Prescriptions for urinary tract infection (UTI) rank among the top indications for antibiotics worldwide.1,2 Although true UTI does occur frequently, overdiagnosis and overtreatment are also well-recognized problems. Because clinicians often obtain urine cultures in patients without localizing urinary symptoms, positive culture results, by definition, will reflect asymptomatic bacteriuria rather than infection. About 5% of young adults have asymptomatic bacteriuria at any time, and the prevalence is higher among patients with diabetes (10%-20%), spinal cord injury (30%), and urinary catheters (50%-70%), as well as among those living in long-term care facilities (30%-50%).3-7 In many populations, asymptomatic bacteriuria may be protective, and antibiotics can paradoxically increase the risk of developing UTI while selecting for antimicrobial resistance and increasing the risk of Clostridioides difficile infection.
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Leis JA, Soong C. De-adoption of Routine Urine Culture Testing—A Call to Action. JAMA Intern Med. 2019;179(11):1466–1468. doi:10.1001/jamainternmed.2019.4515
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