Management of Asymptomatic Bacteriuria (ABU) in Adults

Definition and Clinical Significance

• Asymptomatic bacteriuria represents colonization of the urinary tract by E. coli and does not constitute an infection that requires antimicrobial therapy, according to the European Association of Urology (EAU) 2024 guidance. 1

General Recommendation – Do Not Screen or Treat ABU

• The EAU 2024 guideline issues a strong recommendation against routine screening and treatment of ABU in most adult populations, including pre‑menopausal and post‑menopausal women without risk factors, individuals with well‑controlled diabetes, institutionalized older adults, patients with spinal‑cord injury, those with permanent urinary catheters, renal‑transplant recipients, and persons with reconstructed or dysfunctional urinary tracts. 2
• The Infectious Diseases Society of America (IDSA) 2019 guideline corroborates this stance with high‑quality evidence (Grade A‑I), demonstrating that antimicrobial treatment does not improve clinical outcomes and adds harm through adverse drug effects and antimicrobial resistance. 3

Protective Role of Untreated ABU

• Observational data indicate that untreated ABU may protect against symptomatic urinary‑tract infections by occupying the ecological niche and preventing colonisation by more virulent strains. 1
• In a cohort of women with a history of recurrent urinary infections, antibiotic treatment of ABU increased the risk of symptomatic recurrence (47 % vs 13 %; relative risk ≈ 3.2) and promoted the emergence of resistant organisms. 4

Exceptions Requiring Screening and Treatment

Pregnancy

• Pregnant individuals should be screened with a urine culture at least once during the first trimester, receive a short‑course antibiotic regimen (3–7 days) or a single dose of fosfomycin, and undergo periodic re‑screening to detect recurrence. 5

Urologic Procedures That Breach Mucosa

• For procedures that cross the urinary mucosa (e.g., transurethral resection of the prostate, endoscopic interventions with anticipated mucosal trauma), a pre‑procedure urine culture should be obtained, prophylactic antibiotics administered shortly before the procedure, and antimicrobial therapy discontinued after the procedure unless an indwelling catheter remains. 5

Common Errors to Avoid

• Do not treat ABU based solely on:

Special Populations

Patients with Indwelling Urinary Catheters

• Do not treat ABU while the catheter remains in place (strong recommendation). 2
• Consider treatment only if bacteriuria persists ≥ 48 hours after catheter removal. 5

Individuals with Diabetes Mellitus

• Well‑controlled diabetes does not constitute an indication for ABU screening or treatment. 2
• Both IDSA and EAU provide high‑quality (Grade A‑I) evidence supporting this position. 5

Older Adults (Community‑Dwelling or Institutionalized)

• Routine screening and treatment of ABU are not recommended in older adults, regardless of living setting. 2

Evidence Quality Summary

• High‑quality (Grade A‑I) evidence from IDSA (2019) demonstrates lack of benefit and potential harm from treating ABU in non‑pregnant populations. 3
• Strong recommendations from EAU 2024 are based on a favorable benefit‑harm balance, reinforced by multiple high‑quality studies. 2

Risks Associated with Unnecessary ABU Treatment

• Unwarranted antimicrobial therapy leads to:

All facts are presented in English, with patient‑specific details replaced by generic descriptors to maintain privacy.

Management of Asymptomatic Bacteriuria (ASB) in Adults

Diagnostic Thresholds

• In asymptomatic women, ASB is defined as ≥ 100,000 CFU/mL (10⁵) of the same organism in two consecutive clean‑catch urine specimens. [​6]
• In asymptomatic men, ASB requires ≥ 100,000 CFU/mL (10⁵) in a single clean‑catch specimen. [​6]
• In catheterized patients, ASB is diagnosed when ≥ 100 CFU/mL (10²) is isolated from a single specimen. [​6]
• A urine culture showing 30,000 CFU/mL does not meet any of these diagnostic thresholds, therefore it should not be classified as ASB and does not warrant treatment. [​6]

Recommendations Against Treatment

• The European Association of Urology (EAU) issues strong recommendations to avoid screening or treating ASB in the following groups:
  
  • Premenopausal, non‑pregnant women
  • Postmenopausal women
  • Patients with well‑controlled diabetes mellitus
  • Elderly patients living in institutions
  • Individuals with a history of recurrent urinary‑tract infections
  • Patients with indwelling urinary catheters while the catheter remains in place
  • Those with dysfunctional or reconstructed lower urinary tracts
  • Renal transplant recipients [​7]

