Screening, treatment of asymptomatic bacteriuria not needed for most, guideline states

The majority of patients do not need to be screened or treated for asymptomatic bacteriuria, according to an updated clinical practice guideline on management of the condition from the Infectious Diseases Society of America (IDSA).

The guideline, which was published March 21 by Clinical Infectious Diseases, was developed by an expert panel and was based on review of the literature through June 2017. The guideline authors noted that since publication of the previous IDSA guideline in 2005, additional research has found that antimicrobial treatment of asymptomatic bacteriuria can lead to inappropriate use of these agents. Also, more research has been published on screening and treatment in additional groups of patients, such as those with neutropenia and those who have received solid organ transplants, the authors stated.

The guideline recommends against screening for or treating asymptomatic bacteriuria in infants and children, healthy nonpregnant women, functionally impaired women or men living in the community or long-term care facilities, patients with diabetes, recent recipients of renal transplants, recipients of other solid organ transplants, patients with impaired voiding after spinal cord surgery, patients with short- or long-term indwelling catheters, patients undergoing elective nonurologic surgery, and patients with implanted urologic devices. The guideline suggests not screening for or treating asymptomatic bacteriuria in patients who are planning to have surgery for an artificial urine sphincter or penile prosthesis implantation.

Clinicians should screen for and treat asymptomatic bacteriuria in pregnant women, according to the guideline. In this population, a four- to seven-day course of antimicrobial treatment is suggested rather than a shorter duration, the guideline said, noting that the optimal duration of therapy will vary depending on the antimicrobial chosen and that the shortest effective course should be used. The guideline also recommends screening and treatment before endoscopic urologic procedures associated with mucosal trauma. Patients who will undergo endoscopic urologic procedures should have a urine culture done before the procedure and should receive targeted antimicrobial therapy rather than empiric therapy, the guideline suggests. In patients who have asymptomatic bacteriuria and are undergoing a urologic procedure, the guideline suggests short-course rather than prolonged antimicrobial therapy.

Older patients with functional or cognitive impairment who have bacteriuria and delirium but no local genitourinary symptoms or other systemic signs of infection should be assessed for other causes and carefully observed rather than prescribed antimicrobial treatment, the guideline recommends. This recommendation also applies to patients in this group who experience a fall, the guideline said.

The guideline made no recommendation for or against screening or treatment for asymptomatic bacteriuria in patients with high-risk neutropenia or in patients who are having an indwelling catheter removed.

“Given the potential negative societal consequence of antimicrobial resistance, the guideline committee felt that screening for bacteriuria and treatment of [asymptomatic bacteriuria] should be discouraged unless there is evidence to support a benefit of treatment for a given population,” the authors wrote. “This guideline is most applicable to those who similarly place a high value on addressing the problem of increasing antimicrobial resistance and other harms of antimicrobial exposure, and a lower value on very small or uncertain benefits to individuals.”