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In This Episode:
Dr. K explains why having bacteria in one’s urine does NOT mean one has a urinary tract infection (UTI) that requires antibiotics. In fact, as people get older, they may have bacteria in the urine but no UTI symptoms or other signs of infection. This condition, called “asymptomatic bacteriuria” is common, and is often inappropriately treated with antibiotics. In this episode:
- How to know if one has asymptomatic bacteriuria versus a UTI that warrants antibiotics
- Why having asymptomatic bacteriuria becomes more common as people become older
- Why the Infectious Disease Society of America and others have repeatedly urged doctors to NOT treat asymptomatic bacteriuria
- The challenge of correctly diagnosing UTIs in people with dementia
- How one can be harmed by using antibiotics to try to eliminate bacteria in the bladder
- What to do if you’re worried about urine bacteria — or a possible UTI — in an older person
Related episode:
014 – Delirium & Hospital Confusion
Related Resources:
- Why Urine Bacteria Doesn’t Mean a UTI Needs Antibiotics
- Choosing Wisely Recommendations of the Infectious Disease Society of America
- 26 Recommended Preventive Health Services for Older Adults
- Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms
- Diagnosis and Management of Urinary Tract Infection in Older Adults
- “Urinary Tract Infection”—Requiem for a Heavyweight
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Terry Albrecht says
Thanks for the informative podcast. For those “tricky” situations where delirium or dementia seems to have changed as a potential UTI symptom in an elderly parent -if the urine sample is showing an abnormally high white blood cell counts, is that a reason for anabiotic treatment? You mention visible blood in the urine as a true UTI symptom but not specifically high white blood cell count in a laboratory analysis.
thanks for any feedback
Nicole Didyk, MD says
I’m so glad you enjoyed the podcast.
Your question is a tough one. High white blood cell count in the urine isn’t a definite sign of a UTI, and it really does present a dilemna when we think there may be an infection as a cause for a change in cognition.
In general, we can be confident that antibiotics are the way to go if there is pain with urination or fever, as well as at least one of the following symptoms: blood in the urine, new back pain (specifically at the costovertebral angle, which is where the ribs meet the spine in the back), pain in the region of the bladder, more frequent and urgent urinations, or new incontinence.
It may seem simple to just give an antibiotic, but we try to be cautious in older adults, to avoid side effects or drug interactions. Thanks for your question!
Lee Williams says
Hi Dr K!
I had asked a question a while ago re: asymptomatic bacteriuria and the use of Hiprex and Vitamin C for treatment. I did get your answer, but hadn’t responded to you! Anyway, my Mum went to the urologist for a 3 month check up, and Dr. N was pleased with her progress. They apparently do not repeat a culture, because it’s a colonized situation. They just ask if she’s having symptoms; fever, burning, frequency. I told him I had a concern about her being on Hiprex long term, and he said it was actually safer than using antibiotics. I think he was surprised I had looked up the action, and agreed it does sound scary, so he doesn’t usually disclose the action to his patients (I disagree with this-everyone should be informed of what they’re taking). Me being a nurse of course I had to look it up! Mum seems to be tolerating it well, but the odor of the urine hasn’t changed, and since I’m sensitive to odors, cleaning her commode isn’t pleasant, but it’s short-lived! Thanks again for your input!
Leslie Kernisan, MD MPH says
Thanks for sharing this update. I’m glad your mom is doing ok.
For anyone else who is interested Hiprex or other aspects of this topic, see here.