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Asymptomatic bacteriuria: when the treatment is worse than the disease

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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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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