Response to “When is pus not pus?”

Thank you for your comment1 on our article.2

Based on the Infectious Diseases Society of America’s (IDSA’s) 2010 guideline3 on when to treat asymptomatic bacteriuria, I disagree with your statement and stand by our publication.

“Pyuria accompanying CA-ASB [asymptomatic bacteriuria] should not be interpreted as an indication for antimicrobial treatment (A-II).”3

If a patient’s urine culture grows a pathogenic organism, but the patient does not have symptoms suggestive of urinary tract infection (UTI), then you do not need to treat.

In long-term care facilities, patients develop changes in mental status due to dehydration from diuresis, poor oral intake, infection and a variety of other issues. However, UTI is sometimes blamed for changes in mental status when other factors have not been considered and treated. Also, when a patient does not have fever, dysuria, frequency and leukocytosis, UTI is a less likely cause.

This is a quote directly from the IDSA UTI 2005 guidelines: “Pyuria is present with asymptomatic bacteriuria … in 90% of elderly institutionalized patients, 90% of hemodialysis patients, 30%–75% of bacteriuric patients with short-term catheters in place …”4

Another direct quote from IDSA guidelines: “Screening for or treatment of asymptomatic bacteriuria is not recommended for the following persons.

• Premenopausal, nonpregnant women (A-I).

• Diabetic women (A-I).

• Older persons living in the community (A-II).

• Elderly, institutionalized subjects (A-I).

• Persons with spinal cord injury (A-II).

• Catheterized patients while the catheter remains in situ (A-I).”4