Prevalence, impact, and management strategies for asymptomatic bacteriuria in the acute care elderly patient: a review of the current literature

ABSTRACT

Introduction: It is unclear how to prevent the negative impact of inappropriate urine cultures in older acute care patients who have a high rate of asymptomatic bacteriuria.

Areas covered: A nonsystematic literature review of the definition, impact, and management of elderly acute care patients with asymptomatic bacteriuria (ASB).

Expert opinion: In the elderly, patients with ASB include those with extra-urinary tract diseases (e.g. pneumonia) and those with symptoms/signs that resolve without antibiotic therapy, but the diagnosis of ASB is unclear in febrile patients responding to antibiotics. We consider four management strategies that could decrease the negative impact of culturing the urine including unnecessary antibiotic therapy in those with ASB: (1) Prevent urine testing in patients with extra-urinary tract reasons for their acute care (2) Cancel urine cultures if the urine dipstick is negative. (3) Avoid catheterization in stable patients who cannot provide a urine specimen on demand and (4) Withhold antibiotics in stable non-febrile elderly patients who do not have new local urinary tract symptoms or decompensation on follow-up, and pursue further investigations for another etiology/diagnosis.

KEYWORDS:

• Asymptomatic bacteriuria
• prevalence
• impact
• management
• urethral catheters
• inappropriate antibiotic therapy

Article highlights

• The overuse of urine cultures is common and leads to unnecessary urethral catheterizations, inappropriate antibiotic therapy, and longer hospitalizations.

• The major preventable negative impact of a positive urine culture is in patients who present with clear extra-urinary tract reasons for their symptoms.

• Urethral catheterization to obtain a urine sample for culture has significant short-term and long-term complications.

• “Stable” non-febrile patients with only non-specific symptoms might be monitored for 48 h before antibiotic therapy.

• There is a need to determine how to select elderly patients including those with a fever who can be safely monitored without antibiotic therapy.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The manuscript was not funded.