Asymptomatic Bacteriuria

Children: 1-2% in girls (<1% in boys)
Healthy women
1. Sexually active women: 5%
2. Pregnancy: 2-10%
3. Postmenopausal women 50-70 years old: 2 to 8%
4. Older women in community: Up to 20%
Men over age 75 years old in community: 15%
Long-term care residents: Up to 40-50%
1. Diabetes Mellitus: 11 to 16% in women (1 to 11% in men)
Spinal Cord Injury (e.g. Paraplegia)
1. Intermittent catheterization: 23 to 69%
2. Sphincterotomy and Condom catheter: 57%
Renal Transplant
1. Post-transplant <1 month: 24%
2. Post-transplant 1 month to 1 year: 10 to 17%
3. Post-transplant >1 year: 2 to 9%
Indwelling Urinary Catheter
1. Short-term catheter (<1 month): Increases 3-5% each day the catheter is present
2. Long-term catheter: 100%
References
1. Nicolle (2019) Clin Infect Dis 68(10): e83-110 +PMID: 30895288 [PubMed]

Most Asymptomatic Bacteriuria resolves without treatment (including catheterized patients)
Avoid prophylactic Antibiotics (ineffective and risk of Antibiotic Resistance)
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)

Indications for Urinalysis and Urine Culture
1. Screening for Asymptomatic Bacteriuria in Pregnancy
2. Screening prior to invasive urologic procedures
  1. Includes transurethral surgery, ureteroscopy, lithotripsy, percutaneous nephrolithotomy
  2. No treatment needed in procedures that do not disrupt mucosa (e.g. diagnostic cystoscopy)
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)
5. Spinal Cord Injury with systemic symptoms
  1. Fever, malaise, lethargy, spasticity or Autonomic Dysreflexia
  2. New or worsening Urinary Incontinence or leakage around catheter
  3. Cloudy or malodorous urine, back or Flank Pain, Suprapubic Pain or Dysuria
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. See Urinary Catheter associated UTI
  2. Consider other causes of confusion or falls in the elderly first (e.g. Anticholinergic Medications)
    1. However in those with Sepsis, and other sources not identified, treat as symptomatic 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]
Interpretations
1. Even pyuria and urine nitrates are non-specific and may not warrant Antibiotics

Indications for treatment of Asymptomatic Bacteriuria
1. Asymptomatic Bacteriuria in Pregnancy
2. Urologic procedures that may result in bleeding
Cases in which screening and Antibiotics are not indicated
1. Asymptomatic Bacteriuria in infants and children
2. Asymptomatic Bacteriuria in non-pregnant women
3. Urinary Catheter Associated Asymptomatic Bacteriuria (differentiate from CAUTI)
4. Asymptomatic Bacteriuria in Diabetes Mellitus
5. Asymptomatic Bacteriuria in Spinal Cord Injuries (no systemic symptoms - see above)
6. Asymptomatic Bacteriuria in Older patients

Spontaneous resolution
1. Simple cystitis (typical cystitis, positive UA) without Antibiotics resolves in 25-50% within 1 week
Progression cystitis to pylenophritis
1. Progression to Pyelonephritis occurs in 1 in 38 cases (2.6%)

(2019) Presc Lett 26(6)
(2015) Presc Lett 22(4)
Orman and Glaser in Herbert (2016) EM:Rap 16(1): 8-9
Colgan (2020) Am Fam Physician 102(1):99-104 [PubMed]
Colgan (2006) Am Fam Physician 74(6):985-90 [PubMed]
Nicolle (2005) Clin Infect Dis 40:643-54 [PubMed]