2019 IDSA Guideline Update: Management of Asymptomatic Bacteriuria (ASB)

M3 India Newsdesk May 20, 2019

Summary

The updated guidance includes new recommendations previously unaddressed in the 2005 guidelines, such as for children and adult populations which include patients with solid organ transplants and nonurologic surgery, and also the clinical presentation of symptomatic UTI in populations with high prevalence of ASB, such as in patients with spinal cord injury or adults ≥65 years.


The Infectious Diseases Society of America (IDSA) has recently updated the recommendations of the 2005 guideline for management of asymptomatic bacteriuria (ASB). The guidance has been published in the journal Clinical Infectious Diseases.

The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury.


Key recommendations

  1. Screening for or treating ASB is not recommended in the following populations
  • Infants and children
  • Healthy premenopausal, nonpregnant women or healthy postmenopausal women
  • Elderly patients in long-term care facilities
  • Diabetic patients
  • Renal transplant recipients with renal transplant surgery >1 month prior
  • Nonrenal solid organ transplant (SOT) recipients
  • Spinal cord injury patients
  • Patients with short/long-term indwelling urinary catheters
  • Patients undergoing elective nonurologic surgery
  1. Screening for and treating ASB is recommended for the following patient groups
  • In pregnant women. 4-7 days of antimicrobial Rx rather than a shorter duration has been suggested. The authors further suggest, a urine culture collected at 1 of the initial visits early in pregnancy
  • In patients who will undergo endoscopic urologic procedures associated with mucosal trauma
  1. Careful observation is preferred over antimicrobial therapy for:
  • Older patients with functional and/or cognitive impairment with bacteriuria and delirium (acute mental status change, confusion) without local genitourinary symptoms or other systemic signs of infection (e.g. fever or hemodynamic instability). Same holds true for cognitively impaired patients who experience a fall
  • For the bacteriuric patients with fever and other systemic signs potentially consistent with a severe infection (sepsis) and without a localizing source, broad-spectrum antimicrobial Rx should be initiated
  1. There are no recommendations for patients with high-risk neutropenia (absolute neutrophil count <100 cells/mm3, ≥7 days duration following chemo)

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