that might be helpful to your readers.

http://emedicine.medscape.com/article/2059290-overview#a1

http://www.ncbi.nlm.nih.gov/pubmed/21392102

Nurse Mentor Nancy, author of "Catching Critical Changes:  Six Essential Steps for Effective Nursing Assessment."

Nancy Banfield Johnson, Nursing Author, Nurse Manager, and former ANP - Nurse Mentor Nancy's Blog November 29, 2012 11:16 AM
Upstate NY

I am confused. Rather than treating an asymptomatic UTI, weren't you prepping the patient prior to a cystoscopy? The urologist had requested an urine culture.  Wouldn't that be prophylactic treatment prior to a procedure?   Given the outcome of her sensitivity test requiring Vancomycin, wouldn't you go back to the urologist for consultation regarding what his/her recommendations pre-cystoscopy?

Brenda Lenz November 24, 2012 9:46 PM

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