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Asymptomatic bacteriuria: when the treatment is worse than the disease

Nature Reviews Urology volume 9, pages 85–93 (2012)Cite this article

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Abstract

Asymptomatic bacteriuria (ABU) is a condition in which bacteria are present in a noncontaminated urine sample collected from a patient without signs or symptoms related to the urinary tract. ABU must be distinguished from symptomatic UTI by the absence of signs and symptoms compatible with UTI or by clinical determination that a nonurinary etiology accounts for the patient's symptoms. Interactions between the organism, the host, and the bladder environment determine whether bacteriuria leads to ABU or to UTI. ABU is a very common condition that is often treated unnecessarily with antibiotics—it should be detected and treated in pregnant women and patients undergoing urologic surgery, but in most other patient groups, treatment does not confer benefit and can be harmful. A change in prescribing behavior for ABU has been achieved through several fairly high-intensity interventions, such as interactive educational sessions for physicians, but whether these improvements persist beyond the study period is not known. Further research is needed to determine whether screening for and treatment of ABU is beneficial in patients with renal transplants, patients with orthotopic neobladders, patients undergoing prosthetic joint implantation, and patients with neutropenia.

Key Points

  • Asymptomatic bacteriuria (ABU) is a condition in which bacteria are present in an uncontaminated urine sample collected from a patient without signs or symptoms referable to the urinary tract

  • ABU must be distinguished from symptomatic UTI by the absence of signs and symptoms of UTI or by confirmation that a nonurinary etiology accounts for the patient's symptoms

  • Interaction between the organism, the host, and the bladder environment determines whether bacteriuria leads to ABU or to UTI

  • ABU is a very common condition that is often treated unnecessarily with antibiotics

  • Changes in prescribing behavior for ABU have been achieved through several fairly high-intensity interventions, including interactive physician education, and audit and feedback

  • It remains to be determined whether screening and treatment for ABU is beneficial in patients with renal transplants or orthotopic neobladders, those who have undergone prosthetic joint implantation and patients with neutropenia

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References

  1. Lin, K. & Fajardo, K. Screening for asymptomatic bacteriuria in adults: evidence for the U. S. Preventive Services Task Force reaffirmation recommendation statement. Ann. Intern. Med. 149, W20–W24 (2008).

    Article  PubMed  Google Scholar 

  2. Hooton, T. M. et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin. Infect. Dis. 50, 625–663 (2010).

    Article  PubMed  Google Scholar 

  3. Horan, T., Andrus, M. & Dudeck, M. CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting. Am. J. Infect. Control 36, 309–332 (2009).

    Article  Google Scholar 

  4. Nicolle, L. E. et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin. Infect. Dis. 40, 643–654 (2005).

    Article  PubMed  Google Scholar 

  5. Brown, J., Doloresco Iii, F. & Mylotte, J. M. “Never events”: not every hospital-acquired infection is preventable. Clin. Infect. Dis. 49, 743–746 (2009).

    Article  PubMed  Google Scholar 

  6. Carlet, J., Fabry, J., Amalberti, R. & Degos, L. The “zero risk” concept for hospital-acquired infections: a risky business! Clin. Infect. Dis. 49, 747–749 (2009).

    Article  PubMed  Google Scholar 

  7. Saint, S., Meddings, J. A., Calfee, D., Kowalski, C. P. & Krein, S. L. Catheter-associated urinary tract infection and the Medicare rule changes. Ann. Intern. Med. 150, 877–884 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  8. Greene, L., Marx, J. & Oriola, S. Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs) in An APIC Guide (APIC, Washington, 2008).

    Google Scholar 

  9. Lo, E. et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect. Control Hosp. Epidemiol. 29 (Suppl. 1), S41–S50 (2008).

    Article  PubMed  Google Scholar 

  10. Tenke, P. et al. European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int. J. Antimicrob. Agents 31 (Suppl. 1), S68–S78 (2008).

    Article  CAS  PubMed  Google Scholar 

  11. Yokoe, D. S. et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect. Control Hosp. Epidemiol. 29 (Suppl. 1), S12–S21 (2008).

