Can asymptomatic bacteriuria be treated in a post coronary artery bypass grafting (CABG) patient?

Treatment of Asymptomatic Bacteriuria in Post-CABG Patients

Asymptomatic bacteriuria (ASB) should not be treated in post-coronary artery bypass grafting (CABG) patients as there is no evidence of clinical benefit, and treatment may lead to antimicrobial resistance. 1

Definition and Prevalence

• Asymptomatic bacteriuria is defined as the presence of bacteria in the urine without symptoms of urinary tract infection 1
• Post-CABG patients may develop various complications, including infections, but specific data on ASB prevalence in this population is limited 2

Evidence Against Treatment in Non-Urologic Surgical Patients

• The 2019 Infectious Diseases Society of America (IDSA) guidelines strongly recommend against screening for or treating ASB in patients undergoing elective non-urologic surgery 1
• There is low-quality evidence that treating ASB before non-urologic procedures provides any benefit in preventing surgical site infections or other complications 1
• Treatment of ASB in post-surgical patients does not reduce the risk of symptomatic urinary tract infections and may promote antimicrobial resistance 1

Risks of Unnecessary Treatment

• Treatment of ASB promotes reinfection with organisms increasingly resistant to antimicrobials 1
• Antimicrobial therapy has an important risk of adverse effects including Clostridioides difficile infection 1
• Post-CABG patients are already at risk for various infections, and unnecessary antibiotics may complicate management of these infections 2, 3

Special Considerations for Post-CABG Patients

• Post-CABG patients have a risk of various complications, including sternal wound infections, pneumonia, and other systemic infections 2
• Diabetes is a significant risk factor for post-CABG infections (OR 4.18), and these patients require careful monitoring but not treatment of ASB 3
• Prolonged central venous catheterization is associated with increased infection risk post-CABG (OR 1.019), but this does not justify treatment of ASB 3

When to Consider Treatment of Bacteriuria

• Treatment is only indicated when patients develop symptoms of urinary tract infection 1
• Before urologic procedures that breach the mucosal lining, ASB should be treated to prevent infectious complications 1
• Symptoms that would warrant treatment include dysuria, frequency, urgency, suprapubic pain, or fever with no other identified source 1

Monitoring Recommendations

• Regular clinical assessment for symptoms of urinary tract infection is appropriate 1
• Routine screening for ASB in post-CABG patients is not recommended 1
• Focus infection prevention efforts on other aspects of post-CABG care, such as wound care, early removal of catheters, and glycemic control 3

Conclusion

The evidence clearly demonstrates that treating asymptomatic bacteriuria in post-CABG patients provides no clinical benefit and may lead to adverse outcomes through the development of antimicrobial resistance. The focus should be on monitoring for symptomatic infections and treating only when clinically indicated.