EURURO Vol. 72 No. 6

865 1030

Brief Correspondence
Benefits and Harms of Treatment of Asymptomatic Bacteriuria:
A Systematic Review and Meta-analysis by the European
Association of Urology Urological Infection Guidelines Panel
Bela Ko¨ves Tommaso Cai Rajan Veeratterapillay Robert Pickard Thomas Seisen
Thomas B. Lam Cathy Yuhong Yuan Franck Bruyere Florian Wagenlehner
Riccardo Bartoletti Suzanne E. Geerlings Adrian Pilatz Benjamin Pradere
Fabian Hofmann , Gernot Bonkat Bjo¨rn Wullt
a Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary; bDepartment of Urology, Santa Chiara, Reg. Hospital, Trento, Italy; c Department
of Urology, Freeman Hospital, Newcastle upon Tyne, UK; d Newcastle University Newcastle upon Tyne, UK; e Academic Department of Urology, Pitie´-
Salpeˆtrie`re Hospital, Assistance-Publique Hoˆpitaux de Paris, Paris, France; f Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK; g Academic
Urology Unit, University of Aberdeen, Aberdeen, UK; h Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada;
i Department of Urology, University Hospital of Tours, Loire Valley, France; j Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University,
Giessen, Germany; k Department of Urology, University of Florence, Florence, Italy; l Department of Internal Medicine, Division of Infectious Diseases, Center
for Infection and Immunity Amsterdam, Academic Medical Center, The Netherlands; m Department of Urology, Sunderby Hospital, Lulea˚, Sweden; n Alta uro
AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry (COB), University Basel, Basel, Switzerland; oInstitute of Laboratory Medicine Section of
Microbiology, Immunology and Glycobiology, Lund, Sweden
ava ilable at
journal homepage:
Article info
Article history:
Accepted July 11, 2017
Associate Editor:
James Catto
Keywords:
Asymptomatic bacteriuria
Antibiotic treatment
Urinary tract infection
Abstract
People with asymptomatic bacteriuria (ABU) are often unnecessarily treated with anti-
biotics risking adverse effects and antimicrobial resistance. We performed a systematic
review to determine any benefits and harms of treating ABU in particular patient groups.
Relevant databases were searched and eligible trials were assessed for risk-of-bias and
Grading of Recommendations, Assessment, Development and Education quality. Where
possible, a meta-analysis of extracted data was performed or a narrative synthesis of the
evidence was presented. After screening 3626 articles, 50 studies involving 7088 patients
were included. Overall, quality of evidence ranged from very low to low. There was no
evidence of benefit for patients with no risk factors, patients with diabetes mellitus,
postmenopausal women, elderly institutionalised patients, patients with renal transplants,
or patients prior to joint replacement, and treatment was harmful for patients with
recurrent urinary tract infection (UTI). Treatment of ABU resulted in a lower risk of
postoperative UTI after transurethral resection surgery. In pregnant women, we found
evidence that treatment of ABU decreased risk of symptomatic UTI, low birthweight, and
pretermdelivery. ABU should be treated prior to transurethral resection surgery. In addition,
current evidence also suggests that ABU treatment is required in pregnant women, although
the results of a recent trial have challenged this view.
Patient summary: We reviewed available scientific studies to see if people with bacteria in
their urine but without symptoms of urinary tract infection should be treated with
antibiotics to eliminate bacteria. For most people, treatment was not beneficial and
may be harmful. Antibiotic treatment did appear to benefit women in pregnancy and
those about to undergo urological surgery.
# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Department of Urology, South Pest Teaching Hospital, Koves Str 1, Budapest
1204-H, Hungary. Tel. +3612896200.
E-mail address: (B. Ko¨ves).
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.