Valentine-King et al reported factors associated with antibiotic therapy of a patient with asymptomatic bacteriuria. The authors are from multiple institutions in the United States.
Antibiotic therapy of asymptomatic bacteriuria is considered inappropriate.
Asymptomatic bacteriuria involves:
(1) urine culture positive for bacteria
(2) absence of signs or symptoms associated with a urinary tract infection (the patient may be symptomatic, but the symptoms are not related to UTI or are due to another condition).
Reasons for antibiotic therapy in a patient with asymptomatic bacteriuria:
(1) misleading symptoms (see below)
(2) abnormal vital signs (tachycardia, hypotension, temperature < 36.0°C or > 38.0°C)
(3) laboratory values (abnormal creatinine, leukocytosis, pyuria)
(4) urine characteristics (cloudy, color change)
(5) history of urinary tract infection
(6) decreased urine output
(7) voiding issues (urinary catheter, hesitancy, urinary obstruction, neurogenic bladder, etc)
Misleading symptoms may include:
(1) abdominal pain or other gastrointestinal complaints
(2) falls
(3) weakness and/or fatigue
(4) confusion or disorganized thinking
It is hard to know if some of the cases were due to a failure to document symptoms indicative of UTI. If a patient has abnormal vital signs, a past history of UTI, leukocytosis, pyuria, and a positive urine culture, then antibiotic therapy may be understandable. Retrospective analysis of charts may not be as good as a prospective analysis.
