• Rationale and Comments

    Guidance has been published by the American Urological Association, European Association of Urology, and the Infectious Diseases Society of America that discourage both the screening for and treatment of asymptomatic bacteriuria in nonpregnant patients, including children. Children who perform clean intermittent catheterization may have urinary tract colonization of bacteria sometimes considered to be pathogenic. Typical symptoms of UTI include fever, chills, and/or pain (dysuria, abdominal, flank, suprapubic). Changes in urinary consistency, such as cloudy urine, odor, or sediment, are commonly described, but can be normal in isolation based on hydration and emptying. Atypical symptoms of UTI can include malaise, lethargy, and anorexia. In children with neurological abnormalities, such as those with neurogenic bladder, UTIs may present with atypical symptoms; however, these symptoms should also prompt providers to assess for constipation and other systemic pathologies. Low-grade fever and pyuria in the absence of any other UTI symptoms does not necessarily indicate urinary infection, so clinicians must carefully exclude other sources of fever. A multitude of studies have concluded that the treatment of asymptomatic bacteriuria contributes to the widespread problem of resistant bacterial strains.

    Sponsoring Organizations

    • American Academy of Pediatrics - Section on Urology


    • IDSA/AUA guidelines


    • Infectious disease
    • Pediatric
    • Urologic


    • Averch T, Stoffel J, Goldman HB, et al. Catheter-associated urinary tract infections: definitions and significance in the urologic patient. 2014 white paper guidelines. American Urological Association. Accessed November 20, 2019. https://www.auanet.org/guidelines/catheter-associated-urinary-tract-infections
    • 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):1611-1615.
    • Grabe M, Bartoletti R, Bjerklund Johansen TE, et al. European Association of Urology: guidelines on urological infections. March 2015.
    • Gerber D, Forster CS, Hsieh M. The role of the genitourinary microbiome in pediatric urology: a review. Curr Urol Rep. 2018;19(1):13.