Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of Americaa

Abstract

Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.

Hyperthyroidism is not a risk factor for subclinical bacteriuria in cats: A prospective cohort study

“…The low prevalence of subclinical bacteriuria in our hyperthyroid cats is similar to that reported in human patients with hyperthyroidism, in which cystitis or asymptomatic bacteriuria is very rare 28‐30 . In fact, reviews of asymptomatic bacteriuria in humans do not mention thyroid disease as a possible risk factor 2,31 …”

“…Treatment of humans with asymptomatic bacteriuria does not decrease the frequency of future episodes of bacterial cystitis, pyelonephritis, renal impairment, or survival. By promoting development of antimicrobial resistance, antibiotic treatment may increase the risk of clinical UTI 2,40‐42 …”

“…Subclinical bacteriuria (also called occult bacteriuria or asymptomatic bacteriuria) is defined as a positive bacterial urine culture in the absence of clinical evidence of urinary tract infection (UTI) 1 . Studies have recognized subclinical bacteriuria as a common clinical syndrome in humans, cats, and dogs 1‐4 . Retrospective studies of hyperthyroid cats have reported a prevalence of UTI ranging from 12 to 22%, 5,6 and consisting mostly of subclinical bacteriuria.…”

Evaluation of the trends and appropriateness of fluoroquinolone use in the outpatient treatment of acute uncomplicated cystitis at five family practice clinics

“…Empiric FQ treatment was deemed appropriate if the patient had an allergy to nitrofurantoin, had a urine culture with a pathogen that was non‐susceptible to nitrofurantoin within the previous year, was receiving long‐term suppressive therapy with nitrofurantoin, had a creatinine clearance (CrCl) <30 mL/min or previously failed nitrofurantoin therapy . FQ therapy was considered inappropriate if the patient did not meet any of the criteria for appropriate therapy, was asymptomatic, had a urine culture with a pathogen that was non‐susceptible to FQs within the previous year or had an allergy to FQs . Nitrofurantoin use was appropriate unless the patient had an allergy to nitrofurantoin, had a CrCl <30 mL/min, had a history of UTI with a pathogen that was non‐susceptible to nitrofurantoin within the previous year, was receiving suppressive therapy with nitrofurantoin or was asymptomatic …”

COVID-19: Screening and triage challenges in people with disability due to Spinal Cord Injury

“…Temperature dysregulation has shown to be proportional to the NLI, with persons with tetraplegia being more impaired than persons with paraplegia [4]. Though urinary tract infections (UTIs) are the most common cause of fever and emergency room visits in persons with SCI who have an indwelling catheter, a positive urine analysis (UA) should not stop further investigation of a fever in the setting of associated respiratory symptoms [3] given the high likelihood this represents asymptomatic bacteriuria without any other focal signs of infection [13].…”