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Non-Antibiotic Prophylaxis for Urinary Tract Infections
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The Paradigm Shift to Non-Treatment of Asymptomatic Bacteriuria

Department of Internal Medicine and Medical Microbiology, University of Manitoba, Health Sciences Centre, Room GG443—820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
Academic Editor: Catharina Svanborg
Pathogens 2016, 5(2), 38;
Received: 11 September 2015 / Revised: 21 March 2016 / Accepted: 18 April 2016 / Published: 19 April 2016
(This article belongs to the Special Issue Molecular Aspects of Urinary Tract Infection)
Asymptomatic bacteriuria, also called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract. The characterization and introduction of the quantitative urine culture in the 1950s first allowed the reliable recognition of asymptomatic bacteriuria. The observations that a substantial proportion of patients with chronic pyelonephritis at autopsy had no history of symptomatic urinary infection, and the high frequency of pyelonephritis observed in pregnant women with untreated asymptomatic bacteriuria, supported a conclusion that asymptomatic bacteriuria was harmful. Subsequent screening and long term follow-up programs for asymptomatic bacteriuria in schoolgirls and women reported an increased frequency of symptomatic urinary tract infection for subjects with asymptomatic bacteriuria, but no increased morbidity from renal failure or hypertension, or increased mortality. Treatment of asymptomatic bacteriuria did not decrease the frequency of symptomatic infection. Prospective, randomized, comparative trials enrolling premenopausal women, children, elderly populations, patients with long term catheters, and diabetic patients consistently report no benefits with antimicrobial treatment of asymptomatic bacteriuria, and some evidence of harm. Several studies have also reported that antimicrobial treatment of asymptomatic bacteriuria increases the short term risk of pyelonephritis. Current investigations are exploring the potential therapeutic intervention of establishing asymptomatic bacteriuria with an avirulent Escherichia coli strain to prevent symptomatic urinary tract infection for selected patients. View Full-Text
Keywords: bacteriuria; asymptomatic bacteriuria; asymptomatic urinary tract infection; bacterial interference bacteriuria; asymptomatic bacteriuria; asymptomatic urinary tract infection; bacterial interference
MDPI and ACS Style

Nicolle, L.E. The Paradigm Shift to Non-Treatment of Asymptomatic Bacteriuria. Pathogens 2016, 5, 38.

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