When should asymptomatic urinary infection be treated?
Asymptomatic bacteriuria may be transient or persistent and is common in women, the elderly, and individuals with complicated UTI. The prevalence reaches 25% to 50% of long-term care facility residents and 50% of patients with spinal cord injury managed with intermittent catheters. Screening for and treatment of asymptomatic bacteriuria is indicated for pregnant women. The only other indication for treatment is to prevent bacteremia and sepsis following invasive genitourinary procedures associated with mucosal trauma and bleeding. For these procedures, treatment of antimicrobial therapy is, conceptually, surgical prophylaxis. Usually a single dose initiated immediately prior to the intervention is adequate. Screening for and treatment of asymptomatic bacteriuria is not recommended for other populations, including kidney transplant patients, because this strategy will not decrease subsequent episodes of symptomatic infection or other morbidity, but is associated with increased adverse drug reactions and reinfection with more resistant bacteria.
