Asymptomatic Bacteriuria.

Asymptomatic bacteriuria, defined as the presence of bacteria in the urine in the absence of urinary symptoms, is a common clinical finding that often warrants a decision about whether to initiate antimicrobial therapy. There are few indications to treat asymptomatic bacteriuria, and inappropriate treatment contributes to the development of antimicrobial resistance. In 2019, the Infectious Diseases Society of America revised its 2005 guidelines on asymptomatic bacteriuria, incorporating new evidence. The updated guidelines recommend screening and appropriate treatment for asymptomatic bacteriuria in pregnant women and in individuals undergoing endourological procedures associated with mucosal trauma. The guidelines recommend against screening and treatment in infants and children; healthy adults, including nonpregnant pre- and postmenopausal women; and patients with diabetes mellitus, long-term indwelling catheters, or spinal cord injuries. The guidelines also recommend against screening and treatment in patients undergoing nonurological surgery, patients who have had a kidney transplant more than one month prior, recipients of other solid organ transplants, or those with impaired voiding following spinal cord injury. Although delirium in older adults can be caused by a urinary tract infection, the guidelines recommend that patients with delirium and no urinary or systemic symptoms be assessed for other causes of delirium, rather than initiating treatment for asymptomatic bacteriuria, because treatment has not been shown to have any beneficial effect on clinical outcomes.

Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America.

Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.

Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America.

Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.

Urinary tract infection diagnosis and response to therapy in long-term care: A prospective observational study.

BACKGROUND: The prevalence of asymptomatic bacteriuria among residents of long-term care (LTC) facilities is high, and is a source of inappropriate antibiotic prescription. OBJECTIVE: To establish symptoms and signs associated with a positive urine culture, and to determine whether antibiotic therapy is associated with functional improvement. METHODS: A total of 101 LTC patients were prospectively observed after submission of urine for culture. RESULTS: The culture positivity rate was consistent with the expected asymptomatic bacteriuria rate. Change in mental status and male sex were associated with culture positivity. Treatment decisions were not consistent with culture results. Treatment did not lead to improvement in activities of daily living scores at two days or seven days. DISCUSSION: Significant growth cannot be well predicted based on clinical variables; thus, the decision to submit urine is somewhat arbitrary. Because urine culture testing and treatment does not lead to functional improvement, restricting access to the test may be reasonable. CONCLUSION: Urine culture testing in LTC facilities does not lead to functional improvement.

HISTORIQUE: La prévalence de bactériuries asymptomatiques est élevée chez les résidents d'établissements de soins de longue durée (SLD). Elle suscite la prescription inappropriée d'antibiotiques. OBJECTIF: Déterminer les signes et symptômes associés à une culture d'urine positive et établir si l'antibiothérapie favorise une amélioration fonctionnelle. MÉTHODOLOGIE: Au total, 101 patients en SLD ont fait l'objet d'une observation prospective après l'envoi d'un prélèvement d'urine pour culture. RÉSULTATS: Le taux de cultures positives était conforme au taux prévu de bactériuries asymptomatiques. La détérioration de l'état mental et le sexe masculin s'associaient à des cultures positives. Les décisions thérapeutiques n'étaient pas en accord avec les résultats des cultures. Le traitement ne suscitait pas d'amélioration à l'indice d'activités de la vie quotidienne au bout de deux ou sept jours. EXPOSÉ: Les variables cliniques ne permettent pas de prévoir une croissance importante. Ainsi, la décision de faire une culture d'urine est quelque peu arbitraire. Puisque les cultures d'urine et le traitement n'assurent pas d'amélioration fonctionnelle, il est peut-être raisonnable de restreindre l'accès aux analyses. CONCLUSION: Dans les établissements de SLD, les analyses d'urine ne favorisent pas d'amélioration fonctionnelle.

Asymptomatic bacteriuria.

PURPOSE OF REVIEW: Asymptomatic bacteriuria is a common finding. Inappropriate antimicrobial treatment of asymptomatic bacteriuria has been identified as a major issue for antimicrobial stewardship programs. This review summarizes and evaluates recent studies which extend our knowledge of the occurrence, management, and outcomes of bacteriuria. RECENT FINDINGS: The reported prevalence of bacteriuria is higher in some developing countries than generally reported for developed countries, but reasons for this remain unclear. Clinical studies of young women, renal transplant patients, and patients undergoing minor nontraumatic urologic procedures confirm that treatment of asymptomatic bacteriuria for these populations is not beneficial, and may be harmful. There is also no benefit for treatment of asymptomatic bacteriuria prior to orthopedic surgery to decrease postoperative surgical site infection. Studies continue to report substantial inappropriate antimicrobial use for treatment of asymptomatic bacteriuria. SUMMARY: Recent publications confirm that asymptomatic bacteriuria is benign in most patients. Management strategies for pregnant women with recurrent bacteriuria require further clarification. There is a continuing problem with inappropriate treatment of asymptomatic bacteriuria, and sustainable strategies to optimize antimicrobial use for this problem are needed.

