Asymptomatic bacteriuria is common in older adults, especially women, people in care homes and those with catheters. Treating it does not prevent symptomatic infection or improve outcomes, and it drives resistance and Clostridioides difficile infection.
The usual trap is the confused or unwell older patient with a positive dipstick. Confusion alone is rarely caused by bacteriuria, and labelling it a UTI can mean the real cause is missed.
- Do not send urine dipsticks or cultures from older adults without urinary symptoms or signs of sepsis.
- In a confused older patient with positive urine but no urinary symptoms, look for other causes first: dehydration, drugs, constipation, other infection.
- Treat bacteriuria without symptoms only in pregnancy or before invasive urological procedures.
- Explain to families why antibiotics are not being given; it prevents repeat requests.
Why it matters
Treating bacteriuria is one of the commonest unnecessary antibiotic prescriptions in older people.
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