Asymptomatic Bacteriuria in Elderly Dialysis Patients
Diagnostic Considerations
- The European Urology guidelines recommend that asymptomatic bacteriuria, which occurs in approximately 40% of institutionalized elderly patients, should not be treated with antibiotics as it causes neither morbidity nor mortality 1, 2
- The decision to treat requires recent-onset dysuria PLUS at least one of the following symptoms: urinary frequency, urgency, or new incontinence, systemic signs, or costovertebral angle pain/tenderness of recent onset 1, 2, 3
Nonspecific Urinalysis Findings
- The European Urology guidelines state that the following findings are NOT indications for antibiotic treatment regardless of urinalysis results: turbid/cloudy urine appearance, change in urine color or odor, isolated proteinuria or hematuria, presence of bacteria on urinalysis, elevated white blood cell count in urine, or presence of crystals 1, 2, 3
Alternative Causes and Monitoring
- The European Urology guidelines recommend evaluating for alternative causes and actively monitoring the patient, including assessing for systemic symptoms that would warrant treatment, reviewing for other sources of infection, documenting the decision not to treat, and reassessing if new symptoms develop or existing symptoms worsen 1, 2, 3, 4