Asymptomatic Bacteriuria

Definition

Asymptomatic Bacteriuria (ASB)

Positive urine culture in a patient without symptoms or signs directly attributable to the urinary tract - i.e. dysuria or other irritative symptoms, suprapubic or CVA tenderness, or SIRS/sepsis without another source.

The following are examples of ASB, which should not be treated with antibiotics:
1. Delirium
2. Urine culture performed as a routine pre-operative test, except in urology
3. Change in appearance/odour of urine
4. Fever without SIRS/sepsis
5. Test of cure after treatment of urinary tract infection
6. Urine culture collected by patient or family request

Management of ASB

ASB should NOT be treated except for in pregnancy and prior to urinary tract instrumentation

Comments

The presence of nitrites or pyuria does not definitively indicate infection due to inadequate specificity, especially in a catheterized patient

Catheterized patients develop bacteriuria at a rate of ~5% per day, and virtually all by one month.

Please DO NOT submit urine cultures collected from indwelling catheters.

If urine culture is necessary due to urinary symptoms, insert clean catheter to collect urine.

ASB is more common in females than males, and increases with age.

70% of antibiotics prescribed for urinary tract infection in long term care in St. John's are inappropriate.