Infectious Diseases Society of America Guidelinesfor the Diagnosis and Treatment of AsymptomaticBacteriuria in Adults
Lindsay E. Nicolle,1 Suzanne Bradley,2 Richard Colgan,3 James C. Rice,4 Anthony Schaeffer,5 and Thomas M. Hooton6
1University of Manitoba, Winnipeg, Canada; 2University of Michigan, Ann Arbor; 3University of Maryland, Baltimore; 4University of Texas,Galveston; 5Northwestern University, Chicago, Illinois; and 6University of Washington, Seattle
SUMMARY OF RECOMMENDATIONS
• Periodic screening for recurrent bacteriuria
The diagnosis of asymptomatic bacteriuria should
should be undertaken following therapy (A-III).
be based on results of culture of a urine specimen col-
• No recommendation can be made for or against
lected in a manner that minimizes contamination (A-II)
repeated screening of culture-negative women in
For asymptomatic women, bacteriuria is definedas 2 consecutive voided urine specimens with
Screening for and treatment of asymptomatic bac-
isolation of the same bacterial strain in quanti-
teriuria before transurethral resection of the prostate is
A single, clean-catch voided urine specimen with
An assessment for the presence of bacteriuriashould be obtained, so that results will be avail-
1 bacterial species isolated in a quantitative countу
able to direct antimicrobial therapy prior to the
105 cfu/mL identifies bacteriuria in men (B-
• Antimicrobial therapy should be initiated shortly
A single catheterized urine specimen with 1 bac-
terial species isolated in a quantitative countу
• Antimicrobial therapy should not be continued
102 cfu/mL identifies bacteriuria in women or
after the procedure, unless an indwelling catheter
Pyuria accompanying asymptomatic bacteriuria is
Screening for and treatment of asymptomatic bac-
not an indication for antimicrobial treatment (A-II).
teriuria is recommended before other urologic proce-
Pregnant women should be screened for bacte-
dures for which mucosal bleeding is anticipated (A-III).
riuria by urine culture at least once in early pregnancy,
Screening for or treatment of asymptomatic bac-
and they should be treated if the results are positive
teriuria is not recommended for the following persons.
• Premenopausal, nonpregnant women (A-I).
The duration of antimicrobial therapy should be
• Older persons living in the community (A-II).
Received 29 October 2004; accepted 2 November 2004; electronically published
• Elderly, institutionalized subjects (A-I).
• Persons with spinal cord injury (A-II).
These guidelines were developed and issued on behalf of the Infectious
Diseases Society of America and have been endorsed by the American Society
• Catheterized patients while the catheter remains
of Nephrology and the American Geriatric Society.
Correspondence: Dr. Lindsay E. Nicolle, University of Manitoba, Health Sciences
Centre, Rm. GG443, 820 Sherbrook St., Winnipeg, MB R3A 1R9, Canada
Antimicrobial treatment of asymptomatic wo-
men with catheter-acquired bacteriuria that persists
Clinical Infectious Diseases 2005; 40:643–54
48 h after indwelling catheter removal may be con-
ᮊ 2005 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2005/4005-0001$15.00
IDSA Guidelines for Asymptomatic Bacteriuria • CID 2005:40 (1 March) • 643
No recommendation can be made for screening for or
treatment of asymptomatic bacteriuria in renal transplant or
“Asymptomatic bacteriuria,” or asymptomatic urinary infec-
other solid organ transplant recipients (C-III).
tion, is isolation of a specified quantitative count of bacteria
in an appropriately collected urine specimen obtained from aperson without symptoms or signs referable to urinary infection
The purpose of this guideline is to provide recommendations
. “Acute uncomplicated urinary tract infection” is a symp-
for diagnosis and treatment of asymptomatic bacteriuria in
tomatic bladder infection characterized by frequency, urgency,
adult populations 118 years of age. The recommendations were
dysuria, or suprapubic pain in a woman with a normal geni-
developed on the basis of a review of published evidence, with
tourinary tract, and it is associated with both genetic and be-
the strength of the recommendation and quality of the evidence
havioral determinants . “Acute nonobstructive pyelone-
graded using previously described Infectious Diseases Society
phritis” is a renal infection characterized by costovertebral angle
of America (IDSA) criteria (table 1) . Recommendations are
pain and tenderness, often with fever; it occurs in the same
relevant only for the treatment of asymptomatic bacteriuria and
population that experiences acute uncomplicated urinary in-
do not address prophylaxis for prevention of symptomatic or
fection. “Complicated urinary tract infection,” which may in-
asymptomatic urinary infection. This guideline is not meant
volve either the bladder or kidneys, is a symptomatic urinary
infection in individuals with functional or structural abnor-
Screening of asymptomatic subjects for bacteriuria is appro-
malities of the genitourinary tract . Uncomplicated urinary
priate if bacteriuria has adverse outcomes that can be prevented
infection occurs rarely in men, and urinary infection in men
by antimicrobial therapy . Outcomes of interest are short
is usually considered complicated. A “relapse” is a recurrent
term, such as symptomatic urinary infection (including bac-
urinary tract infection after therapy resulting from persistence
teremia with sepsis or worsening functional status), and longer
of the pretherapy isolate in the urinary tract. “Reinfection” is
term, such as progression to chronic kidney disease or hyper-
recurrent urinary tract infection with an organism originating
tension, development of urinary tract cancer, or decreased du-
from outside of the urinary tract, either a new bacterial strain
ration of survival. Treatment of asymptomatic bacteriuria may
or a strain previously isolated that has persisted in the colo-
itself be associated with undesirable outcomes, including sub-
nizing flora of the gut or vagina . “Pyuria” is the presence
sequent antimicrobial resistance, adverse drug effects, and cost.
of increased numbers of polymorphonuclear leukocytes in the
If treatment of bacteriuria is not beneficial, screening of asymp-
urine and is evidence of an inflammatory response in the uri-
tomatic populations to identify bacteriuria is not indicated,
unless performed in a research study to further explore thebiology or clinical significance of bacteriuria. Thus, there are
2 topics of interest: whether asymptomatic bacteriuria is as-sociated with adverse outcomes, and whether the interventions
The recommendations in this guideline were developed after a
of screening and antimicrobial treatment improve these
review of studies published in English. These were identified
through a search of the PubMed database supplemented by
Infectious Diseases Society of America–US Public Health Service Grading System for ranking recommendations in clinical guidelines.
Good evidence to support a recommendation for use; should always be offered
Moderate evidence to support a recommendation for use; should generally be offered
Poor evidence to support a recommendation; optional
Moderate evidence to support a recommendation against use; should generally not be offered
Good evidence to support a recommendation against use; should never be offered
Evidence from у1 properly randomized, controlled trial
Evidence from у1 well-designed clinical trial, without randomization; from cohort or case-
controlled analytic studies (preferably from 11 center); from multiple time-series; or fromdramatic results from uncontrolled experiments
Evidence from opinions of respected authorities, based on clinical experience, descriptive
644 • CID 2005:40 (1 March) • Nicolle et al.
review of references of relevant papers to identify additional
were symptomatic . If urine specimens are collected using
reports, particularly early studies not accessed through the
a freshly applied condom catheter and leg bag, however, у105
PubMed search. In addition, experts in urinary infection were
cfu/mL is the appropriate quantitative criterion, with 90% va-
asked to identify any additional trials not accessed through
lidity for identifying asymptomatic bacteriuria in the voided
review. Clinical studies include prospective, randomized clinical
specimen, compared with a paired catheterized specimen [19,
trials; prospective cohort studies; case-control studies; and
20]. With single urine specimens obtained by urethral cathe-
other descriptive studies. When appropriate, the methodolog-
terization, lower quantitative counts of у102 cfu/mL are con-
ical rigor of studies was evaluated using accepted criteria (e.g.,
sistent with bacteriuria for both men and women [21, 22].
the CONSORT statement ). Studies were excluded if the
Patients who have chronic kidney disease, who are experiencing
study population was not adequately characterized to assess
diuresis, or who are infected with selected fastidious organisms
generalizability, if procedures for patient follow-up or exclu-
may have bacteriuria with lower quantitative counts in voided
sions may have introduced sufficient bias to limit the credibility
specimens, but the criteria for bacteriuria in such patients are
of observations, or if there were insufficient numbers of patients
enrolled to support valid statistical analysis.