    Article  PubMed  Google Scholar 

  12. Cope, M. et al. Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clin. Infect. Dis. 48, 1182–1188 (2009).

    Article  PubMed  Google Scholar 

  13. Dalen, D. M., Zvonar, R. K. & Jessamine, P. G. An evaluation of the management of asymptomatic catheter-associated bacteriuria and candiduria at The Ottawa Hospital. Can. J. Infect. Dis. Med. Microbiol. 16, 166–170 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gandhi, T., Flanders, S. A., Markovitz, E., Saint, S. & Kaul, D. R. Importance of urinary tract infection to antibiotic use among hospitalized patients. Infect. Control Hosp. Epidemiol. 30, 193–195 (2009).

    Article  PubMed  Google Scholar 

  15. Khawcharoenporn, T., Vasoo, S., Ward, E. & Singh, K. Abnormal urinalysis finding triggered antibiotic prescription for asymptomatic bacteriuria in the ED. Am. J. Emerg. Med. 29, 828–830 (2011).

    Article  PubMed  Google Scholar 

  16. Gross, P. A. & Patel, B. Reducing antibiotic overuse: a call for a national performance measure for not treating asymptomatic bacteriuria. Clin. Infect. Dis. 45, 1335–1337 (2007).

    Article  PubMed  Google Scholar 

  17. Gupta, K. et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin. Infect. Dis. 52, e103–e120 (2011).

    Article  PubMed  Google Scholar 

  18. Paterson, D. L. “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin. Infect. Dis. 38 (Suppl. 4), S341–S345 (2004).

    Article  CAS  PubMed  Google Scholar 

  19. Stevens, V., Dumyati, G., Fine, L. S., Fisher, S. G. & van Wijngaarden, E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin. Infect. Dis. 53, 42–48 (2011).

    Article  PubMed  Google Scholar 

  20. Montini, G., Tullus, K. & Hewitt, I. Febrile urinary tract infections in children. N. Engl. J. Med. 365, 239–250 (2011).

    Article  CAS  PubMed  Google Scholar 

  21. Little, P. et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ 340, c199 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Falagas, M. E., Kotsantis, I. K., Vouloumanou, E. K. & Rafailidis, P. I. Antibiotics versus placebo in the treatment of women with uncomplicated cystitis: a meta-analysis of randomized controlled trials. J. Infect. 58, 91–102 (2009).

    Article  PubMed  Google Scholar 

  23. Duma, R. & Edwards, J. E. Candida urinary tract infections. Clin. Infect. Dis. 52 (Suppl. 6), NP (2011).

    Google Scholar 

  24. Darouiche, R. Device-associated infections: a macroproblem that starts with microadherence. Clin. Infect. Dis. 33, 1567–1572 (2001).

    Article  CAS  PubMed  Google Scholar 

  25. Marrs, C. F., Zhang, L. & Foxman, B. Escherichia coli mediated urinary tract infections: are there distinct uropathogenic E. coli (UPEC) pathotypes? FEMS Microbiol. Lett. 252, 183–190 (2005).

    Article  CAS  PubMed  Google Scholar 

  26. Takahashi, A. et al. Escherichia coli isolates associated with uncomplicated and complicated cystitis and asymptomatic bacteriuria possess similar phylogenies, virulence genes, and O-serogroup profiles. J. Clin. Microbiol. 44, 4589–4592 (2006).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Spurbeck, R. R. et al. Fimbrial profiles predict virulence of uropathogenic E. coli strains: contribution of Ygi and Yad Fimbriae. Infect. Immun. 79, 4753–4763 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Mabbett, A. N. et al. Virulence properties of asymptomatic bacteriuria Escherichia coli. Int. J. Med. Microbiol. 299, 53–63 (2009).

    Article  CAS  PubMed  Google Scholar 

  29. Roos, V., Nielsen, E. M. & Klemm, P. Asymptomatic bacteriuria Escherichia coli strains: adhesins, growth and competition. FEMS Microbiol. Lett. 262, 22–30 (2006).

