This is the current release of the guideline.

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").

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.