From the Guidelines
Asymptomatic urinary tract infections (UTIs) should not be treated with antibiotics except in specific populations, such as pregnant women, due to the risk of pyelonephritis, preterm delivery, and low birth weight infants, as well as before urologic procedures where mucosal bleeding is anticipated to prevent bacteremia, as stated in the most recent guidelines 1. The rationale for this approach is based on the latest evidence from the European Association of Urology guidelines on urological infections, which suggests that asymptomatic bacteriuria often represents colonization rather than infection requiring treatment, and unnecessary antibiotic use contributes to antimicrobial resistance while providing no clinical benefit in these populations. Some key points to consider include:
- Asymptomatic bacteriuria is common and corresponds to commensal colonization, and treatment should only be considered in cases of proven benefit for the patient to avoid the risk of selecting antimicrobial resistance and eradicating a potentially protective ABU strain 1.
- The spectrum of bacteria in asymptomatic bacteriuria is similar to species found in uncomplicated or complicated UTIs, depending on the presence of risk factors, and clinical studies have shown that asymptomatic bacteriuria may protect against superinfecting symptomatic UTI 1.
- Treatment is recommended for pregnant women, as asymptomatic bacteriuria increases the risk of pyelonephritis, preterm delivery, and low birth weight infants, and a 3-7 day course of antibiotics such as nitrofurantoin, amoxicillin-clavulanate, or cephalexin is typically prescribed 1.
- For most other populations, including non-pregnant women, elderly individuals, diabetics, and those with indwelling catheters, antibiotic treatment of asymptomatic bacteriuria is not recommended, as it does not reduce complications, may increase antibiotic resistance, and can cause unnecessary side effects 1.
From the Research
Asymptomatic Urinary Tract Infections (UTIs)
- Asymptomatic UTIs should not be treated except in specific cases, such as pregnant women, patients prior to undergoing an invasive surgical procedure, or renal transplant recipients in the early postrenal transplant period 2.
- Asymptomatic bacteriuria is common, particularly in older women, and should not be treated with antibiotics 3, 4.
Treatment of Asymptomatic UTIs in Specific Populations
- In pregnant women, asymptomatic bacteriuria should be treated to prevent complications such as pyelonephritis, preterm labor, and low birth weight 5.
- In patients prior to undergoing an invasive surgical procedure, asymptomatic bacteriuria should be treated to prevent post-surgical complications 2.
- In renal transplant recipients, asymptomatic bacteriuria should be treated in the early postrenal transplant period to prevent complications 2.