October 16, 2012
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Untreated asymptomatic bacteriuria led to fewer UTI recurrences

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New data suggest that young women affected by recurrent urinary tract infections who have asymptomatic bacteriuria should not be treated because they are less likely to develop recurrence.

“The idea for this study came from the evidence that in everyday clinical practice, we sometimes note that young women affected by recurrent UTI showed, after a course of antibiotic treatment, an asymptomatic period associated with sterile urine and then an episode of asymptomatic bacteriuria,” Tommaso Cai, MD, of the department of urology at Santa Chiara Regional Hospital in Trento, Italy, told Infectious Disease News. “Furthermore, in the majority of cases, even if it is not recommended, asymptomatic bacteriuria is treated with poor results and occasionally can allow the development of multidrug-resistant bacteria.”

Cai and colleagues conducted a prospective study that included 673 consecutive asymptomatic women who presented from 2005 to 2009 with bacteriuria. They were split into two groups: 312 patients were not treated and 361 patients received treatment. The patients underwent microbiological and clinical evaluations at months 3, 6 and 12.

Escherichia coli and Enterococcus faecalis were the two most common pathogens. At the 3-month visit, there were no differences observed between the two groups. At the 6-month visit, 7.6% of patients in the non-treatment group and 29.7% of the patients who received treatment showed a UTI recurrence (RR=1.31; 95% CI, 1.21-1.42). At the 12-month follow-up, 13.1% of patients in the non-treatment group and 46.8% of patients who received treatment had a UTI recurrence (RR=3.17; 95% CI, 2.55-3.90).

“The results of our study provide a clear answer: The antibiotic treatment of asymptomatic bacteriuria in young women with recurrent UTI is not only unnecessary but harmful,” Cai said. “Moreover, asymptomatic bacteriuria is considered generally benign and sometimes even a protective condition. Not treating asymptomatic bacteriuria, in general, except during pregnancy and before invasive intervention of the urinary tract, and especially not in young women with recurrent UTI, is highly recommended and should become the standard of care.”

Disclosure: Cai reports no relevant financial disclosures.