(Asymptomatic) Bacteriuria ≠ Bacteremia

Reviewed by David Cluck, PharmD; East Tennessee State University

Bottom Line: Asymptomatic bacteriuria is unlikely to result in bacteremia in patients who do not have evidence of systemic infection.

Advani and colleagues performed a retrospective cohort study to determine the prevalence of bacteremia from a presumptive urinary source in patients found to have asymptomatic bacteriuria (ASB). This was defined as a positive blood culture within 3 days of urine culture. Factors associated with bacteremia were evaluated using multivariable logistic regression. A 2% risk of bacteremia attributed to ASB was used as a predefined threshold to validate need for empiric antimicrobial therapy. The cohort consisted of non-critically ill patients from 68 Michigan hospitals who were admitted between July 2017 to June 2022. Of 11,590 hospitalized patients with ASB, only 1.4% (n=161) developed bacteremia from a presumed urinary source, while 72.2% received empiric antibiotic therapy for a UTI. In approximately 2100 patients with bacteriuria and altered mental status but no systemic signs of infection, only 0.7% (n=17) developed bacteremia from a presumed urinary source. If the 2% or higher risk of bacteremia were applied as a threshold to initiate empiric antibiotics in this study, nearly 80% of treated patients could have safely been observed off antimicrobial therapy. Notably, older age, altered mental status, change in urine color/odor were not associated with bacteremia with concurrent ASB.

Advani SD, Ratz D, Horowitz JK, et al. Bacteremia From a Presumed Urinary Source in Hospitalized Adults With Asymptomatic Bacteriuria. JAMA Netw Open. 2024;7(3):e242283. doi:10.1001/jamanetworkopen.2024.2283

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