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The American Journal of Medicine Aug 2022Asymptomatic bacteriuria is a common clinical condition that often leads to unnecessary treatment. It has been shown that incidence of asymptomatic bacteriuria increases... (Review)
Review
Asymptomatic bacteriuria is a common clinical condition that often leads to unnecessary treatment. It has been shown that incidence of asymptomatic bacteriuria increases with age and are more prominent in women than men. In older women, the incidence of asymptomatic bacteriuria is recorded to be more than 15%. This number increased up to 50% for those who reside in long-term care facilities. In most scenarios, asymptomatic bacteriuria does not lead to urinary tract infections, and therefore, antibiotic treatment of asymptomatic bacteriuria has not been shown to improve patient outcomes. In 2019, the Infectious Disease Society of America (IDSA) updated its asymptomatic bacteriuria management guidelines, which emphasized on the risks and benefits of treating the condition. Women who are pregnant should be screened for asymptomatic bacteriuria in the first trimester and treated, if positive. Individuals who are undergoing endoscopic urologic procedures should be screened and treated appropriately for asymptomatic bacteriuria as well. Treating asymptomatic bacteriuria in individuals with diabetes, neutropenia, spinal cord injuries, indwelling urinary catheters, and so on has not been found to improve clinical outcomes. Furthermore, unnecessary treatment is often associated with unwanted consequences including but not limited to increased antimicrobial resistance, Clostridioides difficile infection, and increased health care cost. As a result, multiple antibiotic stewardship programs around the US have implemented protocols to appropriately reduce unnecessary treatment of asymptomatic bacteriuria. It is important to appropriately screen and treat asymptomatic bacteriuria only when there is evidence of potential benefit.
Topics: Aged; Anti-Bacterial Agents; Antimicrobial Stewardship; Bacteriuria; Female; Humans; Male; Pregnancy; Prevalence; Urinary Tract Infections
PubMed: 35367448
DOI: 10.1016/j.amjmed.2022.03.015 -
Journal of Feline Medicine and Surgery Nov 2019Urinary tract infection (UTI) is an important cause of feline lower urinary tract disease (FLUTD), particularly in female cats older than 10 years of age. In addition to... (Review)
Review
PRACTICAL RELEVANCE
Urinary tract infection (UTI) is an important cause of feline lower urinary tract disease (FLUTD), particularly in female cats older than 10 years of age. In addition to cats with typical clinical signs of FLUTD or upper UTI, many cats have subclinical bacteriuria, but the clinical relevance of this is currently uncertain. UTIs are one of the most important indications for antimicrobial use in veterinary medicine and contribute to the development of antimicrobial resistance. Adherence to treatment guidelines and confinement to a few first-line antimicrobial agents is imperative to avoid further deterioration of the antimicrobial resistance situation. The decision to treat with antimicrobials should be based on the presence of clinical signs, and/or concurrent diseases, and the results of urine culture and susceptibility testing.
CLINICAL CHALLENGES
Distinguishing between cats with bacterial cystitis, and those with idiopathic cystitis and concurrent clinical or subclinical bacteriuria, is challenging, as clinical signs and urinalysis results may be identical. Optimal treatment of subclinical bacteriuria requires clarification as there is currently no evidence that demonstrates a beneficial effect of routine treatment. Management of recurrent UTIs remains a challenge as evidence for most alternatives used for prevention in cats is mainly anecdotal, and no preventive treatment modality is currently recommended.
EVIDENCE BASE
This review draws on an extensive literature base in veterinary and human medicine, including the recently updated guidelines of the International Society for Companion Animal Infectious Diseases for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Where published evidence is lacking, the authors describe their own approach; notably, for the bacteriuric cat with chronic kidney disease.
