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Asymptomatic Bacteriuria

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Asymptomatic Bacteriuria

  • Epidemiology
  1. Incidence: Asymptomatic Bacteriuria
    1. Sexually active women: 5%
    2. Healthy older women in community: 20%
    3. Men over age 75 years old in community: 15%
    4. Long-term care residents: 40-50%
  • Precautions
  1. Most Asymptomatic Bacteriuria resolves without treatment (including catheterized patients)
  2. Infectious Disease Society of America (IDSA) does not recommend routine UA/UC in asymptomatic patients
    1. Unlikely to offer benefit (poor Specificity for UTI in the absence of urinary tract symptoms)
    2. Risk of Antibiotic Resistance and adverse effects (e.g. Clostridium difficile)
  • Labs
  1. Indications for Urinalysis and Urine Culture
    1. Screening for Asymptomatic Bacteriuria in Pregnancy
    2. Screening prior to invasive urologic procedures
    3. Symptoms suggestive of Urinary Tract Infection (e.g. Dysuria, urgency, frequency)
    4. Cloudy, malodorous or other urine abnormality (however, may also be due to dehydration)
  2. Cases in which screening is not recommended
    1. Asymptomatic non-pregnanct patients (including catheterized patients)
    2. Non-specific symptoms (e.g. weakness, malaise) EXCEPT catheterized or spinal cord injury patients
      1. Consider other causes of confusion or falls in the elderly first (e.g. Anticholinergic Medications)
      2. See Urinary Catheter associated UTI
      3. Treatment of abnormal urine and nonspecific symptoms does not reduce fall risk
        1. Rowe (2013) J Am Geriatr Soc 61(4):653-4 +PMID:23581923 [PubMed]
  3. Interpretations
    1. Even pyuria and urine nitrates are non-specific and may not warrant antibiotics
  • Management
  1. Indications for treatment of Bacteriuria
    1. Asymptomatic Bacteriuria in Pregnancy
    2. Urologic procedures that may result in bleeding
  2. Cases in which screening and antibiotics are not indicated
    1. Asymptomatic Bacteriuria in non-pregnant women
    2. Urinary Catheter Associated Asymptomatic Bacteriuria
    3. Asymptomatic Bacteriuria in Diabetes Mellitus
    4. Asymptomatic Bacteriuria in Spinal Cord Injuries
    5. Asymptomatic Bacteriuria in Older patients
  • Prognosis
  1. Spontaneous resolution
    1. Simple cystitis (typical cystitis, positive UA) without antibiotics resolves in 25-50% within 1 week
  2. Progression cystitis to pylenophritis
    1. Progression to Pyelonephritis occurs in 1 in 38 cases (2.6%)
  • References
  1. (2019) Presc Lett 26(6)
  2. (2015) Presc Lett 22(4)
  3. Orman and Glaser in Herbert (2016) EM:Rap 16(1): 8-9
  4. Colgan (2006) Am Fam Physician 74(6):985-90 [PubMed]
  5. Nicolle (2005) Clin Infect Dis 40:643-54 [PubMed]