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Bacteriuria, Asymptomatic

Bacteriuria, Asymptomatic is a topic covered in the 5-Minute Clinical Consult.

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Asymptomatic bacteriuria (ASB) is diagnosed when significant bacteriuria is not accompanied by signs and symptoms attributable to urinary tract infection (UTI).


  • General population: 3.5%
  • Pregnancy: 7–10%
  • Older women: 16–18%

  • Variable, increased with age, female gender, sexual activity, and presence of genitourinary (GU) abnormalities
  • Pregnancy: 2–10%
  • Short- and long-term indwelling catheter 9–23% and 100%, respectively
  • Long-term care residents in women 25–50% and men 15–40%

Etiology and Pathophysiology

  • Microbiology is similar to that of other UTI, with bacteria originating from periurethral area, vagina, or gut.
  • Organisms are less virulent in ASB than those causing UTI.
  • The most common organism is Escherichia coli. Other common organisms are Klebsiella pneumonia, Enterobacter, Proteus mirabilis, Staphylococcus aureus, group B Streptococcus (GBS), and Enterococcus.

Genetic variations that reduce toll-like receptor-4 function (TLR4) have been associated with ASB by lowering innate immune response and delaying bacterial clearance.

Risk Factors

  • Older age
  • Female gender
  • Sexual activity, use of diaphragm with spermicide
  • GU abnormalities: neurogenic bladder, urinary retention, urinary catheter use (indwelling, intermittent, or condom catheter)
  • Institutionalized residents
  • Diabetes mellitus
  • Immunocompromised status
  • Spinal cord injuries or functional impairment
  • Hemodialysis
  • Pregnancy (decreased peristalsis of the urinary tract)

Commonly Associated Conditions

Depends on the risk factors

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Stephens, Mark B., et al., editors. "Bacteriuria, Asymptomatic." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816441/all/Bacteriuria__Asymptomatic.
Bacteriuria, Asymptomatic. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816441/all/Bacteriuria__Asymptomatic. Accessed April 26, 2019.
Bacteriuria, Asymptomatic. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816441/all/Bacteriuria__Asymptomatic
Bacteriuria, Asymptomatic [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816441/all/Bacteriuria__Asymptomatic.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Bacteriuria, Asymptomatic ID - 816441 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816441/all/Bacteriuria__Asymptomatic PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -