From the Guidelines
Asymptomatic bacteriuria is not typically treated, except in specific cases such as pregnancy, before urological procedures that breach the mucosa, or in patients with certain underlying medical conditions.
Key Points to Consider
- The Infectious Diseases Society of America (IDSA) and the European Association of Urology recommend against screening or treating asymptomatic bacteriuria in most cases, citing the potential for antimicrobial resistance and lack of evidence for benefit in many populations 1.
- Pregnant women are an exception, as screening and treatment of asymptomatic bacteriuria can reduce the risk of symptomatic urinary tract infections and low birth weight 1.
- Urological procedures that breach the mucosa also warrant screening and treatment of asymptomatic bacteriuria to prevent infection 1.
- Antimicrobial stewardship is a key consideration, as the overuse of antibiotics can drive resistance and have negative consequences for individual and public health 1.
Specific Recommendations
- Do not screen or treat asymptomatic bacteriuria in:
- 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
- Screen for and treat asymptomatic bacteriuria before urological procedures breaching the mucosa 1.
- Screen for and treat asymptomatic bacteriuria in pregnant women with standard short-course treatment or single-dose fosfomycin trometamol 1.
From the Research
Treatment of Asymptomatic Bacteriuria
- Asymptomatic bacteriuria is a common clinical condition that often leads to unnecessary treatment 2
- The treatment of asymptomatic bacteriuria is generally not recommended for nonpregnant adults, as it has no net benefit and may be harmful due to adverse effects of antibiotic use and changes to the microbiome 3, 4
- However, screening and treatment of asymptomatic bacteriuria is recommended for pregnant women, as it can reduce the risk of perinatal complications, including pyelonephritis, septicemia, respiratory distress, low birth weight, and spontaneous preterm birth 3, 4, 2, 5
- Treatment of asymptomatic bacteriuria may also be beneficial for individuals undergoing endoscopic urologic procedures, such as transurethral resection surgery, to reduce the risk of postoperative urinary tract infection 4, 2, 5
- The Infectious Diseases Society of America recommends against screening and treatment of asymptomatic bacteriuria in certain patient groups, including infants and children, healthy adults, patients with diabetes mellitus, long-term indwelling catheters, or spinal cord injuries 5
Patient Groups and Treatment Recommendations
- Pregnant women: screening and treatment recommended 3, 4, 2, 5
- Nonpregnant adults: screening and treatment not recommended 3, 4
- Individuals undergoing endoscopic urologic procedures: screening and treatment recommended 4, 2, 5
- Patients with diabetes mellitus, long-term indwelling catheters, or spinal cord injuries: screening and treatment not recommended 5
- Infants and children: screening and treatment not recommended 5