Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms

Abstract

Asymptomatic bacteriuria (ASB) is a condition in which bacteria are present in a noncontaminated urine sample collected from a patient without signs or symptoms related to the urinary tract. ASB must be distinguished from symptomatic UTI by the absence of signs and symptoms compatible with UTI or by clinical determination that a nonurinary etiology accounts for the patient's symptoms. ABU is a very common condition that is often treated unnecessarily with antibiotics. Pregnant women and persons undergoing urologic procedures expected to cause mucosal bleeding are the only two groups with convincing evidence that screening for and treating ASB is beneficial. Randomized, controlled trials of ASB screening and/or treatment have established the lack of efficacy in premenopausal adult women, diabetic women, patients with spinal cord injury, catheterized patients, older adults living in the community, and elderly institutionalized adults. The overall purpose of this review is to promote an awareness of ASB as a distinct condition from UTI and to empower clinicians to withhold antibiotics in situations in which antimicrobial treatment of bacteriuria is not indicated.

Theory-based and evidence-based design of audit and feedback programmes: examples from two clinical intervention studies

“…ASB is frequently misdiagnosed as CAUTI, often leading to unnecessary use of antibiotics, in turn leading to resistant organisms, unnecessary cost, prolonged hospital stays and infections such as Clostridium difficile- associated disease 20. Details of the CAUTI study's design, including the A&F intervention, are published elsewhere;21 highlights are summarised here.…”

The unexplored relationship between urinary tract infections and the autonomic nervous system

“…Pyelonephritis is also commonly, associated with fever, back and flank pain, and malaise (Foxman, 2014). The definitive diagnosis of UTI requires the detection of bacteria in the urine, however, a positive urine culture in the absence of symptoms, defined as asymptomatic bacteriuria (ABU), is a common condition where bacteria colonize the bladder in high numbers without causing disease (Trautner et al, 2014). Additionally, both symptomatic UTIs and ABU are characterized by inflammatory markers in the urine including pyuria.…”

Clinical Guideline for Childhood Urinary Tract Infection (Second Revision)

“…The diagnostic rates of the criterion, over 10 5 CFU/mL, were different according to the urine collection method [70-90% (once) or 90-95% (twice) in the clean midstream catch urine, 95- 99% in the SPA urine, 90-95% in the TUC urine and 14-84% in the sterile bag-collected urine]. A positive culture of the sterile bag-collected urine may suggest asymptomatic bacteriuria (ASB), which is not a true UTI 19) . Therefore, a true UTI must be distinguished from ASB.…”