March 22, 2019
2 min read

Updated guidance on asymptomatic bacteriuria adds patients who should not be tested

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The Infectious Diseases Society of America has issued updated clinical practice guidelines for the management of asymptomatic bacteriuria, or ASB.

The new guidance adds infants and children, people who have had joint replacement or other non-urologic surgery and people who have had organ transplants to the list of patients who should not be tested for a UTI without experiencing other symptoms.

It was the first time the guidelines were updated since 2005, when they did not address the pediatric population and certain adult populations.

“Asymptomatic bacteriuria is a very common finding, and there are only a very limited group of individuals — particularly that is women who are pregnant and individuals who are undergoing endourologic procedures — who require screening or treatment for asymptomatic bacteriuria,” Lindsay E. Nicolle, MD, professor of internal medicine at the University of Manitoba College of Medicine, told Infectious Disease News. “For other groups, treatment would not be recommended.”

The new guidelines emphasize to avoid screening and treating patients that do not present with symptoms.

“The evidence that is available so far does not suggest that nonlocalizing symptoms, such as changes in mental status, falls or smelly urine, are in fact symptoms attributable to the positive urine culture,” Nicolle said.

As previously recommended, healthy nonpregnant women, patients with diabetes and those with spinal cord injuries also should not be screened or tested without symptoms. Nicolle explained that elderly patients should not be tested or screened for ASB unless there is clear clinical evidence of a UTI.

“The biggest issue with the elderly population is that there is an extraordinarily high prevalence of asymptomatic bacteriuria, particularly in the functionally impaired elderly,” Nicolle said. “Because these individuals so often will have positive urine cultures, any clinical change in them may be attributed to urinary tract infection and then they get treated for urinary tract infection.”

For clinicians caring for this patient group, Nicolle suggested to “think of alternate diagnoses” and “avoid treating with antimicrobials.”

According to the IDSA, around 3% to 7% percent of healthy women, 50% of people with spinal injuries and 30% to 50% of nursing home residents have a presence of bacteria in their urine.

“Given the current concerns about overuse of certain antimicrobial agents, this is an important antimicrobial stewardship issue,” Nicolle said.

Disclosures: Nicolle reports serving as a consultant for GlaxoSmithKline, Paratek, Tetraphase, and Utility. Please see the guidelines for all other authors’ relevant financial disclosures.