Abstract
Asymptomatic bacteriuria, also called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract. The characterization and introduction of the quantitative urine culture in the 1950s first allowed the reliable recognition of asymptomatic bacteriuria. The observations that a substantial proportion of patients with chronic pyelonephritis at autopsy had no history of symptomatic urinary infection, and the high frequency of pyelonephritis observed in pregnant women with untreated asymptomatic bacteriuria, supported a conclusion that asymptomatic bacteriuria was harmful. Subsequent screening and long term follow-up programs for asymptomatic bacteriuria in schoolgirls and women reported an increased frequency of symptomatic urinary tract infection for subjects with asymptomatic bacteriuria, but no increased morbidity from renal failure or hypertension, or increased mortality. Treatment of asymptomatic bacteriuria did not decrease the frequency of symptomatic infection. Prospective, randomized, comparative trials enrolling premenopausal women, children, elderly populations, patients with long term catheters, and diabetic patients consistently report no benefits with antimicrobial treatment of asymptomatic bacteriuria, and some evidence of harm. Several studies have also reported that antimicrobial treatment of asymptomatic bacteriuria increases the short term risk of pyelonephritis. Current investigations are exploring the potential therapeutic intervention of establishing asymptomatic bacteriuria with an avirulent Escherichia coli strain to prevent symptomatic urinary tract infection for selected patients.
Highlights
Asymptomatic bacteriuria, called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract
Asymptomatic bacteriuria was first identified in the mid-1950s, when Kass and others described the use of the quantitative urine culture to differentiate true bacteriuria from contamination of voided urine specimens
Randomized clinical trials of treatment of asymptomatic bacteriuria in children, non-pregnant women, elderly persons, spinal cord injury patients, persons with diabetes, and individuals with chronic catheters all reported that treatment of asymptomatic bacteriuria did not decrease the frequency of symptomatic urinary tract infection [1,14]
Summary
Asymptomatic bacteriuria is common in many populations, but the prevalence is highly variable (Table 1) [3]. The prevalence increases with age; by 80 years 20% of healthy women resident in the community have a positive urine culture. Asymptomatic bacteriuria is rare in healthy men prior to 60 years of age, but for elderly men in the community prevalence rates of 3.6%–19% are reported [3]. Some populations with functional or structural genitourinary abnormalities, including patients with indwelling urinary devices, have a very high prevalence of bacteriuria [3]. Patients with spinal cord injury managed with intermittent catheterization or, in men, with sphincterotomy, have a prevalence of bacteriuria of 50% [3,4]. The prevalence of bacteriuria is increased in women with diabetes compared with non-diabetic women, primarily attributable to neurological complications of diabetes which impair bladder voiding, but is not increased for diabetic men [3,4]
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