Short CIAFU recommendations on the screening and management of asymptomatic bacteriuria in immunocompromised patients

Immunosuppression refers to a functional or quantitative reduction in immune defenses, resulting in a diminished ability to combat microbial pathogens. Immunocompromised patients are at increased risk of severe infections, associated with elevated morbidity and mortality. In routine clinical practice, urine cultures are often performed systematically in patients considered at risk of infection, regardless of urinary symptoms, with the aim of detecting and subsequently treating potential asymptomatic bacteriuria. This study aimed to assess the clinical relevance of screening for and potentially treating asymptomatic bacteriuria in immunocompromised individuals.

A comprehensive literature search was conducted using PubMed and Medline, without restrictions on language or year of publication. This was complemented by an exploration of the scientific grey literature, including expert reports and guidelines from professional societies. Studies were selected using the following keywords: antibiotic treatment, urinary tract infection, asymptomatic bacteriuria, bacteriuria, pyelonephritis, cystitis, immunodeficiency, diabetes, renal transplant, neurogenic bladder, cirrhosis, pregnancy, and antimicrobial resistance. All abstracts and full-text articles were reviewed. The synthesis of the findings was subsequently evaluated by members of the CIAFU expert committee, who formulated the most consensual recommendation possible.

Across the reviewed literature, no clear benefit was identified in screening for or treating asymptomatic bacteriuria in immunocompromised patients.

It is not recommended to screen for or treat asymptomatic bacteriuria in immunocompromised patients, except in specific, well-established scenarios. Treating asymptomatic bacteriuria does not reduce infection risk; rather, it increases the likelihood of adverse effects and contributes to the development of antimicrobial resistance, with its associated morbidity and mortality.