Understanding bacteria as always pathogens fuels overprescribing of antibiotics for urinary tract infections in hospitals: Clinicians’ and older adult patients’ experiences

• In Event: Producing Transformations: Drugs, Bodies, and Experimentation 3

Abstract

Older adults often have asymptomatic bacteriuria or bacteria in their urine without symptoms of a urinary tract infection (UTI), which guidelines recommend not to treat with antibiotics. Drawing on science and technology studies we argue that a Pasteurian understanding of bacteria as always pathogens makes it difficult for clinicians not to treat bacteria in urine and fuels antimicrobial resistance (AMR). Our argument is based on interviews with doctors, nurses and older adult patients (n=41) in three UK hospitals in 2016-17. Following Arthur Frank’s work on illness narratives we identified three ways of understanding, acting on and speaking about UTIs and bacteria. First, some clinicians, particularly nurses, and patients saw UTI diagnosis as a straightforward process of spotting signs of infection, treating it and restoring the patient’s health. Second, other clinicians, particularly doctors, experienced UTI diagnosis as a chaotic process, leading to overprescribing and shot through with ambiguities about symptoms, urinary dipstick and laboratory results and recovery. Older adult patients were often bewildered by repeated UTI diagnoses and courses of antibiotics. Third, we identified some alternative, post-Pasteurian ways of understanding bacteria as a natural part of older patients’ biology, as being harmful in specific clinical situations and as clearing with waiting and hydrating. We conclude with discussing how understandings of bacteria intersect with the professional cultures of nurses and doctors and lay understandings, creating both obstacles and possibilities for reducing overprescribing.

Authors

• Paula Saukko, Loughborough University

• Emily Rousham, Loughborough University

• Beryl Oppenheim, University Hospitals Birmingham NHS Foundation Trust