Treatment of UTI in residents of an aged-care facility

Establish whether an advance care plan is in place and if antibiotic treatment is consistent with the expressed goals of the patient. Antibiotic therapy may not be inconsistent with a declared palliative treatment plan. For information on advance care plans, see Advance care planning.

Before starting antibiotic therapy, optimise hydration, if possible, and reassess the patient for symptoms of urinary tract infection (UTI). Delaying antibiotic therapy to assess for symptomatic UTI does not generally lead to adverse outcomes in residents of an aged-care facility.

If antibiotic therapy is indicated, see Approach to empirical antibiotic choice for UTI in adults for a discussion of drug choice. As relevant, also see:

• Treatment of acute cystitis in nonpregnant adult females
• Treatment of acute cystitis in adult males
• Approach to managing acute pyelonephritis in nonpregnant adults
• Acute bacterial prostatitis.

For the management of residents of an aged-care facility with catheters, see Catheter-associated bacteriuria and UTI in adults.

Patients requiring intravenous therapy for pyelonephritis may be able to receive it in the aged-care facility (eg through a Residential In-Reach Program) as an alternative to hospital admission – see also ambulatory antimicrobial therapy.

Do not perform post-treatment urine culture to confirm resolution of infection for asymptomatic patients, except for males with acute bacterial prostatitis.

For strategies to prevent recurrent UTIs in residents of an aged-care facility, see Treatment and prevention of recurrent UTI in nonpregnant adults.