This is the current release of the guideline.

Asymptomatic bacteriuria

Note: Recommendations are relevant only for the treatment of asymptomatic bacteriuria and do not address prophylaxis for prevention of symptomatic or asymptomatic urinary infection.

Diagnosis
Management
Treatment

Family Practice
Geriatrics
Infectious Diseases
Internal Medicine
Obstetrics and Gynecology
Urology

Physicians

To provide recommendations for diagnosis and treatment of asymptomatic bacteriuria in adult populations >18 years of age

Adult patients >18 years of age with asymptomatic bacteriuria

Special populations considered include:

• Premenopausal, nonpregnant women
• Pregnant women
• Diabetic women
• Older persons residing in the community
• Elderly institutionalized subjects
• Subjects with spinal cord injuries
• Patients with indwelling urethral catheters (both short-term and long-term catheters considered)
• Patients undergoing urologic interventions
• Immunocompromised patients and organ transplant patients

Diagnosis/Screening

1. Screening of special populations for asymptomatic bacteriuria
2. Collection of urine specimens to minimize contamination
3. Urine culture

Treatment

1. Nitrofurantoin
2. Sulfonamides
3. Mandelamine
4. Ampicillin
5. Nalidixic acid
6. Tetracycline
7. Cefaclor
8. Trimethoprim
9. Norfloxacin
10. Cephalexin

• Symptomatic urinary infection
• Bacteremia with sepsis
• Worsening functional status
• Progression to chronic kidney disease or hypertension
• Development of urinary tract cancer
• Decreased duration of survival
• Subsequent antimicrobial resistance
• Adverse drug effects
• Cost factors
• Mortality
• Progression to diabetic complications (i.e., nephropathy)
• Incidence of fever

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Literature Review

The recommendations in this guideline were developed after a review of studies published in English. These were identified through a search of the PubMed database supplemented by review of references of relevant papers to identify additional reports, particularly early studies not accessed through the PubMed search. In addition, experts in urinary infection were asked to identify any additional trials not accessed through review. Clinical studies include prospective, randomized clinical trials; prospective cohort studies; case-control studies; and other descriptive studies. When appropriate, the methodological rigor of studies was evaluated using accepted criteria (e.g., the CONSORT statement). Studies were excluded if the study population was not adequately characterized to assess generalizability, if procedures for patient follow-up or exclusions may have introduced sufficient bias to limit the credibility of observations, or if there were insufficient numbers of patients enrolled to support valid statistical analysis.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Quality of Evidence

1. Evidence from >1 properly randomized, controlled trial
2. Evidence from >1 well-designed clinical trial, without randomization; from cohort or case-controlled analytic studies (preferably from >1 center); from multiple time-series; or from dramatic results from uncontrolled experiments
3. Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees

Review of Published Meta-Analyses
Systematic Review with Evidence Tables

Not stated

Expert Consensus

Not stated

Strength of Recommendation

1. Good evidence to support a recommendation for use; should always be offered
2. Moderate evidence to support a recommendation for use; should generally be offered
3. Poor evidence to support a recommendation; optional
4. Moderate evidence to support a recommendation against use; should generally not be offered
5. Good evidence to support a recommendation against use; should never be offered

Pregnant Women

An American cost evaluation from the viewpoint of the outcome of pyelonephritis concluded that a single screening culture in the first trimester was cost-effective if the prevalence of bacteriuria was >2% and the risk of pyelonephritis in bacteriuric women was >13%.

External Peer Review
Internal Peer Review

Respected peers - those who are not members of the guideline panel but who are experts in the same field - reviewed the guidelines for scientific validity. These outside reviewers are acknowledged at the end of the original guideline document. Guidelines were also reviewed by the Infectious Diseases Society of America (IDSA) Practice Guidelines Committee for content and format. The guideline group submitted its final draft to the Practice Guidelines Committee for approval. After approval was grated, the draft was forwarded to the IDSA Governing Council for final approval and then to Clinical Infectious Diseases for publication.

The strength of recommendation (A-E) and quality of evidence (I-III) are defined at the end of the "Major Recommendations" field.

Note: Recommendations are relevant only for the treatment of asymptomatic bacteriuria and do not address prophylaxis or prevention of symptomatic or asymptomatic urinary infection.