    Article  CAS  PubMed  Google Scholar 

  30. Zdziarski, J., Svanborg, C., Wullt, B., Hacker, J. & Dobrindt, U. Molecular basis of commensalism in the urinary tract: low virulence or virulence attenuation? Infect. Immun. 76, 695–703 (2008).

    Article  CAS  PubMed  Google Scholar 

  31. Watts, R. E. et al. Escherichia coli isolates causing asymptomatic bacteriuria in catheterized and noncatheterized individuals possess similar virulence properties. J. Clin. Microbiol. 48, 2449–2458 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Schlager, T. A., Johnson, J. R., Ouellette, L. M. & Whittam, T. S. Escherichia coli colonizing the neurogenic bladder are similar to widespread clones causing disease in patients with normal bladder function. Spinal Cord 46, 633–638 (2008).

    Article  CAS  PubMed  Google Scholar 

  33. Zdziarski, J. et al. Host imprints on bacterial genomes--rapid, divergent evolution in individual patients. PLoS Pathog. 6, e1001078 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Prasad, A., Cevallos, M. E., Riosa, S., Darouiche, R. O. & Trautner, B. W. A bacterial interference strategy for prevention of UTI in persons practicing intermittent catheterization. Spinal Cord 47, 565–569 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Darouiche, R., Thornby, J., Cerra-Stewart, C., Donovan, W. & Hull, R. Bacterial interference for preventing urinary tract infection: a prospective, randomized, placebo-controlled, double-blind pilot trial. Clin. Infect. Dis. 41, 1531–1540 (2005).

    Article  PubMed  Google Scholar 

  36. Sunden, F., Hakansson, L., Ljunggren, E. & Wullt, B. Escherichia coli 83972 bacteriuria protects against recurrent lower urinary tract infections in patients with incomplete bladder emptying. J. Urol. 184, 179–185 (2010).

    Article  PubMed  Google Scholar 

  37. Vejborg, R. M., Friis, C., Hancock, V., Schembri, M. A. & Klemm, P. A virulent parent with probiotic progeny: comparative genomics of Escherichia coli strains CFT073, Nissle 1917 and ABU 83972. Mol. Genet. Genomics 283, 469–484 (2010).

    Article  CAS  PubMed  Google Scholar 

  38. Klemm, P., Hancock, V. & Schembri, M. A. Mellowing out: adaptation to commensalism by Escherichia coli asymptomatic bacteriuria strain 83972. Infect. Immun. 75, 3688–3695 (2007).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Klemm, P., Roos, V., Ulett, G. C., Svanborg, C. & Schembri, M. A. Molecular characterization of the Escherichia coli asymptomatic bacteriuria strain 83972: the taming of a pathogen. Infect. Immun. 74, 781–785 (2006).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Hancock, V., Vejborg, R. M. & Klemm, P. Functional genomics of probiotic Escherichia coli Nissle 1917 and 83972, and UPEC strain CFT073: comparison of transcriptomes, growth and biofilm formation. Mol. Genet. Genomics 284, 437–454 (2010).

    Article  CAS  PubMed  Google Scholar 

  41. Hancock, V., Seshasayee, A. S., Ussery, D. W., Luscombe, N. M. & Klemm, P. Transcriptomics and adaptive genomics of the asymptomatic bacteriuria Escherichia coli strain 83972. Mol. Genet. Genomics 279, 523–534 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Roos, V., Ulett, G. C., Schembri, M. A. & Klemm, P. The asymptomatic bacteriuria Escherichia coli strain 83972 outcompetes uropathogenic E. coli strains in human urine. Infect. Immun. 74, 615–624 (2006).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Dobrindt, U., Zdziarski, J., Salvador, E. & Hacker, J. Bacterial genome plasticity and its impact on adaptation during persistent infection. Int. J. Med. Microbiol. 300, 363–366 (2010).

    Article  PubMed  Google Scholar 

  44. Nielubowicz, G. R. & Mobley, H. L. Host-pathogen interactions in urinary tract infection. Nat. Rev. Urol. 7, 430–441 (2010).

