This may be an naive question- why would you not treat a positive urine culture with significant colony forming units? I've had two physicians question me on why I would be treating an asymptomatic UTI. My first thought that I kept to myself was, "why not?" I guess since I'm still in my first year, NP school may still be in my head to do things the textbook way. Someone care to shed some light on this? Thank you.

Edit: I work as a nephrology NP and part of my workup for ckd and aki is ordering UA. I don't just through UAs on everyone, and we do pick up UTIs occasionally.

Lots of people, especially elders (more than 20% of women >80) are colonized and if they aren't symptomatic (or without another compelling reason i.e. pregnancy, urologic intervention, renal transplant, etc) they shouldn't get treated.

And...dialysis patients frequently have +UC but I don't treat unless its a high colony count

Like was mentioned above, asymptomatic bacteruria is not an indication for antibiotics (unless the patient is pregnant as these patients have a higher risk of developing pyelo - there may be other instances as well but none that come to mind right now). In fact, a patient who is asymptomatic generally doesn't need a UC at all - even if the urine is turbid, or smells foul or is discolored. I just listened to a podcast from an ID physician not too long ago and the take away was do a UC and treat if the patient is symptomatic, is pregnant, or is highly suspicious for infection/sepsis and you just can't find another source. Also, if the patient is a young, sexually active female who has had an uncomplicated UTI in the past and is reporting the same symptoms - just treat it w/o much further investigation. Nitrofurantoin, etc.

I just tried finding that podcast and I can't... it was some emergency medicine podcast. Obviously certain patients are a bit more complicated but that's the general idea.

All great information. One case was a workup for AKI in a patient without a clear etiology. Ran a UA/UC+S with proteus spp high colony count. PCP didn't want to treat because she didn't have any clear symptoms.

All great information. One case was a workup for AKI in a patient without a clear etiology. Ran a UA/UC+S with proteus spp high colony count. PCP didn't want to treat because she didn't have any clear symptoms.

Do you feel that asymtomatic bacteria caused the AKI?

Bostonfnp- I felt it was the most likely etiology. No diuretics or obvious nephrotoxic agents. I figured at this point it would benefit the patient to try a course of abx therapy. The next step would be to start working up other intrarenal causes.

I meant to post this sooner but I got sidetracked with a busy week.

According to Cecil's, asymptomatic bacteruria does not equal a UTI and therefore does not warrant antimicrobial therapy unless the patient is pregnant, neutropenic or has a known anatomic defect.