IDWeek 2018 — Asymptomatic bacteriuria: a guidelines update

  • Emily Willingham, PhD
  • Conference Reports
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  • Updated guidelines for the management of asymptomatic bacteriuria (ASB) are coming out soon. 
  • Lindsay Nicolle, MD, from the University of Manitoba Health Sciences Center in Winnipeg, Manitoba, Canada, detailed some of the changes from the previous Infectious Disease Society of America guidelines. 

Why this matters

  • This update focuses on populations, such as transplant patients, who were not fully addressed or were omitted from the 2005 guidelines.
  • Limiting unnecessary treatment can be part of antibiotic stewardship.

Key recommendations

  • Dr. Nicolle explained that a key issue with the evidence base for ASB guidelines is that many of the supporting studies, although quite solid, also are quite old.
  • Applying the GRADE process guidelines development to these older studies presents some obstacles. 
  • For this reason, many recommendations are rated as "strong," even as the evidence is rated as low or very low quality.
  • The guidelines recommend against screening or treating for ASB in the following populations (all strong recommendations):
    • Infants and children (low-quality [LQ] evidence).
    • Healthy, nonpregnant young women (moderate-quality [MQ] evidence).
    • Functionally impaired older men and women residing in the community or older residents of long-term care facilities (LQ evidence).
    • Patients with diabetes (MQ evidence).
    • Patients 1 month or more beyond kidney transplant (high-quality evidence).
    • Solid organ transplant patients (MQ evidence).
    • Patients with impaired voiding after spinal cord injury (LQ evidence).
    • Patients with an indwelling short- or long-term catheter (LQ evidence).
    • With elective nonurologic surgery (LQ evidence).
  • They do recommend screening and treatment in pregnant women (strong recommendation/MQ evidence).
  • Evidence insufficient for patients with neutropenia and patients having indwelling catheter removal.

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