Bacteria in urine doesn't always indicate infection

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Doctors should think carefully before testing patients for a urinary tract infection (UTI) to avoid over-diagnosis and unnecessary antibiotic treatment, according to updated asymptomatic bacteriuria (ASB) guidelines released by the Infectious Diseases Society of America (IDSA) and published in Clinical Infectious Diseases.

ASB—the presence of bacteria in the urine without the symptoms of an infection—is quite common and has been identified as a contributor to antibiotic misuse, which promotes resistance. While the updated guidelines follow previous recommendations to avoid testing certain groups of patients who don't have symptoms (called screening) - including healthy non-pregnant women, the elderly, people with diabetes and those with —they also include groups that weren't previously addressed, such as infants and children, people who have had joint replacement or other non-urologic surgery and those who have had .

"Screening these patients is far too common and leads to the inappropriate prescribing of antibiotics, which some studies suggest may actually increase the risk of a UTI, as well as contribute to other serious infections such as Clostridioides difficile," said Lindsay E. Nicolle, MD, FIDSA, chair of the committee that developed the guidelines and professor emeritus at the Rady Faculty of Health Sciences at the University of Manitoba, Winnipeg. "Generally, physicians should not obtain urine cultures unless patients have symptoms consistent with an infection, such as burning during urination, frequent urination or or tenderness on the back near the lower ribs."

Some symptoms that people assume indicate a UTI—such as urine odor and confusion in the elderly—are usually caused by other conditions that should be ruled out before testing, Dr. Nicolle said.

About 3 to 7 percent of healthy women have ASB at any given time, especially those who are sexually active, she said. About 50 percent of people with and 30 to 50 percent of people in nursing homes have ASB.

The updated guidelines follow previous guideline recommendations to screen and treat only patients who are at risk of developing complications of ASB, including and those undergoing endoscopic urologic procedures.


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More information: Lindsay E Nicolle et al, Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of Americaa, Clinical Infectious Diseases (2018). DOI: 10.1093/cid/ciy1121
Journal information: Clinical Infectious Diseases

Citation: Bacteria in urine doesn't always indicate infection (2019, March 21) retrieved 8 July 2020 from https://medicalxpress.com/news/2019-03-bacteria-urine-doesnt-infection.html
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