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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.


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.



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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