Pyuria is evidence of inflammation in the genitourinary tract
and is common in subjects with asymptomatic bacteriuria [13,
24–27]. Pyuria is present with asymptomatic bacteriuria in∼32% of young women , 30%–70% of pregnant women
Asymptomatic bacteriuria is a microbiologic diagnosis deter-
[25, 26], 70% of diabetic women , 90% of elderly insti-
mined with a urine specimen that has been collected in a man-
tutionalized patients , 90% of hemodialysis patients ,
ner to minimize contamination and transported to the labo-
30%–75% of bacteriuric patients with short-term catheters in
ratory in a timely fashion to limit bacterial growth. The usual
place , and 50%–100% of individuals with long-term in-
quantitative definition is у105 cfu/mL in 2 consecutive urine
dwelling catheters in place . Pyuria also accompanies other
specimens , initially proposed after studies performed in the
inflammatory conditions of the genitourinary tract in patients
1940s and 1950s [8, 9]. In these studies, a bacterial count of
with negative urine culture results. These may be either infec-
у105 cfu/mL in a clean, voided specimen was confirmed by a
tious, such as renal tuberculosis and sexually transmitted dis-
concomitant count in a catheterized specimen in 195% of sub-
eases, or noninfectious, such as interstitial nephritis. Thus, by
jects in several asymptomatic clinical groups, whereas lower
itself, the presence of pyuria is not sufficient to diagnose bac-
quantitative counts in the voided specimen were not usually
teriuria, and the presence or absence of pyuria does not dif-
confirmed by the catheterized specimen . When the screen-
ferentiate symptomatic from asymptomatic urinary infection.
ing of asymptomatic women using multiple voided specimens
was evaluated, bacteriuria documented in an initial voided
riuria should be based on culture of a urine specimen collected
urine specimen was confirmed in a second voided specimen,
in a manner that minimizes contamination (A-II).
usually obtained several days later, only 80% of the time. If 2successive bacteriuric voided specimens had similar positive
• For asymptomatic women, bacteriuria is defined as 2 con-
culture results, a third consecutive specimen also yielded con-
secutive voided urine specimens with isolation of the same
sistent results in 95% of cases [9, 10]. Some studies involving
bacterial strain in quantitative counts of у105 cfu/mL (B-II).
women have used a more restrictive criterion of 3 consecutive
• A single, clean-catch, voided urine specimen with 1 bacterial
voided urine specimens collected over 3 weeks with consistent
species isolated in a quantitative count of у105 cfu/mL iden-
bacteriologic results [11, 12], whereas other studies have used
tifies bacteriuria in asymptomatic men (B-III).
a more permissive criterion of a single positive urine specimen
• A single catheterized urine specimen with 1 bacterial species
yielding у105 cfu/mL [13, 14]. Because transient bacteriuria is
isolated in a quantitative count of у102 cfu/mL identifies
common in healthy young women [13, 15, 16], the prevalence
will be lower if 11 specimen is required for identification ofbacteriuria .
Pyuria accompanying asymptomatic bacteriuria is not an in-
Microbiologic criteria for diagnosis of asymptomatic bac-
dication for antimicrobial treatment (A-II).
teriuria in men are not as well validated. The finding of a single
PREVALENCE OF ASYMPTOMATIC
voided urine specimen with у105 cfu/mL of an Enterobacter-
iaceae was reproducible in 98% of asymptomatic ambulatorymen when the culture was repeated within 1 week . A
Asymptomatic bacteriuria is common, but the prevalence in
voided specimen with the lower quantitative count of у103
populations varies widely with age, sex, and the presence of
cfu/mL was 97% sensitive and 97% specific for identification
genitourinary abnormalities (table 2). For healthy women, the
of bacteriuria in ambulatory men, but most of these patients
prevalence of bacteriuria increases with advancing age, from
IDSA Guidelines for Asymptomatic Bacteriuria • CID 2005:40 (1 March) • 645 Prevalence of asymptomatic bacteriuria in selected populations.
Elderly persons in a long-term care facility
Sphincterotomy and condom catheter in place
∼1% among schoolgirls to 120% among healthy women у80
five percent to 50% of elderly women and 15%–40% of elderly
years of age living in the community . The prevalence of
men in long-term care facilities are bacteriuric . The ma-
bacteriuria among young women is strongly associated with
jority of these elderly persons have chronic neurologic illnesses,
sexual activity. It was 4.6% among premenopausal married
with the highest prevalence of bacteriuria observed in the most
women but only 0.7% among nuns of similar age . Pregnant
highly functionally impaired residents. The clinical assessment
and nonpregnant women have a similar prevalence of bacte-
of elderly bacteriuric residents to ascertain the presence or ab-
riuria (2%–7%) . Bacteriuria is more common in diabetic
sence of symptoms may be problematic, and observations of
women, with a prevalence of 8%–14%, and is usually correlated
cloudy or smelly urine by themselves should not be interpreted
with duration of diabetes and presence of long-term compli-
as indications of symptomatic infection . Use of a long-
cations of diabetes, rather than with metabolic parameters of
term indwelling catheter  or permanent ureteric stent 
diabetic control . Asymptomatic bacteriuria is rare in
is associated with bacteriuria virtually 100% of the time.
healthy young men . The prevalence in men increases sub-stantially after the age of 60 years, presumably because of ob-
MICROBIOLOGY OF ASYMPTOMATIC
structive uropathy and voiding dysfunction associated with pro-
static hypertrophy [27, 37]. From 6% to 15% of men 175 yearsof age who reside in the community are bacteriuric . Di-
Escherichia coli remains the single most common organism iso-
abetic men do not appear to have an increased prevalence of
lated from bacteriuric women [11, 12, 41], although this hap-
bacteriuria, compared with nondiabetic men .
pens proportionally less frequently than for women with acute
Many patient groups with chronic disabilities or comorbid-
uncomplicated urinary tract infection. E. coli strains isolated
ities characterized by impaired urinary voiding or with in-
from women with asymptomatic bacteriuria are characterized
dwelling urinary devices have a very high prevalence of asymp-
by fewer virulence characteristics than are those isolated from
tomatic bacteriuria, irrespective of sex. Patients with short-term
women with symptomatic infection . Other Enterobacter-
indwelling urethral catheters acquire bacteriuria at the rate of
iaceae (such as Klebsiella pneumoniae) and other organisms
2%–7% per day (table 2) [35, 38]. Patients with spinal cord
(including coagulase-negative staphylococci, Enterococcus spe-
injury have a prevalence of 150%, whether voiding is managed
cies, group B streptococci, and Gardnerella vaginalis) are com-
by intermittent catheterization or by sphincterotomy and con-
mon as well. For men, coagulase-negative staphylococci are also
dom drainage [33, 34]. Patients undergoing hemodialysis have
common, in addition to gram-negative bacilli and Enterococcus
a prevalence of asymptomatic bacteriuria of 28% . Twenty-
species [43, 44]. Subjects with abnormalities of the genitouri-
646 • CID 2005:40 (1 March) • Nicolle et al.
