From the Guidelines
Asymptomatic bacteriuria generally does not require treatment except in specific populations, such as pregnant women and patients undergoing urologic procedures with mucosal bleeding, as recommended by the most recent guidelines 1. The treatment approach for asymptomatic bacteriuria is guided by the principle of minimizing unnecessary antibiotic use to prevent antibiotic resistance and potential harm.
- For pregnant women, treatment is recommended to prevent pyelonephritis, which can lead to preterm labor and low birth weight, with a 3-7 day course of antibiotics such as nitrofurantoin, amoxicillin-clavulanate, or cephalexin being appropriate 1.
- For urologic procedures, a single dose of antibiotics just before the procedure is sufficient, typically trimethoprim-sulfamethoxazole or a fluoroquinolone, to prevent bacteremia and sepsis 1. Key populations where treatment is not recommended include:
- Non-pregnant women
- Elderly individuals
- Diabetics
- Those with indwelling catheters as studies show no benefit and potential harm from unnecessary antibiotic use 1. The rationale for this approach is to balance the benefits of treatment with the risks of antibiotic resistance and adverse effects, such as Clostridioides difficile infection, and to prioritize the management of symptomatic urinary tract infections over asymptomatic bacteriuria 1.
From the Research
Treatment of Asymptomatic Bacteriuria
- Asymptomatic bacteriuria is often unnecessarily treated with antibiotics, risking adverse effects and antimicrobial resistance 2.
- The European Association of Urology Urological Infection Guidelines Panel found no evidence of benefit for patients with no risk factors, patients with diabetes mellitus, postmenopausal women, elderly institutionalised patients, patients with renal transplants, or patients prior to joint replacement, and treatment was harmful for patients with recurrent urinary tract infection (UTI) 2.
- Treatment of asymptomatic bacteriuria resulted in a lower risk of postoperative UTI after transurethral resection surgery 2.
- In pregnant women, treatment of asymptomatic bacteriuria decreased the risk of symptomatic UTI, low birthweight, and preterm delivery 2, 3, 4.
Patient Groups that Benefit from Treatment
- Pregnant women should be screened for asymptomatic bacteriuria in the first trimester and treated if positive 3, 4.
- Individuals who are undergoing endoscopic urologic procedures should be screened and treated appropriately for asymptomatic bacteriuria 3.
- Treatment of asymptomatic bacteriuria is recommended prior to transurethral resection surgery 2.
Patient Groups that Do Not Benefit from Treatment
- Patients with diabetes, neutropenia, spinal cord injuries, indwelling urinary catheters, and other conditions do not benefit from treatment of asymptomatic bacteriuria 3, 5, 4, 6.
- Treatment of asymptomatic bacteriuria in these patients is not beneficial and may be associated with harmful outcomes, such as increased short-term frequency of symptomatic infection, adverse drug effects, and reinfection with organisms of increased antimicrobial resistance 5, 4, 6.