Treating asymptomatic bacteriuria can have negative effects for patients.
In cases of asymptomatic bacteriuria, patients’ urine may be colonized with bacteria, but they do not have signs or symptoms of urinary tract infection (UTI). Evidence shows that treatment of asymptomatic bacteriuria does not benefit patients but does increase healthcare costs, hospital lengths of stay, and may precipitate C. difficile infections and antimicrobial resistance.
Patients who should be treated for asymptomatic bacteriuria are those who are undergoing urologic surgery and pregnant patients. Urinalysis and urine culture are useful screening tests for patients with urinary tract symptoms such as urinary frequency, burning, and pain. However, these tests are neither sensitive nor specific for predicting UTI in patients without urinary symptoms.
A simple two-step algorithm for determining whether patients need a UTI diagnostic workup is:
1) Does my patient have urinary symptoms?
2) Are these symptoms explained by other non-urinary diagnoses?
For additional information, review the UTI diagnosis and management guideline, which includes guidance for assessing patients who cannot reliably report symptoms.