nary tract, including elderly institutionalized subjects, have a
antoin or placebo . The antibiotic group had a signifi-
wide variety of organisms isolated. E. coli remains the single
cantly lower prevalence of bacteriuria at 6 months but not at
most common organism isolated from women, but other or-
1 year. Episodes of symptomatic infection 1 year after therapy
ganisms, such as Proteus mirabilis, are more common in men
occurred with a similar frequency in the treatment and pla-
. Men and women with a long-term urologic device in
place usually have polymicrobial bacteriuria, which often in-
These studies support the conclusions that healthy, bacter-
cludes Pseudomonas aeruginosa and urease-producing organ-
iuric, premenopausal women are at an increased risk for symp-
isms, such as P. mirabilis, Providencia stuartii, and Morganella
tomatic urinary infection and are more likely to have bacteriuria
at follow-up. However, asymptomatic bacteriuria is not asso-ciated with long-term adverse outcomes, such as hypertension,
THE MANAGEMENT OF ASYMPTOMATIC
chronic kidney disease, genitourinary cancer, or decreased du-
ration of survival. The association of asymptomatic bacteriuriawith symptomatic urinary infection is likely attributable to host
Premenopausal, Nonpregnant Women
factors that promote both symptomatic and asymptomatic uri-
The natural history of asymptomatic bacteriuria in premeno-
nary infection, rather than symptomatic infection being attrib-
pausal nonpregnant women has been described in short-term
utable to asymptomatic bacteriuria. Finally, treatment of
 and long-term [41, 45–48] prospective cohort studies. In
asymptomatic bacteriuria neither decreases the frequency of
young women, symptomatic urinary infection occurred sig-
symptomatic infection nor prevents further episodes of asymp-
nificantly more frequently in bacteriuric women than in non-
bacteriuric women within 1 week after a urine culture (8% of
bacteriuric women became symptomatic, compared with 1%
tomatic bacteriuria in premenopausal, nonpregnant women is
of women without bacteriuria) . The increased risk of
symptomatic infection remained at 1 month after new-onsetbacteriuria . Long-term cohort studies also report an in-
creased frequency of symptomatic urinary infection in womenidentified with asymptomatic bacteriuria at initial screening
Women identified with asymptomatic bacteriuria in early preg-
[46, 47]. In a Swedish study, after 15 years of follow-up, symp-
nancy have a 20–30-fold increased risk of developing pyelo-
tomatic urinary infection and pyelonephritis occurred at least
nephritis during pregnancy, compared with women without
once in 55% and 7.5% of women with bacteriuria at enrollment,
bacteriuria [26, 51–59]. These women also are more likely to
respectively, and in 10% and 0% of those without bacteriuria,
experience premature delivery and to have infants of low birth
respectively . Women with bacteriuria at enrollment were
weight. Prospective, comparative clinical trials have consistently
also more likely to be bacteriuric at follow-up, regardless of
reported that antimicrobial treatment of asymptomatic bacte-
whether antimicrobial therapy was given [41, 47, 49].
riuria during pregnancy decreases the risk of subsequent py-
In 3 prospective studies from Wales and Jamaica that enrolled
elonephritis from 20%–35% to 1%–4% (table 3) . Meta-
women aged 15–84 years, increased mortality was observed
analyses of cohort studies and randomized clinical trials also
among bacteriuric women . The association of bacteriuria
support the conclusion that antimicrobial treatment of asymp-
and mortality was not as strong when the bacteriuric and non-
tomatic bacteriuria decreases the frequency of low–birth weight
bacteriuric groups were age- and weight-matched, and no strat-
infants and preterm delivery [61, 62]. Most of these studies
ification for other potential confounders was performed. In a
were performed early in the antimicrobial era, with nitrofur-
Swedish study that enrolled women with a median age of 58
antoin and sulfonamides being the most common antimicro-
years (range, 35–72 years), there were no differences in the
bials. The consistency and robustness of observations from
rates of hypertension or chronic kidney disease between bac-
multiple studies resulted in screening for and treatment of
teriuric and nonbacteriuric women after 15 years of follow-up
asymptomatic bacteriuria during pregnancy becoming a stan-
. In another Swedish study of women initially enrolled at
dard of care in developed countries. More-recent reports of
38–60 years of age, the rates of progression to chronic kidney
implementation of screening and treatment programs for
disease and mortality were similar for bacteriuric and nonbac-
asymptomatic bacteriuria in pregnant women report a decrease
teriuric subjects after 24 years . Bacteriuric women and
in rates of pyelonephritis for all pregnant women, from 1.8%
nonbacteriuric control subjects did not differ with regard to
to 0.6% in a Spanish health care center , and 2.1% to 0.5%
serum creatinine levels and intravenous pyelogram findings af-
in a Turkish health care center . These are consistent with
ter 3–5 years of follow-up in an English study .
the early reports of benefits with screening for and treatment
A prospective, controlled trial randomized bacteriuric
of asymptomatic bacteriuria during pregnancy.
women to receive a 1-week course of therapy with nitrofur-
In the therapeutic studies that established the benefit of treat-
IDSA Guidelines for Asymptomatic Bacteriuria • CID 2005:40 (1 March) • 647 Findings of comparative clinical trials of antimicrobial therapy for the treatment of asymptomatic bacteriuria in pregnancy.
furantoin, or mandelamine alone;mandelamine to term
a Microbiologic results from initial screening urine culture in pregnancy.
ment of asymptomatic bacteriuria during pregnancy, admin-
and they should be treated if the results are positive (A-I).
istration of antimicrobial therapy usually continued for the
• The duration of antimicrobial therapy should be 3–7 days
duration of the pregnancy (table 3). A prospective, randomized
study of continuous antimicrobial therapy to the end of preg-
• Periodic screening for recurrent bacteriuria should be un-
nancy compared with 14 days of nitrofurantoin or sulfameth-
izole, followed by weekly urine culture screening and re-treat-
• No recommendation can be made for or against routine
ment if bacteriuria recurred, reported similar outcomes for the
repeated screening of culture-negative women in the later
2 treatment groups . A recent Cochrane systematic review
concluded that there was insufficient evidence to recommend
a duration of antimicrobial therapy for pregnant women among
single-dose, 3-day, 4-day, and 7-day treatment regimens .
Prospective, cohort studies of diabetic women report no dif-
Thus, the optimal duration of antimicrobial therapy for treat-
ferences in rates of symptomatic urinary infection, mortality,
ment of bacteriuria in pregnant women has not been
or progression to diabetic complications between initially bac-
teriuric and nonbacteriuric women at 18 months  or 14
The appropriate screening test is a urine culture . Screen-
years  of follow-up. A randomized, controlled trial of an-
ing for pyuria has a low sensitivity—only ∼50% for identifi-
tibiotic therapy or no therapy for diabetic women with asymp-
cation of bacteriuria in pregnant women . The optimal
tomatic bacteriuria and continued screening for bacteriuria
frequency of screening is not well defined. Women with a neg-
every 3 months reported, after a maximum of 3 years of follow-
ative urine culture result for a single screening specimen at 12–
up, that antimicrobial therapy did not delay or decrease the
16 weeks have a 1%–2% risk of developing pyelonephritis later
frequency of symptomatic urinary infection, nor did it decrease
in pregnancy (table 3). What proportion of this may be pre-
the number of hospitalizations for urinary infection or other
vented with repeated routine screening is not known. A single
causes . There was no acceleration of progression of diabetic
urine sample obtained for culture at week 16 of gestation was
complications, such as nephropathy, in bacteriuric subjects who
concluded to be optimal in a Swedish study . An American
did not receive antimicrobial therapy. Diabetic women who
cost evaluation from the viewpoint of the outcome of pyelo-
received antimicrobial therapy, however, had 5 times as many
nephritis concluded that a single screening culture in the first
days of antimicrobial use and significantly more adverse an-
trimester was cost-effective if the prevalence of bacteriuria was
timicrobial effects. Thus, there were no benefits for continued
12% and the risk of pyelonephritis in bacteriuric women was
screening and treatment of asymptomatic bacteriuria in diabetic
women, and there was evidence of some harm. Recommendation. Recommendation.
bacteriuria by urine culture at least once in early pregnancy,
tomatic bacteriuria in diabetic women is not indicated (A-I).
