Testing Item for Hospitalists (Poster)

HOSPITALISTS:
BE ANTIBIOTICS AWARE

Avoid Treatment
of Asymptomatic
Bacteriuria

SCENARIO
The microbiology lab calls you with a positive urine
culture result for a patient admitted for chest pain.
The patient does not report any urinary signs
and symptoms.

Asymptomatic bacteriuria (ASB) refers to the isolation of bacteria in a urine culture from a
patient without signs or symptoms of urinary tract infection (UTI).1 Professional society guidelines
recommend against antibiotic therapy for ASB (with or without pyuria). Exceptions include
pregnancy and patients undergoing invasive genitourinary procedures. ASB prevalence increases
with age and is high in some populations, such as diabetic women (9-27%) and long-term care
residents (up to 50%).2

Hospitalists can help avoid treatment of
asymptomatic bacteriuria by:
1. O
 nly sending a urine culture if the patient has signs and symptoms
consistent with a UTI.
UTI-specific signs and symptoms include urinary urgency, frequency, dysuria,
suprapubic pain, flank pain, pelvic discomfort and/or acute hematuria. Delirium
or nausea/vomiting only should be interpreted with caution, as they have low
specificity for UTI.

2. Not treating with antibiotics, if the patient has ASB.
Treating patients with ASB does not reduce morbidity and mortality1 and can
lead to preventable adverse events, including Clostridioides difficile and
antibiotic-resistant infections.
The scenarios and recommendations are applicable to most immunocompetent adult patients. Always assess the individual patient and
use your clinical judgment. Follow your institution’s treatment guidelines when applicable.
References:
1. Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;
2. Lin K, Fejardo K; U.S. Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med.
2008 Jul 1;149(1):W20-4.
3. “ Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals.” Centers for Disease Control and Prevention, 12 Dec. 2017,
www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements-small-critical.html.

www.cdc.gov/antibiotic-use

www.cdc.gov/antibiotic-use