People with asymptomatic bacteriuria (ABU) are often unnecessarily treated with antibiotics risking adverse effects and antimicrobial resistance. We performed a systematic review to determine any benefits and harms of treating ABU in particular patient groups. Relevant databases were searched and eligible trials were assessed for risk-of-bias and Grading of Recommendations, Assessment, Development and Education quality. Where possible, a meta-analysis of extracted data was performed or a narrative synthesis of the evidence was presented. After screening 3626 articles, 50 studies involving 7088 patients were included. Overall, quality of evidence ranged from very low to low. There was no evidence of benefit for patients with no risk factors, patients with diabetes mellitus, postmenopausal women, elderly institutionalised patients, patients with renal transplants, or patients prior to joint replacement, and treatment was harmful for patients with recurrent urinary tract infection (UTI). Treatment of ABU resulted in a lower risk of postoperative UTI after transurethral resection surgery. In pregnant women, we found evidence that treatment of ABU decreased risk of symptomatic UTI, low birthweight, and preterm delivery. ABU should be treated prior to transurethral resection surgery. In addition, current evidence also suggests that ABU treatment is required in pregnant women, although the results of a recent trial have challenged this view.
PATIENT SUMMARY: We reviewed available scientific studies to see if people with bacteria in their urine but without symptoms of urinary tract infection should be treated with antibiotics to eliminate bacteria. For most people, treatment was not beneficial and may be harmful. Antibiotic treatment did appear to benefit women in pregnancy and those about to undergo urological surgery.
Good summary that reinforces what many of us likely already think and try to do.
It`s surprising how long it has taken to change thinking about antibiotic overuse. I still see it happen and lead to harm. Although the evidence isn`t perfect, it seems that two groups of folks in whom asymptomatic bacteriuria needs to be treated are pregnant women and folks prior to TURP.
This review confirms that, in most situations, treatment of asymptomatic bacteruria confers no benefit and may cause harms such as antibiotic resistance. Treatment is indicated in pregnancy and in patients scheduled for transurethral resections. In my primary care experience, specialists in Nephrology and Urology often prescribe antibiotics when evidence-based guidelines recommend against it.
These are very useful data especially in this era of antibiotic overuse and resistance.