Asymptomatic bacteriuria due to Streptococcus gallolyticus
Streptococcus gallolyticus bacteriuria generally does not require antimicrobial treatment when it represents asymptomatic bacteriuria (ASB). [1]
ASB is defined as growth of bacteria in urine at specified quantitative counts in the absence of signs or symptoms attributable to urinary tract infection (UTI). [1]
When Streptococcus gallolyticus bacteriuria should be treated
Antimicrobial therapy is recommended for ASB in the following settings. [1]
- Pregnancy (screening and treatment are recommended). [1]
- Endoscopic urologic procedures associated with mucosal trauma (screening and treatment are recommended prior to surgery). [1]
Antimicrobial therapy is suggested (rather than recommended) in the following setting. [1]
- Endourologic procedures in patients with ASB (short-course targeted therapy is suggested). [1]
When Streptococcus gallolyticus bacteriuria should not be treated
Antimicrobial therapy is not recommended for ASB in most other populations, including the following. [1]
- Healthy nonpregnant adults (including older community-dwelling persons who are functionally impaired). [1]
- Patients with diabetes. [1]
- Renal transplant recipients more than 1 month after transplant surgery. [1]
- Nonrenal solid organ transplant recipients. [1]
- Patients with short-term indwelling urethral catheters (<30 days). [1]
- Patients undergoing elective nonurologic surgery. [1]
- Patients living with implanted urologic devices. [1]
Differentiating ASB from symptomatic UTI
Antimicrobial treatment is indicated when urine culture results occur with signs or symptoms attributable to UTI rather than ASB. [1]
Nonlocalizing symptoms in older or spinal cord injury populations are common and should not be automatically attributed to urinary infection when ASB is present. [1]
Practical management approach for reported Streptococcus gallolyticus bacteriuria
Management should be based on symptom status and the clinical setting that affects ASB treatment decisions (pregnancy or planned endoscopic urologic mucosal trauma). [1]
In the absence of indications requiring treatment, observation without antibiotics is recommended. [1]
Treatment duration in situations where therapy is indicated
In pregnant women with ASB, a 4–7 day course of antimicrobial therapy is suggested. [1]
For endoscopic urologic procedures associated with mucosal trauma, treatment is targeted to culture results and given as a short course. [1]
For endourologic procedures, antimicrobial therapy should be initiated 30–60 minutes before the procedure. [1]