Urinary tract infections in long-term care facility residents.

You are in your office seeing patients when a nurse calls from the nursing home to report the urinalysis results of Mrs. X. Mrs. X, 75 years-old, with mild Alzheimer’s dementia, was admitted to the facility for rehabilitation and low back pain control after two falls. Her medical history also includes hypertension, hyperlipidemia, chronic obstructive pulmonary disease (COPD), osteoporosis, and two new vertebral compression fractures. Yesterday the nursing staff noticed foul smelling urine and contacted your covering physician for an order to obtain a clean catch urine. Currently, Mr.s X is afebrile, without any specific complaints. She takes oxycodone and acetaminophen for pain control, donepezil for her Alzheimer’s, a bisphosphonate for her osteoporosis, and an albuterol inhaler for her COPD. She has no medication allergies. The urinalysis reveals 20-30 WBC/ml, 5-10 RBC /ml, and numerous bacteria. A urine culture has been sent but results are unavailable. The nurse asks whether you would like to start antibiotics.