Dimitri M. Drekonja, MD, MS, Staff Physician, Minneapolis Veterans Affairs Medical Center; Assistant Professor of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.

Urinary tract infections (UTIs) are a frequent diagnosis in older adults, leading to substantial antimicrobial use. Increased antimicrobial use is associated with higher rates of resistance, making future infections more difficult to treat. Unfortunately, many UTIs actually represent asymptomatic bacteriuria, which should not be treated in most cases. Adhering to clinical guidelines (based on high-quality evidence from randomized trials) would likely result in fewer UTI diagnoses, less antimicrobial use, and decreased antimicrobial resistance. Knowing when treatment for asymptomatic bacteriuria is recommended, and limiting therapy to these well defined circumstances is vital to appropriately managing a patient with a positive urine culture.
Key words: urinary tract infection, asymptomatic bacteriuria, catheter-associated bacteriuria, antimicrobial management.