The Role of Asymptomatic Bacteriuria in Young Women With Recurrent Urinary Tract Infections: To Treat or Not to Treat?

Abstract

This study shows that AB should not be treated in young women affected by UTI, suggesting it may play a protective role in preventing symptomatic recurrence.

A 78-year-old woman with lethargy and a positive urine culture

“…8 In a recent randomized prospective trial involving 673 young women with asymptomatic bacteriuria, the occurrence of symptomatic urinary tract infection in the subsequent year was significantly higher among those who received treatment for asymptomatic bacteriuria than among those who did not (48.6% v. 13%, p < 0.001). 9 This study supports the theory that antimicrobial therapy for asymptomatic bacteriuria increases a patient's susceptibility to urinary tract infection by altering the normal intestinal and vaginal flora, which can lead to overgrowth of other uropathogens.…”

“…Five prospective randomized controlled trials have not shown any benefit in treating asymptomatic bacteriuria. 1,8,9 Despite these findings, about half of patients with asymptomatic bacteriuria are prescribed antimicrobial therapy, which may result in unintended negative consequences.…”

Interpreting positive urine cultures

“…One trial showed an increased risk of symptomatic urinary tract infection in those who were treated for asymptomatic bacteriuria. 9 The practice is also associated with adverse drug reactions and Clostridium difficile infection.…”

Recomendaciones prácticas para el diagnóstico y tratamiento de la infección urinaria en el adulto (II)

“…2 La BA no se trata en la mayoría de adultos debido a los posibles efectos secundarios de los fármacos, los costos innecesarios y el desarrollo potencial de resistencias a antimicrobianos. 3 En el momento actual, la detección sistemática y el tratamiento solo están indicados en dos situaciones:…”

“…No mejoría 3 1. Los antibióticos que mejor difunden a la secreción prostática son las fluorquinolonas y cotrimoxazol.…”