Antibiotics play a crucial role in treating bacterial infections, but their misuse has led to antimicrobial resistance (AMR), a growing global health threat.
Morgan Katz, M.D., M.H.S.
Johns Hopkins University School of Medicine, Society for Healthcare Epidemiology of America
AMR occurs when bacteria become resistant to medications that once effectively treated them, making infections more difficult to manage and leaving fewer, and sometimes no, effective antibiotics for treatment. One area of concern is the overuse of antibiotics for urinary tract infections (UTIs), especially among older adults. The Society for Healthcare Epidemiology of America (SHEA) is dedicated to ensuring safe healthcare for all by promoting evidence-based guidelines for accurately diagnosing and managing UTIs in older adults, reducing unnecessary antibiotic use, and helping to combat AMR.
Understanding UTIs and antibiotic use
UTIs are common, particularly in women, and are often treated with antibiotics. However, studies have shown that a significant percentage of antibiotic prescriptions for suspected UTIs are unnecessary, with estimates ranging from 32% to 93%. This overprescription is partly due to the misinterpretation of nonspecific symptoms and the presence of asymptomatic bacteriuria (bacteria in the urine without symptoms) in urine cultures, which is prevalent in up to 50% of non-catheterized older adults. Treating asymptomatic bacteriuria with antibiotics does not benefit patients and can lead to adverse effects and increased AMR.
What can patients do?
SHEA encourages patients, caregivers, and healthcare providers to work together for responsible antibiotic use. As a patient, you play a crucial role in promoting responsible antibiotic use. Here are a few things you can do:
- Clearly Communicate Your Symptoms: Describe your symptoms in detail during your appointment with your healthcare provider. Accurate information helps providers make a precise diagnosis and decide if antibiotics are truly needed.
- Know the Signs of a UTI and the Difference from Asymptomatic Bacteriuria: Typical UTI symptoms include a persistent urge to urinate, burning during urination, and pelvic discomfort. Nonspecific signs like confusion or fatigue — common in older adults — do not necessarily indicate an infection and are often due to other reasons, like medication changes or lack of sleep. Remember, bacteria can be present without causing an infection. Not all bacteria found in the urine require treatment.
- Avoid Pressure for Antibiotics: If your healthcare provider advises against antibiotics, trust their assessment. If you have concerns about their assessment, discuss these concerns but avoid insisting on unnecessary medication.
- Take Steps to Prevent UTIs: Reduce your risk of UTIs by staying hydrated, practicing regular voiding, and practicing good hygiene. Drinking plenty of water helps flush bacteria from the urinary tract, and regular bathroom visits prevent urine from sitting too long in the bladder.
- Limit Unnecessary Use of Indwelling Catheters and Other Invasive Devices
Since catheters can increase the risk of UTIs, work with medical professionals to minimize their use. When catheters or similar devices are needed, talk with your healthcare team about strategies to limit their use and ensure strict infection control practices.
These steps can help ensure that treatment is based on clear evidence of an infection rather than on non-specific signs or misinterpretations. Remember, antibiotic exposure can lead to adverse effects, such as Clostridiodes difficile infection, allergic reactions, or kidney or liver injury, and using antibiotics when they are not needed can be detrimental. By being informed and proactive, patients and their caregivers can help reduce unnecessary antibiotic use, thereby combating the threat of antimicrobial resistance and ensuring these vital medications remain effective for when they are truly needed.