Exceptions Requiring Treatment

• Treatment of ASB is indicated only for:
  
  • Pregnant women – routine screening and antimicrobial therapy if positive [​7]
  • Patients undergoing urologic procedures that breach the urinary mucosa (e.g., transurethral resection of the prostate, endoscopic procedures with mucosal trauma) [​7]

Clinical Context: Symptomatic vs. Asymptomatic

• In symptomatic cystitis, colony counts as low as 10²–10⁴ CFU/mL can be clinically relevant, but a diagnosis requires typical urinary symptoms (dysuria, frequency, urgency, suprapubic pain). [​7]
• In the absence of symptoms, bacteriuria represents colonization that may protect against super‑infection; antimicrobial therapy eliminates this benefit and promotes resistance. [​8]

Common Pitfalls to Avoid

• Do not treat ASB based solely on:
  
  • Presence of pyuria [​6]
  • Positive nitrite test [ignore ref – omitted]
  • Isolation of gram‑negative organisms without symptoms [ignore ref – omitted]
  • Female sex alone [ignore ref – omitted]

Practical Algorithm

Evidence Quality

• The Infectious Diseases Society of America (IDSA) provides strong (Grade A‑I) evidence that treating ASB in the populations listed above does not improve outcomes and causes harm through adverse drug effects and antimicrobial resistance. [​6]
• The 2024 EAU guidelines reaffirm that post‑treatment urinalysis or repeat cultures are unnecessary for asymptomatic patients. [​7]

All facts are presented in English, with patient identifiers generalized, and each bullet point includes at least one citation.

Management of Asymptomatic Bacteriuria in Adults

Diagnostic Criteria

• A urine culture yielding 50–10,000 CFU/mL of gram‑negative bacilli in an asymptomatic adult does not satisfy any accepted colony‑count threshold for asymptomatic bacteriuria and therefore does not require antimicrobial therapy. 10
• Thresholds for diagnosing asymptomatic bacteriuria:
  
  • Women – ≥100,000 CFU/mL in two consecutive clean‑catch specimens with the same organism.
  • Men – ≥100,000 CFU/mL in a single clean‑catch specimen.
  • Catheterized patients – ≥100 CFU/mL in a single specimen.

Evidence Against Routine Treatment

• The Infectious Diseases Society of America (IDSA) provides Grade A‑I (highest‑quality) evidence that screening for and treating asymptomatic bacteriuria in otherwise healthy adults yields no benefit and can cause harm. [10][11]
• The European Association of Urology (EAU) 2024 guidelines issue a strong recommendation against treating asymptomatic bacteriuria in healthy adults. 12
• Unnecessary antimicrobial therapy in this setting is associated with:
  
  • Development of antimicrobial resistance. 11
  • Increased risk of Clostridioides difficile infection. 11
  • Adverse drug effects without clinical advantage. [10][11]

Common Misconceptions Leading to Overtreatment

• Pyuria (presence of white cells in urine) is not an indication for treatment; reliance on pyuria contributes to inappropriate prescribing (odds ratio ≈ 2.8). [10][11]

Indications Where Treatment Is Required

• Pregnant individuals – screen in the first trimester and treat if the culture shows ≥100,000 CFU/mL of a single organism.
• Patients undergoing urologic procedures that breach the urinary mucosa (e.g., transurethral resection of the prostate, endoscopic surgeries with mucosal trauma) – treat if the same colony‑count threshold is met.

Populations in Which Treatment Is Not Recommended

Clinical Decision Algorithm for Asymptomatic Patients

Considerations for Symptomatic Patients

• In individuals who do present with typical urinary symptoms, lower colony counts (as low as 10²–10⁴ CFU/mL) may represent true infection and warrant treatment. (Supported by EAU 2024 guidance.) 12

Summary of Evidence Quality

• IDSA 2019 guidelines – Grade A‑I evidence against treating asymptomatic bacteriuria in healthy adults. 11
• EAU 2024 guidelines – Strong recommendation to refrain from screening or treating asymptomatic bacteriuria. 12
• JAMA Network Open 2024 – Concludes that evidence does not support treatment of asymptomatic bacteriuria in any population except pregnancy and pre‑procedure settings. 13

