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Kranz J, Bartoletti R, Bruyère F, et al. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. Eur Urol. 2024 Jul;86(1):27-41. doi: 10.1016/j.eururo.2024.03.035. Epub 2024 May 6. PMID: 38714379.
Nicolle LE, Gupta K, Bradley SF, 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. doi: 10.1093/cid/ciy1121. PMID: 30895288.
Guidelines on Urological Infections. European Association of Urology. Available at http://uroweb.org/wp-content/uploads/19-Urological-infections_LR2.pdf. Accessed 24 March 2015.
Gupta K, Hooton TM, Naber KG, et al; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52(5):e103-20. doi: 10.1093/cid/ciq257. Review. PMID: 21292654.
Hooton TM, Bradley SF, Cardenas DD, et al; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010 Mar 1;50(5):625-63. PMID: 20175247.
DiagnosisTop
Asymptomatic bacteriuria (ABU) is diagnosed when significant bacteriuria (≥105 colony-forming units [CFU]/mL of ≥1 strain) is detected in properly collected urine samples (midstream specimens or catheter samples) and is not accompanied by clinical signs or symptoms of urinary tract infection. Two consecutive cultures, preferably at an interval of ≤2 weeks, are required to diagnose asymptomatic bacteriuria based on a midstream specimen in women. Except for certain cases (see Treatment, below), ABU must not be treated with antibiotics, as the potential harm outweighs the potential benefits.Evidence 1Strong recommendation (downsides clearly outweigh benefits; right action for all or almost all patients). High Quality of Evidence (high confidence that we know true effects of the intervention). Zalmanovici Trestioreanu A, Lador A, Sauerbrun-Cutler MT, Leibovici L. Antibiotics for asymptomatic bacteriuria. Cochrane Database Syst Rev. 2015 Apr 8;4(4):CD009534. doi: 10.1002/14651858.CD009534.pub2. Epub ahead of print. PMID: 25851268; PMCID: PMC8407041. Accessed October 15, 2021. Cai T, Mazzoli S, Mondaini N, Meacci F, Nesi G, D'Elia C, Malossini G, Boddi V, Bartoletti R. The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat? Clin Infect Dis. 2012 Sep;55(6):771-7. doi: 10.1093/cid/cis534. Epub 2012 Jun 7. PMID: 22677710. Considering this, the Infectious Diseases Society of America (IDSA) specifically stated that screening for ABU in patient populations that would not benefit from ABU treatment is not indicated. This includes:
1) Elderly people with disabilities (including those staying in chronic care facilities).
2) Patients with diabetes.
3) Transplant recipients (except for the first month after kidney transplant).
4) People with spinal cord injury and urination disorders.
5) People with a bladder catheter.
6) Patients before elective surgical treatment other than urologic surgery (including elective arthroplasty).
TreatmentTop
ABU requires no treatment, except for:
1) Pregnant patients (see Urinary Tract Infections in Pregnant Women).
2) Patients scheduled for urologic procedures when bleeding is anticipated, including transurethral resection of the prostate. In such individuals start antibacterial prophylaxis on the evening prior to the procedure using an antibiotic selected on the basis of culture results (preferably a fluoroquinolone if susceptible) and continue only in case of delayed catheter removal.
