A Brief Check for Asymptomatic Bacteriuria

Asymptomatic bacteriuria is defined as presence of ≥ 105 colony forming units in a voided urine specimen without signs or symptoms associated with urinary tract infection in absence of indwelling catheters.

Asymptomatic bacteriuria is a common clinical condition that often leads to unnecessary treatment. The following are the main risk factors: old age, diabetes mellitus, cognitive decline, structural abnormalities of the urinary system, and indwelling catheters. In the majority of cases, asymptomatic bacteriuria does not result in urinary tract infections and antibiotic treatment has not been demonstrated to enhance patient outcomes. However, asymptomatic bacteriuria has a significant risk of side effects in patients having invasive urinary procedures or pregnant women. Hence, they should be checked for it and treated if a positive result is obtained.

Managing asymptomatic bacteriuria can be difficult because it necessitates extensive clinical judgment. There is a need to carefully examine and implement interventional techniques that can lower the number of asymptomatic bacteriuria cases that are treated needlessly. It is crucial to follow the recommendations for screening, diagnosis, and therapy. Otherwise, health care system would be heavily burdened by needless antibiotic therapy, which could have disastrous effects.

The desire to administer antimicrobial therapy can be hard to resist, but the carefully thought out and communicated studies maintained a common objective of lowering antibiotic use in order to avoid antimicrobial resistance. A larger cause can undoubtedly be achieved with smaller initiatives.

 References

1. Gupta K, Trautner BW. The 2019 USPSTF Report on Screening for Asymptomatic Bacteriuria—Lessons From History. JAMA Netw Open. 2019;2(9): e1912522.

2. Nicolle LE et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019 May 2;68(10): e83-e110.

3. Henderson JT, Webber EM, Bean SI.  Screening for asymptomatic bacteriuria in adults: updated evidence report and systematic review for the US Preventive Services Task Force.  JAMA. 2019;322(12):1-10. 

4. Owens DK, Davidson KW, Krist AH et al; US Preventive Services Task Force.  Screening for asymptomatic bacteriuria in adults: US Preventive Services Task Force recommendation statement.  JAMA. 2019;322(12): e1913069. 

5. Harding G, Nicolle L, Ronald A, et al. How long should catheter-acquired urinary tract infection in women be treated? A randomized controlled study. Ann Intern Med 1991;114(9):713–9.