648 • CID 2005:40 (1 March) • Nicolle et al. Older Persons Residing in the Community
asymptomatic bacteriuria in older persons resident in the com-
Large, long-term, cohort studies of asymptomatic bacteriuria
have enrolled both pre- and postmenopausal women [41, 46,47, 49]. These studies uniformly report no excess adverse out-
Elderly Institutionalized Subjects
comes in women with asymptomatic bacteriuria. A prospective,
Prospective, randomized clinical trials of antimicrobial ther-
randomized study of nitrofurantoin or placebo also enrolled
apy or no therapy for elderly residents of long-term care
women aged 20–65 years, with a median age between 40–49
facilities have reported no benefits of screening for or treat-
years . Thus, these studies report that outcomes of bac-
ment of asymptomatic bacteriuria (table 4) [76–79]. There
teriuria and treatment of bacteriuria in healthy postmenopausal
was no decrease in the rate of symptomatic infection or im-
women are similar to those observed in premenopausal, non-
provement in survival [76–78], and there were no changes in
chronic genitourinary symptoms  associated with anti-
A prospective, randomized clinical trial of antimicrobial
microbial therapy. Treatment of asymptomatic bacteriuria was
treatment versus placebo for bacteriuria enrolled ambulatory
associated with significantly increased adverse antimicrobial
women who resided in a geriatric apartment facility and re-
effects  and reinfection with organisms of increasing re-
ported a decrease in the prevalence of asymptomatic bacteriuria
sistance . Prospective cohort studies report similar sur-
at 6 months, but there was no significant difference in the
vival data for long-term care facility residents with and those
number of symptomatic episodes . A prospective cohort
without bacteriuria among women in the United States ,
study of 134 ambulatory male veterans 165 years of age ob-
men in Canada , and women or men in Greece .
served for 1–4.5 years, including 29 subjects with bacteriuria,
reported no adverse outcomes attributable to untreated bac-
tomatic bacteriuria in elderly institutionalized residents of long-
teriuria . Population-based cohort studies report no as-
term care facilities is not recommended (A-I).
sociation between bacteriuria and survival for Swedish menand women at 5 years of follow-up  or Finnish men and
Subjects with Spinal Cord Injuries
women aged 185 years during 5 years of follow-up .
Subjects with spinal cord injuries have a high prevalence of
bacteriuria, and they also experience a high incidence of symp-
Randomized clinical trials of treatment of asymptomatic bacteriuria in elderly populations.
given for symptomatic UTI, 16.4%vs. 7.9% (P p
patient-year for the therapy group(P p
Ϫ0.05 to +0.47); therapy recipi-ents had significantly more ad-verse drug-related events and rein-fections with resistant organisms
cin administered every 14 days;cultures were performed every6 months
RR, relative risk; TMP, trimethoprim; UTI, urinary tract infection.
a Data are mean age, unless otherwise indicated. b Median age.
IDSA Guidelines for Asymptomatic Bacteriuria • CID 2005:40 (1 March) • 649
tomatic urinary infection [34, 82]. When asymptomatic bac-
guria 2 weeks after therapy for catheterized subjects and no
teriuria was uniformly treated in a cohort of catheter-free, pri-
clinical benefits of treatment .
marily male, spinal cord–injured subjects, early recurrence of
A prospective, randomized, placebo-controlled trial of an-
bacteriuria after therapy was the usual outcome. After 7–14
timicrobial treatment of asymptomatic bacteriuria persisting 48
days of antibiotic therapy, 93% of subjects were again bacter-
h after removal of short-term catheters in women with catheter-
iuric by 30 days after completion of therapy, and after a 28-
acquired bacteriuria reported significantly improved microbi-
day course of antibiotic therapy, 85% were bacteriuric by 30
ologic and clinical outcomes at 14 days in treated women .
days . Reinfecting strains showed increased antimicrobial
Although 15 (36%) of 42 women randomized to receive no
resistance. When 52 patients with a relatively recent onset of
therapy had spontaneous microbiologic resolution by 14 days,
spinal cord injury were observed prospectively for 4–26 weeks,
7 (17%) developed symptoms. No women in the treatment
the results of 78% of weekly urine cultures were positive, but
group became symptomatic. This study enrolled a selected
only 6 symptomatic episodes occurred, all of which responded
group of hospitalized women characterized by being relativelyyoung (median age, 50 years) and experiencing a short period
promptly to antimicrobial treatment . In a small, random-
of catheterization (median duration, 3 days).
ized, placebo-controlled trial, rates of symptomatic urinary in-
fection and recurrence of bacteriuria were similar among re-
cephalexin therapy versus no antibiotic therapy for bacteriuric
cipients of either antimicrobial or placebo for patients with
patients with long-term indwelling urethral catheters in place
bladder emptying managed by intermittent catheterization .
and drug-susceptible organisms isolated reported a similar in-
A prospective, randomized trial of antimicrobial treatment or
cidence of fever among both treated and untreated patients
no treatment of asymptomatic bacteriuria enrolled 50 patients
observed for 12–44 weeks . Rates of reinfection were also
who were treated with intermittent catheterization and reported
similar, but 75% of reinfecting organisms in the control group
a similar frequency of symptomatic urinary infection during
remained susceptible to cephalexin, compared with only 36%
an average of 50 days of follow-up, irrespective of whether
in the cephalexin treatment group. A prospective, noncom-
prophylactic antimicrobials were given . Although there
parative study of consecutive courses of antimicrobial treatment
have been a limited number of clinical trials, and although
to eradicate bacteriuria in elderly patients with long-term cath-
interpretation of results is compromised by relatively short du-
eters reported no decrease in the number of episodes of fever
rations of follow-up and small study numbers, review articles
with treatment, compared with the pretreatment period, and
[87, 88] and consensus guidelines  uniformly recommend
there was immediate recurrence of bacteriuria after therapy,
treatment only of symptomatic urinary tract infection in pa-
often with organisms of increasing resistance . Recommendation. Recommendation.
should not screened for or treated in patients with an indwelling
screened for or treated in spinal cord–injured patients (A-II). Patients with Indwelling Urethral Catheters
• Antimicrobial treatment of asymptomatic womenwithcath-
eter-acquired bacteriuria that persists 48 h after catheter
cility patients with short-term (!30 days) indwelling urethralcatheters receive antimicrobial therapy, usually for an indicationother than urinary infection [90, 91]. This high frequency of
concurrent antimicrobial use makes assessment of outcomes
Patients with asymptomatic bacteriuria who undergo traumatic
unique to treatment of asymptomatic bacteriuria problematic.
genitourinary procedures associated with mucosal bleeding have
A prospective, cohort study of 235 catheter-acquired infections
a high rate of postprocedure bacteremia and sepsis. Bacteremia
among 1497 patients, 90% of whom were asymptomatic, re-
occurs in up to 60% of bacteriuric patients who undergo tran-
ported only 1 secondary bloodstream infection . A case-
surethral prostatic resection, and there is clinical evidence of
control study reported that acquisition of bacteriuria with in-
sepsis in 6%–10% of these persons . Retrospective analysis
dwelling urethral catheterization increased mortality 3-fold, but
 and prospective, randomized clinical trials [100–103] sup-
the explanation for this association was not clear, and multi-
port the effectiveness of antimicrobial treatment in preventing
variate analysis found that antimicrobial therapy did not alter
these complications in bacteriuric men undergoing transurethral
the association with mortality . A prospective, randomized,
resection of the prostate. In one comparative trial, the efficacy
placebo-controlled trial of treatment of funguria in 313 pa-
of cefotaxime was superior to that of methenamine mandelate
tients, more than one-half of whom had indwelling urethral
. There is little information relevant to other procedures,
catheters in place, showed no differences in eradication of fun-
but any intervention with a high probability of mucosal bleeding
650 • CID 2005:40 (1 March) • Nicolle et al.
should be considered a risk . Pretreatment of asymptomatic
rather than bacteriuria . Thus, with current management
bacteriuria is not beneficial for all invasive procedures. For in-
strategies, screening for bacteriuria is unlikely to provide a ben-
stance, replacement of a long–term indwelling foley catheter is
efit. Some experts do recommend screening for bacteriuria, at
associated with a low risk of bacteremia, and antimicrobial treat-
least for the first 6 months after renal transplantation .
