Management of Asymptomatic Patients with Multi-Resistant Organisms
Key Principles
- The European Association of Urology recommends that urinary tract infection requires symptoms, and the presence of bacteria in urine without clinical symptoms constitutes asymptomatic bacteriuria, which should not be treated in most patients 1, 2, 3, 4
- The European Association of Urology guidelines indicate that asymptomatic bacteriuria should not be screened or treated in patients before cardiovascular surgeries, patients with diabetes mellitus, long-term care facility residents, patients with recurrent UTIs when currently asymptomatic, and any patient without urinary symptoms 1, 2, 3, 4
Treatment Exceptions
- The European Association of Urology recommends treating asymptomatic bacteriuria in pregnant women, before urological procedures breaching the mucosa, patients with renal transplants, and patients before arthroplasty surgery 2, 3, 5
Clinical Monitoring
- The European Urology guidelines suggest documenting clearly that the patient is asymptomatic, not performing surveillance urine testing or repeat cultures while asymptomatic, and educating the patient about symptoms that would indicate true infection 1, 2, 4
- Monitor for development of dysuria, frequency, or urgency, fever, flank pain, costovertebral angle tenderness, suprapubic pain, or lower abdominal discomfort 1, 2, 6
Treatment of Symptomatic Infection
- If symptoms develop, obtain new urine culture with susceptibility testing, and treat based on culture results and clinical syndrome 1, 2, 4
- For multi-resistant organisms, consider carbapenems or novel broad-spectrum agents based on susceptibilities 5, 6, 7