What are the guideline sources, guidelines and references for Asymptomatic bacteriuria ?
Guideline sources The following summarized guidelines for the evaluation and management of asymptomatic bacteriuria (ASB) are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2022), the American Urological Association (AUA/CUA/SUFU 2019), the U.S. Preventive Services Task Force (USPSTF 2019), the Infectious Diseases Society of America (IDSA 2019; 2016; 2015; 2010; 2005), the German Society of Urology (GUS 2018), the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC 2017), and the Society of Obstetricians and Gynaecologists of Canada (SOGC 2012). 1 2 3 4 5 6 7 8 9 10 11 12 12 13 13 14 Definition ASB is defined as the presence of bacteria in an uncontamined urine sample at a microbial load of 10 CFU/mL, without any associated signs or symptoms of UTI. 12 Epidemiology ASB is most frequently caused by E. coli, followed by P. mirabilis, K. pneumoniae, Enterobacter species, P. aeruginosa, Enterococcus species, S. aureus, S. saprophyticus, and Streptococcus agalactiae. 13 Pathophysiology https://web.pathway.md/diseases/receHyJljqRdbzlPx 1/8 6/23/23, 3:13 AM Asymptomatic bacteriuria Pathway Pathophysiology The prevalence of ASB is 1-2% in healthy men, 1-9% in healthy women, 2-15% in pregnant women, 1-30% in diabetic adults, 2-50% in community-dwelling adults, 14-75% in institutionalized adults, and 9-100% in patients with indwelling catheters. 13 Disease course In patients with ASB, symptoms of UTI are absent for a variety of reasons, including attenuated host immune response, as well as reduced microbial virulence, growth rates, and cell densities. 14 Prognosis and risk of recurrence Treatment of ASB should be avoided in low-risk populations given the absence of demonstrated benefit, potential for adverse drug reactions, and risk of promoting antibiotic-resistance. Select patients who may derive benefit from treatment include pregnant women and patients undergoing certain invasive procedures. 12 Guidelines 1. Screening and diagnosis Indications for screening, pregnant patients: As per EAU 2022 guidelines, screen pregnant females for and treat ASB with standard short- course treatment. B As per IDSA 2019 guidelines, screen pregnant females for ASB. (strong recommendation, moderate-quality evidence. As per USPSTF 2019 guidelines, screen pregnant females for ASB with a midstream, clean- catch urine for culture at the first prenatal visit or at 12-16 weeks of gestation, whichever is earlier. B Indications for screening, catheterized patients: As per IDSA 2019 guidelines: Avoid screening patients with short-term (< 30 days) or long-term indwelling urethral catheters for ASB. D Insufficient evidence to recommend for or against screening for ASB at the time of catheter removal in patients with indwelling catheters. I As per SEIMC 2017 guidelines, avoid screening patients with short-term D or long-term indwelling urethral catheters for ASB. D Indications for screening, patients undergoing urologic surgery: As per EAU 2022 guidelines, screen for and treat ASB before urological procedures breaching the mucosa. A As per IDSA 2019 guidelines: https://web.pathway.md/diseases/receHyJljqRdbzlPx 2/8 6/23/23, 3:13 AM Asymptomatic bacteriuria Pathway Screen for ASB in patients scheduled to undergo endoscopic urologic procedures associated with mucosal trauma. A Avoid screening for ASB in patients scheduled to undergo surgery for an artificial urinary sphincter or penile prosthesis implantation. D As per SEIMC 2017 guidelines: Screen for and treat ASB in patients undergoing TURP A or any other high-risk urological procedure. B Do not screen for ASB in patients undergoing low-risk urological procedures. D Indications for antibiotics, patients with a renal transplant: as per SEIMC 2017 guidelines, screen patients with a renal transplant for ASB only in the first month after transplantation. B Indications for screening (patients with nonrenal transplants): insufficient evidence to recommend for or against screening for and treating ASB in patients with hematopoietic stem cell transplants or nonrenal solid organ transplants. I Indications for screening, patients not to screen: As per EAU 2022 guidelines, do not screen or treat ASB in the following conditions: females without risk factors postmenopausal females elderly institutionalized patients renal transplant recipients well-controlled diabetes mellitus dysfunctional and/or reconstructed lower urinary tracts recurrent UTIs before arthroplasty surgeries. D As per IDSA 2019 guidelines, do not screen for or treat ASB in the following groups: healthy premenopausal, nonpregnant females D healthy postmenopausal females D infants and children D functionally impaired, older, community-dwelling individuals D older individuals residing in long-term care facilities D patients with