New IDSA Guideline on Asymptomatic Bacteriuria

May 20, 2019

Written by Clay Smith

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The IDSA now only recommends screening for and treating asymptomatic bacteriuria (ASB) in pregnant women and those undergoing an invasive urologic procedure.

Why does this matter?
ASB is common in healthy women and patients who have had urologic abnormalities. This is an update to the 2005 version. The IDSA highly values prevention of antibiotic associated complications, such as C. difficile colitis and antimicrobial resistance. So, they have limited conditions for which screening and treatment is warranted. ASB is defined as – “1 or more species of bacteria growing in the urine at specified quantitative counts (≥10^5 colony-forming units [CFU]/mL or ≥10^8 CFU/L), irrespective of the presence of pyuria, in the absence of signs or symptoms attributable to urinary tract infection (UTI).”

Don’t worry – urine is sterile…or not
The only people for whom the IDSA recommends screening and treatment are pregnant women and those undergoing an invasive urologic procedure.

• Should ASB Be Screened for and Treated in Pregnant Women?
  Answer: Yes, with the shortest course of effective medication possible

• Should Patients Undergoing Endourological Procedures Be Screened or Treated for ASB?
  Answer: Yes, targeted based on culture data prior to the procedure and only 1-2 doses just prior to surgery.

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For all others, screening for and treating ASB is not recommended.

• In an Older, Functionally or Cognitively Impaired Patient, Which Nonlocalizing Symptoms Distinguish ASB From Symptomatic UTI?
  Answer: They recommend no treatment, even in the presence of delirium or fall, if genitourinary symptoms, fever, and hemodynamic instability are absent.

• Should Asymptomatic Bacteriuria Be Screened for and Treated in Pediatric Patients?
  Answer: No

• Should ASB Be Screened for or Treated in Healthy Nonpregnant Women?
  Answer: No

• Should ASB Be Screened for and Treated in Functionally Impaired Older Women or Men Residing in the Community, or in Older Residents of Longterm Care Facilities?
  Answer: No

• Should Diabetic Patients Be Screened or Treated for ASB?
  Answer: No

• Should Patients Who Have Received a Kidney Transplant Be Screened or Treated for ASB?
  Answer: No

• Should Patients Who Have Received a Solid Organ Transplant Other Than a Renal Transplant Be Screened or Treated for ASB?
  Answer: No

• Should Patients With Neutropenia Be Screened or Treated for ASB?
  Answer: They don’t know. It is unknown how often ASB occurs in patients with high risk neutropenia (<100 cells/mm3, ≥7 days’ duration). Patients with “low risk” neutropenia (>100 cells/mm3, ≤7 days, clinically stable) have risk similar to non-neutropenic patients.

• Should ASB Be Screened for or Treated in Individuals With Impaired Voiding Following Spinal Cord Injury?
  Answer: No

• Should Patients With an Indwelling Urethral Catheter Be Screened or Treated for ASB?
  Answer: No for both short and long term catheters, and they comment this likely equally applies for suprapubic catheters.

• Should Patients Undergoing Elective Nonurologic Surgery Be Screened and Treated for ASB?
  Answer: No

• Should Patients Undergoing Implantation of Urologic Devices or Living With Urologic Devices Be Screened for or Treated for ASB?
  Answer: No

Source
Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America Clin Infect Dis. 2019 Mar 21. pii: ciy1121. doi: 10.1093/cid/ciy1121. [Epub ahead of print]

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Reviewed by Thomas Davis