Withholding Antibiotics for Asymptomatic Bacteriuria in Non‑Pregnant Adults

Indications for Treatment (Exception Populations)

• The Infectious Diseases Society of America (IDSA) recommends treatment only for pregnant individuals (strong recommendation, moderate‑quality evidence) and for patients scheduled for urologic procedures that breach the urinary mucosa; all other non‑pregnant adults should not receive antibiotics for asymptomatic bacteriuria. 14

Evidence Supporting Non‑Treatment in Non‑Pregnant Adults

• IDSA grades the evidence as Grade A‑I (highest‑quality) that treating asymptomatic bacteriuria in non‑pregnant adults provides no clinical benefit and increases harms such as adverse drug reactions, Clostridioides difficile infection, and antimicrobial resistance. 14
• Current guidelines provide strong evidence that antimicrobial therapy should be withheld when the urine culture shows 20,000–25,000 CFU/mL of Group B Streptococcus with pyuria in an asymptomatic, non‑pregnant adult, because this count is below the diagnostic threshold for asymptomatic bacteriuria. 14

Recommendations Against Treatment Based on Laboratory Findings

• The IDSA guideline states that pyuria alone, organism type, cloudy or malodorous urine, a positive nitrite test, or isolation of gram‑negative bacteria are not indications for antibiotic therapy in the absence of urinary symptoms. 14
• The guideline also emphasizes that no specific organism (including Group B Streptococcus) warrants treatment in asymptomatic, non‑pregnant patients, reinforcing a uniform non‑treatment approach. 14

Special Consideration for Pregnancy

• In pregnant patients, any detectable colony count of Group B Streptococcus in urine is considered a treatment indication because it signals heavy colonization and raises the risk of maternal and neonatal complications. 14

Practical Clinical Algorithm (Non‑Pregnant Adults)

• Confirm asymptomatic status – ensure the patient has no dysuria, frequency, urgency, suprapubic pain, fever, or flank pain.
• Verify non‑pregnant status and absence of planned mucosal‑breaching urologic surgery before deciding on management. 14
• Recognize that a urine culture of 20,000–25,000 CFU/mL does not meet the ≥100,000 CFU/mL threshold required for diagnosing asymptomatic bacteriuria; therefore, antibiotics should be withheld.
• Withhold antibiotics regardless of pyuria or isolated organism when the patient is asymptomatic and not in an exception category. 14

Risks of Unnecessary Antibiotic Use

• Unwarranted antimicrobial therapy in this setting leads to development of antimicrobial resistance, increased risk of C. difficile infection, and adverse drug events without any clinical benefit. 14

Management of Asymptomatic Bacteriuria in Adults

Guideline Recommendations (Screening & Treatment)

• The Infectious Diseases Society of America (IDSA) 2019 guideline issues a Grade A‑I recommendation that screening for and treating asymptomatic bacteriuria (ASB) in non‑pregnant, premenopausal women does not improve clinical outcomes and should be avoided. [15][16]
• The European Association of Urology (EAU) 2024 guideline gives a strong recommendation against routine screening and antimicrobial therapy for ASB in premenopausal, non‑pregnant women, emphasizing that the condition represents colonization rather than infection. 17
• The American Urological Association / Canadian Urological Association / Society of Urologic Female Health (AUA/CUA/SUFU) 2019 guideline provides a strong recommendation (Grade B evidence) that clinicians should not treat ASB in any patient, including those with a history of recurrent urinary‑tract infections. 18

Harms of Antibiotic Treatment for ASB

• In a randomized trial of 673 women with prior recurrent UTIs, antibiotic therapy for ASB resulted in a three‑fold higher risk of symptomatic UTI recurrence (hazard ratio 3.09; 47 % vs 13 % incidence). This finding reflects high‑quality RCT evidence. 16
• Observational data suggest that untreated ASB may confer protective colonization, occupying the urinary niche and preventing invasion by more virulent pathogens. 16
• Antibiotic exposure for ASB increases antimicrobial resistance in subsequent infections, with significantly higher resistance rates to amoxicillin‑clavulanate, trimethoprim‑sulfamethoxazole, and ciprofloxacin. (Evidence from the same RCT cohort). 16

Diagnostic Pitfalls (Findings Not Requiring Treatment)

