
A study of Veterans Affairs (VA) patients found no benefit from treatment of asymptomatic bacteriuria, researchers reported yesterday in Infection Control & Hospital Epidemiology.
The study, conducted at five sites within the VA Midsouth Healthcare Network, analyzed data on urine cultures with bacterial growth collected in the outpatient setting in 2021. The primary outcome of the study was the comparison of urinary tract infection (UTI) incidence at 30 days, 6 months, and 1 year in those untreated versus those treated with antibiotics.
Although guidelines from the Infectious Diseases Society of America (IDSA) do not recommend treating asymptomatic bacteriuria (ASB), clinicians prescribe antibiotics for ASB in 40% t0 78% of older men.
"Unnecessary antibiotic use (AU) has well-established negative consequences including adverse drug events (ADEs) and increased antimicrobial resistance," VA researchers wrote. "The high rate of inappropriate AU in this disease state creates an area ripe for antimicrobial stewardship intervention."
More than half of ASB cases treated with antibiotics
Of the 988 urine cultures collected, 281 (28.4%) represented ASB. Of these, 154 (54.8%) were treated with antibiotics, and 127 (45.2%) went untreated. The incidence of UTI was 0.6% versus 3.1% at 30 days, 11.7% versus 9.6% at 6 months, and 11.7% versus 11.4% at 12 months in the treated and untreated cohorts, respectively.
There was no significant difference in admissions for UTI or sepsis from UTI at 30 days between the cohorts. Two patients in the treatment group reported an adverse drug event at 30 days.
The authors say the fact that 28% of urine cultures were collected in the absence of urinary symptoms, and more than half were treated with antibiotics, highlights opportunities for diagnostic and antibiotic stewardship.
"In conclusion, there was no difference in the development of symptomatic UTI in a predominately male veteran population with untreated ASB compared to those treated with antibiotics at 30 days, 6 months, and 1 year," they wrote. "These findings align with the 2019 IDSA ASB guidelines and support avoidance of unnecessary urine screening and antibiotic use in the veteran population."