    Article  CAS  PubMed  Google Scholar 

  45. Ragnarsdottir, B. et al. TLR- and CXCR1-dependent innate immunity: insights into the genetics of urinary tract infections. Eur. J. Clin. Invest. 38 (Suppl. 2), 12–20 (2008).

    Article  CAS  PubMed  Google Scholar 

  46. Ragnarsdottir, B. et al. Reduced toll-like receptor 4 expression in children with asymptomatic bacteriuria. J. Infect. Dis. 196, 475–484 (2007).

    Article  CAS  PubMed  Google Scholar 

  47. Ragnarsdottir, B. et al. Toll-like receptor 4 promoter polymorphisms: common TLR4 variants may protect against severe urinary tract infection. PLoS ONE 5, e10734 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Hawn, T. R. et al. Genetic variation of the human urinary tract innate immune response and asymptomatic bacteriuria in women. PLoS ONE 4, e8300 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Lundstedt, A. C. et al. Inherited susceptibility to acute pyelonephritis: a family study of urinary tract infection. J. Infect. Dis. 195, 1227–1234 (2007).

    Article  PubMed  Google Scholar 

  50. Agace, W., Hedges, S., Ceska, M. & Svanborg, C. Interleukin-8 and the neutrophil response to mucosal gram-negative infection. J. Clin. Invest. 92, 780–785 (1993).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. May, M. et al. Post-void residual urine as a predictor of urinary tract infection--is there a cutoff value in asymptomatic men? J. Urol. 181, 2540–2544 (2009).

    Article  PubMed  Google Scholar 

  52. Truzzi, J. C., Almeida, F. M., Nunes, E. C. & Sadi, M. V. Residual urinary volume and urinary tract infection-when are they linked? J. Urol. 180, 182–185 (2008).

    Article  PubMed  Google Scholar 

  53. Tsan, L. et al. Nursing home-associated infections in Department of Veterans Affairs community living centers. Am. J. Infect. Control 38, 461–466 (2010).

    Article  PubMed  Google Scholar 

  54. Hecker, M. T., Aron, D. C., Patel, N. P., Lehmann, M. K. & Donskey, C. J. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch. Intern. Med. 163, 972–978 (2003).

    Article  PubMed  Google Scholar 

  55. Werner, N. L., Hecker, M. T., Sethi, A. K. & Donskey, C. J. Unnecessary use of fluoroquinolone antibiotics in hospitalized patients. BMC Infect. Dis. 11, 187 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Foxman, B. The epidemiology of urinary tract infection. Nat. Rev. Urol. 7, 653–660 (2010).

    Article  PubMed  Google Scholar 

  57. Powers, J. H. Risk perception and inappropriate antimicrobial use: yes, it can hurt. Clin. Infect. Dis. 48, 1350–1353 (2009).

    Article  PubMed  Google Scholar 

  58. Kass, E. H. Pyelonephritis and bacteriuria. A major problem in preventive medicine. Ann. Intern. Med. 56, 46–53 (1962).

    Article  CAS  PubMed  Google Scholar 

  59. Nordenstam, G. R., Brandberg, C. A., Oden, A. S., Svanborg Eden, C. M. & Svanborg, A. Bacteriuria and mortality in an elderly population. N. Engl. J. Med. 314, 1152–1156 (1986).

    Article  CAS  PubMed  Google Scholar 

  60. Tambyah, P. A. & Maki, D. G. The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch. Intern. Med. 160, 673–677 (2000).

    CAS  PubMed  Google Scholar 

  61. Silver, S. A., Baillie, L. & Simor, A. E. Positive urine cultures: A major cause of inappropriate antimicrobial use in hospitals? Can. J. Infect. Dis. Med. Microbiol. 20, 107–111 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  62. Walker, S., McGeer, A., Simor, A. E., Armstrong-Evans, M. & Loeb, M. Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people? A qualitative study of physicians' and nurses' perceptions. CMAJ 163, 273–277 (2000).

    CAS  PubMed  PubMed Central  Google Scholar 

  63. Drinka, P. J. & Crnich, C. J. Diagnostic accuracy of criteria for urinary tract infection in a cohort of nursing home residents. J. Am. Geriatr. Soc. 56, 376–378 (2008).