Recent guidelines for outpatient surveillance of renal transplant
The appropriate timing for initiation of antimicrobial ther-
recipients, however, make no recommendation for screening
apy is not well defined. Although 72 h before the intervention
has been suggested , this is likely to be excessive and allows
Screening for or treatment of bacteriuria has not been eval-
the opportunity for superinfection before the procedure. Ini-
uated for other solid organ transplant recipients. Guidelines
tiation of therapy the night before or immediately before the
for infection prevention in bone marrow transplant recipients
procedure is effective [99, 103]. The optimal time to obtain a
make no recommendation for screening for bacteriuria .
sample for culture before the procedure and the duration of
A small study of women with primary biliary cirrhosis and
antimicrobial therapy are also not addressed in clinical trials.
bacteriuria randomized to receive either antimicrobial therapy
In the absence of an indwelling catheter, antimicrobial therapy
or no antimicrobial therapy reported no differences in the time
can likely be discontinued immediately after the procedure [99,
to reinfection or the number of reinfections in the 2 groups
102, 103]. When an indwelling catheter remains in place after
. Limited studies involving HIV-infected patients have re-
a prostatic resection, it has been recommended by some in-
ported no association between asymptomatic bacteriuria and
vestigators that antimicrobial therapy be continued until the
HIV infection in women, but there was an increased prevalence
of bacteriuria among HIV-infected men that was inversely cor-
related with CD4+ cell counts . Adverse clinical outcomes
tomatic bacteriuria before transurethral resection of the pros-
associated with bacteriuria in these populations have not been
• An assessment for the presence of bacteriuria should be
screening for or treatment of asymptomatic bacteriuria in renal
obtained, so results will be available to direct antimicrobial
transplant or other solid organ transplant recipients (C-III).
therapy prior to the procedure (A-III).
• Antimicrobial therapy should be initiated shortly before the
Asymptomatic bacteriuria is common. Pregnant women with
Antimicrobial therapy should not be continued beyond the
asymptomatic bacteriuria are at an increased risk for adverse
procedure, unless an indwelling catheter remains in place
outcomes, and these can be prevented with antimicrobial treat-
ment of asymptomatic bacteriuria. Thus, pregnant women
Screening for and treatment of asymptomatic bacteriuria is
should be screened for bacteriuria and treated if test results are
recommended before other urologic procedures in which mu-
positive. Asymptomatic bacteriuria is also a risk for patients
cosal bleeding is anticipated (A-III).
who undergo traumatic urologic interventions with mucosalbleeding, and such patients should be treated prior to such
Immunocompromised Patients and Other Patients
interventions. For all other adult populations, asymptomatic
Cohort studies performed early in the transplantation era re-
bacteriuria has not been shown to be harmful. Although per-
ported a high prevalence of asymptomatic bacteriuria among
sons with bacteriuria are at an increased risk of symptomatic
renal transplant recipients, especially in the first 6 months after
urinary infection, treatment of asymptomatic bacteriuria does
transplantation [108, 109]. Evolution in management of trans-
not decrease the frequency of symptomatic infection or improve
plantation has introduced routine perioperative prophylaxis,
other outcomes. Thus, in populations other than those for
minimization of use of indwelling urethral catheters, and long-
whom treatment has been documented to be beneficial, screen-
term antimicrobial prophylaxis to prevent pneumonia and
ing for or treatment of asymptomatic bacteriuria is not ap-
other infections. These interventions also prevent both asymp-
propriate and should be discouraged.
tomatic bacteriuria and symptomatic urinary infection [110,
111]. Recent studies, including a retrospective chart review and a prospective cohort study , have not reported
Many issues relevant to asymptomatic bacteriuria require fur-
an association between asymptomatic bacteriuria and graft sur-
ther research and evaluation in appropriately conducted clinical
vival. Transplant recipients with urinary infection and poor
graft outcome are also characterized by urologic abnormalitiesand are identified by episodes of symptomatic urinary infection,
• Exploration of the clinical and microbiologic implications,
IDSA Guidelines for Asymptomatic Bacteriuria • CID 2005:40 (1 March) • 651
if any, of pyuria in selected populations, such as pregnant
teriuria. In: Guide to clinical preventive services. 2nd edition. 1996. Available at: http://www.ahcpr.gov/clinic/uspstfix.htm. Accessed May
• The utility of obtaining a second urine specimen to confirm
3. Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE. Evalu-
asymptomatic bacteriuria prior to treatment after an initial
ation of new anti-infective drugs for the treatment of urinary tract
positive screening specimen in pregnant women.
infection. Clin Infect Dis 1992; 15(Suppl 1):S216–27.
4. Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated
The optimal duration of antimicrobial therapy for treatment
urinary tract infection. Infect Dis Clin North Am 1997; 11:551–82.
of asymptomatic bacteriuria in pregnant women requires
5. Nicolle LE. A practical approach to the management of complicated
evaluation in appropriate clinical trials.
urinary tract infection. Drugs Aging 2001; 18:243–54.
6. Stamm WE. Measurement of pyuria and its relation to bacteriuria.
Further characterization of symptomatic presentations of
Am J Med 1983; 75(Suppl 1B):53–58.
urinary infection in elderly institutionalized populations
7. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised
with a high prevalence of bacteriuria.
recommendations for improving the quality of reports of parallel-
• Management of asymptomatic bacteriuria in subjects with
group randomized trials. CONSORT Group (Consolidated Standards of Reporting Trials). Ann Intern Med 2001; 134:657–62.
8. Kass EH. Bacteriuria and the diagnosis of infections of the urinary
• Characterization of the natural history and appropriate
tract. Arch Intern Med 1957; 100:709–14.
management of individuals with long-term indwelling uri-
9. Kass EH. Pyelonephritis and bacteriuria: a major problem in preven-
tive medicine. Ann Intern Med 1962; 56:46–53.
nary devices other than indwelling catheters (e.g., urinary
10. Kunin CM. Asymptomatic bacteriuria. Ann Rev Med 1966; 17:
• Whether individuals with asymptomatic bacteriuria with
11. Evans DA, Williams DN, Laughlin LW, et al. Bacteriuria in a popu-
urea-splitting organisms but without indwelling devices re-
lation-based cohort of women. J Infect Dis 1978; 138:768–73.
12. Kunin CM, McCormack RC. An epidemiologic study of bacteriuria
quire a distinct approach for investigation or treatment.
and blood pressure among nuns and working women. N Engl J Med
• Select immunocompromised patients, including those with
neutropenia or who have undergone solid organ transplan-
13. Hooton TM, Scholees D, Stapleton AE, et al. A prospective study of
asymptomatic bacteriuria in sexually active young women. N Engl J
tation, require further characterization of the impacts, if
Med 2000; 343:992–7.
