Thank you for your comment1 on our article.2
Based on the Infectious Diseases Society of America’s (IDSA’s) 2010 guideline3 on when to treat asymptomatic bacteriuria, I disagree with your statement and stand by our publication.
“Pyuria accompanying CA-ASB [asymptomatic bacteriuria] should not be interpreted as an indication for antimicrobial treatment (A-II).”3
If a patient’s urine culture grows a pathogenic organism, but the patient does not have symptoms suggestive of urinary tract infection (UTI), then you do not need to treat.
In long-term care facilities, patients develop changes in mental status due to dehydration from diuresis, poor oral intake, infection and a variety of other issues. However, UTI is sometimes blamed for changes in mental status when other factors have not been considered and treated. Also, when a patient does not have fever, dysuria, frequency and leukocytosis, UTI is a less likely cause.
This is a quote directly from the IDSA UTI 2005 guidelines: “Pyuria is present with asymptomatic bacteriuria … in 90% of elderly institutionalized patients, 90% of hemodialysis patients, 30%–75% of bacteriuric patients with short-term catheters in place …”4
Another direct quote from IDSA guidelines: “Screening for or treatment of asymptomatic bacteriuria is not recommended for the following persons.
Premenopausal, nonpregnant women (A-I).
Diabetic women (A-I).
Older persons living in the community (A-II).
Elderly, institutionalized subjects (A-I).
Persons with spinal cord injury (A-II).
Catheterized patients while the catheter remains in situ (A-I).”4
Footnotes
Competing interests: None declared.
References
- 1.Carr T. When is pus not pus? [letter]. CMAJ 2017; 189:E414. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ajayi T, Radhakrishnan R. Urinary tract infection in older adults in long-term care facilities. CMAJ 2016;188:899. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Hooton TM, Bradley SF, Cardenas DD, et al. ; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50:625–33. [DOI] [PubMed] [Google Scholar]
- 4.Nicolle LE, Bradley S, Colgan R. Infectious Diseases Society of America; American Society of Nephrology; American Geriatric Society. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643–54. [DOI] [PubMed] [Google Scholar]