Diagnosis and Management of Asymptomatic ESBL Colonization

Understanding McGeer's Criteria for UTI

The Infectious Diseases Society of America recommends that a urinary tract infection diagnosis requires the presence of urinary symptoms, such as dysuria, fever, suprapubic tenderness, costovertebral angle pain/tenderness, urinary urgency, or frequency, in addition to laboratory findings 1
Laboratory findings, such as pyuria or positive culture, support but do not alone establish the diagnosis of a urinary tract infection, according to the Infectious Diseases Society of America 1

The Infectious Diseases Society of America states that ESBL colonization without symptoms represents asymptomatic bacteriuria, not an active infection requiring treatment, and is associated with an increased risk of antimicrobial resistance 1, 2
The presence of leukocytosis, such as an elevated WBC count, may reflect a systemic inflammatory process unrelated to the urinary tract, an underlying condition, or a stress response, according to the Infectious Diseases Society of America 1

The Infectious Diseases Society of America strongly recommends against screening for or treating asymptomatic bacteriuria in most patient populations, even with impaired renal function, due to the lack of reduction in progression to symptomatic UTI and the increased risk of antimicrobial resistance 1, 2
The Infectious Diseases Society of America guidelines state that treating asymptomatic bacteriuria provides no improvement in renal function outcomes and increases the risk of Clostridioides difficile infection 2

The Infectious Diseases Society of America recommends against treating asymptomatic ESBL colonization, even in patients with moderately impaired renal function, due to the lack of clinical benefit and the increased risk of antimicrobial resistance 1, 2
The 2019 IDSA guidelines explicitly address patients with renal insufficiency and recommend against treatment of asymptomatic bacteriuria, according to the Infectious Diseases Society of America 1