SHM's Clinical Quick Talks-Asymptomatic Bacteriuria

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Asymptomatic bacteriuria refers to the presence of bacteria in the urine without any signs or symptoms of a urinary tract infection (UTI). It is defined as the growth of one or more species of bacteria in the urine, with a colony forming unit count of at least 105/mL, in individuals without indwelling catheters. Notable urinalysis findings include a high leukocyte count (suggesting a true UTI) and the presence of nitrites (indicating gram-negative bacteria).<br /><br />Studies have shown that asymptomatic bacteriuria is not a predictor of a UTI. Therefore, guidelines recommend that patients without symptoms should not be treated, except for pregnant women or those undergoing invasive urologic procedures. Patients with chronic indwelling catheters have a high risk of bacterial colonization, but routine screening and treatment of asymptomatic bacteriuria in these patients is not recommended.<br /><br />Screening and treating asymptomatic bacteriuria can lead to increased risk of antimicrobial adverse effects, higher healthcare costs, and increased antimicrobial resistance. Therefore, it is important to carefully consider which patients to screen and treat. Pregnant women, infants and children, patients undergoing urologic procedures, and those with certain medical conditions (such as diabetes or a history of spinal cord injury) may benefit from screening and treatment. However, healthy premenopausal and postmenopausal women, older functionally impaired individuals, and patients with short-term indwelling catheters or urologic devices generally should not be screened and treated unless they develop symptoms or signs of infection.<br /><br />In conclusion, asymptomatic bacteriuria is the presence of bacteria in the urine without symptoms of a UTI. Routine screening and treatment of asymptomatic bacteriuria is generally not recommended, as it does not predict the development of a UTI and can lead to various adverse effects. However, certain populations may benefit from screening and treatment, while others do not require intervention unless they develop symptoms of infection. Individualized assessment and careful consideration of the patient's clinical situation is key in determining the appropriate approach.

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Parth Shah

Keywords

asymptomatic bacteriuria

urinary tract infection

bacteria in urine

leukocyte count

nitrites

indwelling catheters

pregnant women

urologic procedures

antimicrobial adverse effects

increased antimicrobial resistance