diabetes D renal transplant recipients undergone renal transplant surgery > 1 month before D patients with non-renal solid organ transplant D patients with spinal cord injury D patients undergoing elective non-urologic surgery. D Show 2 more As per USPSTF 2019 guidelines, do not screen nonpregnant females for ASB. D As per GUS 2018 guidelines, do not screen nonpregnant females without other relevant concomitant diseases for ASB. D https://web.pathway.md/diseases/receHyJljqRdbzlPx 3/8 6/23/23, 3:13 AM Asymptomatic bacteriuria Pathway As per SEIMC 2017 guidelines, do not screen for and/or treat ASB in the following groups: elderly patients living in the community D institutionalized elderly patients D nonpregnant females < 60 years of age D nonpregnant females with diabetes mellitus D patients scheduled to undergo total hip or knee arthroplasty D patients with an orthotopic neobladder D patients with spinal cord injury treated with intermittent urinary catheterization. D Diagnostic criteria, general population: As per SEIMC 2017 guidelines, define bacteriuria in asymptomatic females as two consecutive clean-voided specimens with isolation of the same bacterial species in quantitative counts of 10 CFU/mL, or one positive urine culture with a positive nitrite test in another sample. B Show 2 more As per IDSA 2005 guidelines, diagnose ASB based on results of culture of a urine specimen collected in a manner minimizing contamination. B Show 2 more Diagnostic criteria, catheterized patients: As per SEIMC 2017 guidelines, define catheter-associated ASB in asymptomatic patients with indwelling urinary catheters, or undergoing intermittent catheterization, as a single catheterized urine specimen with one bacterial species isolated in a quantitative count 10 CFU/mL. B Show 2 more As per IDSA 2010 guidelines, define catheter-associated ASB in patients with indwelling urethral or indwelling suprapubic catheters as the presence of 10 CFU/mL of 1 bacterial species in a single catheter urine specimen in a patient without symptoms compatible with UTI. B Show 6 more 2. Diagnostic investigations Urine tests: Do not obtain urine test strips for the detection of ASB. D Obtain an initial urine culture in pregnant females at 12-16th weeks of gestation. A 3. Medical management Indications for antibiotics, pregnant patients: As per IDSA 2019 guidelines, treat ASB in pregnant patients. A As per USPSTF 2019 guidelines, initiate treatment if urine culture shows > 100,000 CFU/mL of a single uropathogen or > 10,000 CFU/mL of group B streptococcus. https://web.pathway.md/diseases/receHyJljqRdbzlPx 4/8 6/23/23, 3:13 AM Asymptomatic bacteriuria Pathway As per SEIMC 2017 guidelines, treat ASB in pregnant patients in order to decrease the risk of pyelonephritis A , preterm labor, and low birth weight infants. B As per IDSA 2015 guidelines, treat ASB in pregnant patients. B As per IDSA 2005 guidelines, complete a 3-7-days of antimicrobial therapy in pregnant patients with ASB. B Indications for antibiotics, catheterized patients: As per IDSA 2019 guidelines: Avoid treating ASB in patients with short-term (< 30 days) or long-term indwelling urethral catheters. D Insufficient evidence to recommend for or against treating ASB at the time of catheter removal. I As per SEIMC 2017 guidelines, treat ASB in females with an indwelling urethral catheter only if ASB persists 48 hours after removal of the catheter. B As per IDSA 2010 guidelines: Consider initiating antimicrobial treatment for catheter-associated ASB persisting 48 hours after short-term indwelling catheter removal in females, to reduce the risk of subsequent catheter-associated UTI. B Insufficient evidence to recommend treatment of persistent catheter-associated ASB in males. I Indications for antibiotics, patients undergoing urologic procedures: As per IDSA 2019 guidelines: Treat ASB in patients scheduled to undergo endoscopic urologic procedures associated with mucosal trauma. A Consider administering a short course of antibiotic therapy (1 or 2 doses) in patients with ASB scheduled to undergo a urologic procedure. C As per SEIMC 2017 guidelines, treat ASB in patients undergoing TURP A or any other high- risk urological procedure. B Show 2 more As per IDSA 2015 guidelines, treat ASB in patients undergoing invasive urological or prostate surgery. B Indications for antibiotics (patients undergoing spinal surgery): treat ASB prior to performing instrumental spinal surgery in patients with urinary catheters, neurogenic bladders or urinary incontinence, in order to reduce the risk of Gram-negative surgical site infections. B Indications for antibiotics, patients with a renal transplant: as per IDSA 2015 guidelines, treat ASB in renal or renal-pancreas transplant recipients within the first year post-transplant. B Indications for antibiotics (patients with nonrenal transplants): do