From the Guidelines
Having bacteria in your urine without symptoms of a urinary tract infection (UTI) is called asymptomatic bacteriuria and typically doesn't require treatment in most people, unless you're pregnant or about to undergo urological procedures, as stated in the 2024 European Association of Urology guidelines 1.
Key Points to Consider
- Asymptomatic bacteriuria is common, especially in older adults, where up to 50% of elderly women and 30% of elderly men may have bacteria in their urine without symptoms.
- The immune system often manages these bacteria without causing infection.
- If you have no symptoms like burning during urination, frequent urination, or lower abdominal pain, doctors generally recommend monitoring rather than treatment, as per the Infectious Diseases Society of America guidelines 1.
- Unnecessary antibiotic use can lead to side effects and antibiotic resistance.
- However, pregnant women should be treated with appropriate antibiotics like nitrofurantoin 100mg twice daily for 5-7 days or amoxicillin-clavulanate 500mg three times daily for 3-7 days to prevent complications, as recommended by the 2019 Infectious Diseases Society of America guideline update 1.
Recommendations for Management
- Do not screen or treat asymptomatic bacteriuria in the following conditions:
- Women without risk factors
- Patients with well-regulated diabetes mellitus
- Postmenopausal women
- Elderly institutionalized patients
- Patients with a dysfunctional and/or reconstructed lower urinary tract
- Patients with a renal transplant
- Patients before arthroplasty surgery
- Patients with recurrent urinary tract infections, as stated in the 2024 European Association of Urology guidelines 1.
- Screen for and treat asymptomatic bacteriuria before urological procedures breaching the mucosa, as recommended by the 2024 European Association of Urology guidelines 1.
- Screen for and treat asymptomatic bacteriuria in pregnant women with standard short-course treatment or single-dose fosfomycin trometamol, as stated in the 2024 European Association of Urology guidelines 1.
Prevention and Hygiene
- Stay hydrated to help prevent bacteria from causing actual infections.
- Practice good hygiene, such as washing your hands before and after using the bathroom.
- Urinate after sexual activity to help prevent bacteria from entering the urinary tract.
From the Research
Significance of Bacteriuria without Confirmed UTI
- Bacteriuria, or the presence of bacteria in urine, does not always indicate a urinary tract infection (UTI) 2, 3, 4, 5, 6
- Asymptomatic bacteriuria (ABU) is a common condition where bacteria are present in urine without any symptoms of UTI 3, 4, 6
- ABU is often treated unnecessarily with antibiotics, which can lead to antimicrobial resistance 3, 4
Diagnosis and Treatment
- Urine culture is the gold standard for detecting UTI, but it can take days to produce results and may have false-positive or false-negative results 2, 5
- The presence of bacteria in urine does not always require treatment, and antibiotics should only be initiated when there is a high probability of UTI based on symptoms and test results 2, 3, 4, 5, 6
- Treatment of ABU is only recommended in certain cases, such as in pregnant women and individuals undergoing endourological procedures associated with mucosal trauma 3, 4
Clinical Considerations
- The decision to treat bacteriuria should be based on the patient's symptoms, medical history, and risk factors for UTI 2, 3, 4, 5, 6
- Clinicians should be aware of the differences between ABU and symptomatic UTI and withhold antibiotics when antimicrobial treatment is not indicated 3, 4, 6
- Further research is needed to determine the benefits and harms of screening for and treating ABU in certain patient populations 4, 5