Episode Details

Episode 69: Asymptomatic Bacteriuria. 

When do you screen for and treat asymptomatic bacteriuria? Find out what the IDSA recommends during this episode. PARTNER studies demonstrated that HIV transmission is minimal with condom-less sex if viral load is undetectable.

Introduction: Urine.  

Urine is a straw-colored, pale yellow, or colorless liquid, which is a by-product of metabolism. It is normally sterile when excreted under normal conditions, but it can also have bacteria even in the absence of infection. When you have bacteriuria with no symptoms, it is called asymptomatic bacteriuria or ASB. Today you will hear Dr Covenas, Dr Civelli and Dr Lundquist discussing when to screen and treat asymptomatic bacteriuria.

This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. [Music continues and fades…]

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Asymptomatic bacteriuria (update by the IDSA)
Written by Hector Arreaza, MD. 
Participation by Cecilia Covenas, MD; Valeri Civelli, MD; and Ariana Lundquist, MD.

Case: 19-year-old female who came to clinic to review lab results with you. She is coming from another clinic and brings her results on paper. Routine labs were done 1 week ago. Her complete blood count is normal, TSH (thyroid stimulating hormone) is normal, hemoglobin A1C of 5.3, and a urine culture showing >100,000 CFU of E. coli. Patient denies dysuria, polyuria, or any urinary symptoms. She has a negative pregnancy test in clinic today. What are you going to do with this significant bacteriuria?

This is an Asymptomatic Bacteriuria (ASB). The first question you may ask is “why did she get a urine culture in the first place?” The Infectious Disease Society of America (IDSA) published in its journal “Clinical Infectious Disease” an update in the management of ASB. It is a 28-page long document with answers to 14 questions regarding ASB screening and management in different patient populations.

Recommended ASB screening and treatment: IDSA concluded that the only two groups of patients who benefit from screening and treatment of asymptomatic bacteriuria are: Pregnant women and patients who undergo traumatic urologic interventions that result in mucosal bleeding.

Pregnant women: Recommend one urine culture at one of the initial visits early in pregnancy. There is insufficient evidence to recommend for or against repeat screening during the pregnancy for a woman with an initial negative screening culture or following treatment of an initial episode of ASB. Treatment: IDSA suggests 4–7 days of antimicrobial treatment rather than a shorter duration, the optimal duration of treatment will vary depending on the antimicrobial given; the shortest effective course should be used.

Patients who will undergo endoscopic urologic procedures associated with mucosal trauma: Screening for ASB and treating prior to surgery is RECOMMENDED. The goal is to avoid serious post-operative complication of sepsis. IDSA suggests a urine culture prior to the procedure and targeted antimicrobial therapy prescribed rather than empiric therapy. If bacteriuria is detected, a short course (1 or 2 doses) rather than more prolonged antimicrobial therapy is recommended, and antibiotic should be initiated 30–60 minutes before the procedure.

Against ASB screening and treatment: IDSA suggests no screening for or treating ASB in these patients:

Pediatric patients

Healthy nonpregnant women

Community-dwelling persons who are functionally impaired

Older persons residing in long-term care facilities

Patients with diabetes

Patients who had a