What is the significance of abnormal urinalysis results indicating a possible urinary tract infection in an asymptomatic patient with a medical history of hypothyroidism, hyperlipidemia, type 2 diabetes mellitus, vitamin D deficiency, and lichen sclerosus, and taking medications such as GlipiZIDE (glipizide), Unithroid (levothyroxine), Vitamin D, Diclofenac Sodium (diclofenac), Liraglutide, Meloxicam, and Rosuvastatin Calcium (rosuvastatin)?

Reassurance About Asymptomatic Bacteriuria

You should be reassured that your abnormal urinalysis does not require treatment because you have no urinary symptoms, and treating asymptomatic bacteriuria in your situation would cause more harm than good by promoting antibiotic resistance without providing any benefit. 1

What You Have: Asymptomatic Bacteriuria

Your urinalysis shows bacteria, white blood cells, and leukocyte esterase, but you lack the key symptoms that define a true urinary tract infection—no dysuria (burning with urination), no urinary frequency, no urgency, and no suprapubic pain. 1 This condition is called asymptomatic bacteriuria (ABU), which represents harmless bacterial colonization rather than infection. 1

Asymptomatic bacteriuria is extremely common in women your age—affecting 10-16% of women aged 50-70 years living in the community. 1 This increases to 25-50% in elderly women in long-term care facilities. 1

Why Treatment Would Be Harmful

The most recent 2024 European Association of Urology guidelines provide a strong recommendation against screening for or treating asymptomatic bacteriuria in postmenopausal women, patients with well-regulated diabetes mellitus, and elderly patients. 1 The Infectious Diseases Society of America guidelines similarly recommend against treatment. 1, 2

The reasons not to treat include: 1, 2

• Treatment does not prevent symptomatic UTIs from developing later
• Treatment does not prevent kidney damage or progression of kidney disease
• Antibiotics promote colonization with increasingly resistant bacteria, making future infections harder to treat
• Antibiotics cause adverse drug effects and unnecessary healthcare costs
• Asymptomatic bacteriuria may actually protect against more harmful bacterial strains

Your Medical Conditions and Medications Are Not the Cause

None of your medical conditions (hypothyroidism, hyperlipidemia, type 2 diabetes, vitamin D deficiency, or lichen sclerosus) directly cause abnormal urinalysis results. 1 However, your diabetes does place you in a population with slightly higher rates of asymptomatic bacteriuria (9-27% in diabetic women vs. 1-5% in healthy premenopausal women). 1 The 2024 EAU guidelines specifically state that patients with well-regulated diabetes should not be screened or treated for asymptomatic bacteriuria. 1

Your medications do not cause these urinalysis findings. 1 While NSAIDs like diclofenac and meloxicam can occasionally cause interstitial nephritis with pyuria, this would present with symptoms and other laboratory abnormalities, not isolated asymptomatic bacteriuria. None of your other medications (glipizide, levothyroxine, vitamin D, liraglutide, or rosuvastatin) cause urinary tract colonization or abnormal urinalysis results.

Important Caveat About Pyuria

The presence of white blood cells (pyuria) in your urine does not change the recommendation against treatment. 1, 2 Pyuria accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment. 1 Research shows that pyuria is commonly found in the absence of infection, particularly in older adults, and abnormal urinalysis results are common in disease-free women regardless of collection technique. 3, 4

When Treatment Would Be Indicated

The only situations where asymptomatic bacteriuria should be treated are: 1, 2

• Pregnancy (you should be screened and treated if positive)
• Before urological procedures that breach the mucosa (such as cystoscopy, prostate biopsy, or urinary tract surgery)

You do not need treatment before cardiovascular surgeries or arthroplasty (joint replacement) surgery. 1

What to Do About the Antibiotic

The antibiotic that was sent to the pharmacy should not be taken unless you develop symptoms. 1 If you develop dysuria, frequency, urgency, or suprapubic pain, then you should take the antibiotic as prescribed. Otherwise, the prescription represents inappropriate treatment that could harm you by promoting antibiotic resistance.

Common Pitfall to Avoid

The most common error in clinical practice is treating abnormal urinalysis results in asymptomatic patients simply because the test was ordered. 2, 5 In fact, guidelines recommend against obtaining urine cultures in asymptomatic patients because the presence of a positive culture often drives inappropriate treatment regardless of symptoms. 2 Your urinalysis should not have been ordered in the absence of urinary symptoms, but now that it has been done, the appropriate response is reassurance and no treatment.