Topics: Animals; Asymptomatic Infections; Bacteriuria; Cat Diseases; Cats; Female; Humans; Male; Urinary Tract Infections
PubMed: 31601143
DOI: 10.1177/1098612X19880435 -
Medicina Clinica Nov 2022
Topics: Humans; Bacteriuria
PubMed: 35791981
DOI: 10.1016/j.medcli.2022.05.005 -
Infectious Disease Clinics of North... Dec 1987The urinary tract undergoes profound physiologic and anatomic changes during pregnancy that facilitate the development of symptomatic urinary tract infections in women... (Review)
Review
The urinary tract undergoes profound physiologic and anatomic changes during pregnancy that facilitate the development of symptomatic urinary tract infections in women with bacteriuria. While the adverse effects of asymptomatic bacteriuria on maternal and fetal health continue to be debated, it is clear that asymptomatic bacteriuria is the major risk factor for developing symptomatic urinary tract infection and that symptomatic infections are associated with significant maternal and fetal risks. Because the majority of symptomatic urinary tract infections develop in women with bacteriuria earlier in pregnancy, treatment of bacteriuria is undertaken to prevent symptomatic infections. All women should be screened at the first antenatal visit, which is reliably and inexpensively done with a dipstick culture. Short-course therapy is as effective as prolonged therapy and should be followed with a repeat culture to document clearing of the bacteriuria. Failure to eliminate bacteriuria with repeated therapy or recurrence with the same organism is indicative of renal parenchymal infection or a structural abnormality. All women with persistent bacteriuria or recurrent infection should have follow-up cultures and a complete urologic evaluation after delivery.
Topics: Anti-Bacterial Agents; Bacteriuria; Female; Humans; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications, Infectious; Urinary Tract; Urinary Tract Infections
PubMed: 3333660
DOI: No ID Found -
Journal of Clinical Microbiology Apr 2020This minireview focuses on the microbiologic evaluation of patients with asymptomatic bacteriuria, as well as indications for antibiotic treatment. Asymptomatic... (Review)
Review
This minireview focuses on the microbiologic evaluation of patients with asymptomatic bacteriuria, as well as indications for antibiotic treatment. Asymptomatic bacteriuria is defined as two consecutive voided specimens (preferably within 2 weeks) with the same bacterial species, isolated in quantitative counts of ≥10 CFU/ml in women, including pregnant women; a single voided urine specimen with one bacterial species isolated in a quantitative count ≥10 CFU/ml in men; and a single catheterized urine specimen with one or more bacterial species isolated in a quantitative count of ≥10 CFU/ml in either women or men (or ≥10 CFU/ml of a single bacterial species from a single catheterized urine specimen). Any urine specimen with ≥10 CFU/ml group B is significant for asymptomatic bacteriuria in a pregnant woman. Asymptomatic bacteriuria occurs, irrespective of pyuria, in the absence of signs or symptoms of a urinary tract infection. The two groups with the best evidence of adverse outcomes in the setting of untreated asymptomatic bacteriuria include pregnant women and patients who undergo urologic procedures with risk of mucosal injury. Screening and treatment of asymptomatic bacteriuria is not recommended in the following patient populations: pediatric patients, healthy nonpregnant women, older patients in the inpatient or outpatient setting, diabetic patients, patients with an indwelling urethral catheter, patients with impaired voiding following spinal cord injury, patients undergoing nonurologic surgeries, and nonrenal solid-organ transplant recipients. Renal transplant recipients beyond 1 month posttransplant should not undergo screening and treatment for asymptomatic bacteriuria. There is insufficient evidence to recommend for or against screening of renal transplant recipients within 1 month, patients with high-risk neutropenia, or patients with indwelling catheters at the time of catheter removal. Unwarranted antibiotics place patients at increased risk of adverse effects (including diarrhea) and contribute to antibiotic resistance. Methods to reduce unnecessary screening for and treatment of asymptomatic bacteriuria aid in antibiotic stewardship.
Topics: Antimicrobial Stewardship; Bacteriuria; Child; Female; Humans; Laboratories; Male; Pregnancy; Pyuria; Urinary Tract Infections
PubMed: 32051261
DOI: 10.1128/JCM.00518-18 -
The Journal of Pediatrics Jul 2020
Topics: Asymptomatic Infections; Bacteriuria; Child; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Prevalence
PubMed: 32586532
DOI: 10.1016/j.jpeds.2020.04.022 -
The Veterinary Clinics of North... Mar 2019"Urinary tract infection (UTI) is a common diagnosis in companion animal practice and is responsible for a significant proportion of antimicrobial use in veterinary... (Review)
Review
"Urinary tract infection (UTI) is a common diagnosis in companion animal practice and is responsible for a significant proportion of antimicrobial use in veterinary medicine. The veterinary community has begun to follow the standards of care in human medicine and shift its definition of an UTI based on culture results and toward the presence of lower urinary tract symptoms. An improved understanding of the pathophysiology of UTI, risk factors for clinical disease, and the implementation of more reliable in-house diagnostic testing can lead to improved outcomes for patients and reduce inappropriate treatment. Investigation of antibiotic-sparing therapies holds some promise as well."
