Asymptomatic Bacteriuria in Older Adults – Diagnosis, Management, and Future Directions: A Narrative Review

Abstract

Asymptomatic bacteriuria (ASB) is defined as the presence of bacteria in the urine in the absence of urinary tract infection (UTI) symptoms. The prevalence of ASB increases with advancing age, particularly among older patients with underlying health conditions. ASB is especially common among residents of long-term care facilities; however, distinguishing ASB from symptomatic UTI in this population remains a significant clinical challenge. The frequent occurrence of ASB often results in unnecessary antibiotic administration, thereby contributing to the development of antibiotic resistance. Current clinical guidelines recommend screening for and treating ASB only in certain circumstances, such as prior to urological procedures or in pregnant women. There is a pressing need for improved diagnostic approaches to differentiate ASB more accurately from UTI, particularly in older adults. Reducing unnecessary urine testing and inappropriate antibiotic use may help prevent over-treatment and minimize associated risks, including Clostridium difficile infection and increased antimicrobial resistance.