IDSA Issues Updated Treatment Guidelines for Asymptomatic Bacteriuria

For the first time since 2005, the Infectious Diseases Society of America (IDSA) has issued an update to its treatment guidelines for asymptomatic bacteriuria (ASB), expanding the populations who don’t require screening or treatment.

Compiled by the multidisciplinary IDSA Standards and Practice Guideline Committee and published in Clinical Infectious Diseases, the new recommendations also provide new guidance on the clinical presentation of symptomatic urinary tract infections (UTIs) in groups with a high prevalence of ASB.

The revised guidelines seek to improve antibiotic stewardship by cutting down on the over-prescribing of unnecessary antibiotics. Because ASB is so common among certain populations—about 3 to 7% of healthy women, 50% of patients with spinal injuries, and 30 to 70% of people in nursing homes—screening and treatment is not recommended for them.

Now, the IDSA has added infants, children, and adult patients with solid organ transplants or neutropenia to the groups who do not require testing or treatment.

"Screening these patients is far too common and leads to the inappropriate prescribing of antibiotics, which some studies suggest may actually increase the risk of a UTI, as well as contribute to other serious infections such as [Clostridium] difficile," Lindsay E. Nicolle, MD, FIDSA, chair of the committee that developed the guidelines and professor emeritus at the Rady Faculty of Health Sciences at the University of Manitoba, Winnipeg, said in a press release.

"Generally, physicians should not obtain urine cultures unless patients have symptoms consistent with an infection, such as burning during urination, frequent urination or abdominal pain, or tenderness on the back near the lower ribs,” Dr. Nicolle continued.

Screening for and treatment of ASB is still recommended for pregnant women, with a treatment regimen of 4 to 7 days of antimicrobial therapy. The committee identified studies evaluating the optimal duration of treatment for various antimicrobial regimens, including fosfomycin, as focal points for future research.

Moreover, ASB screening and treatment is also recommended for patients who will undergo endoscopic urologic procedures associated with mucosal trauma.

“In individuals with bacteriuria, these are procedures in a heavily contaminated surgical field,” the committee wrote. “High-quality evidence for other surgical procedures consistently shows that preoperative antimicrobial treatment or prophylaxis for contaminated or clean-contaminated procedures confers important benefits.”

In general, clinicians should attempt to rule out any other potential causes for symptoms mimicking a UTI, think carefully before testing patients, and look for opportunities to decrease inappropriate antimicrobial use whenever possible.