    Article  PubMed  Google Scholar 

  64. Warren, J. W., Tenney, J. H., Hoopes, J. M., Muncie, H. L. & Anthony, W. C. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J. Infect. Dis. 146, 719–723 (1982).

    Article  CAS  PubMed  Google Scholar 

  65. Nicolle, L. Asymptomatic bacteriuria in the elderly. Infect. Dis. Clin. N. Am. 11, 647–662 (1997).

    Article  CAS  Google Scholar 

  66. Orr, P. et al. Febrile urinary tract infection in the institutionalized elderly. Am. J. Med. 100, 71–77 (1996).

    Article  CAS  PubMed  Google Scholar 

  67. Warren, J. et al. Fever, bacteremia, and death as complications of bacteriuria in women with long-term urethral catheters. J. Infect. Dis. 155, 1151–1158 (1987).

    Article  CAS  PubMed  Google Scholar 

  68. Bonnal, C. et al. Bacteriuria in a geriatric hospital: impact of an antibiotic improvement program. J. Am. Med. Dir. Assoc. 9, 605–609 (2008).

    Article  PubMed  Google Scholar 

  69. Linares, L. A., Thornton, D. J., Strymish, J., Baker, E. & Gupta, K. Electronic memorandum decreases unnecessary antimicrobial use for asymptomatic bacteriuria and culture-negative pyuria. Infect. Control Hosp. Epidemiol. 32, 644–648 (2011).

    Article  PubMed  Google Scholar 

  70. Loeb, M. et al. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial. BMJ 331, 669 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  71. Pavese, P. et al. Does an educational session with an infectious diseases physician reduce the use of inappropriate antibiotic therapy for inpatients with positive urine culture results? A controlled before-and-after study. Infect. Control Hosp. Epidemiol. 30, 596–599 (2009).

    Article  PubMed  Google Scholar 

  72. Zabarsky, T. F., Sethi, A. K. & Donskey, C. J. Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention. Am. J. Infect. Control 36, 476–480 (2008).

    Article  PubMed  Google Scholar 

  73. Lutters, M. et al. Effect of a comprehensive, multidisciplinary, educational program on the use of antibiotics in a geriatric university hospital. J. Am. Geriatr. Soc. 52, 112–116 (2004).

    Article  PubMed  Google Scholar 

  74. Monette, J. et al. Effect of an educational intervention on optimizing antibiotic prescribing in long-term care facilities. J. Am. Geriatr. Soc. 55, 1231–1235 (2007).

    Article  PubMed  Google Scholar 

  75. Schwartz, D. N. et al. An educational intervention to improve antimicrobial use in a hospital-based long-term care facility. J. Am. Geriatr. Soc. 55, 1236–1242 (2007).

    Article  PubMed  Google Scholar 

  76. Nicolle, L. E. Asymptomatic bacteriuria: review and discussion of the IDSA guidelines. Int. J. Antimicrob. Agents 28 (Suppl. 1), S42–S48 (2006).

    Article  CAS  PubMed  Google Scholar 

  77. Smaill, F. & Vazquez, J. C. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD000490. doi:10.1002/14651858.CD000490.pub2 (2007).

  78. Guinto, V. T., De Guia, B., Festin, M. R. & Dowswell, T. Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy. Cochrane Database of Systematic Reviews, Issue 9. Art. No.: CD007855. doi:10.1002/14651858.CD007855.pub2 (2010).

  79. Lumbiganon, P. et al. One-day compared with 7-day nitrofurantoin for asymptomatic bacteriuria in pregnancy: a randomized controlled trial. Obstet. Gynecol. 113, 339–345 (2009).

    Article  PubMed  Google Scholar 

  80. Grabe, M., Forsgren, A., Bjork, T. & Hellsten, S. Controlled trial of a short and a prolonged course with ciprofloxacin in patients undergoing transurethral prostatic surgery. Eur. J. Clin. Microbiol. 6, 11–17 (1987).

    Article  CAS  PubMed  Google Scholar 

  81. Bootsma, A. M., Laguna Pes, M. P., Geerlings, S. E. & Goossens, A. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur. Urol. 54, 1270–1286 (2008).