Topics: Animal Husbandry; Animals; Bacteriuria; Cat Diseases; Cats; Dog Diseases; Dogs; Reagent Kits, Diagnostic; Urinary Tract Infections; Veterinary Medicine
PubMed: 30591189
DOI: 10.1016/j.cvsm.2018.11.005 -
Clinical Infectious Diseases : An... Mar 2005
Topics: Adult; Aged; Aging; Anti-Bacterial Agents; Bacteriuria; Female; Humans; Male; Risk Factors; Spinal Cord Injuries; Urinary Catheterization
PubMed: 15714408
DOI: 10.1086/427507 -
Current Opinion in Urology Mar 2017Asymptomatic bacteriuria (ABU) is a common clinical condition that often leads to unnecessary treatment. The purpose of this review is to outline and evaluate the most... (Review)
Review
PURPOSE OF REVIEW
Asymptomatic bacteriuria (ABU) is a common clinical condition that often leads to unnecessary treatment. The purpose of this review is to outline and evaluate the most recent literature on the management of ABU.
RECENT FINDINGS
The role of ABU management has been evaluated in several patient subgroups: healthy patients without identified risk factors, pregnant women, postmenopausal women, women with recurrent UTI, patients with diabetes, elderly institutionalized patients, patients with renal transplants, patients with indwelling catheters and prior to surgery. Available evidence only supports the need for screening and treatment of ABU in pregnant women and prior to urological procedures breaching the mucosa. In all the other conditions the treatment of ABU is not only useless but also harmful. A short course treatment in pregnant women is recommended; in patients with ABU prior to urological procedures breaching the mucosa the treatment should be given in line with antibiogram and in line with the recommendations of European Association of Urology guidelines.
SUMMARY
The approach to patients with ABU has changed completely during recent years. Today, screening and treatment of ABU is recommended only in pregnant women and in all patients who are candidates for urological procedures breaching the mucosa.
Topics: Anti-Bacterial Agents; Bacteriological Techniques; Bacteriuria; Female; Humans; Risk Factors; Urology
PubMed: 27906777
DOI: 10.1097/MOU.0000000000000368 -
JAMA Feb 2014Asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) in older women are commonly encountered in outpatient practice. (Review)
Review
IMPORTANCE
Asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) in older women are commonly encountered in outpatient practice.
OBJECTIVE
To review management of asymptomatic bacteriuria and symptomatic UTI and review prevention of recurrent UTIs in older community-dwelling women.
EVIDENCE REVIEW
A search of Ovid (Medline, PsycINFO, Embase) for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013.
RESULTS
The clinical spectrum of UTIs ranges from asymptomatic bacteriuria, to symptomatic and recurrent UTIs, to sepsis associated with UTI requiring hospitalization. Recent evidence helps differentiate asymptomatic bacteriuria from symptomatic UTI. Asymptomatic bacteriuria is transient in older women, often resolves without any treatment, and is not associated with morbidity or mortality. The diagnosis of symptomatic UTI is made when a patient has both clinical features and laboratory evidence of a urinary infection. Absent other causes, patients presenting with any 2 of the following meet the clinical diagnostic criteria for symptomatic UTI: fever, worsened urinary urgency or frequency, acute dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness. A positive urine culture (≥105 CFU/mL) with no more than 2 uropathogens and pyuria confirms the diagnosis of UTI. Risk factors for recurrent symptomatic UTI include diabetes, functional disability, recent sexual intercourse, prior history of urogynecologic surgery, urinary retention, and urinary incontinence. Testing for UTI is easily performed in the clinic using dipstick tests. When there is a low pretest probability of UTI, a negative dipstick result for leukocyte esterase and nitrites excludes infection. Antibiotics are selected by identifying the uropathogen, knowing local resistance rates, and considering adverse effect profiles. Chronic suppressive antibiotics for 6 to 12 months and vaginal estrogen therapy effectively reduce symptomatic UTI episodes and should be considered in patients with recurrent UTIs.
CONCLUSIONS AND RELEVANCE
Establishing a diagnosis of symptomatic UTI in older women requires careful clinical evaluation with possible laboratory assessment using urinalysis and urine culture. Asymptomatic bacteriuria should be differentiated from symptomatic UTI. Asymptomatic bacteriuria in older women should not be treated.
Topics: Aged; Bacteriuria; Female; Humans; Recurrence; Urinary Tract Infections
PubMed: 24570248
DOI: 10.1001/jama.2014.303