Asymptomatic Bacteriuria in Young Women with Recurrent Urinary Tract Infections: Is treatment Necessary

Here is an article that I will discuss with our infectious diseases trainees later in the week.The clinical question is as follows: in young women with recurrent urinary tract infections, should asymptomatic bacteriuria (bacterial colonization of the urine) be treated?

The investigators used a prospective, non-blinded,  randomized  methodology to compare treatment to no-treatment of asymptomatic bacteriuria in a total of 637 women. 

The result? At the last follow-up, 41 (13.1%) in the no treatment group and 169 (46.8%) in treatment group showed showed symptomatic urinary tract infection recurrence (RR, 3.17; 95% CI, 2.55-3.90; P < .0001).

The message: don't treat urinary colonization with bacteria, only treat active infections! 

The indiscriminate use of antibiotics leads to selection of resistant pathogens and likely alters the normal colonic and vaginal flora. The intestinal and vaginal bacteria are important defense mechanisms against invasion of the urinary tract by E.coli.