14. Geerlings SE, Stolk RP, Camps MJ, et al. Asymptomatic bacteriuria
• The optimal time to initiate therapy, duration of therapy,
may be considered a complication in women with diabetes. Diabetes
and antimicrobial choice for treatment of bacteriuria prior
Care 2000; 23:744–9.
15. Kunin CM, Polyak F, Postel E. Periurethral bacterial flora in women:
to invasive genitourinary procedures require evaluation in
prolonged intermittent colonization with E. coli. JAMA 1980; 243:
• Whether there are clinical benefits of screening for and treat-
16. Nicolle LE, Harding GKM, Preiksaitis J, Ronald AR. The association
of urinary tract infection with sexual intercourse. J Infect Dis 1982;
ment of bacteriuria prior to a surgical procedure with prosthetic
implantation, including orthopedic and vascular procedures.
17. Gleckman R, Esposito A, Crowley M, Natsios GA. Reliability of a
single urine culture in establishing diagnosis of asymptomatic bac- teriuria in adult males. J Clin Microbiol 1979; 9:596–7.
18. Lipsky BA, Ireton RC, Fihn SD, Hackett R, Berger RE. Diagnosis of
bacteriuria in men: specimen collection and culture interpretation. J Infect Dis 1987; 155:847–54.
We thank the following individuals for review and helpful suggestions
19. Ouslander JG, Greengold BA, Silverblatt FJ, Garcia JP. An accurate
in the development of this guideline: Elias Abrutyn, Diana Cardenas, Ste-
method to obtain urine for culture in men with external catheters.
phan Fihn, Kalpana Gupta, Jeremy Hamilton-Miller, Godfrey Harding,
Arch Intern Med 1987; 147:286–8.
Andy Hoepelman, James R. Johnson, Calvin Kunin, Leonard Leibovici,
20. Nicolle LE, Harding GKM, Kennedy J, McIntyre M, Aoki F, Murray
Benjamin Lipsky, Kurt G. Naber, Raul Raz, Allan Ronald, Thomas Russo,
D. Urine specimen collection with external devices for diagnosis of
Jack Sobel, Walter Stamm, Ann Stapleton, and John Warren. Expert sec-
bacteriuria in elderly incontinent men. J Clin Microbiol 1988; 26:
retarial assistance was provided by Brenda DesRosiers. Potential conflicts of interest.
from Ortho-McNeil. R.C. has received research funding from Ortho-
21. Saint SJ, Chenoweth CE. Biofilms and catheter-associated urinary tract
McNeil and has served on the speakers’ bureau for Bayer. A.S. has been a
infections. Infect Dis Clin North Am 2003; 17:411–32.
consultant for Ortho-McNeil, Proctor & Gamble, Gerson Lehrman Group,
22. Warren JW, Tenney JH, Hoopes JM, Muncie HL, Anthony WC. A
Urologix, DepoMed, Schwarz BioSciences GmbH, and SynerMed Com-
prospective microbiologic study of bacteriuria in patients with
munications. T.M.H. has been a consultant for Bayer and served on the
chronic-indwelling urethral catheters. J Infect Dis 1982; 146:719–23.
speakers’ bureau for Aventis, Bayer, Merck, and Pfizer.
23. Kass EH. Asymptomatic infections of the urinary tract. Trans Assoc
Amer Phys 1956; 69:56–64.
24. Zhanel GG, Nicolle LE, Harding GM. Prevalence of asymptomatic
bacteriuria and associated host factors in women with diabetes mel-litus. Manitoba Diabetic Urinary Infection Study Group. Clin Infect
1. McGowan JE, Chesney PJ, Crossley KB, La Forea FM. Guidelines for
Dis 1995; 21:316–22.
the use of systemic glucocorticosteroids in the management of selected
25. Bachman JW, Heise RH, Naessons JM, Timmerman MG. A study of
infections. J Infect Dis 1992; 165:1–13.
various tests to detect asymptomatic urinary tract infections in an
2. US Preventive Services Task Force. Screening for asymptomatic bac-
obstetric population. JAMA 1993; 270:1971–4.
652 • CID 2005:40 (1 March) • Nicolle et al.
26. Kincaid-Smith P, Bullen M. Bacteriuria in pregnancy. Lancet 1965; 1:
in the non-pregnant woman. II. Response to treatment and follow-
up. BMJ 1969; 1:804–6.
27. Nicolle LE. Asymptomatic bacteriuria in the elderly. Infect Dis Clin
51. Nicolle LE. Screening for asymptomatic bacteriuria in pregnancy. In:
North Am 1997; 11:647–62.
The Canadian guide to clinical preventive health care. The Canadian
28. Chaudhry A, Stone WJ, Breyer JA. Occurrence of pyuria and bac-
Task Force on the Periodic Health Examination, ed. Ottawa: Canada
teriuria in asymptomatic hemodialysis patients. Am J Kid Dis 1993;
Communication Group, 1994:P100–6.
52. Savage WE, Hajj SN, Kass EH. Demographic and prognostic char-
29. Tambyah PA, Maki DG. The relationship between pyuria and infection
acteristics of bacteriuria in pregnancy. Medicine 1967; 46:385–407.
in patients with indwelling urinary catheters. Arch Intern Med
53. Gilstrap LC, Leveno KJ, Cunningham EF, et al. Renal infection and
pregnancy outcome. Am J Obstet Gynecol 1981; 141:709–16.
30. Steward DK, Wood GL, Cohen RL, Smith JW, Mackowiak PA. Failure
54. Little PJ. The incidence of urinary infection in 5000 pregnant women.
of the urinalysis and quantitative urine culture in diagnosing symp-
Lancet 1966; 2:925–8.
tomatic urinary tract infections in patients with long-term urinary
55. LeBlanc AL, McGanity WJ. The impact of bacteriuria in pregnancy—
catheters. Am J Infect Control 1985; 13:154–60.
a survey of 1300 pregnant patients. Biol Med (Paris) 1964; 22:336–47.
31. Nicolle LE. Asymptomatic bacteriuria: when to screen and when to
56. Brumfitt W. The effects of bacteriuria in pregnancy on maternal and
treat. Infect Dis Clin North Am 2003; 17:367–94.
fetal health. Kidney Int Suppl 1975; 8:S113–9.
32. Zhanel G, Harding GKM, Nicolle LE. Asymptomatic bacteriuria in
57. Condie AP, Williams JD, Reeves DS, Brumfitt W. Complications of
diabetics. Rev Infect Dis 1991; 13:150–4.
bacteriuria in pregnancy. In: O’Grady FW, Brumfitt W, eds. Urinary
33. Bakke A, Digranes A. Bacteriuria in patients treated with clean, in-
tract infection. London: Oxford University Press, 1968:148.
termittent catheterization. Scand J Infect Dis 1991; 23:577–82.
58. Wren BG. Subclinical renal infection and prematurity. Med J Aust
34. Waites KB, Canupp KC, DeVivo MJ. Epidemiology and risk factors
for urinary tract infection following spinal cord injury. Arch Phys
59. Elder HA, Santamarina BAG, Smith S, Kass EH. The natural history
Med Rehabil 1993; 74:691–5.
of asymptomatic bacteriuria during pregnancy: the effect of tetracy-
35. Stamm WS. Catheter-associated urinary tract infections: epidemiol-
cline on the clinical course and the outcome of pregnancy. Am J
ogy, pathogenesis and prevention. Am J Med 1991; 91(Suppl B):
Obstet Gynecol 1971; 111:441–62.
