Bela Köves1, Tommaso Cai2, Rajan Veeratterapillay3, Robert Pickard4, Thomas Seisen5, Thomas B Lam6, Cathy Yuhong Yuan7, Franck Bruyere8, Florian Wagenlehner9, Riccardo Bartoletti10, Suzanne E Geerlings11, Adrian Pilatz9, Benjamin Pradere8, Fabian Hofmann12, Gernot Bonkat13, Björn Wullt14. 1. Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary. Electronic address: bkoves@gmail.com. 2. Department of Urology, Santa Chiara, Reg. Hospital, Trento, Italy. 3. Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK. 4. Newcastle University Newcastle upon Tyne, UK. 5. Academic Department of Urology, Pitié-Salpêtrière Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France. 6. Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK; Academic Urology Unit, University of Aberdeen, Aberdeen, UK. 7. Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada. 8. Department of Urology, University Hospital of Tours, Loire Valley, France. 9. Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany. 10. Department of Urology, University of Florence, Florence, Italy. 11. Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center, The Netherlands. 12. Department of Urology, Sunderby Hospital, Luleå, Sweden. 13. Alta uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry (COB), University Basel, Basel, Switzerland. 14. Institute of Laboratory Medicine Section of Microbiology, Immunology and Glycobiology, Lund, Sweden.
Abstract
People with asymptomatic bacteriuria (ABU) are often unnecessarily treated with antibiotics risking adverse effects and antimicrobial resistance. We performed a systematic review to determine any benefits and harms of treating ABU in particular patient groups. Relevant databases were searched and eligible trials were assessed for risk-of-bias and Grading of Recommendations, Assessment, Development and Education quality. Where possible, a meta-analysis of extracted data was performed or a narrative synthesis of the evidence was presented. After screening 3626 articles, 50 studies involving 7088 patients were included. Overall, quality of evidence ranged from very low to low. There was no evidence of benefit for patients with no risk factors, patients with diabetes mellitus, postmenopausal women, elderly institutionalised patients, patients with renal transplants, or patients prior to joint replacement, and treatment was harmful for patients with recurrent urinary tract infection (UTI). Treatment of ABU resulted in a lower risk of postoperative UTI after transurethral resection surgery. In pregnant women, we found evidence that treatment of ABU decreased risk of symptomatic UTI, low birthweight, and preterm delivery. ABU should be treated prior to transurethral resection surgery. In addition, current evidence also suggests that ABU treatment is required in pregnant women, although the results of a recent trial have challenged this view. PATIENT SUMMARY: We reviewed available scientific studies to see if people with bacteria in their urine but without symptoms of urinary tract infection should be treated with antibiotics to eliminate bacteria. For most people, treatment was not beneficial and may be harmful. Antibiotic treatment did appear to benefit women in pregnancy and those about to undergo urological surgery.
People with asymptomatic bacteriuria (ABU) are often unnecessarily treated with antibiotics risking adverse effects and antimicrobial resistance. We performed a systematic review to determine any benefits and harms of treating ABU in particular patient groups. Relevant databases were searched and eligible trials were assessed for risk-of-bias and Grading of Recommendations, Assessment, Development and Education quality. Where possible, a meta-analysis of extracted data was performed or a narrative synthesis of the evidence was presented. After screening 3626 articles, 50 studies involving 7088 patients were included. Overall, quality of evidence ranged from very low to low. There was no evidence of benefit for patients with no risk factors, patients with diabetes mellitus, postmenopausal women, elderly institutionalised patients, patients with renal transplants, or patients prior to joint replacement, and treatment was harmful for patients with recurrent urinary tract infection (UTI). Treatment of ABU resulted in a lower risk of postoperative UTI after transurethral resection surgery. In pregnant women, we found evidence that treatment of ABU decreased risk of symptomatic UTI, low birthweight, and preterm delivery. ABU should be treated prior to transurethral resection surgery. In addition, current evidence also suggests that ABU treatment is required in pregnant women, although the results of a recent trial have challenged this view. PATIENT SUMMARY: We reviewed available scientific studies to see if people with bacteria in their urine but without symptoms of urinary tract infection should be treated with antibiotics to eliminate bacteria. For most people, treatment was not beneficial and may be harmful. Antibiotic treatment did appear to benefit women in pregnancy and those about to undergo urological surgery.
Authors: Rosa Gaglione; Katia Pane; Maria De Luca; Monica Franzese; Angela Arciello; Francesco Trama; Stefano Brancorsini; Marco Salvatore; Ester Illiano; Elisabetta Costantini Journal: Life (Basel) Date: 2022-05-27
Authors: Florian M E Wagenlehner; Truls E Bjerklund Johansen; Tommaso Cai; Bela Koves; Jennifer Kranz; Adrian Pilatz; Zafer Tandogdu Journal: Nat Rev Urol Date: 2020-08-25 Impact factor: 14.432
Authors: Kimberly C Claeys; Min Zhan; Lisa Pineles; Alison Lydecker; Gosia Clore; Michihiko Goto; Surbhi Leekha; Darren Linkin; Charlesnika T Evans; Barbara W Trautner; Matthew B Goetz; Jonathan D Baghdadi; Eli N Perencevich; Daniel J Morgan Journal: Infect Control Hosp Epidemiol Date: 2020-08-25 Impact factor: 3.254