db_pavnp Posted January 12, 2015 Share Posted January 12, 2015 Under what circumstances would a male patient, seen in an ER, with UA results of 4+ bacteria, 500 esterase, >50 wbc / hpf, positive nitrites be sent home without a script for antibiotics? I had to edit this to add that the PT is not currently on antibiotics, as that was one reason that occurred to me. Link to comment Share on other sites More sharing options...
GreatChecko Posted January 12, 2015 Share Posted January 12, 2015 When they are asymptomatic? It's common in the older folk. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 12, 2015 Administrator Share Posted January 12, 2015 Had the patient recently had a urology workup and/or be under urologist care, and this fact known to the ER provider? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 12, 2015 Moderator Share Posted January 12, 2015 Under what circumstances would a male patient, seen in an ER, with UA results of 4+ bacteria, 500 esterase, >50 wbc / hpf, positive nitrites be sent home without a script for antibiotics? I had to edit this to add that the PT is not currently on antibiotics, as that was one reason that occurred to me. treated for gc/chlamydia in er with rocephin and zithromax? Link to comment Share on other sites More sharing options...
delco714 Posted January 12, 2015 Share Posted January 12, 2015 Just wondering.. have you checked a bladder scan or ultrasound. I bet they're walking around with 100-300cc in their bladder. Positive for nitrites? I don't think you should send them home. Usually if they've been on abx recently they wouldn't be nitrite positive and their culture usually negative even though it looks infected otherwise. Lots of leuk, blo. I may consider it "normal" potentially, if they the sample is somehow from a chronic foley or sp tube. Link to comment Share on other sites More sharing options...
gbrothers98 Posted January 12, 2015 Share Posted January 12, 2015 Need to know more about the patient. Elderly, young? Prior UTI? Has foley in place? Recent instrumentation? How was sample obtained? Cath spec? Clean catch? Dirty catch? If elderly, I would recommend culture and see what it grows. Younger, I agree with E, got to think of STD and by younger I now think under 70. You never know what situation patients have themselves in. Last, why was the urine obtained? If it was because of dysuria, then I would ? why pt not sent home. If it was some sort of shotgun get a bunch of labs thing then definitely dont do anything till the culture comes back. G Brothers PA-C Link to comment Share on other sites More sharing options...
db_pavnp Posted January 12, 2015 Author Share Posted January 12, 2015 I was unaware that an asymptomatic bacteriuria in a male does not always need treated. So much of the material on the subject references women that I missed that detail. I feel everyone would culture it, though. Link to comment Share on other sites More sharing options...
dchampigny Posted January 12, 2015 Share Posted January 12, 2015 Being a male.....he has a complicated UTI by definition. Unless he's elderly and asymptomatic, Treat em! Link to comment Share on other sites More sharing options...
RRivas2004 Posted January 12, 2015 Share Posted January 12, 2015 Pos nitrates require treatment in men across the board. If the gentleman had a pre-existing in dwelling foley, than this would most certainly skew the UA results. But should still be treated. If the gentleman had a Ureteral stent, again, he should be treated, but this would skew the results. A colovessical fistula would most certainly cause a very dirty urine, and would most likely need antibiotics if having symptoms at the time, pending repair by Urology / CORS. Other causes of a dirty UA with a seemingly asymptomatic patient could be a chronic smoldering bacterial prostattiis that has not been treated adequately. A bladder stone can harbor many bacteria and cause a recalcitrant UTI. Bladder diverticula also tend to harbor bacteria and are difficult to completely eradicate the bacterial colonization. Thats all I got! - Rudy, Former Urology PA Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 14, 2015 Moderator Share Posted January 14, 2015 only way I would not treat this is if he is asymptomatic AND has a foley in place AND does not complain of any type of uro complaint - and even then I would likely treat with quick PCP or URO follow up Asym Bacturia is a female condition (mostly unless some anatomy issue with male ie surgery) Link to comment Share on other sites More sharing options...
cbrsmurf Posted January 15, 2015 Share Posted January 15, 2015 Male with that UA: Would treat empirically. No one mentioned infectious prostatitis. Link to comment Share on other sites More sharing options...
winterallsummer Posted January 24, 2015 Share Posted January 24, 2015 asymptomatic w/ chronic foley. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.