Asymptomatic bacteriuria (ASB) is generally not recommended for treatment due to the lack of benefit and potential for harm, such as antibiotic resistance and adverse drug reactions. However, there are specific populations where treatment is indicated:
Pregnant patients
- ASB should be treated in pregnant patients with a urine culture showing >10⁵ CFU/mL of a single uropathogen or >10⁴ CFU/mL of group B streptococcus, as per the USPSTF 2019 guidelines
- Pregnant patients with documented group B streptococcal bacteriuria should receive appropriate IV antibiotics at the time of labor or rupture of membranes for the prevention of early-onset neonatal group B streptococcal disease, as per the SOGC 2012 guidelines
Patients undergoing urologic procedures
- ASB should be treated in patients undergoing transurethral resection of the prostate (TURP) or any other high-risk urological procedure, as per the SEIMC 2017 guidelines
- ASB should be treated in patients scheduled to undergo endoscopic urologic procedures associated with mucosal trauma, as per the IDSA 2019 guidelines
Patients undergoing spinal surgery
- ASB should be treated prior to performing instrumental spinal surgery in patients with urinary catheters, neurogenic bladders, or urinary incontinence to reduce the risk of Gram-negative surgical site infections, as per the SEIMC 2017 guidelines
Patients with a renal transplant
- ASB should be treated in renal or renal-pancreas transplant recipients within the first year post-transplant, as per the IDSA 2015 guidelines
Duration of treatment
- For the eradication of bacteriuria, the SEIMC 2017 guidelines recommend administering standard 4- to 7-day treatment regimens or a single 3 g dose of fosfomycin tromethamine as an alternative over short one-day treatments
In conclusion, while ASB is generally not recommended for treatment, there are specific populations where treatment is indicated, including pregnant patients, patients undergoing certain urologic or spinal surgeries, and renal transplant recipients. The duration of treatment typically ranges from a single dose to a 4- to 7-day regimen.