60. Smaill F. Antibiotics for asymptomatic bacteriuria in pregnancy. Coch-
36. Zhanel GG, Nicolle LE, Harding GKM, Prevalence of asymptomatic
rane Database Syst Rev 2001; 2:CD000490.
bacteriuria in women with diabetes mellitus. Manitoba Diabetic Uri-
61. Mittendorf R, Williams MA, Kass EH. Prevention of preterm delivery
and low birth weight associated with asymptomatic bacteriuria. Clin
nary Infection Study Group. Clin Infect Dis 1995; 21:316–22.
Infect Dis 1992; 14:927–32.
37. Lipsky B. Urinary tract infections in men: epidemiology, pathophys-
62. Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins JC, Bracken M.
iology, diagnosis, and treatment. Ann Intern Med 1989; 110:138–50.
Meta-analysis of the relationship between asymptomatic bacteriuria
38. Garibaldi RA, Burke JP, Dickman ML, Smith CB. Factors predisposing
and preterm delivery/low birth weight. Obstet Gynecol 1989; 73:
to bacteriuria during indwelling urethral catheterization. N Engl J
Med 1974; 291:215–9.
63. Gratacos E, Torres P-J, Vila J, Alonso PL, Cararach V. Screening and
39. Nicolle LE. Urinary tract infections in long-term care facilities. SHEA
treatment of asymptomatic bacteriuria in pregnancy prevent-pyelo-
Long Term Care Committee. Infect Control Hosp Epidemiol 2001;
nephritis. J Infect Dis 1994; 169:1390–2.
64. Uncu Y, Uncu G, Esmer A, Bilgel N. Should asymptomatic bacteriuria
40. Reidl CR, Plas E, Hubner WA, Zimmer IH, Ulrish W, Pfluger H.
be screened in pregnancy? Clin Exp Obstet Gynecol 2002; 29:281–5.
Bacterial colonization of ureteral stents. Eur Urol 1999; 36:53–9.
65. Whalley PJ, Cunningham FG. Short-term versus continuous anti-
41. Bengtsson C, Bengtsson U, Bjorkelund C, Lincoln KM, Sigurdson JA.
microbial therapy for asymptomatic bacteriuria in pregnancy. Obstet
Bacteriuria in a population sample of women: 24-year follow-up
Gynecol 1977; 49:262–5.
study. Results from the prospective population-based study of women
66. Villar J, Lydon-Rochelle MT, Gulmezoglu AM, Roganti A. Duration
in Gottenburg, Sweden. Scand J Urol Nephrol 1998; 32:284–9.
of treatment for asymptomatic bacteriuria during pregnancy. Coch-
42. Svanborg C, Godaly G. Bacterial virulence in urinary tract infection.
rane Database Syst Rev 2000; 2:CD000491.
Infect Dis Clin North Am 1997; 11:513–30.
67. The US Preventive Services Task Force. Screening for asymptomatic
43. Lipsky BA, Inui TS, Plorde JJ, Berger RE. Is the clean-catch midstream
bacteriuria, hematuria and proteinuria. Am Fam Physician 1990; 42:
void procedure necessary for obtaining urine culture specimens from
men? Am J Med 1984; 76:257–62.
68. Stenqvist K, Kahlen-Nilsson I, Lidin-Janson G, et al. Bacteriuria in
44. Mims AD, Norman DC, Yamamura RH, Yoshikawa TT. Clinically
pregnancy: frequency and risk of acquisition. Am J Epidemiol
inapparent (asymptomatic) bacteriuria in ambulatory elderly men:
epidemiological, clinical, and microbiological findings. J Am Geriatr
69. Wadland WC, Plante DA. Screening for asymptomatic bacteriuria in
Soc 1990; 38:1209–14.
pregnancy: a decision and cost analysis. J Fam Pract 1989; 29:372–6.
45. Freedman LR. Natural history of urinary infection in adults. Kidney
70. Geerlings SE, Stolk RP, Camps MJL, et al. Consequences of asymp-
Inter Suppl 1975; 4:S96–100.
tomatic bacteriuria in women with diabetes mellitus. Arch Intern Med
46. Alwall N. On controversial and open questions about the course and
complications of non-obstructive urinary tract infection in adult
71. Semetkowska-Jurkicwicz E, Horoszek-Maziarz S, Galinski J, Manitius
women. Acta Med Scand 1978; 203:369–77.
A, Krupa-Wojciechowska B. The clinical course of untreated asymp-
47. Tencer J. Asymptomatic bacteriuria—a long term study. Scand Jour
tomatic bacteriuria in diabetic patients—14 year follow-up. Mater
Urol Nephrol 1988; 22:31–4.
Med Pol 1995; 27:91–5.
48. Asscher AW, Chick S, Radford N. Natural history of asymptomatic
72. Harding GKM, Zhanel GG, Nicolle LE, Cheang M. Antimicrobial
bacteriuria in non-pregnant women. In: Urinary tract infection.
treatment in diabetic women with asymptomatic bacteriuria. Mani-
Brumfit W, Asscher AW, eds. London: Oxford University Press, 1973:
toba Diabetes Urinary Tract Infection Study Group. N Engl J Med
49. Evans DA, Kass EH, Hennekens CH, et al. Bacteriuria and subsequent
73. Boscia JA, Kobasa WD, Knight RA, Abrutyn E, Levison ME, Kaye D.
mortality in women. Lancet 1982; 1:156–58.
Therapy vs. no therapy for bacteriuria in elderly, ambulatory, non-
50. Asscher AW, Sussman M, Waters WE, et al. Asymptomatic bacteriuria
hospitalized women. JAMA 1987; 257:1067–71.
IDSA Guidelines for Asymptomatic Bacteriuria • CID 2005:40 (1 March) • 653
74. Nordenstam GR, Brandberg CA, Oden AS, Svanborg-Eden CM, Svan-
for susceptible bacteriuria in afebrile, long-term catheterized patients.
borg A. Bacteriuria and mortality in an elderly population. N Engl J
JAMA 1982; 248:454–8.
Med 1986; 314:1152–6.
97. Alling B, Brandberg A, Secberg S, Svanborg A. Effect of consecutive
75. Heinamaki P, Haavesto M, Hakulinen T, Mattila K, Rajola S. Mortality
antibacterial therapy on bacteriuria in hospitalized geriatric patients.
in relation to urinary characteristics in the very aged. Gerontology
Scand J Infect Dis 1975; 7:201–7. 1986; 32:167–71.
98. Grabe M. Antimicrobial agents in transurethral prostatic resection. J
76. Nicolle LE, Mayhew WJ, Bryan L. Prospective, randomized compar-
Urol 1987; 138:245–52.
ison of therapy and no therapy for asymptomatic bacteriuria in in-
99. Cafferkey MT, Falkiner FR, Gillespie DM, Murphy DM. Antibiotics
stitutionalized elderly women. Am J Med 1987; 83:27–33.
for the prevention of septicaemia in urology. J Antimicrob Chemother
77. Nicolle LE, Bjornson J, Harding GK, MacDonell JA. Bacteriuria in
elderly institutionalized men. N Engl J Med 1983; 309:1420–5.
100. Grabe M, Forsgren A, Bjork T, Hellsten S. Controlled trial of a short
78. Abrutyn E, Mossey J, Berlin JA, et al. Does asymptomatic bacteriuria
and a prolonged course with ciprofloxacin in transurethral prostatic
predict mortality and does antimicrobial treatment reduce mortality
surgery. Eur J Clin Microbiol 1987; 6:11–7.
in elderly ambulatory women? Ann Intern Med 1994; 120:827–33.
