From the Guidelines
Test of cure for asymptomatic bacteriuria is generally not recommended in most patient populations. After completing antibiotic treatment for asymptomatic bacteriuria, routine follow-up urine cultures are unnecessary unless the patient is pregnant or undergoing urologic procedures 1. For pregnant women who have been treated, a test of cure should be performed 1-2 weeks after completing antibiotics, with subsequent monthly urine cultures until delivery to ensure the bacteriuria doesn't recur. The typical treatment regimen for asymptomatic bacteriuria in pregnancy is based on guidelines that recommend a duration of antimicrobial therapy of 3–7 days 1. Some key points to consider in the management of asymptomatic bacteriuria include:
- Pyuria accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment 1
- Screening for and treatment of asymptomatic bacteriuria is recommended before transurethral resection of the prostate and other urologic procedures for which mucosal bleeding is anticipated 1
- Asymptomatic bacteriuria should only be treated in specific populations, including pregnant women and patients undergoing urologic procedures with mucosal bleeding 1. The rationale for avoiding routine post-treatment cultures in non-pregnant patients is that asymptomatic bacteriuria is generally benign in most populations and frequently recurs even after successful treatment 1. Additionally, unnecessary testing can lead to detection of colonization rather than infection, potentially resulting in overtreatment and antimicrobial resistance.
From the Research
Test of Cure in Asymptomatic Bacteriuria
- The test of cure in asymptomatic bacteriuria is not routinely recommended, as treatment of asymptomatic bacteriuria has not been shown to improve patient outcomes in most cases 2, 3, 4.
- However, certain groups, such as pregnant women, should be screened for asymptomatic bacteriuria and treated if positive, as it can help prevent symptomatic infection and other health outcomes 3, 4.
- The Infectious Disease Society of America (IDSA) updated its asymptomatic bacteriuria management guidelines in 2019, emphasizing the risks and benefits of treating the condition 2.
- Unnecessary treatment of asymptomatic bacteriuria can lead to increased antimicrobial resistance, Clostridioides difficile infection, and increased healthcare costs 2, 5.
- Studies have shown that screening and treatment for asymptomatic bacteriuria during pregnancy can reduce rates of pyelonephritis and low birth weights, but the evidence for nonpregnant adult populations is limited 4.
- Implementation of an inpatient urine culture algorithm in the electronic medical record can help reduce unnecessary cultures and improve prescribing practices for asymptomatic bacteriuria 5.