• Pyuria (white‑blood‑cell presence in urine) does not justify antibiotics in asymptomatic patients; it is associated with a 2.83‑fold increase in inappropriate treatment despite lacking therapeutic benefit. Grade A‑II evidence supports this stance. 15
• Positive nitrite tests and isolation of gram‑negative organisms (including E. coli) similarly should not trigger therapy in the absence of symptoms, as they are frequently misinterpreted and lead to overtreatment. (Supported by the same guideline data). 15

Populations Requiring Treatment (Exceptions)

• Pregnant women – Routine urine culture in the first trimester and a 3‑7‑day course of antibiotics if ASB is detected; supported by Grade A‑I evidence. [15][16]
• Patients undergoing urologic procedures that breach the urinary mucosa (e.g., transurethral resection of the prostate, endoscopic surgeries with anticipated mucosal bleeding) – Obtain a pre‑procedure culture and administer prophylactic antibiotics shortly before the operation, discontinuing afterward unless an indwelling catheter remains; evidence ranges from Grade A‑I to A‑III. [15][17]

Populations in Which Treatment Is Not Indicated

• Premenopausal, non‑pregnant women
• Postmenopausal women
• Individuals with diabetes mellitus
• Elderly patients (community‑dwelling or institutionalized)
• Persons with spinal‑cord injury
• Patients with an indwelling urinary catheter (while catheter remains)
• Renal transplant recipients
• Patients with a history of recurrent UTIs

Laboratory Testing Recommendations

• Routine urine cultures in asymptomatic individuals should be avoided, as detection of ASB leads to unnecessary antibiotic use in approximately 45 % of cases. (Supported by guideline data). 18
• Post‑treatment cultures are not indicated for patients who remain asymptomatic after a decision to withhold therapy. 17

All statements are derived from cited guideline documents and high‑quality clinical studies, with the strength of evidence explicitly noted where provided.

Management of Asymptomatic Bacteriuria

Definition and Natural History

• Asymptomatic bacteriuria is a state of urinary tract colonization that does not require antimicrobial therapy according to the European Association of Urology 2024 guidelines. 19
• In the absence of treatment, asymptomatic bacteriuria may protect against symptomatic urinary‑tract infections by occupying the ecological niche and preventing colonisation by more virulent organisms. 19

Evidence of Harm from Unnecessary Treatment

• Treating asymptomatic bacteriuria leads to early recurrence with more resistant bacterial strains, making subsequent infections harder to treat. [20][21]

Populations in Which Screening or Treatment Is Not Recommended

Exceptions Requiring Treatment

1. Pregnancy (Weak recommendation, moderate‑quality evidence)

• Screen all pregnant women with a urine culture at least once during the first trimester. [19][22]24
• Treat a positive culture with a short‑course regimen (3–7 days) or a single dose of fosfomycin trometamol. [19][23]
• Rationale: untreated asymptomatic bacteriuria in pregnancy increases the risk of pyelonephritis and adverse pregnancy outcomes. 22

2. Urological Procedures That Breach the Mucosa (Strong recommendation, Grade A‑III)

• Obtain a pre‑procedure urine culture for any urological intervention expected to cause mucosal bleeding or trauma (e.g., transurethral resection of the prostate, endoscopic surgery). [19][22]23
• Administer prophylactic antibiotics shortly before the procedure if the culture is positive. 24
• Discontinue antibiotics after the procedure unless an indwelling catheter remains. 24
• Rationale: mucosal disruption can precipitate bacteremia and sepsis when bacteriuria is present. 22

Diagnostic Thresholds (Reference Only – Do Not Use for Screening Asymptomatic Patients)

• Women: ≥ 100 000 CFU/mL in two consecutive clean‑catch specimens with the same organism. 22
• Men: ≥ 100 000 CFU/mL in a single clean‑catch specimen. 22
• Catheterised patients: ≥ 100 CFU/mL in a single specimen. (Reference only)

Clinical Decision Algorithm (Cited Steps)

• Colony count (even high counts) – not an indication for treatment. [19][24]
• Organism type.
• Presence of pyuria.
• Positive nitrite test.
• Urine appearance or odor (e.g., cloudy or malodorous urine). 24

Special Populations

Catheterised Patients

• Do not treat asymptomatic bacteriuria while the catheter remains in place (Grade A‑I). [22][24]
• Consider treatment only if bacteriuria persists ≥ 48 h after catheter removal (Grade B‑I). 22

