Prof. Lindsay E NicolleDepartment of Internal Medicine, School of MedicineRady Faculty of Health SciencesUniversity of Manitoba, Winnipeg, Canada 

Most Urinary Bacteria Do Not Require Antibiotics Interview with:

Prof. Lindsay E NicolleDepartment of Internal Medicine, School of MedicineRady Faculty of Health SciencesUniversity of Manitoba, Winnipeg, Canada 

Dr. Nicolle

Prof. Lindsay E Nicolle
Department of Internal Medicine, School of Medicine
Rady Faculty of Health Sciences
University of Manitoba, Winnipeg, Canada What is the background for these updated guidelines? What are the main recommendations?

Response: The guideline updates the guideline previously published in 2005. There is some new information published in the interim, but the recommendations from the earlier guideline have not changed.

In addition, some populations not included in the 2005 guideline are addressed in the update. These include children, transplant recipients, and patients undergoing elective surgery with prosthesis implantation. Who should be screened for a UTI?  Should all women with bacteruria be treated?  What determines the type of treatment? 

Response: The guideline differentiates between asymptomatic bacteriuria (ASB) and symptomatic UTI, and only addresses management issues for asymptomatic bacteriuria. For ASB, screening is only recommended for populations where there has been shown to be a benefit of treating ASB. This is only pregnant women and persons who will undergo an endourologic procedure.

Treatment is these two groups is determined by clinical trials which address the type of antibiotic and duration of therapy. Is there anything women can do to limit the likelihood of a UTI?

Response: Again, the document does not address UTI – just ASB. There are no recommendations relevant to limiting the likelihood of asymptomatic bacteriuria. What should readers take away from your report?

Response: Asymptomatic bacteriuria is a very common finding, and apart from the two groups mentioned above, outcomes are not improved with antibiotic therapy. In fact, antibiotic therapy should be avoided where possible as it will be associated with adverse effects and promote antimicrobial resistance. One problematic area is the treatment of older men and women, who have a high prevalence of ASB, with antibiotics based on symptoms which are not due to UTI. This issue requires more clinical studies, but current evidence suggests symptomatic UTI should not b diagnosed or treated unless there are acute symptoms localizing to the bladder or kidneys. Thank you for your contribution to the community.


Lindsay E Nicolle, Kalpana Gupta, Suzanne F Bradley, Richard Colgan, Gregory P DeMuri, Dimitri Drekonja, Linda O Eckert, Suzanne E Geerlings, Béla Köves, Thomas M Hooton, Manisha Juthani-Mehta, Shandra L Knight, Sanjay Saint, Anthony J Schaeffer, Barbara Trautner, Bjorn Wullt, Reed Siemieniuk; Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, , ciy1121,

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on March 21, 2019 by Marie Benz MD FAAD