Infection prevention issues in long-term care.

PURPOSE OF REVIEW: Infections and antimicrobial use are common in residents of long-term care facilities. This review discusses recent articles that address infection prevention and control and antimicrobial stewardship in these facilities. RECENT FINDINGS: National surveys confirm the continuing high prevalence of infections in residents of long-term care facilities, with the greatest risk for patients with the highest acuity and greatest functional disability. Long-term acute care facilities are a unique environment where residents are characterized by high levels of indwelling device use and antimicrobial-resistant organisms. The major determinant of antimicrobial resistance in long-term care facilities is antimicrobial use. The Centers for Disease Control (CDC) has proposed revised evidence-based definitions for surveillance of infections on the basis of the original McGeer criteria. Consensus national performance standards for infection prevention and antimicrobial stewardship programs in long-term care facilities have been developed in a European initiative. Evidence to support the efficacy of infection control programs is limited. Antimicrobial stewardship programs may, however, be effective in reducing inappropriate antimicrobial use. SUMMARY: The extent to which endemic infections or antimicrobial resistance in long-term care facilities can be prevented remains unclear. Efforts to limit infections in these facilities should focus on outbreak prevention and standard procedures for environmental cleaning, food preparation, and hand hygiene, together with optimal resident medical care. Antimicrobial stewardship programs should be implemented.

Reducing Treatment of Asymptomatic Bacteriuria: What Works?

Asymptomatic bacteriuria is common, but usually benign. Inappropriate antimicrobial treatment of asymptomatic bacteriuria contributes to negative antimicrobial outcomes. Optimizing antimicrobial use for bacteriuria is a component of antimicrobial stewardship programs and includes key practices of dissemination and implementation of guidelines, laboratory practices which support stewardship, and programs to monitor and implement optimal antimicrobial treatment for urinary infection. These activities vary in their effectiveness, costs, and complexity to institute. Stewardship strategies targeting unique populations with a high prevalence of bacteriuria and for whom symptom assessment is not straightforward need to be further developed and evaluated to support optimal stewardship.

Consumers' familiarity with wine increased their acceptance of pasta sauce containing grape pomace.

Grape pomace (GP) is a waste product of the winemaking process and has been proposed as a nutritionally beneficial ingredient, as it contains phenolic compounds, dietary fiber, and antioxidant activity. It can be a polarizing ingredient due to its flavor components. Familiarity has been found to influence consumers' preferences and sensory perception of food. A sensory test was conducted to evaluate the acceptance, sensory perception, and emotional response to pasta sauces containing GP (3% [3GP], 6% [6GP], 9% [9GP] by volume and control without GP addition). The sensory trials included wine consumers (n = 44) and nonconsumers of wine (n = 58) to determine how consumers' familiarity with the flavor properties of GP influenced their perception of the pasta sauce. Overall, the addition of GP decreased the liking scores of the GP-containing sauces, but the wine consumers' hedonic scores for the control, 3GP, and 9GP were significantly higher than the nonconsumers. Both consumer groups identified that the samples with a higher amount of GP addition were associated with sour, bitter, astringency, grainy, and gritty attributes. However, the wine consumers used more positive emotions to describe their emotional response to the GP-containing samples. The study identified that GP led to off-flavors and textures in the pasta sauces. PRACTICAL APPLICATION: GP is currently a waste product, but it has many nutritional benefits. Consumers are increasingly looking for nutritional benefits from their food. When incorporated into pasta sauces, GP decreased the acceptance of the pasta sauce and negatively impacted the flavor and texture. Familiarity has been found to impact consumer acceptance, and wine consumers had a more positive emotional response and higher hedonic scores in response to the GP-containing pasta sauce than nonconsumers of wine.

Urinary tract infection in patients with diabetes mellitus.

