BERKELEY, CA (UroToday.com) - The understanding off asymptomatic bacteriuria (ABU) pathophysiology and natural history has been improved over the years. Initially, it was assumed to be a strong relationship between bacteriuria and pyelonephritis due to the fact that ABU has been found with particular frequency in populations more likely to develop pyelonephritis.[1] However, subsequent well-performed, randomized clinical studies have consistently documented that the treatment of bacteriuria in asymptomatic patients does not provide any benefit for the patient.[2]
| "Not to treat ABU in general (except during pregnancy and before invasive intervention of the urinary tract), and especially not in young women with recurrent UTI, is highly recommended and should become the standard of care." |
The idea of this study[3]comes from the evidence that in everyday clinical practice, we sometimes note that young women affected by recurrent UTI showed, after a course of antibiotic treatment, an asymptomatic period associated with sterile urine and then an episode of ABU. Furthermore, in the majority of cases, even if it is not recommended, ABU is treated with poor results and occasionally can allow the development of selection of multidrug-resistant bacteria. From this background, the questions are:
- Should ABU be treated in women affected by recurrent UTI, after antibiotic treatment?
- Does ABU play a protective role for preventing recurrence in women affected by UTI?
This evidence should be important for health policy in terms of cost reduction and antibiotic stewardship. By using a randomized, controlled clinical trial on 699 young women affected by recurrent uncomplicated UTI, we found that after 6 months from the enrollment, 23 (7.6%) not treated subjects and 98 (29.7%) treated patients showed recurrence with a statistically significant difference (RR, 1.31; 95% CI, 1.21-1.42; P <.0001). Moreover, at the last follow-up, 41 of treated subjects (13.1%) and 169 of not treated subjects (46.8%) showed recurrence (RR, 3.17; 95% CI, 2.55-3.90; P <.0001).[3]Furthermore, we noted that at the second and third follow-up evaluations, the majority of patients who were recurrence-free were found to have ABU caused by E. faecalis. This may lead to the question whether specific strains of E. faecalis, able to adhere to the bladder mucosa but not virulent enough to produce symptomatic UTI, may be even better suited for study of bacterial interference than E. coli strains.[1]
The results of our study provide a clear answer: The antibiotic treatment of ABU in young women with recurrent UTI is not only unnecessary, but harmful. Moreover, we would like to stress the fact that ABU is now considered a generally benign and sometimes even protective condition. Not to treat ABU in general (except during pregnancy and before invasive intervention of the urinary tract), and especially not in young women with recurrent UTI, is highly recommended and should become the standard of care.
References:
- Wagenlehner FME and Naber KG. Editorial Commentary: Asymptomatic Bacteriuria—Shift of Paradigm. Clin Infect Dis. (2012) 55 (6): 778-780.
- Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643-54.
- Cai T, Mazzoli S, Mondaini N, Meacci F, Nesi G, dÉlia C, Malossini G, Boddi V, Bartoletti R The Role of Asymptomatic Bacteriuria in Young Women With Recurrent Urinary Tract Infections: To Treat or Not to Treat?” - Clin Infect Dis. (2012) 55 (6): 771-777.
Written by:
Tommaso Caia and Florian M. E. Wagenlehnerb as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
