The Dangers of Overtreating Asymptomatic Bacteriuria

Segment Description: Barbara Wells Trautner, MD, PhD, associate professor and director, clinical research, Baylor College of Medicine, explains how overtreating asymptomatic bacteriuria can lead to antibiotic resistance or incorrect diagnoses.

Interview transcript: (modified slightly for readability):

“The main effect is overuse of antibiotics, because if you were treating asymptomatic bacteriuria you’re overusing antibiotics and using them unnecessarily. Of course, there’s all the downstream effects of overusing antibiotics; there’s promoting antibiotic resistance, you increase the risk for Clostridium difficile (C diff), you increase hospital costs, etc. That’s the main aspect from overusing antibiotics. The other aspect that comes from treating asymptomatic bacteria is missing the real diagnosis and it happens all the time.

The patient comes into the emergency room (ER) with an indwelling catheter. Say, it’s a marginally vulnerable older adult, and they have an indwelling catheter, and everyone can see the cloudy urine and it smells bad. [Therefore,] everybody starts working up and treating for a urinary tract infection (UTI), but they might be missing the real reason why the person is in the ER. Say they are there for falls—we’re not assuming that as a symptom of UTI, there are a lot of reasons people fall—and the most common reason is that we overtreated their high blood pressure medication and we need to change that so they don’t fall again when they leave the hospital and go back to their care facility.

Another [reason they may be in the ER] is dehydration; that’s extremely common. While they are in the hospital and receiving intravenous (IV) antibiotics, they are also getting IV fluids, so they get better, but we gave them an unnecessary course of antibiotics.

People have minor strokes, and that causes behavior change, but we’re still treating them for UTI.

And so, we miss a lot and there’s an extremely dramatic case that happened in our long-term care facility—and it’s not a fault of our long-term care facility, this is happening everywhere—but the patient actually developed necrotizing fasciitis from a buttock wound and was treated for UTI for the initial 24 hours, but they had this very serious infection that was later picked up and they went to the operating room for that.”