Prevalence, impact, and management strategies for asymptomatic bacteriuria in the acute care elderly patient: a review of the current literature

Zvi Shimoni, Regev Cohen, Paul Froom*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: It is unclear how to prevent the negative impact of inappropriate urine cultures in older acute care patients who have a high rate of asymptomatic bacteriuria. Areas covered: A nonsystematic literature review of the definition, impact, and management of elderly acute care patients with asymptomatic bacteriuria (ASB). Expert opinion: In the elderly, patients with ASB include those with extra-urinary tract diseases (e.g. pneumonia) and those with symptoms/signs that resolve without antibiotic therapy, but the diagnosis of ASB is unclear in febrile patients responding to antibiotics. We consider four management strategies that could decrease the negative impact of culturing the urine including unnecessary antibiotic therapy in those with ASB: (1) Prevent urine testing in patients with extra-urinary tract reasons for their acute care (2) Cancel urine cultures if the urine dipstick is negative. (3) Avoid catheterization in stable patients who cannot provide a urine specimen on demand and (4) Withhold antibiotics in stable non-febrile elderly patients who do not have new local urinary tract symptoms or decompensation on follow-up, and pursue further investigations for another etiology/diagnosis.

Original languageEnglish
Pages (from-to)453-460
Number of pages8
JournalExpert Review of Anti-Infective Therapy
Volume18
Issue number5
DOIs
StatePublished - 3 May 2020

Keywords

  • Asymptomatic bacteriuria
  • impact
  • inappropriate antibiotic therapy
  • management
  • prevalence
  • urethral catheters

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