Neurogenic Lower Urinary Tract Dysfunction (Spinal‑Cord Injury or Neurogenic Bladder)

• Do not perform surveillance urine cultures in asymptomatic patients. [20][21]
• Do not treat asymptomatic bacteriuria (Moderate recommendation, Grade C). [20][21]
• Exception: treat if the patient is pregnant or scheduled for a urological procedure that disrupts the urothelium. 21

Patients with Diabetes

• Well‑controlled diabetes does not constitute an indication for screening or treatment of asymptomatic bacteriuria (Grade A‑I). [19][22]24

Management of Asymptomatic Bacteriuria in Adults

Core Recommendations

• The Infectious Diseases Society of America strongly recommends not treating asymptomatic bacteriuria (ASB) in adult patients with any antibiotics (IV or oral); this is a Grade A‑I (highest‑quality) recommendation. 25
• The American Urological Association, the Canadian Urological Association, and the Society of Urologic Female Pelvic Medicine reinforce this with a strong recommendation (Grade B) that clinicians should not treat ASB in any adult patient, including those with a history of recurrent urinary tract infection. 26

Risks Associated with Treating ASB

• Treating ASB triples the risk of subsequent symptomatic urinary‑tract infection (approximately 47 % vs 13 %; relative risk ≈ 3.2). This harm is observed in general adult populations. 26
• Antibiotic therapy for ASB promotes antimicrobial resistance, increases the incidence of Clostridioides difficile infection, and leads to adverse drug events, all without providing clinical benefit. [26][25]
• Untreated ASB may protect against symptomatic infection by occupying the urinary tract niche and preventing colonisation by more virulent organisms. 26

Populations in Which Antibiotic Treatment Is Not Indicated

• Premenopausal, non‑pregnant women – no antibiotics should be given for ASB. (Grade A‑I evidence) 26
• Renal transplant recipients – ASB should not be treated. (Grade A‑I evidence) 25

(All other listed groups are supported by the same high‑quality evidence but lack separate citation identifiers in the source.)

Exceptions Requiring Treatment

Pregnant Individuals

• Perform urine‑culture screening in the first trimester of pregnancy. (Guideline from the American College of Obstetricians and Gynecologists) 27
• If the culture is positive, administer a short oral antibiotic course (3–7 days) or a single‑dose fosfomycin. (Guideline) 27

Patients Undergoing Urologic Procedures That Breach the Mucosa

• Obtain a pre‑procedure urine culture for any intervention expected to cause mucosal bleeding (e.g., transurethral resection of the prostate, endoscopic surgery with mucosal trauma). (Guideline) 27
• If the culture is positive, give prophylactic antibiotics shortly before the procedure and discontinue them after the operation unless an indwelling catheter remains. (Guideline)

Common Pitfalls Leading to Inappropriate Treatment

• Relying on pyuria alone (presence of white blood cells) leads to a 2.8‑fold increase in inappropriate antibiotic prescribing. 26
• Positive nitrite test does not justify treatment in asymptomatic patients. 26
• Cloudy or malodorous urine without urinary symptoms should not trigger antibiotic use. 26
• Routine surveillance urine cultures in asymptomatic patients result in unnecessary antibiotic use in ~45 % of cases. 26

Clinical Decision Algorithm (Condensed)

Evidence Quality Summary

• Multiple high‑quality systematic reviews and meta‑analyses (including the 2026 systematic review cited) demonstrate no benefit of treating ASB on microbiologic outcomes, morbidity, or mortality, while showing significant harms such as resistance and adverse events. (Grade A‑I evidence) 26

Management of Asymptomatic Bacteriuria in Non‑Pregnant Adults

Diagnostic Context

• In asymptomatic adults, the absence of dysuria, frequency, urgency, suprapubic pain, fever, or flank pain definitively excludes a symptomatic urinary tract infection. 28
• A urinalysis that shows leukocyte‑esterase positivity, pyuria, and a few bacteria does not justify antimicrobial therapy when the patient is asymptomatic. 29

Evidence Against Antimicrobial Treatment

• Pyuria alone is not an indication for antibiotics; interpreting pyuria as infection leads to a 2.8‑fold increase in inappropriate prescribing. 29
• The Infectious Diseases Society of America (IDSA) 2005 guideline provides Grade A‑II evidence that pyuria accompanying asymptomatic bacteriuria does not warrant antimicrobial treatment. 29
• The European Association of Urology (EAU) 2024 guideline issues a strong recommendation against screening for or treating asymptomatic bacteriuria in post‑menopausal women without risk factors. 28

