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.