Asymptomatic Bacteriuria: A Qualitative Exploration of Barriers to Acceptance

Asymptomatic bacteriuria (ASB) is common, particularly among women as they age, yet awareness is low and patient education materials are often limited in quality.

We conducted a qualitative study to assess patient feedback on existing ASB information and identify gaps in understanding to guide future educational efforts.

We convened 5 focus groups among postmenopausal women with previous experience of treatment for urinary tract infections. Participants were asked to describe their experiences of urinary symptoms, reflect on a handout describing ASB, and make recommendations on how to improve patient education. Three team members read deidentified transcripts of the focus groups, developed a thematic codebook following Conventional Content Analysis guidelines, and coded the data using NVivo software.

Twenty women participated in 5 focus groups. The average age of participants was 69.1 years (SD 10.8). Three participants (15.0%) identified as Black and the remaining participants identified as White. Many had postsecondary education, 12 with some college (60.0%) and 7 with graduate-level education (35.0%). Five overarching themes emerged: (1) ASB confusion, (2) presence of bacteria must indicate infection, (3) diagnosis requires treatment, (4) antibiotics as a "cure-all," and (5) in favor of antimicrobial stewardship. Quotations illustrated both persistent misconceptions and openness to learning, highlighting opportunities to improve communication and reduce inappropriate antibiotic use.

Among postmenopausal women, there is a lack of awareness surrounding ASB and the concept that bacteriuria could exist without requiring antibiotics. While misconceptions are common, willingness to learn suggests potential for targeted, plain-language educational materials as we seek to improve understanding of ASB and support antibiotic stewardship.