The Infectious Diseases Society of America (IDSA) has released evidence-based recommendations for the diagnosis and treatment of asymptomatic bacteriuria in adults. The IDSA guidelines, which appear in the March 1, 2005, issue of Clinical Infectious Diseases and are available online athttp://cid.oxfordjournals.org/content/40/5.toc, are as follows:
• Diagnosis of asymptomatic bacteriuria should be based on the results of a urine culture collected in a way that prevents contamination. Diagnosis of bacteriuria in asymptomatic women is defined as two consecutive voided urine specimens in which the same strain of bacteria is isolated in quantitative counts of at least 105 cfu per mL. In men, diagnosis of bacteriuria is defined as one bacterial species isolated in a quantitative count of at least 105 cfu per mL in a clean-catch voided urine sample. In women and men, bacteriuria is diagnosed when, in a single catheterized urine sample, one bacterial species is isolated in a quantitative count of at least 102 cfu per mL.
• Antimicrobial treatment is not indicated when pyuria accompanies asymptomatic bacteriuria.
• Pregnant women should be screened for bacteriuria during early pregnancy and given antimicrobial therapy for three to seven days if the results are positive. Women with a positive screen should be monitored for recurrence of bacteriuria after treatment.
• Shortly before transurethral resectioning of the prostate, patients should be screened and treated for bacteriuria, but treatment should not be continued after the procedure unless a catheter remains in place.
• Screening and treatment are recommended before any urologic procedure in which mucosal bleeding is expected.
• Screening and treatment are not recommended for premenopausal women who are not pregnant, women with diabetes, older persons living in the community or institutions, patients with spinal cord injury, or catheterized patients while the catheter is in situ.
• Physicians should consider antimicrobial treatment of asymptomatic women with catheter-acquired bacteriuria if it persists for 48 hours after catheter removal.
• The IDSA does not recommend for or against screening or treatment of patients with renal or other solid-organ transplants.