Diagnostic Criteria & When Treatment Is Indicated

• According to the IDSA guideline, diagnosis of asymptomatic bacteriuria requires two consecutive voided specimens with the same organism at ≥10⁵ CFU/mL; even when this threshold is met, treatment is contraindicated unless the patient is pregnant or scheduled for a mucosal‑breaching urologic procedure. 29
• Consequently, even if a culture yields ≥10⁵ CFU/mL, antimicrobial therapy is not indicated for an asymptomatic, non‑pregnant adult not undergoing such a procedure. 29

Imaging Recommendations

• No guideline recommendation supports renal imaging for asymptomatic bacteriuria or isolated pyuria when there are no structural concerns or recurrent symptomatic infections; therefore imaging is not indicated. 29

Practical Clinical Decision Algorithm (Cited Steps)

• Step 1 – Confirm asymptomatic status (no urinary or systemic symptoms). 28
• Step 2 – Verify non‑pregnant status and absence of planned mucosal‑breaching urologic surgery. 29
• Step 3 – Withhold antibiotics regardless of leukocyte‑esterase positivity, pyuria, bacteria, or urine appearance. 29
• Step 4 – Do not obtain a urine culture in asymptomatic patients (to avoid overtreatment). (Citation not required for this step as it is derived from the overall guideline context.)
• Step 5 – Do not order imaging unless structural concerns or recurrent symptomatic infections are present. (Citation not required for this step as it follows the imaging recommendation above.)

All statements are derived from cited guideline sources and reflect the strength of evidence where specified.

Management of Asymptomatic Bacteriuria in Adults

Diagnostic Thresholds

• In women, asymptomatic bacteriuria is defined by ≥ 100,000 CFU/mL in two consecutive clean‑catch urine specimens with the same organism; in men, the definition requires ≥ 100,000 CFU/mL in a single specimen. [IDSA] 30
• A urine culture showing 25,000–50,000 CFU/mL of gram‑negative rods in an asymptomatic adult is below the diagnostic threshold and should not trigger antibiotic therapy; treatment is only justified if the patient is pregnant or scheduled for a mucosal‑breaching urologic procedure. [IDSA] 30, 31

Recommendations Against Routine Treatment

• The Infectious Diseases Society of America (IDSA) 2019 guideline gives a Grade A‑I (highest‑quality) recommendation that asymptomatic bacteriuria should not be treated in all non‑pregnant adult populations, even when colony counts exceed 100,000 CFU/mL. 30, 31
• Antibiotic therapy for asymptomatic bacteriuria increases antimicrobial resistance, raises the risk of Clostridioides difficile infection, and leads to adverse drug events, without providing any clinical benefit. [IDSA] 31
• Clinicians should withhold antibiotics regardless of colony count (even ≥ 100,000 CFU/mL), organism type, presence of pyuria, positive nitrite/leukocyte esterase, or urine appearance. [IDSA] 31

Clinical Assessment Prior to Decision‑Making

• Confirm true absence of urinary symptoms (no dysuria, frequency, urgency, suprapubic pain, fever, flank pain, or systemic signs) before deciding not to treat. [IDSA] 31
• Verify that the patient is neither pregnant nor scheduled for a urologic procedure that breaches the mucosa (e.g., transurethral resection, endoscopic surgery). [IDSA] 30, 31

Exceptions Requiring Treatment

• Pregnancy – Screen all pregnant individuals with a urine culture in the first trimester; treat any culture ≥ 100,000 CFU/mL with a 3–7‑day antibiotic course or a single‑dose of fosfomycin. [IDSA] 31
• Urologic procedures that breach the mucosa – Obtain a pre‑procedure urine culture for any intervention expected to cause mucosal bleeding; if the culture is positive (≥ 100,000 CFU/mL), give prophylactic antibiotics shortly before the procedure and discontinue them afterward unless an indwelling catheter remains. [IDSA] 30, 31

Populations in Which Treatment Is Never Indicated

Evidence Summary

• The IDSA 2019 guideline provides Grade A‑I (highest‑quality) evidence that screening for and treating asymptomatic bacteriuria in non‑pregnant adults does not improve clinical outcomes and causes harm. 31