";s:4:"text";s:4140:" Asymptomatic candiduria, which was addressed in the 2005 guideline, has been recently reviewed and recommendations made in There are important considerations unique to the use of antimicrobials. Tambyah et al [154] reported that 235 of 1497 (14.9%) evaluable newly catheterized patients developed bacteriuria (defined as ≥10Whether or not the presence of CAUTI or ASB increases the risk of mortality is controversial. TMP-SMX was compared to norfloxacin for 5 days’ treatment, starting the evening before the procedure, in 165 randomized patients with ASB (>10Two RCTs reported since the publication of the previous guideline assess the efficacy of single-dose compared to longer-course antimicrobial treatment of preoperative ASB [189, 190]. In a more recent observational study, outcomes were reported for 320 hospitalized patients who had urine cultures sent to the microbiology laboratory and documentation in the hospital record of the indication for obtaining urine cultures; 191 (57%) had changes in mental status as the indication for the culture [99]. However, review articles [139, 140] and consensus guidelines [141], as well as the 2005 IDSA ASB Guideline Committee [6] and 2009 IDSA Catheter-Acquired UTI Guideline Committee [18], concluded that ASB should not be screened for or treated in SCI patients. A prospective registry study reported that the incidence of symptomatic UTI per 1000 patient-days for patients with at least 1 year of follow-up was 0.06 for 1507 liver transplants, 0.07 for 404 heart transplants, and 0.02 for 303 lung transplants, compared with 0.45 for kidney transplants and 0.22 for combined kidney and pancreas transplants [UTIs are uncommon in nonkidney SOT, and the evidence suggests that serious harms resulting from symptomatic UTIs are extremely rare. 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]. The summaries of evidence were discussed and reviewed by all committee members and edited as appropriate. In the years since the publication of the guideline, further information relevant to ASB has become available. Hospitalization rates for UTI and pyelonephritis were significantly higher in children with ASB (15%) than controls (2.6%; RD, 13.4% [95% CI, 2.0%–24.7%]). 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]. Following matching and adjustment, UTI was no longer associated with mortality. Kunin et al [168] reported increased mortality in residents with chronic indwelling catheters, but when adjusted for other differences between catheterized and noncatheterized long-term care facility residents, the CI included no effect. There is high-quality evidence that antimicrobials increase the risk of adverse effects. There is high-quality evidence that antibiotics have an increased risk of adverse effects, that screening and treating ASB is extremely costly, and that the use of antibiotics promotes emergence of antimicrobial resistance.ASB occurs in 2%–7% of pregnant women [6, 65]. For diagnostic, nontraumatic procedures, randomized studies of outpatient cystoscopy have generally been the standard for other, less frequent nontraumatic endoscopic procedures [180].Two RCTs [181, 182] and 2 prospective nonrandomized studies [183, 184] enrolling a total of 570 patients with ASB, all published prior to the 2005 guideline, compared the effect of antimicrobial treatment to no treatment before TURP or bladder tumor resection (TURBT).