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Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases
Lindsay E Nicolle1, Kalpana Gupta2, Suzanne F Bradley3
1Department of Internal Medicine, School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Insights
Asymptomatic bacteriuria (ASB) screening and treatment guidelines are updated. New recommendations address previously unaddressed populations and the risks of antimicrobial resistance from treating ASB.
Area of Science:
- Infectious Diseases
- Urology
- Antimicrobial Stewardship
Background:
- Asymptomatic bacteriuria (ASB) is common, but treatment recommendations have been limited.
- The 2005 guideline advised ASB treatment only for pregnant women and those undergoing urologic procedures.
- Concerns about antimicrobial resistance have increased regarding ASB treatment.
Purpose of the Study:
- To update the 2005 Infectious Diseases Society of America (IDSA) guideline on ASB.
- To provide recommendations for populations not covered in the previous guideline.
- To address the role of ASB in nonlocalizing symptoms and antimicrobial resistance.
Main Methods:
- Review of recent scientific literature and clinical evidence on ASB.
- Expert consensus development for updated recommendations.
- Consideration of antimicrobial resistance implications.
Main Results:
- Updated recommendations for screening and treatment of ASB in various populations.
- Specific guidance for populations like children, transplant recipients, and neutropenic patients.
- Emphasis on judicious antimicrobial use to combat resistance.
Conclusions:
- The updated guideline refines ASB management strategies.
- It aims to optimize patient care while minimizing the contribution of ASB treatment to antimicrobial resistance.
- The guideline provides a framework for evidence-based ASB management in diverse clinical scenarios.
Abstract:
Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.
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