Treating bacteria in urine: IDSA recommendation update
Wednesday, April 17, 2019
Urinary tract infections (UTIs) are considered the most common bacterial infection, accounting for 25% of all infections. Approximately 50 to 60% of women report at least one UTI in their lifetimes, and 1 in 3 will have at least one symptomatic UTI that requires antibiotic treatment by age 24.
According to the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, UTIs accounted for nearly 7 million office visits and 1 million emergency department visits, resulting in 100,000 hospitalizations.
Accurate diagnosis depends on both the presence of symptoms and a positive urine culture, although in most outpatient settings this diagnosis is made without the benefit of culture. Asymptomatic bacteriuria (ASB), the presence of bacteria in the urine without the symptoms of an infection, is common and has been a contributor to antibiotic misuse, which promotes resistance.
According to updated ASB guidelines released by the Infectious Diseases Society of America (IDSA), which recommend avoiding screening in certain groups of patients who don’t have symptoms, such as healthy non-pregnant women, elderly patients, those with diabetes and spinal cord injuries, new groups include infants and children, those who have had joint replacement or organ transplants.
Urinary tract bacterial infections are most commonly observed in general practice. According to Lindsay E. Nicolle, MD, FIDSA, chair of the committee that developed the guidelines and professor emeritus at the Rady Faculty of Health Sciences at the University of Manitoba, Winnipeg, physicians should not obtain urine cultures unless patients have symptoms consistent with an infection, such as burning during urination, frequent urination, abdominal pain, or tenderness on the back near the lower ribs.
Nicolle claims that screening these patients is too common and leads to inappropriate prescribing of antibiotics, which could increase the risk of UTI and contribute to serious infections such as Clostridioides difficile and stresses that only those with symptoms consistent with an infection be treated.
People who have ABS include about 3 to 7% of healthy women, especially those who are sexually active, 50% of people with spinal cord injuries, and 30 to 50% of people in nursing homes. Giving antibiotics to patients with ASB has no benefit, and can lead to harm, including an increase in urinary infections, adverse drug reactions, and a higher level of antibiotic resistance.
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