Whether or not antimicrobials for ASB are effective in preventing symptomatic UTI, sepsis, or death is uncertain. The panel thanks the Infectious Diseases Society of America for supporting guideline development, and specifically Vita Washington and Rebecca Goldwater for their continued support throughout the guideline process. In a trial of short-term antimicrobial therapy in the Swedish cohort, 30 patients received nitrofurantoin and 31 no treatment [56]. More than one-half of positive cultures were identified in the first month after transplantation, when screening was most frequent. at Moreover, treatment of ASB may not decrease the frequency of symptomatic UTI, including pyelonephritis (moderate quality). In another study, an increased frequency of bacteriuric episodes was significantly associated with an increased frequency of receiving an antimicrobial and of subsequent isolation of multidrug-resistant gram-negative bacilli in urine, but not changes in mental status or admission to hospital for UTI [87]. There were no differences in the frequency of subsequent UTI during 1 year of follow-up after treatment of bacteriuric women with a 1-week course of therapy with nitrofurantoin or placebo [60]. Asymptomatic bacteriuria (ASB) is the presence of 1 or more species of bacteria growing in the urine at specified quantitative counts (≥10 5 colony-forming units [CFU]/mL or ≥10 8 CFU/L), irrespective of the presence of pyuria, in the absence of signs or symptoms attributable to urinary tract infection (UTI). Studies which evaluated antimicrobial treatment or prophylaxis, compared with placebo or no treatment, enrolled patients managed with intermittent catheterization and observed no differences in rates of symptomatic UTI between treatment groups [137, 138]. Only 1 of 15 (7%) device infections had the same organism isolated from the infection and the preoperative urine culture.No evidence identified through the systematic literature search addressed the treatment of ASB in patients living with previously implanted urological devices. The studies were heterogeneous in design and, in general, had a high risk of selection and attrition bias.We make a strong recommendation because there is very low certainty of any benefit and high-quality evidence of harm. In the penicillin group, bacteriuria was eradicated in 5 girls, but 6 girls developed acute pyelonephritis and 1 developed cystitis within 5 months following the penicillin therapy (7 of 46 [15%]), all with new E. coli strains isolated. Identifying objective criteria to diagnose symptomatic UTI is essential to facilitate optimal management for these older populations, including limiting inappropriate antimicrobial use.Classic symptoms of UTI include focal genitourinary symptoms such as urinary frequency, urgency, dysuria, and costovertebral angle tenderness [80]. Treatment probably increases the risk of antibiotic-associated diarrhea, including CDI, and increases the risk of antimicrobial resistance for the individual patient, the institution, and the community [87, 88, 100].This recommendation places a high value on avoiding adverse outcomes of antimicrobial therapy in the functionally impaired older individual in the absence of evidence that such treatment is beneficial.Since bacteriuria is often detected and treated in patients with delirium or falls, further studies—ideally randomized—to evaluate the risks and benefits of antimicrobial treatment and determine if there is any improvement in mental status, frequency of repeat falls, or benefits in nonlocalizing clinical signs and symptoms, should be undertaken.In the 2005 IDSA ASB guideline [6], there was a recommendation against screening for or treatment of ASB in people with diabetes. One RCT in women, published in 1991 [163], addressed this topic and was included in prior guidelines [6, 18]. However, we did not identify any evidence that antimicrobial treatment of bacteriuria in persons with long-term indwelling catheters can reduce the risk of death.A prospective cohort study of prophylaxis to prevent ASB and UTI in patients with long-term indwelling catheters reported no benefits [169]. This practice is of questionable efficacy to prevent prosthetic device infection, as prosthetic infections are typically associated with biofilm-producing skin flora rather than common urinary pathogens [197, 198].Our systematic literature search identified only 1 publication assessing the role of ASB treatment prior to urological device implantation. 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