Asymptomatic Bacteriuria 2019 IDSA Guidelines

Question 1

What is asymptomatic bacteriuria (ASB)?

Answer 1

The presence of 1 or more species of bacteria growing in the urine at specified quantitative counts (≥10^5 CFU/mL or ≥10^8 CFU/L), irrespective of the presence of pyuria, in the absence of signs or symptoms attributable to urinary tract infection (UTI).

Question 2

Who should be screened and treated for ASB according to the 2005 guideline?

Answer 2

Pregnant women or individuals prior to undergoing invasive urologic procedures.

Question 3

Is treatment recommended for healthy women with ASB?

Answer 3

No, treatment was not recommended for healthy women, older women or men, or persons with diabetes, indwelling catheters, or spinal cord injury.

Question 4

What populations were not addressed in the 2005 guidelines regarding ASB?

Answer 4

Children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery.

Question 5

What has been recognized as an important contributor to inappropriate antimicrobial use?

Answer 5

Antimicrobial treatment of ASB.

Question 6

What are the quantitative counts that define ASB?

Answer 6

≥10^5 CFU/mL or ≥10^8 CFU/L.

Question 7

What is the significance of nonlocalizing clinical symptoms in populations with a high prevalence of ASB?

Answer 7

They may lead to clinical uncertainty in the diagnosis of symptomatic infection.

Question 8

What is the purpose of the updated guideline on ASB?

Answer 8

To review and update the 2005 guideline, incorporating new evidence and addressing previously unconsidered populations.

Question 9

True or False: Candiduria is addressed in the ASB management guidelines.

Answer 9

False.

Question 10

What process did the panel follow in the development of the ASB guidelines?

Answer 10

A systematic weighting of the strength of recommendation and quality of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Question 11

What is a common finding in healthy female populations regarding ASB?

Answer 11

ASB is a common finding in some healthy female populations.

Question 12

Fill in the blank: ASB is recognized as an important opportunity for decreasing inappropriate _______.

Answer 12

antimicrobial use.

Question 13

What age group is particularly highlighted in the updated guideline regarding symptomatic UTI?

Answer 13

Older adults (≥65 years).

Question 14

What type of treatment is not recommended for patients with spinal cord injury regarding ASB?

Answer 14

Antimicrobial treatment.

Question 15

What is the main goal of antimicrobial stewardship programs related to ASB?

Answer 15

To identify nontreatment of ASB as an important opportunity for decreasing inappropriate antimicrobial use.

Question 16

What should the guidelines not replace in patient management?

Answer 16

Clinical judgment.

Question 17

Should asymptomatic bacteriuria (ASB) be screened for and treated in pediatric patients?

Answer 17

We recommend against screening for or treating ASB in infants and children (strong recommendation, low-quality evidence).

Question 18

Should ASB be screened for or treated in healthy nonpregnant women?

Answer 18

We recommend against screening for or treating ASB in healthy premenopausal and postmenopausal women (strong recommendation, moderate-quality evidence).

Question 19

Should ASB be screened for and treated in pregnant women?

Answer 19

We recommend screening for and treating ASB in pregnant women (strong recommendation, moderate-quality evidence).

Question 20

What is suggested for urine culture in pregnant women?

Answer 20

A urine culture should be collected at one of the initial visits early in pregnancy.

Question 21

What is the suggested duration of antimicrobial treatment for pregnant women with ASB?

Answer 21

4–7 days of antimicrobial treatment is suggested rather than a shorter duration (weak recommendation, low-quality evidence).

Question 22

Should ASB be screened for or treated in functionally impaired older adults?

Answer 22

We recommend against screening for or treating ASB in older, community-dwelling persons who are functionally impaired (strong recommendation, low-quality evidence).

Question 23

What is recommended for older residents of long-term care facilities regarding ASB?

Answer 23

We recommend against screening for or treating ASB in older persons resident in long-term care facilities (strong recommendation, moderate-quality evidence).

Question 24

In older patients with bacteriuria and delirium, what is recommended?

Answer 24

Assessment for other causes and careful observation rather than antimicrobial treatment (strong recommendation, very low-quality evidence).

Question 25

Should diabetic patients be screened or treated for ASB?

Answer 25

We recommend against screening for or treating ASB in patients with diabetes (strong recommendation, moderate-quality evidence).

Question 26

What is the recommendation for renal transplant recipients regarding ASB?

Answer 26

We recommend against screening for or treating ASB in renal transplant recipients who have had surgery >1 month prior (strong recommendation, high-quality evidence).

Question 27

Should patients with nonrenal solid organ transplants be screened or treated for ASB?

Answer 27

We recommend against screening for or treating ASB in patients with nonrenal solid organ transplant (strong recommendation, moderate-quality evidence).

Question 28

What is the recommendation for patients with high-risk neutropenia regarding ASB?

Answer 28

We make no recommendation for or against screening for or treatment of ASB (knowledge gap).

Question 29

Should individuals with impaired voiding following spinal cord injury be screened for ASB?

Answer 29

We recommend against screening for or treating ASB in patients with spinal cord injury (strong recommendation, low-quality evidence).

Question 30

What is the recommendation for patients with indwelling urethral catheters regarding ASB?

Answer 30

We recommend against screening for or treating ASB in patients with short-term indwelling urethral catheters (<30 days) (strong recommendation, low-quality evidence).

Question 31

Should patients undergoing elective nonurologic surgery be screened and treated for ASB?

Answer 31

We recommend against screening for or treating ASB in patients undergoing elective nonurologic surgery (strong recommendation, low-quality evidence).

Question 32

What is recommended for patients undergoing endourological procedures regarding ASB?

Answer 32

We recommend screening for and treating ASB prior to surgery (strong recommendation, moderate-quality evidence).

Question 33

Should patients with implanted urologic devices be screened for ASB?

Answer 33

We suggest not screening for or treating ASB in patients living with implanted urologic devices (weak recommendation, very low-quality evidence).

Question 34

What is the significance of ASB in healthy women and those with urologic abnormalities?

Answer 34

ASB is common in healthy women and in adults and children with urologic abnormalities associated with impaired voiding.

Question 35

What has been observed regarding the treatment of ASB in various populations?

Answer 35

Antimicrobial treatment did not confer benefits and increased the risk of antimicrobial resistance and Clostridioides difficile infection.

Question 36

What does the guideline committee emphasize regarding antimicrobial use?

Answer 36

Screening for bacteriuria and treatment of ASB should be discouraged unless there is evidence to support a benefit.