April 17, 2019
Updated IDSA Guidelines for Managing Asymptomatic Bacteriuria
Jason T. McMullan, MD, MS, FAEMS reviewing Nicolle LE et al. Clin Infect Dis 2019 Mar 21
Screening for, or treating, asymptomatic bacteriuria is not recommended, except in pregnant patients.Sponsoring Organization: Infectious Diseases Society of America (IDSA)
Background and Objective
Nontreatment of asymptomatic bacteriuria (ASB) is a priority in antimicrobial stewardship initiatives. This update to the 2005 IDSA guidelines incorporates new evidence and addresses additional populations, including children, patients with neutropenia, recipients of solid organ transplants, and patients undergoing nonurologic surgery.
Key Recommendations
Screening for, and then treating, asymptomatic bacteriuria is recommended for pregnant women; 4 to 7 days of antibiotics is recommended for pregnant women with ASB.
Screening and treatment is not recommended in the following populations: infants and children; healthy nonpregnant women of any age; elderly persons living independently or in a long-term care facility; patients with diabetes; renal transplant recipients >1 month after surgery; any nonrenal solid organ transplant recipients; patients with spinal cord injury; and patients with indwelling urinary catheters of any duration.
No recommendation is made for high-risk afebrile neutropenic patients due to lack of evidence.
Observation is preferred over antimicrobial treatment for cognitively impaired adults who experience a fall and are found to have bacteriuria without signs of infection.COMMENT
These guidelines reinforce that the risks associated with treatment of asymptomatic bacteriuria generally outweigh the benefits, even in populations generally considered fragile. Notably, symptomatic patients are not covered by these recommendations.
EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Jason T. McMullan, MD, MS, FAEMS at time of publication
Consultant/Advisory Board EMCREG International; Shire Pharmaceuticals
Grant/Research Support NIH (Strategies to Innovate EmeRgENcy Care Clinical Trials Network; The ACCESS Trial); DoD (USAF; Intranasal Ketamine as an Adjunct to Fentanyl for the Prehospital Treatment of Acute Traumatic Pain; Pharmaceutical Degradation in Prehospital Deployment and in Extreme Temperature Simulation)
Editorial Boards Journal of Emergency Medical Services
Leadership Positions in Professional Societies NAEMSP (Chair, Research Committee)
CITATION(S):
Nicolle LE et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis 2019 Mar 21; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή
Είσοδος)
Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή
Είσοδος