The prevalence of asymptomatic bacteriuria tends to increase with age and is common in nursing home residents (up to 50% of subjects). Unnecessary antibiotic treatment for asymptomatic bacteriuria in older adults do not reduce the rates of complication and is associated with acquisition of drug-resistant pathogens, risk for subsequent urinary tract infections and Clostridium difficile infection. The diagnosis of urinary tract infection instead of asymptomatic bacteriuria requires clinical symptoms of infection, laboratory evidence of pyuria and bacteriuria and the absence of another infection or non-infectious process to which the patient’s symptoms can be attributed. In older adults symptoms include fever, dysuria, suprapubic pain, gross hematuria and delirium. Treatment of asymptomatic bacteriuria is recommended only before urologic procedures for which mucosal bleeding is anticipated.

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