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[Asymptomatic bacteriuria; management choices in different patient groups]
R Meiland1, S E Geerlings, A W Hoes
1Afd. Interne Geneeskunde, Zorgeenheid Acute Geneeskunde & Infectieziekten, Universitair Medisch Centrum Utrecht, Postbus 85, 500. 3508 GA Utrecht.
Insights
Asymptomatic bacteriuria (ASB) is usually harmless and doesn't need treatment. Screening is generally not advised, with few exceptions for specific pediatric cases and ongoing research for pregnant women and diabetics.
Area of Science:
- Urology
- Infectious Diseases
- Public Health
Context:
- Asymptomatic bacteriuria (ASB) is a common condition, particularly in women and the elderly.
- It is often considered benign and does not typically require screening or antibiotic intervention.
Purpose:
- To evaluate the necessity and efficacy of screening for asymptomatic bacteriuria (ASB) in various populations.
- To identify specific circumstances where ASB screening may be beneficial.
- To highlight areas requiring further research regarding ASB complications and management.
Summary:
- Current evidence does not support routine ASB screening in most populations, including pregnant women and adults with type I diabetes.
- Screening may be considered for young children in the early months post-urinary tract infection.
- The clinical outcomes of early ASB detection in children remain unclear.
Impact:
- This review informs clinical guidelines on ASB screening, emphasizing a cautious approach outside of specific pediatric indications.
- Highlights the need for research into ASB's role in pyelonephritis, adverse pregnancy outcomes, and diabetic nephropathy.
- Aims to prevent unnecessary antibiotic use and associated resistance while identifying at-risk groups.
Abstract:
Asymptomatic bacteriuria is a common medical condition, especially in women and elderly people. It is generally considered to be a benign condition, which does not require screening or antibiotic treatment. However, there are a few exceptions for which screening is possibly worthwhile. For children it is unclear whether the early detection of ASB can result in better clinical outcomes. Screening is therefore not advised, except for young children during the first few months after a symptomatic urinary tract infection. For pregnant women the use of screening for ASB is also unclear and in general not indicated. Research is necessary into the possible transition from ASB to pyelonephritis and the possible connection with low birth weight and premature births. There are indications that ASB in women with type I diabetes mellitus can lead to a deterioration in the renal function, yet these are insufficient to recommend screening as a routine procedure.