not initiate systemic antifungal therapy for asymptomatic candiduria in transplant patients, except for neutropenic patients or patients scheduled to undergo urological procedures. D https://web.pathway.md/diseases/receHyJljqRdbzlPx 5/8 6/23/23, 3:13 AM Asymptomatic bacteriuria Pathway Indications for antibiotics, patients not to treat: As per IDSA 2019 guidelines, do not treat ASB in the following groups: healthy premenopausal, nonpregnant females D healthy postmenopausal females D infants and children D functionally impaired, older, community-dwelling individuals D older individuals residing in long-term care facilities D patients with diabetes D renal transplant recipients undergone renal transplant surgery > 1 month before D patients with non-renal solid organ transplant D patients with spinal cord injury D patients undergoing elective non-urologic surgery. D Show 2 more As per SUFU/CUA/AUA 2019 guidelines, do not treat nonpregnant patients with ASB not scheduled to undergo invasive urinary tract procedures. D Duration of treatment: administer standard 4-7-day treatment regimens, or a single 3 g dose of fosfomycin tromethamine as an alternative, over short one-day treatments for eradicating bacteriuria. A 4. Specific circumstances Pregnant patients: treat any bacteriuria with colony counts 10 CFU/mL in pregnancy. B Show 3 more Elderly patients: assess for non-urinary pathology as part of the initial evaluation of falls or delirium (acute mental status change, confusion) in older patients with functional and/or cognitive impairment, bacteriuria, and no local genitourinary symptoms or other systemic signs of infection (such as fever or hemodynamic instability). B Catheterized patients: do not screen for catheter-associated ASB except in research studies evaluating interventions designed to reduce the incidence of catheter-associated ASB or catheter- associated UTI and in selected clinical situations, such as pregnant patients and patients undergoing urologic procedures for which visible mucosal bleeding is anticipated. D Show 6 more Patients with asymptomatic candiduria: eliminate predisposing factors, such as indwelling bladder catheters, whenever feasible in patients with asymptomatic candiduria. B Show 3 more 5. Preventative measures https://web.pathway.md/diseases/receHyJljqRdbzlPx 6/8 6/23/23, 3:13 AM Asymptomatic bacteriuria Pathway Routine catheter change: insufficient evidence to recommend routine catheter change (such as every 2-4 weeks) in patients with functional long-term indwelling urethral or suprapubic catheters to reduce the risk of catheter-associated ASB or catheter-associated UTI. I 6. Follow-up and surveillance Post-treatment surveillance: As per SEIMC 2017 guidelines: Obtain a follow-up urine culture in order to verify bacteriuria eradication in pregnant patients. B Obtain subsequent monthly urine cultures until delivery. B As per IDSA 2005 guidelines: Obtain periodic screening for recurrent bacteriuria following therapy in pregnant patients. B Insufficient evidence to recommend for or against repeated screening in culture-negative females in later pregnancy. I References 1. Anger J, Lee U, Ackerman AL et al. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline. J Urol. 2019 Aug;202 2 282 289. Open 2. de Cueto M, Aliaga L, Al s JI et al. Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases SEIMC . Enferm Infecc Microbiol Clin. 2017 May;35 5 314 320. Open 3. Hooton TM, Bradley SF, Cardenas DD et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010 Mar 1;50 5 625 63. Open 4. US Preventive Services Task Force, Douglas K Owens, Karina W Davidson et al. Screening for Asymptomatic Bacteriuria in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2019 Sep 24;322 12 1188 1194. Open 5. Nicolle LE, Bradley S, Colgan R et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005 Mar 1;40 5 643 54. Open 6. Nicolle LE, Gupta K, Bradley SF et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019 May 2;68 10):e83-e110. Open 7. Kranz J, Schmidt S, Lebert C et al. The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients: Part 1. Urol Int. 2018;100 3 263 270. Open 8. Infectious Diseases Society of America. Choosing Wisely: Recommendations of the Infectious Diseases Society of America. Choosing Wisely. 2015 Feb. Open https://web.pathway.md/diseases/receHyJljqRdbzlPx 7/8 6/23/23, 3:13 AM Asymptomatic bacteriuria Pathway 9. G. Bonkat, R. Bartoletti, F. Bruy re et al. EAU Guidelines on Urological Infections. EAU. 2022. Open 10. Pappas PG, Kauffman CA, Andes DR et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62 4):e1 50. Open 11. Victoria M Allen, Mark H Yudin, INFECTIOUS DISEASES COMMITTEE. Management of group B streptococcal bacteriuria in pregnancy. J Obstet Gynaecol Can. 2012 May;34 5 482 486. Open 12. 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