SOURCE: Bush LM, Vazquez-Pertejo MT. The unintended deleterious consequences of the ‘routine’ urinalysis. Am J Med 2017;130:3-4.

The only population in which treatment of asymptomatic bacteriuria might be beneficial appears to be pregnant women, and even that widely held belief has been challenged recently. Part of the problem of addressing asymptomatic bacteriuria is that often we are dealing with results of a test we may not have thought was really pertinent to the patients well-being (or lack thereof) in the first place. That is, so-called “routine” urinalysis — usually by urine dipstick — may be part of standard protocol for patients presenting with no symptoms even remotely referable to the genitourinary tract.

Were asymptomatic bacteriuria rare, perhaps the problem would not be so vexing. On the contrary, the prevalence in long-term care facility residents may be as high as 25-50% in women and 15-40% in men. When presented with such abnormal results, clinicians often are tempted to treat, hoping to avoid more serious consequences. However, clinical trial data do not demonstrate achieved benefit.

Both the Infectious Diseases Society of America and the American Board of Internal Medicine advise against treatment of asymptomatic bacteriuria in non-pregnant adults. Clinicians would be wise to heed such advice, and perhaps even better, be more selective about seeking urine testing only when clinically pertinent.