1. The diagnosis of asymptomatic bacteriuria should be based on results of culture of a urine specimen collected in a manner that minimizes contamination (A-II).
   • For asymptomatic women, bacteriuria is defined as 2 consecutive voided urine specimens with isolation of the same bacterial strain in quantitative counts >10⁵ colony forming units (cfu)/mL (B-II).
   • A single, clean-catch voided urine specimen with 1 bacterial species isolated in a quantitative count >10⁵ cfu/mL identifies bacteriuria in men (BIII).
   • A single catheterized urine specimen with 1 bacterial species isolated in a quantitative count >10² cfu/mL identifies bacteriuria in women or men (A-II).
2. Pyuria accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment (A-II).
3. Pregnant women should be screened for bacteriuria by urine culture at least once in early pregnancy, and they should be treated if the results are positive (A-I).
   • The duration of antimicrobial therapy should be 3-7 days (A-II).
   • Periodic screening for recurrent bacteriuria should be undertaken following therapy (A-III).
   • No recommendation can be made for or against repeated screening of culture-negative women in later pregnancy.
4. Screening for and treatment of asymptomatic bacteriuria before transurethral resection of the prostate is recommended (A-I).
   • An assessment for the presence of bacteriuria should be obtained, so that results will be available to direct antimicrobial therapy prior to the procedure (A-III).
   • Antimicrobial therapy should be initiated shortly before the procedure (A-II).
   • Antimicrobial therapy should not be continued after the procedure, unless an indwelling catheter remains in place (B-II).
5. Screening for and treatment of asymptomatic bacteriuria is recommended before other urologic procedures for which mucosal bleeding is anticipated (A-III).
6. Screening for or treatment of asymptomatic bacteriuria is not recommended for the following persons.
   • Premenopausal, nonpregnant women (A-I)
   • Diabetic women (A-I)
   • Older persons living in the community (A-II)
   • Elderly, institutionalized subjects (A-I)
   • Persons with spinal cord injury (A-II)
   • Catheterized patients while the catheter remains in situ (A-I)
7. Antimicrobial treatment of asymptomatic women with catheter-acquired bacteriuria that persists 48 hours after indwelling catheter removal may be considered (B-I).
8. No recommendation can be made for screening for or treatment of asymptomatic bacteriuria in renal transplant or other solid organ transplant recipients (C-III).

Definitions:

Quality of Evidence

1. Evidence from >1 properly randomized, controlled trial
2. Evidence from >1 well-designed clinical trial, without randomization; from cohort or case-controlled analytic studies (preferably from >1 center); from multiple time-series; or from dramatic results from uncontrolled experiments
3. Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees

Strength of Recommendation

1. Good evidence to support a recommendation for use; should always be offered
2. Moderate evidence to support a recommendation for use; should generally be offered
3. Poor evidence to support a recommendation; optional
4. Moderate evidence to support a recommendation against use; should generally not be offered
5. Good evidence to support a recommendation against use; should never be offered

None provided

The type of supporting evidence is identified and graded for most recommendations (see "Major Recommendations").

Appropriate diagnosis and treatment of asymptomatic bacteriuria in adults

Not stated

This guideline is not meant to replace clinical judgment.

An implementation strategy was not provided.

Getting Better

Effectiveness

Not applicable: The guideline was not adapted from another source.

2005 Mar 1

Infectious Diseases Society of America - Medical Specialty Society

Infectious Diseases Society of America (IDSA)

Infectious Diseases Society of America (IDSA) Practice Guidelines Committee

Authors: Lindsay E. Nicolle, University of Manitoba, Winnipeg, Canada; Suzanne Bradley, University of Michigan, Ann Arbor; Richard Colgan, University of Maryland, Baltimore; James C. Rice, University of Texas, Galveston; Anthony Schaeffer, Northwestern University, Chicago, Illinois; Thomas M. Hooton, University of Washington, Seattle

Potential conflicts of interest. L.E.N. has received research funding from Ortho-McNeil. R.C. has received research funding from Ortho-McNeil and has served on the speakers' bureau for Bayer. A.S. has been a consultant for Ortho-McNeil, Proctor & Gamble, Gerson Lehrman Group, Urologix, DepoMed, Schwarz BioSciences GmbH, and SynerMed Communications. T.M.H. has been a consultant for Bayer and served on the speakers' bureau for Aventis, Bayer, Merck, and Pfizer.

This is the current release of the guideline.

None available

This summary was completed by ECRI on April 6, 2005. This summary was updated by ECRI Institute on July 28, 2008 following the U.S. Food and Drug Administration advisory on fluoroquinolone antimicrobial drugs.

This NGC summary is based on the original guideline, which may be subject to the guideline developer's copyright restrictions.