Asymptomatic Bacteriuria
Am Fam Physician. 2020 Jul 15;102(2):99-104.
Author disclosure: No relevant financial affiliations.
Asymptomatic bacteriuria, defined as the presence of bacteria in the urine in the absence of urinary symptoms, is a common clinical finding that often warrants a decision about whether to initiate antimicrobial therapy. There are few indications to treat asymptomatic bacteriuria, and inappropriate treatment contributes to the development of antimicrobial resistance. In 2019, the Infectious Diseases Society of America revised its 2005 guidelines on asymptomatic bacteriuria, incorporating new evidence. The updated guidelines recommend screening and appropriate treatment for asymptomatic bacteriuria in pregnant women and in individuals undergoing endourological procedures associated with mucosal trauma. The guidelines recommend against screening and treatment in infants and children; healthy adults, including nonpregnant pre- and postmenopausal women; and patients with diabetes mellitus, long-term indwelling catheters, or spinal cord injuries. The guidelines also recommend against screening and treatment in patients undergoing nonurological surgery, patients who have had a kidney transplant more than one month prior, recipients of other solid organ transplants, or those with impaired voiding following spinal cord injury. Although delirium in older adults can be caused by a urinary tract infection, the guidelines recommend that patients with delirium and no urinary or systemic symptoms be assessed for other causes of delirium, rather than initiating treatment for asymptomatic bacteriuria, because treatment has not been shown to have any beneficial effect on clinical outcomes.
Urinary tract infections (UTIs) are among the most common reasons antimicrobials are prescribed. Often, however, clinicians prescribe antimicrobials for asymptomatic bacteriuria, which is defined as the presence of bacteria in the urine in the absence of urinary symptoms. Treating asymptomatic bacteriuria is not beneficial for most patients and may be detrimental. For example, a retrospective study of more than 2,700 patients with asymptomatic bacteriuria at 46 hospitals showed that antimicrobial treatment did not improve outcomes and was associated with longer hospitalization.1
WHAT'S NEW ON THIS TOPIC
A 2019 retrospective study of more than 2,700 patients with asymptomatic bacteriuria at 46 hospitals showed that antimicrobial treatment does not improve outcomes and is associated with longer hospitalization.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
Healthy nonpregnant premenopausal women should not be screened or treated for asymptomatic bacteriuria.2–5 | B | Observational studies, randomized controlled trials, expert opinion, and clinical guidelines |
Pregnant women should be screened for asymptomatic bacteriuria early in pregnancy and treated appropriately.2,6–8 | B | Consistent, good-quality patient-oriented evidence from the Infectious Diseases Society of America, the U.S. Preventive Services Task Force, and a Cochrane review. |
Older patients with functional or cognitive impairment and bacteriuria |
References
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2. Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):e83–e110.
3. Epocrates. Accessed December 1, 2019. https://www.epocrates.com
4. Asscher AW, Sussman M, Waters WE, et al. Asymptomatic significant bacteriuria in the non-pregnant woman. II. Response to treatment and follow-up. Br Med J. 1969;1(5647):804–806.
5. Nicolle LE. The paradigm shift to non-treatment of asymptomatic bacteriuria. Pathogens. 2016;5(2):e38.
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7. U.S. Preventive Services Task Force. Asymptomatic bacteriuria in adults: screening. September 2019. Accessed February 1, 2020. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/asymptomatic-bacteriuria-in-adults-screening
8. Owens DK, Davidson KW, Krist AH, et al. Screening for asymptomatic bacteriuria in adults: U.S. Preventive Services Task Force recommendation statement. JAMA. 2019;322(12):1188–1194.
9. American Academy of Family Physicians. Clinical preventive service recommendation. Asymptomatic bacteriuria in adults: screening. Accessed February 21, 2020. https://www.aafp.org/patient-care/clinical-recommendations/all/bacteriuria.html
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