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You may remember a day when peeing in a cup was a routine part of your yearly physical.
Doctors used to test for traces of blood, protein or sugar, so they could see if you had a hidden case of diabetes or kidney disease.
Some doctors still do a urine test at a routine check-up.
However, most doctors don’t request a urine test unless they have a specific reason to (like they suspect you have a bladder infection or you’re at risk for kidney disease).
But just in case you get your urine tested for any reason other than a bladder infection, there’s something you need to know…
Just because you have bacteria in your urine doesn’t mean you necessarily need a round of antibiotics.
Unless you have symptoms of a bladder infection, the bacteria in your urine could be harmless.
At least, that’s what the Infectious Diseases Society of America (IDSA) says in their new guidelines.
Unfortunately, doctors are prescribing antibiotics for these benign bacteria anyway and contributing to antibiotic resistance in a big way…
Lots of people have harmless bacteria in their urine
A new set of guidelines released by the Infectious Diseases Society of America says people without symptoms of a bladder infection shouldn’t receive a urine test that screens for one.
This includes people who were screened regularly in the past, like healthy non-pregnant women, older adults, people with diabetes, people with spinal cord injuries, infants, children, people who’ve had joint replacement or other non-urologic surgery and people who’ve had organ transplants.
Why is the IDSA suddenly poo-pooing (or, should I say, pee-peeing) this screening that used to be routine?
Because bladder infection screening does more harm than good.
Research shows that having bacteria in the urine without symptoms of infection is common. It’s called asymptomatic bacteriuria (ASB).
Three to seven percent of healthy women have ASB. So do 50 percent of people with spinal injuries. And 30 to 50 percent of people in nursing homes have it as well.
ASB doesn’t need to be treated with antibiotics. In fact, treating ASB with antibiotics can make you more likely to develop a urinary tract infection.
It also puts you more at risk for more serious infections like Clostridioides difficile (C. diff), formerly known as Clostridium difficile.
Then, of course, there’s the issue of antibiotic resistance…
Antibiotic resistance refers to the fact that bacteria have developed resistance to the antibiotics we’ve been taking the past century or so.
The antibiotics used to treat UTIs are a huge culprit in the antibiotic resistance epidemic.
In fact, the World Health Organization even found that one of the antibiotics most widely used to treat UTIs already has a 50 percent resistance rate — which means this antibiotic is now ineffective for half of all people who try it.
So, if you can reduce antibiotic resistance by not prescribing antibiotics to people who don’t have a bladder infection in the true sense of the word, then why not do it. Especially considering that more than 2 million people in the U.S. get antibiotic-resistant infections per year, and 23,000 of these people die.
Don’t take antibiotics blindly
The moral of the story is… don’t take antibiotics blindly. If you don’t think antibiotics are necessary based on your symptoms, have a candid conversation with your doctor.
At this point, doctors are so used to prescribing antibiotics for every little thing, and many have experience with patients who demand them, it’s hard for them to start prescribing them more sparingly… even when they know about the risks of antibiotic resistance.
I always double-check with my doctors before taking antibiotics, and there have been a few times when he or she has ceded that it’s probably not necessary. The key is to find a doctor who you can trust and who listens to your concerns and opinions.
This study also shows that you should be wary of an unnecessary urine test, and advocate for your older loved ones in this regard too.
The IDSA mentioned that older adults with ASB often get prescribed antibiotics because they’re having symptoms that aren’t bladder-infection related (like urine odor or confusion).
Really, the only time people of all ages should be prescribed antibiotics for a bladder infection is when they have certain signs of a bladder infection, like burning during urination and frequent urination or signs of a kidney infection, like abdominal pain or tenderness on the back near the lower ribs.
- Bacteria in urine doesn’t always indicate infection — MedicalXpress
- Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America — Clinical Infectious Diseases
- EPA proposal to allow streptomycin to treat citrus disease poses unacceptable risk to health and the environment — Consumer Reports
- Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with a recent history of urinary tract infection — American Journal of Clinical Nutrition
- Urine testing no longer routine — Harvard Health Publishing