Don’t use antimicrobials to treat asymptomatic bacteriuria in older adults

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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.


1. American Geriatrics Society. Ten Things Physicians and Patients Should Question.
2. Nicolle LE. Asymptomatic Bacteriuria and Bacterial Interference. Microbiol Spectr. 2015 Oct;3(5). doi: 10.1128/microbiolspec.UTI-0001-2012.
3. Cortes-Penfield NW, Trautner BW, Jump RLP. Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults. Infect Dis Clin North Am. 2017 Dec;31(4):673-688. doi: 10.1016/j.idc.2017.07.002.



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