The daily educational pearl – Asymptomatic patient, positive urine culture

Asymptomatic bacteriuria

– screen and treat as acute cystitis in pregnant women because of the risk of developing pyelonephritis and adverse pregnancy outcomes

Patients with indwelling urinary catheters
– asymptomatic bacteriuria and pyuria are common and should not be treated with antimicrobials (no evidence that treatment decreases symptomatic episodes, but there is evidence that treatment leads to emergence of more resistant organisms)
– urine culture should only be requested if the patient has signs of systemic infection (eg fever, rigors), or risk factors for systemic infection (eg neutropenia, transplant, pregnancy)
– if treatment is started, it is essential to change the catheter to eradicate infection. A catheter change should precede antimicrobial therapy

Asymptomatic candiduria

– common, particularly in association with indwelling urinary catheters
– in most patients represents only colonisation

Antifungal therapy is not usually indicated and bladder irrigation with amphotericin B desoxycholate is rarely indicated. Removal of urinary tract catheters and stents is often helpful. Persistent candiduria may prompt renal imaging studies.

Consider treatment of candiduria in:
– symptomatic patients
– neutropaenic patients
– patients who will undergo urological procedures
– severe sepsis

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