Testing Item for Nurses (Avoid Treatment)

NURSING HOME STAFF:
BE ANTIBIOTICS AWARE

Avoid Treatment
of Asymptomatic
Bacteriuria

SCENARIO
You receive a positive urine culture for a resident. The
resident is feeling well and does not have symptoms
that indicate a urinary tract infection. It’s unclear why
the urine culture was done.
Asymptomatic bacteriuria (ASB) is the isolation of bacteria in a urine culture from a resident without
signs or symptoms of a urinary tract infection (UTI). ASB is common in nursing home residents, found in
an estimated 15-35% of men, 25-50% of women, and 100% of residents with catheters.
Residents with a positive urine culture result (even with pyuria ≥10 white blood cells/cml) alone should
typically not be treated with antibiotics. In older adults, pyuria does NOT indicate that ASB needs
treatment.1

Nursing home staff can avoid treatment of ASB by:
1. A
 voiding a urine analysis and culture unless a resident has local
signs and symptoms suggestive of a UTI.

2. Avoiding antibiotic therapy unless the resident meets the minimum
criteria for antibiotic treatment.
Minimum Criteria for Starting Antibiotics in a Suspected Urinary Tract Infection2
Without Catheter

Either one of the following:
Acute dysuria OR

Fever*

AND at least one of the following:

With Catheter

New or worsening urgency

Frequency

Suprapubic pain

Urinary incontinence

Gross hematuria

Costovertebral angle tenderness

AND at least one of the following:
Fever*

New Costovertebral angle tenderness

Shaking chills

New onset delirium

*Fever >37.9° [100°F], 1.5°C [2.4°F] increase above baseline temperature.
Antibiotics should not be started for cloudy, foul smelling urine.

The scenarios and recommendations are applicable to most nursing home residents. This document is meant to provide general guidance
and does not apply to all clinical scenarios. Always assess the individual resident, use your clinical judgment and follow your facility’s
protocols and treatment guidelines when applicable.
References:
1. Nicolle LE, Bradley S, Colgan R et al. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clin Infect Dis. 2005 Mar 1;40(5):643-54.
2. Loeb M1, Bentley DW, Bradley S et al. “Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference.”
Infect Control Hosp Epidemiol. 2001 Feb;22(2):120-4.

www.cdc.gov/antibiotic-use

www.cdc.gov/antibiotic-use