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. While few infants and toddlers have asymptomatic bacteriuria, the incidence increases with age. The incidence is up to 15% or greater in women and men age 65 to 80 years and as high as 40% to 50% after age 80. Most patients with asymptomatic bacteriuria will never develop symptomatic urinary tract infections and will have no adverse consequences from asymptomatic bacteriuria. In an age when decreasing unnecessary antibiotic use is emphasized, the important clinical question is this: Which patients with asymptomatic bacteriuria benefit from treatment? The answer is that most patients with asymptomatic bacteriuria do not benefit from treatment. There are, however, a few exceptions. There is sufficient evidence that a pregnant woman with asymptomatic bacteriuria should be treated. Also, patients undergoing urologic 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.
The etiology of asymptomatic bacteriuria has not been conclusively determined. Asymptomatic bacteriuria is more common among women than among men probably because of the shorter female urethra, which gives bacteria from the urethral meatus and the perineum a shorter distance to the bladder. In fact, most women have transient bacteriuria after sexual intercourse, but few of these women will develop symptomatic infections because the body's normal defense mechanisms prevent symptomatic infection in most cases. In the elderly, it is thought that incomplete bladder emptying contributes to the increased incidence of asymptomatic bacteriuria.
Patients with asymptomatic bacteriuria are, by definition, asymptomatic. They have no symptoms that can be attributed to bacteria in the urine. This is completely different from the evaluation and management of symptomatic bacteriuria or urinary tract infections. Several factors are thought to increase the likelihood of asymptomatic bacteriuria.
These include:
obstructive uropathy (stones, prostatic hypertrophy, cystocele, etc.),
fecal soiling of the perineum (especially in women),
indwelling urinary catheters, and
frequent instrumentation of the urinary tract.
Diagnosis of asymptomatic bacteriuria is made by urine culture. Either a properly collected clean-catch specimen or a catheterized specimen is acceptable. The Infectious Diseases Society of America (IDSA) has established criteria for diagnosing asymptomatic bacteriuria.
Midstream clean catch urine specimen:
For women, two consecutive specimens with isolation of the same bacteria species with at least 100,000 colony-forming units (CFUs) per ml of urine.
For men, a single specimen with isolation of one bacteria species with at least 100,000 CFUs per ml of urine.
Catheterized specimen:
For women or men, a single specimen with isolation of one bacteria species with at least 100 CFUs per ml of urine.
Givler DN, Givler A. Asymptomatic Bacteriuria. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NB...
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