May 20, 2024
symptomatic bacteriuria


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I have a confession to make and most of your medical providers will tell you this exact same thing. Here's what's really going on.

What is Asymptomatic Bacteriuria?

For years we thought if there were bacteria in your urine then you were supposed to be on antibiotics. This was called a urinary tract infection. However, research now shows that there is something called asymptomatic bacteriuria, what this means is that the urine has bacteria in it but it's not causing you any problems.

I saw many folks in my office that were put on antibiotics and then said they were now having symptoms stop.

Enter...Margaret, a 92-year-old...

Let's take Margaret, for example. Margaret is a 92-year-old who comes in for another urinary tract infection, or is it? Margaret has been put on antibiotics since she was 70 years old for what she thought was a urinary tract infection because her urine culture came back positive showing she had bacteria in her urine. Her doctor usually gave her the same antibiotic and after a couple of days she felt better, but Margaret always felt uncomfortable taking antibiotics all the time. She didn't like the cost of them for sure and she hated waiting at the pharmacy for another prescription. She felt that her friends were always put on antibiotics and there had to be another way. She was too scared to mention what alternatives she had to her doctor. 

[Margaret is not in the medical field so she felt that the only thing she could do was trust her doctor to know what's best for her and it was all too confusing anyway. Besides, her doctor had warned her that having a urinary tract infection and leaving it untreated could put her in the hospital. So now Margaret was really scared, and the confusion was more than it was before.]

Speaking Up is Always OK

How many of us feel uncomfortable opening up a conversation with our doctor and questioning their decisions? Well, you're not alone because even one physician to another hesitates to question another doctor's decision.

So, when Margaret came into my office because the antibiotic she was on was not working I asked her what her symptoms were. 

She took the time to explain to me that she had a few symptoms, like confusion and didn't feel like eating. I explained that while we would look at her urine, that was not the only thing we would base her treatment plan on. I also gave her these alternatives and asked her what choices she would like to make.

She brought up the point that her doctor said she would end up in the hospital if she didn't get antibiotics and this was her real fear factor. So, Margaret and I discussed in detail how we could alleviate this problem and who we could bring him in to guide her through this. Was it her daughter or my nurse that was going to respond if she had the beginnings of any of the symptoms we talked about?

How will Margaret Know What To Do?

This opened up a whole new world for Margaret. Plus, I explained to her that the use of antibiotics is not only costly (and she agreed with that) but also there is a potential for resistance which means we have to start trying new antibiotics if the old ones didn't work anymore, the side effects might be more disastrous and her gut is full of good bacteria which we don't want antibiotics to destroy. She agreed with me that a healthy gut is the most important thing that a senior can keep.

Here's what we talked about:

  • Rarely seen before age 40. This condition is found in an estimated 20% of women aged 80 or older, and also affects older men. The older the person, the more common it is. Asymptomatic bacteriuria is even more common in nursing homes, where it’s estimated to affect 30-50% of residents. Sadly, in nursing homes, the doctor rarely comes in to examine or talk with the patient.  They tend to just call in another antibiotic prescription. 
  • Bacteriuria is not a urinary tract infection.  Instead, know the symptoms that can get you in trouble. Discuss these with your doctor so you know when or if you will need to take an antibiotic. This can lead to unnecessary — and potentially harmful — treatment with antibiotics. Dehydration or lack of sleep can make us all confused.  Don't jump right to "UTI!!" just because you see this. 
  • Know the difference between the two. Antibiotics don't treat any symptoms in asymptomatic bacteriuria because there are NO symptoms.  In fact, such treatment can be harmful: one study found that treatment increased the risk of future (real) UTIs and increased the risk of infection with antibiotic-resistant bacteria.
  • Why medical providers overprescribe antibiotics. Because they won't take the time. You have to look at other things besides just the urine. Instead, health providers must take the time to talk to the patient — or family caregiver — and ask about what symptoms are present. In a busy clinical environment, this step is all-too-often neglected.

It is always okay to speak up with your physician and ask them for an alternative or several choices.  Use these choices to guide your own treatment plan.  It is a feeling of relief to know that you are now in Partnership with your physician and you both have a voice in your health.

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  • About the Author

    Hi, I'm Suzanne. My passion is creating working knowledge to well-informed, well-prepared seniors and their families so they may enjoy the later years with health, wealth, and happiness, I've helped over 10,000 patients, seniors and their famlies like yourselves do just that through my courses, eBooks, the Senior Freedom Club™, and in my physician assistant medical practice.


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