Asymptomatic bacteriuria is common and does not generally require treatment unless prior to urological surgery. Urinalysis and culture are not able to differentiate between asymptomatic bacteriuria and urinary tract infection. Clinical features of urinary tract infection include: dysuria, frequency, urgency, loin pain, polyuria, suprapubic tenderness, flank or loin pain and fever (in the absence of an alternative source for fever).
Symptoms of UTI do NOT include cloudy or smelly urine.
The inclusion of appropriate clinical details allows the laboratory to ensure that urine culture is indicated, and to optimise laboratory workup, culture interpretation and susceptibility reporting.
Sending a urine culture following antibiotics is not necessary if symptoms have resolved. There may be residual asymptomatic bacteriuria present which may lead to unnecessary antibiotic treatment.
Asymptomatic bacteriuria is relatively common in older patients, particularly those who reside in long term care facilities. As a result, dipstick urinalysis has poor positive predictive value in diagnosing infection in this cohort and may lead to unnecessary urine cultures and antibiotic treatment.
Patients who have underlying dementia cognitive impairment have high rates of asymptomatic bacteriuria. Patients with acutely worsened confusion who are otherwise clinically stable should have other causes excluded before considering UTI. Rehydrate and monitor in those without acute urinary symptoms. Urine culture is only indicated if the baseline confusion becomes acutely worse. Urine cultures on patients with longstanding baseline confusion is likely to lead to unnecessary antibiotic treatment.