In this episode, I’ll discuss the two scenarios where asymptomatic bacteriuria (ASB) is treated with antibiotics in adult patients.
Considerable focus has appropriately been placed on reducing unnecessary antibiotic use in patients with otherwise asymptomatic bacteriuria. However, there are a few scenarios in which treatment with antibiotics is considered appropriate in adult patients with asymptomatic bacteriuria.
The IDSA guidelines on asymptomatic bacteriuria outline these scenarios in their recommendations:
In pregnant women, we recommend screening for and treating ASB (strong recommendation, moderate-quality evidence).
The rationale behind this recommendation is that, in pregnant women with asymptomatic bacteriuria, antimicrobials probably reduce the risk of pyelonephritis and may reduce the risk of low birth weight. In addition, the guidelines point out that antimicrobials in this setting may also reduce the risk of preterm labor.
In patients who will undergo endoscopic urologic procedures associated with mucosal trauma, we recommend screening for and treating ASB prior to surgery (strong recommendation, moderate-quality evidence).
The rationale behind this recommendation is that, bacteriuria, even without symptoms, may be an important cause of serious postoperative infectious complications in patients undergoing transurethral surgery.
Members of my Hospital Pharmacy Academy have access to an in-depth, practical training on antimicrobial stewardship considerations in UTI. In addition, there are trainings on de-escalation of patients with sepsis or pneumonia, aspiration pneumonia, and how to provide last-minute coverage for antibiotic stewardship rounds.
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