Choosing Wisely:

Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.

Rationale and Comments: Cohort studies have found no adverse outcomes for older men or women associated with asymptomatic bacteriuria. Antimicrobial treatment studies for asymptomatic bacteriuria in older adults demonstrate no benefits and show increased adverse antimicrobial effects. Consensus criteria have been developed to characterize the specific clinical symptoms that, when associated with bacteriuria, define urinary tract infection. Screening for and treatment of asymptomatic bacteriuria is recommended before urologic procedures for which mucosal bleeding is anticipated.
Sponsoring Organizations:
  • American Geriatrics Society
  • Sources:
  • Infectious Diseases Society of America guidelines
  • Disciplines:
  • Geriatric Medicine
  • Infectious disease
  • Urologic
  • References: • Nordenstam GR, et al. Bacteriuria and mortality in an elderly population. N Engl J Med. 1986;314(18):1152-6.
    • Nicolle LE, et al. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. Am J Med. 1987;83(1):27-33.
    • Juthani-Mehta M. Asymptomatic bacteriuria and urinary tract infection in older adults. Clin Geriatr Med. 2007;23:585-94.
    • Nicolle LE, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):643-5.

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