Urinary tract infection occurs with increased frequency and severity in patients with diabetes mellitus. General host factors enhancing risk for urinary tract infection in diabetics include age, metabolic control, and long term complications, primarily diabetic nephropathy and cystopathy. Alterations in the innate immune system have been described and may also contribute. Treatment of asymptomatic bacteriuria in diabetic patients is not indicated. Early diagnosis and prompt intervention is recommended to limit morbidity of symptomatic infection. Clinical studies comparing management of urinary tract infection in persons with diabetes compared to those without as well as diabetic patients with good or poor glucose control will be necessary to improve care of urinary infection in persons with diabetes mellitus.

A global perspective on improving patient care in uncomplicated urinary tract infection: expert consensus and practical guidance.

OBJECTIVES: Uncomplicated urinary tract infections (uUTIs) are a common problem in female patients. Management is mainly based on empirical prescribing, but there are concerns about overtreatment and antimicrobial resistance (AMR), especially in patients with recurrent uUTIs. METHODS: A multidisciplinary panel of experts met to discuss diagnosis, treatment, prevention, guidelines, AMR, clinical trial design and the impact of COVID-19 on clinical practice. RESULTS: Symptoms remain the cornerstone of uUTI diagnosis, and urine culture is necessary only when empirical treatment fails or rapid recurrence of symptoms or AMR is suspected. Specific antimicrobials are first-line therapy (typically nitrofurantoin, fosfomycin, trimethoprim/sulfamethoxazole and pivmecillinam, dependent on availability and local resistance data). Fluoroquinolones are not first-line options for uUTIs primarily due to safety concerns but also rising resistance rates. High-quality data to support most non-antimicrobial approaches are lacking. Local AMR data specific to community-acquired uUTIs are needed, but representative information is difficult to obtain; instead, identification of risk factors for AMR can provide a basis to guide empirical antimicrobial prescribing. The COVID-19 pandemic has impacted the management of uUTIs in some countries and may have long-lasting implications for future models of care. CONCLUSION: Management of uUTIs in female patients can be improved without increasing complexity, including simplified diagnosis and empirical antimicrobial prescribing based on patient characteristics, including a review of recent antimicrobial use and past pathogen resistance profiles, drug availability and guidelines. Current data for non-antimicrobial approaches are limited. The influence of COVID-19 on telehealth could provide an opportunity to enhance patient care in the long term.

International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.

A Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. Co-sponsoring organizations include the American Congress of Obstetricians and Gynecologists, American Urological Association, Association of Medical Microbiology and Infectious Diseases-Canada, and the Society for Academic Emergency Medicine. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelonephritis, diagnoses limited in these guidelines to premenopausal, non-pregnant women with no known urological abnormalities or co-morbidities. The issues of in vitro resistance prevalence and the ecological adverse effects of antimicrobial therapy (collateral damage) were considered as important factors in making optimal treatment choices and thus are reflected in the rankings of recommendations.

Update in adult urinary tract infection.

Urinary tract infection remains a common problem for many populations. Recent studies have expanded our understanding of the host innate immune response and its role in the familial association observed for recurrent uncomplicated urinary tract infection in healthy women. Therapeutic management for uncomplicated infection has been compromised by increasing antimicrobial resistance, particularly global dissemination of the CTXM-15 extended spectrum ß-lactamase (ESBL) producing Escherichia coli ST-131 strain. Prevention strategies exploring non-antimicrobial approaches continue to show limited promise, and approaches to limit empiric antimicrobials are now being explored. For complicated urinary tract infection, increasing antimicrobial resistance limits therapeutic options for many patients. In addition to ESBL producing E. coli, NDM-1 E. coli and Klebsiella pneumoniae and other resistant Gram negatives, such as Acinetobacter species, are being isolated more frequently. There has been renewed interest in catheter-acquired urinary tract infection, the most common health-care associated infection, with several recent evidence-based guidelines for infection prevention available. However, technologic progress in development of adherence-resistant catheter materials remains disappointing.

Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America.

Guidelines for the diagnosis, prevention, and management of persons with catheter-associated urinary tract infection (CA-UTI), both symptomatic and asymptomatic, were prepared by an Expert Panel of the Infectious Diseases Society of America. The evidence-based guidelines encompass diagnostic criteria, strategies to reduce the risk of CA-UTIs, strategies that have not been found to reduce the incidence of urinary infections, and management strategies for patients with catheter-associated asymptomatic bacteriuria or symptomatic urinary tract infection. These guidelines are intended for use by physicians in all medical specialties who perform direct patient care, with an emphasis on the care of patients in hospitals and long-term care facilities.