Asymptomatic Bacteriuria

ASYMPTOMATIC BACTERIURIA

What is asymptomatic bacteriuria?

Bacteriuria is said to occur when a significant number of bacteria is present in the urine.

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.

Asymptomatic bacteriuria is most common in:

• Elderly women
• Elderly people under nursing home settings
• People with diabetes
• People with bladder catheters, ureteric stents and other artificial material, foreign bodies or even naturally occurring substances like stones and tumors.
• People who had a recent urological operation

Unlike the general idea that presence of bacteria equates to infection, infection is said to occur only when there is invasion of bacteria into the tissues and circulation causing inflammation and other symptoms.

In easier understandable terms, an abnormal urine test or a positive urine test for bacteria in a person without any symptoms does not mean an infection, and does not require treatment.

Kindly note that if the urine test is abnormal, you will still require investigations to find out why it is abnormal. For example blood in the urine requires a complete investigation (see subsection on “Hematuria”)

Currently, as per medical literature, the only time asymptomatic bacteriuria needs treatment is only during pregnancy, but that too has exceptions in certain case scenarios. For example a positive urine test while the pregnant lady has a ureteric stent, or any catheter, which may be associated with persistent bacterial presence along the stent or catheter, does not require treatment with antibiotics. The urologist need to be consulted before any decision making on this.

Also, patients undergoing urological 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.

There are also exceptions to this, for example elderly and immunocompromised patients may not exhibit obvious urinary tract infection symptoms but may have subtle symptoms like loss of appetite, aggressive behaviors, very quiet, in distress etc., as they present differently than other group of people.

Most patients with asymptomatic bacteriuria will not develop symptomatic urinary tract infections and will have no adverse consequences from asymptomatic bacteriuria.  Specifically, children, patients with diabetes, older patients, patients with spinal cord injuries, and patients with indwelling urinary catheters do not benefit from treatment with antibiotics for asymptomatic bacteriuria. Treatment in these patients does not decrease the incidence of symptomatic urinary tract infections or improve survival. However, it does increase the likelihood of adverse effects from antibiotics and the development of antibiotic-resistant bacteria.

In other words, in the following groups of patients, screening or treatment of asymptomatic bacteriuria is not recommended:

• Pre-menopausal, non-pregnant women
• diabetic women
• older persons living in the community
• elderly institutionalized patients
• persons with spinal cord injury
• catheterized patients while the catheter remains in situ

For this, it is best to see a urologist if one has asymptomatic bacteriuria so that a proper assessment may be done, and a decision made whether it requires treatment or not.

In general, asymptomatic bacteriuria needs treatment only during pregnancy.