Don’t send urine specimens for culture on asymptomatic patients including the elderly, diabetics, or as a follow up to confirm effective treatment.

There is no evidence that antibiotic treatment is indicated in any of these patients. Thus sending urine specimens in asymptomatic patients will only result in inappropriate antibiotic use and increased risk of resistance. The only exceptions are screening of pregnant women early in pregnancy for whom there are clear guidelines for screening/management; and screening for asymptomatic bacteriuria before urologic procedures for which mucosal bleeding is anticipated.

 

Sources:

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin; No. 91: Treatment of urinary tract infections in nonpregnant women. Obstet Gynecol. 2008 Mar;111(3):785-94. PMID: 18310389.

Mums Health. Anti-Infective Guidelines for Community-Acquired Infections, 13th edition [Internet]. Toronto (ON): MUMS Guideline Clearinghouse; 2013 [cited 2017 May 5].

Juthani-Mehta, M. Asymptomatic bacteriuria and urinary tract infection in older adults. Clin Geriatr Med. 2007 Aug;23(3):585-94, vii. PMID: 17631235.

Nicolle LE. Asymptomatic bacteriuria: when to screen and when to treat. Infect Dis Clin North Am. 2003 Jun;17(2):367-94. PMID: 12848475.

Nicolle LE, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005 Mar 1;40(5):643-54. PMID: 15714408.