From the Guidelines
Treatment of Group B Streptococcus (GBS) found in a urine culture of an 89-year-old female with increased urinary frequency is not necessary unless the patient is symptomatic and the bacterial count is significant. According to the most recent guidelines from the Infectious Diseases Society of America, asymptomatic bacteriuria, including GBS, should not be treated in elderly individuals living in the community 1. The guidelines emphasize that treatment of asymptomatic bacteriuria can lead to antimicrobial resistance and does not provide a benefit to the patient. In this case, since the patient is 89 years old and has increased urinary frequency, it is essential to assess whether the symptoms are due to a urinary tract infection (UTI) or another cause. If the patient is symptomatic and the bacterial count is significant (typically >100,000 CFU/mL), treatment with antibiotics such as amoxicillin or nitrofurantoin may be considered 1. However, it is crucial to weigh the benefits and risks of treatment, considering the potential for antimicrobial resistance and side effects, especially in elderly patients. The decision to treat should be based on a thorough evaluation of the patient's symptoms, medical history, and laboratory results, rather than solely on the presence of GBS in the urine culture. In general, it is recommended to avoid treating asymptomatic bacteriuria in women with recurrent UTIs, as this can foster antimicrobial resistance and increase the number of recurrent episodes 1. Instead, treatment should be focused on symptomatic UTIs, and the choice of antibiotic should be guided by prior culture data, local antibiograms, and patient-specific factors such as allergies and side effects.
From the Research
Group B Strep in Urine Culture
- The presence of Group B Streptococcus (GBS) in urine culture is not always indicative of a urinary tract infection (UTI) 2, 3.
- In nonpregnant adults, GBS can cause UTIs, but it is also commonly found in asymptomatic bacteriuria (ABU) 2, 3.
- A study found that GBS growth in human urine is more likely to be associated with high-grade ABU rather than acute UTI 3.
Treatment of UTIs in the Elderly
- The treatment of UTIs in the elderly should take into account the patient's symptoms, medical history, and underlying conditions 4, 5.
- Asymptomatic bacteriuria, including GBS, should not be treated with antibiotics in the absence of symptoms 4.
- In symptomatic women, even low levels of bacterial growth (e.g., 10^2 colony-forming unit/mL) can indicate a UTI 4.
Specific Considerations for the 89-Year-Old Female
- The patient's increased urinary frequency may be due to various factors, including UTI, ABU, or other conditions such as overactive bladder or benign prostatic hyperplasia 6.
- A thorough assessment, including medical history, physical examination, and laboratory tests, is necessary to determine the cause of the patient's symptoms 6.
- Treatment should be guided by the patient's specific diagnosis and symptoms, rather than solely by the presence of GBS in the urine culture 4, 5, 2, 3.