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Asymptomatic Bacteriuria Pre-Operative Screening and Treatment - Adult - Ambulatory [71]

Asymptomatic Bacteriuria Pre-Operative Screening and Treatment - Adult - Ambulatory [71] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols



Delegation Protocol Number: 71

Delegation Protocol Title:
Asymptomatic Bacteriuria Pre-Operative Screening and Treatment - Adult - Ambulatory

Delegation Protocol Applies To:
UW Health Clinics: Gynecologic Oncology Clinics

Target Patient Population:
Nonpregnant, female patients scheduled for surgical procedures

Delegation Protocol Champion:
Ellen Hartenbach, MD, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology

Delegation Protocol Reviewers:
Joanne Rash, PA-C, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology
Caroline Croft, MSN, RN - Department of Obstetrics and Gynecology, Division of Gynecologic
Oncology

Responsible Department:
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology

Purpose Statement:
This protocol delegates authority from the ordering provider to Registered Nurses (RNs) in the UW Health
Gyn/Oncology clinics to order laboratory testing and medications to treat uncomplicated asymptomatic
bacteriuria in women scheduled for surgical procedures.

Who May Carry Out This Delegation Protocol:
Registered Nurses (RNs) trained in the use of this delegation protocol.

Guidelines for Implementation:
1. The protocol is initiated by the identification of asymptomatic bacteriuria found on a preoperative urinalysis.
2. The supervising provider will be consulted prior to placing any orders if any of the following conditions are present:
2.1. If the patient has allergies to all antibiotic options or is allergic to the only antibiotic active against
the cultured organism.
2.2. If yeast are found.
2.3. If the patient has a history of renal dysfunction or a recent eGFR less than 50 mL/min. (Note to providers
- if the eGFR is less than 30 mL/min avoid nitrofurantoin and consider reducing the dose of
ciprofloxacin or trimethoprim/sulfamethoxazole.)
2.4. If the patient has recurrent UTIs (i.e. more than three UTIs in a period of six months)
2.5. If the patient is on warfarin.
3. If the preoperative urinalysis is contaminated with three or more epithelial cells or urine culture is
contaminated with skin flora, the RN will order a repeat urinalysis with culture at a local laboratory (use
lab code UACUL if being performed at a UW lab). If surgery is in less than 3 days, a urinalysis without
culture will be ordered.
4. If the patient’s isolate is resistant to the allowed antibiotics or if the resistant organism is susceptible only
to intravenous antibiotics, a prescribing provider must be consulted.
5. If the culture is positive for a uropathogen (Note: cultures positive for Lactobacillus or coagulase-
negative non-Staphylococcus saprophyticus do not require treatment), the RN will determine all patient
allergies to medications prior to ordering any antibiotics.
6. The RN will order the appropriate antibiotic based on the reported susceptibilities and the patient’s
allergy profile and renal function. The allowed antibiotic regimens in order of preference are:
6.1. Nitrofurantoin macrocrystals 100 mg by mouth twice daily for 5 days (protocol contraindicated if GFR < 60)
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


Quantity: 10 Refills: 0
6.2. Trimethoprim/sulfamethoxazole (TMP/SMZ), 160 mg / 800 mg by mouth twice daily for three days. (protocol
contraindicated if patient on Warfarin) Quantity: 6 Refills: 0
6.3. Fosfomycin 3 g by mouth ONCE. Quantity: 1 Refills: 0
7. In patients on concomitant phenytoin therapy the order will be signed and the prescribing provider will
be notified of the potential interaction.

Order Mode: Medications: Protocol/Policy, Without Cosign
Laboratory Orders: Cosign Required, Protocol/Policy

References:
1. U.S. Food and Drug Administration. (2016, July 26). FDA updates warnings for fluoroquinolone antibiotics:
limits use for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis and uncomplicated
urinary tract infections. Retrieved from
http://fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm513183.htm
2. Neuner, E., Sekeres, J., Hall, G. and vanDuin, D. Experience with Fosfomycin for Treatment of Urinary Tract
Infections Due to Multidrug-Resistant Organisms. Antimicrob Agents Chemopther 2012 Nov; v.56(11);
2012 Nov.
3. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute
uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of
America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011 Mar;
52(5): e103-e120.
4. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 91: Treatment of urinary
tract infections in nonpregnant women. Obstet Gynecol 2008 Mar; 111(3): 785-794.
5. University of Wisconsin Hospital and Clinics. Antimicrobial Use Guidelines July 2011-2012. 21st edition.
https://uconnect.wisc.edu/servlet/Satellite?cid=1126654726361&pagename=B_EXTRANET_UWH_HOME%2
FFexMemberFile%2FLoad_File&c=FlexMemberFile. Accessed March 2, 2012.
6. Hooton TM. Uncomplicated Urinary Tract Infection. N Eng J Med 2012 Mar; 366(11): 1028-37.

Collateral Documents/Tools:
UW Health Clinical Monitoring of Outpatient Parenteral Antimicrobial Therapy (OPAT) and Selected Oral Antimicrobial
Agents – Adult – Inpatient/Ambulatory – Clinical Practice Guideline. December 2016.
OP – Asymptomatic Bacteruria Pre-Operative Screening – Delegation Protocol – Adult [4608]

Approved By:
UW Health Ambulatory Protocol Committee: November 2017
UWCH Antimicrobial Use Subcommittee: November 2017
UWHC Nursing Practice Council: November 2017
UWHC Pharmacy and Therapeutics Committee: November 2017
UWHC Medical Board: November 2017
UW Health Chief Medical Officer: November 2017

Effective Date: November 2017

Scheduled for Review: November 2020

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org