Choosing Wisely:

Avoid the use of surveillance cultures for the screening and treatment of asymptomatic bacteruria.

Rationale and Comments: There is minimal evidence that surveillance urine cultures or treatment of asymptomatic bacteruria is beneficial. Surveillance cultures are costly and produce both false-positive and false-negative results. Treatment of asymptomatic bacteruria also increases exposure to antibiotics, which is a risk factor for subsequent infections with a resistant organism. This also results in the overall use of antibiotics in the community and may lead to unnecessary imaging.
Sponsoring Organizations:
  • American Academy of Pediatrics
  • Sources:
  • American Academy of Pediatrics guidelines
  • Disciplines:
  • Infectious disease
  • References: • Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA. 2007 Jul 11;298(2):179–86.
    • Kemper KJ, Avner ED. The case against screening urinalysis for asymptomatic bacteruria in children. Am J Dis Child. 1992 Mar;146(3):343–6.
    • Nicolle LE. Asymptomatic bacteruria: when to screen and when to treat. Infect Dis Clin North Am. 2003 Jun;17(2):367–94.
    • Roberts KB; American Academy of Pediatrics Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011 Sep;128(3):595–610.

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