    Article  PubMed  Google Scholar 

  82. Wolf, J. S. Jr et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J. Urol. 179, 1379–1390 (2008).

    Article  PubMed  Google Scholar 

  83. Leone, M., Garnier, F., Avidan, M. & Martin, C. Catheter-associated urinary tract infections in intensive care units. Microbes Infect. 6, 1026–1032 (2004).

    Article  PubMed  Google Scholar 

  84. Golob, J. F. Jr et al. Fever and leukocytosis in critically ill trauma patients: it's not the urine. Surg. Infect. (Larchmt.) 9, 49–56 (2008).

    Article  Google Scholar 

  85. Chant, C., Smith, O. M., Marshall, J. C. & Friedrich, J. O. Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis of observational studies. Crit. Care Med. 39, 1167–1173 (2011).

    Article  PubMed  Google Scholar 

  86. Leone, M. et al. A randomized trial of catheter change and short course of antibiotics for asymptomatic bacteriuria in catheterized ICU patients. Intensive Care Med. 33, 726–729 (2007).

    Article  CAS  PubMed  Google Scholar 

  87. Chant, C. et al. Discordance between perception and treatment practices associated with intensive care unit-acquired bacteriuria and funguria: a Canadian physician survey. Crit. Care Med. 36, 1158–1167 (2008).

    Article  PubMed  Google Scholar 

  88. Fiorante, S. et al. Acute graft pyelonephritis in renal transplant recipients: incidence, risk factors and long-term outcome. Nephrol. Dial. Transplant. 26, 1065–1073 (2011).

    Article  PubMed  Google Scholar 

  89. Fiorante, S. et al. Systematic screening and treatment of asymptomatic bacteriuria in renal transplant recipients. Kidney Int. 78, 774–781 (2010).

    Article  PubMed  Google Scholar 

  90. Ei Amari, E. B. et al. Outcome of treated and untreated asymptomatic bacteriuria in renal transplant recipients. Nephrol. Dial. Transplant doi:10.1093/ndt/gfr198 (2011).

  91. Green, H., Rahamimov, R., Gafter, U., Leibovitci, L. & Paul, M. Antibiotic prophylaxis for urinary tract infections in renal transplant recipients: a systematic review and meta-analysis. Transpl. Infect. Dis. 13, 441–447 (2011).

    Article  CAS  PubMed  Google Scholar 

  92. US National Library of Medicine Clinicaltrials.gov [online], (2011).

  93. Suriano, F. et al. Bacteriuria in patients with an orthotopic ileal neobladder: urinary tract infection or asymptomatic bacteriuria? BJU Int. 101, 1576–1579 (2008).

    Article  PubMed  Google Scholar 

  94. Wullt, B. et al. Mucosal host responses to bacteriuria in colonic and ileal neobladders. Eur. Urol. 50, 1065–1072 (2006).

    Article  PubMed  Google Scholar 

  95. Rajamanickam, A., Noor, S. & Usmani, A. Should an asymptomatic patient with an abnormal urinalysis (bacteriuria or pyuria) be treated with antibiotics prior to major joint replacement surgery? Cleve. Clin. J. Med. 74 (Suppl. 1), S17–S18 (2007).

    Article  PubMed  Google Scholar 

  96. Wymenga, A. B., van Horn, J. R., Theeuwes, A., Muytjens, H. L. & Slooff, T. J. Perioperative factors associated with septic arthritis after arthroplasty. Prospective multicenter study of 362 knee and 2651 hip operations. Acta Orthop. Scand. 63, 665–671 (1992).

    CAS  PubMed  Google Scholar 

  97. Lin, E., Bhusal, Y., Horwitz, D., Shelburne, S. & Trautner, B. Enterococcal bacteriuria is often overtreated and rarely leads to infectious complications. Arch. Intern. Med. (in press).

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Trautner, B. Asymptomatic bacteriuria: when the treatment is worse than the disease. Nat Rev Urol 9, 85–93 (2012). https://doi.org/10.1038/nrurol.2011.192

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