Here’s an interesting question that came up during a Geriatrics for Caregivers Q&A call:
What can be done when an elderly woman has bacteria in her urine but no symptoms, and how might a urology consultation help?
According to the caller, a friend in her 90s had been having bacteria in her urine, but no symptoms. Despite treatment with antibiotics, she was still having urine in the bacteria, so the doctor had recommended chronic antibiotics and a referral to urology.
(Now, these Q&A sessions — and these blog posts, for that matter — are for health education purposes only, so it’s not possible to make specific recommendations on how this elderly woman should be treated. The doctors involved are able to talk to her, examine her, and review her medical history, and that will affect what kinds of recommendations they make.)
On the call, I shared some of what I know about this topic in general: that although urine is usually sterile, some people do develop chronic bacteria without having a urinary tract infection (UTI), and that we call this having a “colonized” bladder. I also noted that unless there are symptoms of a urinary tract infection (UTI), it wasn’t clear to me that treating the bacteria repeatedly would be helpful.
We went on to discuss the kinds of questions that a family could ask a doctor, to make sure that all the appropriate treatment options had been considered, and to better understand why the doctor was recommending a urologist. We also talked about applying a “benefits vs burdens” approach to going through the options with the doctor.
But after the call, I decided to look up the problem of “asymptomatic bacteriuria,” which is the technical term for having bacteria in the urine but no signs of UTI. (“Asymptomatic” means no symptoms.)
As often happens when I look things up, I learned some useful things! Below are the highlights, which I hope will be helpful to older adults and caregivers (and even doctors!) who encounter this health issue.
(Note: this information is summarized from this topic page in UpToDate, a peer-reviewed clinical reference used widely by practicing doctors.)
What to know about urine bacteria if there are no symptoms of UTI
Asymptomatic bacteriuria is common in older adults. In women aged 80 or older, 20% or more may have this condition. In healthy men aged 75 or older, 6-15% have been found to have bacteria with no UTI symptoms. These statistics actually surprised me; I hadn’t realized this condition was quite so common among the elderly, nor had I realized it’s more common in women than men.
- Practical implications: if you go testing the urine of older adults who don’t have UTI symptoms, you very well may grow some bacteria.
Asymptomatic bacteriuria generally does NOT need to be treated in older adults. Yes, you read that right. The expert authors of the UpToDate topic reviewed the clinical studies and concluded that treating older adults with bacteriuria was usually not beneficial, because the bacteria just keep coming back. Also, the bacteria tend to become resistant to antibiotics. Even in nursing homes, where people are frail and up to 50% of residents may have asymptomatic bacteriuria, treatment didn’t help. As in, treatment didn’t reduce symptomatic UTIs, didn’t improve incontinence, and didn’t help people live longer.
- Practical implications: If a doctor recommends treatment of bacteria in the urine and there are no UTI symptoms, it would be reasonable to ask them to explain why they feel your loved one is especially likely to benefit from treatment.
So in general, who should be treated for asymptomatic bacteriuria? According to the UpToDate authors, clinical research only supports treating asymptomatic bacteriuria in pregnant women, and in people about to have a bladder or prostate procedure.
In other words, based on this summary of clinical studies, I’d summarize the benefits and burdens of treating asymptomatic bacteriuria in an elderly woman as follows:
- Benefits: No proven benefit to antibiotic treatment in someone who doesn’t have clinical signs of a UTI.
- Burdens: Antibiotics cost money, and increase pill burden. There is a risk of side-effects, of interactions with other medications, and of developing an infection resistant to antibiotics. Also, the overuse of antibiotics in society means we are developing more resistant bugs all around us.
Of course, the benefits and burdens summarized above are a general starting point, and medical care does need to be tailored to an individual’s circumstances.
So it’s impossible to say what kind of care the elderly woman in the example should be getting. Still, I hope some of you caregivers will find it useful to have this background information on what the experts suggest be done about bacteria in the urine, when there’s no sign of UTI.
You can also learn more about urine bacteria in older adults by visiting this HealthinAging.org resource page on Urinary Tract Infections & Asymptomatic Bacteriuria.
Update Dec 2015: A clinical research study finds that treatment of asymptomatic bacteriuria is associated with a much higher chance of developing a UTI later, and that these UTIs often involve antibiotic-resistant bacteria.