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The Infectious Diseases Society of America has published updated clinical practice guidelines for the management of asymptomatic bacteriuria, or ASB.
The new directive adds infants and children, people who have undergone joint replacement or other non-urological surgery, and people who have undergone organ transplants on the list of patients who should not be tested. Urinary tract infection without experiencing any other symptoms.
This was the first time that the guidelines had been updated since 2005, when they were not sent to the pediatric population and some adult populations.
"Asymptomatic bacteriuria is a very common finding, and there is only a very small group of individuals – especially pregnant women and people who undergo endourological procedures – who require screening. or treatment for asymptomatic bacteriuria ", Lindsay E. Nicolle, MD, professor of internal medicine at the University of Manitoba College of Medicine, said Infectious Diseases News. "For other groups, treatment would not be recommended."
The new guidelines emphasize avoiding detection and treatment of patients with no symptoms.
"The evidence available to date does not suggest that non-localized symptoms, such as changes in mental status, falls, or urine odor, are actually attributable to a urine culture." positive, "said Nicolle.
As previously recommended, non-pregnant healthy women, patients with diabetes and those with spinal cord injuries should also not be screened or tested without symptoms. Nicolle explained that elderly patients should not be tested or screened for BSA unless there is clear clinical evidence of a urinary tract infection.
"The biggest problem with the elderly population is that there is an extremely high prevalence of asymptomatic bacteriuria, especially in older people with functional impairment," Nicolle said. "Because these people have so often positive urine cultures, any clinical changes on their part can be attributed to a urinary tract infection and then they are treated for a urinary tract infection."
For the clinicians involved with this group of patients, Nicolle suggested "thinking about other diagnoses" and "avoiding dealing with antimicrobials".
According to IDSA, about 3% to 7% of healthy women, 50% of people with spinal injuries and 30% to 50% of nursing home residents have a bacteria presence in their body. urine.
"Given current concerns about the overuse of some antimicrobial agents, this is an important antimicrobial management problem," Nicolle said.
Disclosures: Nicolle reports having served as a consultant for GlaxoSmithKline, Paratek, Tetraphase and Utility. Please refer to the guidelines for the relevant financial statements of all other authors.
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