101. Olsen JH, Friis-Moller A, Jensen SK, Korner B, Hvidt V. Cefotaxime
79. Ouslander JG, Schapira M, Schnelle JF, et al. Does eradicating bac-
for prevention of infectious complications in bacteriuric men un-
teriuria affect the severity of chronic urinary incontinence in nursing
dergoing transurethral prostatic resection: a controlled comparison
home residents? Ann Intern Med 1995; 122:749–54.
with methenamine. Scand J Urol Nephrol 1983; 17:299–301.
80. Nicolle LE, Henderson E, Bjornson J, McIntyre M, Harding GK,
102. Grabe M, Forsgren A, Hellsten S. The effect of a short antibiotic
MacDonell JA. The association of bacteriuria with resident charac-
course in transurethral prostatic resection. Scand J Urol Nephrol
teristics and survival in elderly institutionalized men. Ann Intern Med
1984; 18:37–42. 1987; 106:682–6.
103. Allan WR, Kumar A. Prophylactic mezlocillin for transurethral pros-
81. Dontas AS, Tzonou A, Kasviki-Charvati P, Georgiades GL, Christakis
tatectomy. Brit J Urol 1985; 57:46–9.
G, Trichopoulos D. Survival in a residential home: an eleven-year
104. Rao PN, Dube DA, Weightman NC, Oppenheim BA, Morris J. Pre-
longitudinal study. J Am Geriatr Soc 1991; 39:641–9.
diction of septicemia following endourological manipulation for
82. Erickson RP, Merritt JL, Opitz JL, Ilstrup DM. Bacteriuria during
stones in the upper urinary tract. J Urol 1991; 146:955–60.
follow-up in patients with spinal cord injury. I. Rates of bacteriuria
105. Bregenzer T, Frei R, Widmer AF, et al. Low risk of bacteremia during
in various bladder-emptying methods. Arch Phys Med Rehabil
catheter replacement in patients with long term urinary catheters. 1982; 63:409–12.
Arch Intern Med 1997; 157:521–5.
83. Waites KB, Canupp KC, DeVivo MJ. Eradication of urinary tract
106. Jewes LA, Gillespie WA, Leadbetter A, et al. Bacteriuria and bacteremia
infection following spinal cord injury. Paraplegia 1993; 31:645–52.
in patients with long-term indwelling catheter—a domiciliary study.
84. Lewis RI, Carrion HM, Lockhart JL, Politano VA. Significance of
J Med Microbiol 1988; 26:61–5.
asymptomatic bacteriuria in neurogenic bladder disease. Urology
107. Scherz HC, Parson CL. Prophylactic antibiotics in urology. Urol Clin
North Am 1987; 14:265–71.
85. Mohler JL, Cowen DL, Flanigan RC. Suppression and treatment of
108. Ramsey DE, Finch WT, Birch AG. Urinary tract infections in kidney
urinary tract infection in patients with an intermittently catheterized
transplant recipients. Arch Surg 1979; 114:1022–5.
neurogenic bladder. J Urol 1987; 138:336–40.
109. Prat LV, Jorcickova M, Matousovic K, Hatala M, Liska M. Urinary
86. Maynard FM, Diokno AC. Urinary infection and complications dur-
tract infection in renal transplant patients. Infection 1985; 13:207–10.
ing clean intermittent catheterization following spinal cord injury. J
110. Hoy WE, Kissel SM, Freeman RB, Sterling WA Jr. Altered patterns
Urol 1984; 132:943–6.
of post-transplant urinary tract infections associated with perioper-
87. Ditunno JF, Formal CS. Chronic spinal cord injury. N Engl J Med
ative antibiotics and curtailed catheterization. Am J Kidney Dis
1994; 330:550–6. 1985; 6:212–6.
88. Cardenas DD, Hooton TM. Urinary tract infection in persons with
111. Fox BC, Sollinger HW, Belzer FO, Maki DG. A prospective, random-
spinal cord injury. Arch Phys Med Rehabil 1995; 76:272–80.
ized, double-blind study of trimethoprim-sulfamethoxazole for pro-
89. National Institute on Disability and Rehabilitation Research Consen-
phylaxis of infection in renal transplantation: clinical efficacy, ab-
sus Statement: Jan 27–29, 1992. The prevention and management of
sorption of trimethoprim/sulfamethoxazole, effects on the microflora,
urinary tract infections among people with spinal cord injuries. J Am
and the cost-benefit of prophylaxis. Am J Med 1990; 89:255–74.
Paraplegia Soc 1992; 15:194–204.
112. Takai K, Tollemar J, Wilczek HE, Groth CG. Urinary tract infections
90. Johnson JR, Roberts PL, Olsen RJ, Moyer KA, Stamm WG. Prevention
following renal transplantation. Clin Transplant 1998; 12:19–23.
of catheter-associated urinary tract infection with a silver-ox-
113. Lyerova L, Lacha J, Skibova J, Teplan V, Virko S, Schuck O. Urinary
ide–coated urinary catheter: clinical and microbiologic correlates. J
tract infection in patients with urological complications after renal
Infect Dis 1990; 162:1145–50.
transplantation with respect to long-term function and allograft sur-
91. Riley DK, Classen DC, Stevens LE, Burke JP. A large, randomized
vival. Ann Transplant 2001; 6:19–20.
clinical trial of a silver-impregnated urinary catheter: lack of efficacy
114. Snydman DR. Posttransplant microbiological surveillance. Clin Infect
and staphylococcal superinfection. Am J Med 1995; 98:349–56.
Dis 2001; 33(Suppl 1):S22–5.
92. Tambyah PA, Maki DG. Catheter associated urinary tract infection is
115. Ghasemian SM, Guleria AS, Khawand NY, Light JA. Diagnosis and
rarely symptomatic: a prospective study of 1497 catheterized patients.
management of the urologic complications of renal transplantation.
Arch Intern Med 2000; 160:678–82.
Clin Transplant 1996; 10:218–23.
93. Platt R, Polk BI, Murdock B, Rosner B. Mortality associated with
116. Kasiske BL, Vazquez MA, Harmon WE, et al. Recommendations for
nosocomial urinary-tract infection. N Engl J Med 1982; 307:637–42.
the outpatient surveillance of renal transplant recipients. American
94. Sobel JP, Kauffman CA, McKinsey D, et al. Candiduria: a randomized,
Society of Transplantation. J Am Soc Nephrol 2000; 11:S1–86.
double-blind study of treatment with fluconazole and placebo. The
117. Centers for Disease Control and Prevention. Guidelines for preventing
National Institute of Allergy and Infectious Diseases Mycoses Study
opportunistic infections among hematopoietic stem cell transplant
Group. Clin Infect Dis 2000; 30:19–24.
recipients. MMWR Morb Mortal Wkly Rep 2000; 49(RR-10):1–125.
95. Harding GKM, Nicolle LE, Ronald AR, et al. How long should cath-
118. Butler P, Hamilton-Miller JM, McIntyre N, Burroughs AK. National
eter-associated urinary tract infection in women be treated. Ann In-
history of bacteriuria in women with primary biliary cirrhosis and
tern Med 1991; 114:713–9.
the effect of antimicrobial therapy in symptomatic and asymptomatic
96. Warren JW, Anthony WC, Hoopes JM, Muncie HL Jr. Cephalexin
groups. Gut 1995; 36:931–4.
654 • CID 2005:40 (1 March) • Nicolle et al.
MPE – Nível Médio 3. ANÁLISE DOS DIREITOS FUNDAMENTAIS EM ESPÉCIE (ART. 5.º) Direito à vida O direito à vida, garantido logo no caput do artigo 5.º da CF/88, deve ser entendido em dois sentidos: direito de continuar vivo e direito de viver com dignidade. Assim, a CF/88 não protege qualquer vida, mas uma vida que seja digna. Para resguardar tal direito, a Constitui
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