Choosing Wisely:

Don’t treat asymptomatic bacteruria with antibiotics.

Rationale and Comments: Inappropriate use of antibiotics to treat asymptomatic bacteruria, or a significant number of bacteria in the urine that occurs without symptoms such as burning or frequent urination, is a major contributor to antibiotic overuse in patients. With the exception of pregnant patients, patients undergoing prostate surgery or other invasive urological surgery, and kidney or kidney pancreas organ transplant patients within the first year of receiving the transplant, use of antibiotics to treat asymptomatic bacteruria is not clinically beneficial and does not improve morbidity or mortality. The presence of a urinary catheter increases the risk of bacteruria; however, antibiotic use does not decrease the incidence of symptomatic catheter-associated urinary tract infection, and unless there are symptoms referable to the urinary tract or symptoms with no identifiable cause, catheter-associated asymptomatic bacteruria does not require screening and antibiotic therapy. The overtreatment of asymptomatic bacteruria with antibiotics is not only costly, but can lead to Clostridum difficile infection and the emergence of resistant pathogens, raising issues of patient safety and quality.
Sponsoring Organizations:
  • Infectious Diseases Society of America
  • Sources:
  • Infectious Diseases Society of America guidelines
  • Disciplines:
  • Infectious disease
  • Urologic
  • References: • Trautner B, Kelly PA, Petersen N, Hysong S, Kell H, Liao KS, Patterson JE, Naik AN. A hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of catheter-associated asymptomatic bacteriuria. Implement Sci. 2011;6:41.
    • Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America, American Society of Nephrology, American Geriatric Society. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):643-54.
    • Gross PA, Patel B. Reducing antibiotic overuse: a call for a national performance measure for not treating asymptomatic bacteriuria. Clin Infect Dis. 2007;45(10):1335-7.

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