Treating Asymptomatic Patients
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.