Asymptomatic Bacteriuria

Asymptomatic bacteriuria is the presence of bacteria in the properly collected urine of a patient that has no signs or symptoms of a urinary tract infection. Asymptomatic bacteriuria is very common in clinical practice. While few infants and toddlers have asymptomatic bacteriuria, the incidence increases with age. The incidence is up to 15% or greater in women and men age 65 to 80 years and as high as 40% to 50% after age 80. Most patients with asymptomatic bacteriuria will never develop symptomatic urinary tract infections and will have no adverse consequences from asymptomatic bacteriuria. In an age when decreasing unnecessary antibiotic use is emphasized, the important clinical question is this: Which patients with asymptomatic bacteriuria benefit from treatment? The answer is that most patients with asymptomatic bacteriuria do not benefit from treatment. There are, however, a few exceptions. There is sufficient evidence that a pregnant woman with asymptomatic bacteriuria should be treated. Also, patients undergoing urologic procedures in which mucosal bleeding is expected and patients who are in the first three months following renal transplantation should probably be treated for asymptomatic bacteriuria.