Asymptomatic Bacteriuria

Clinical Description, Epidemiology, and Etiology

Asymptomatic bacteriuria (ABU) is defined by the presence of bacteria in the urine in a patient who does not have any symptoms (or, more generally, any clinical manifestations whatsoever) attributable to the bacteriuria, irrespective of the presence or absence of pyuria (1). At any point in time, ABU is present in a fraction of the healthy population, including males and females of all ages. However, the likelihood of ABU is greatest throughout life in females, and increases in both genders with advancing age and progressive debility (66). The spectrum of organisms causing ABU is generally similar to that of symptomatic UTI, with polymicrobial infection and certain bacterial species (e.g., enterococci, coagulase-negative staphylococci, and Gram-negative bacilli such as Providencia) encountered more frequently (66).

Treatment

Treatment of ABU has been recommended for patients in whom ABU is a known or strongly suspected direct contributor to adverse outcomes [A] (9,67). Such patients include infants, pregnant women, patients about to undergo urinary tract instrumentation, recent renal transplant recipients, neutropenic patients, and individuals with postcatheteri-zation bacteriuria. In most other patients, as ABU is of no known clinical significance, its treatment is without defined benefit but predictably will result in increased costs, toxicity, and antimicrobial resistance [B] (7,23,66,67). Consequently, except for in the above patient groups urine from asymptomatic patients generally should not be tested to detect ABU, and if for some reason UTI is documented in a patient without signs or symptoms attributable to the infection treatment usually should be withheld [B].

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