DEFINITIONS
RISK FACTORS
Catheterization, sexual activity, diabetes, elderly patients, pregnancy, hemodialysis, spinal cord injury
CAUSATIVE ORGANISMS
WOMEN
MEN
Men and women with long term urologic device may have polymicrobial cultures, often including Pseudomonas and urease-producing organisms such as P. mirabilis, Providencia stuartii, and Morganella morganii
TREATMENT OVERVIEW
DO NOT TREAT
TREAT
NO RECOMMENDATION
- Asymptomatic Bacteriuria: + urine culture, possible pyuria, asymptomatic patient.
- Women: 2 consecutive voided specimens with ≥ 100,000 cfu/mL of same bacterial strain
- Men: 1 clean-catch voided specimen with ≥ 100,000 cfu/mL
- Catheterized (male or female): single specimen with ≥ 100 cfu/mL
- Pyuria not an indication for antibiotics
RISK FACTORS
Catheterization, sexual activity, diabetes, elderly patients, pregnancy, hemodialysis, spinal cord injury
CAUSATIVE ORGANISMS
WOMEN
- E. Coli (most common)
- Enterobacteriaceae (e.g. Klebsiella pneumoniae)
- CONS
- Enterococcus
- Group B Strep
- Gardnerella vaginalis
MEN
- CONS
- GNR
- Enterococcus
Men and women with long term urologic device may have polymicrobial cultures, often including Pseudomonas and urease-producing organisms such as P. mirabilis, Providencia stuartii, and Morganella morganii
TREATMENT OVERVIEW
DO NOT TREAT
- Premenopausal, non-pregnant women, diabetics, the elderly, spinal cord injuries, or those with indwelling catheters (may consider treatment in women with bacteriuria that persists 48 hours after catheter removal), not recommended at time of catheter removal, elective non-urologic surgery, patients with urologic devices, patients with impaired voiding, infants and children, or older patients with delirium but without local GU symptoms of signs of infection.
TREAT
- Pregnant women (UptoDate)
- Nitrofurantoin 100 mg PO q12h x 5-7 days (avoid during 1st TM or at term if other options available; do not use for pyelo)
- Amoxicillin 500 mg PO q8h or Augmentin 875 mg PO q12h x 5-7 days
- Cephalexin 500 mg PO q6h x 5-7 days
- Bactrim DS PO q12h x 3 days (avoid in 1st TM and at term)
- Men undergoing TURP or urologic procedure where mucosal bleeding expected
- In absence of indwelling catheter, antibiotics can be stopped immediately after procedure
- If indwelling catheter remains in place after procedure, some recommend giving antibiotics until catheter removal
NO RECOMMENDATION
- Immunocompromised and transplant patients
- No recommendation for screening or treatment; some experts do recommend screening for bacteriuria in first six months after renal transplant but recent guidelines make no recommendation; limited data on other solid organ transplants