Quality standard

Quality statement 3: Antibiotic treatment for asymptomatic bacteriuria in men and non-pregnant women

Quality statement 3: Antibiotic treatment for asymptomatic bacteriuria in men and non-pregnant women

Quality statement

Men and non-pregnant women are not prescribed antibiotics to treat asymptomatic bacteriuria. [2015, updated 2023]

Rationale

Asymptomatic bacteriuria is not routinely treated with antibiotics in men and non-pregnant women because it is not a risk factor for harm. Unnecessary antibiotic treatment of asymptomatic bacteriuria is associated with increased risk of adverse events and is of no clinical benefit. It can also increase the resistance of bacteria that cause urinary tract infections (UTIs), making antibiotics less effective for future use. Asymptomatic bacteriuria is especially problematic for older people, as incidence increases with age and is high among people in long-term residential care. Symptoms should be assessed and identified before a urine sample is sent for culture. Antibiotics should not be routinely prescribed when a urine culture identifies bacteriuria for a person without symptoms. In older people, symptoms can include non-specific signs of infection such as delirium.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

a) Proportion of episodes of suspected UTI in men and non-pregnant women with signs and symptoms documented in the patient's records.

Numerator – the number in the denominator with signs and symptoms documented in the patient's records.

Denominator – the number of episodes of suspected UTI in men and non-pregnant women.

Data source: Data can be collected from information recorded locally by provider organisations, for example from GP practice computer systems. Data collection forms are available to collect information on UTI symptoms from GP patients. Some forms collect data using text messages and mobile phones, and allow the data to be saved to the patient's electronic record. NHS England's Pharmacy Quality Scheme Guidance 2022/23 includes a data collection form for community pharmacy teams which collects information on UTI symptoms at consultations for women aged under 65.

b) Proportion of episodes of asymptomatic bacteriuria in men and non-pregnant women treated with antibiotics.

Numerator – the number in the denominator treated with antibiotics.

Denominator – the number of episodes of bacteriuria in men and non-pregnant women with no symptoms recorded.

Data source: No routinely collected data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from an audit of patient records.

Outcome

Antimicrobial prescribing rates for men and non-pregnant women with asymptomatic bacteriuria.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from an audit of patient records.

What the quality statement means for different audiences

Service providers (such as GP practices, hospitals, community services) ensure that procedures are in place so that healthcare professionals do not routinely prescribe antibiotics to treat asymptomatic bacteriuria in men and non-pregnant women. They provide internal training and education to healthcare professionals on when to send urine samples for culture and when to treat bacteriuria.

Healthcare professionals (GPs, physician associates, hospital doctors and community pharmacists) do not prescribe antibiotics to treat asymptomatic bacteriuria in men and non-pregnant women. They assess symptoms to determine if a urine sample should be sent for culture and if antibiotics should be prescribed when a urine culture identifies bacteriuria.

Integrated care systems lead on antimicrobial stewardship in their area.

Men and non-pregnant women who have bacteria in their urine but no symptoms of a UTI are not prescribed antibiotics.

Definitions of terms used in this quality statement

Asymptomatic bacteriuria

The presence of significant levels of bacteria in the urine in a person without signs or symptoms of UTI. [NICE's clinical knowledge summary on urinary tract infection (lower) – women, background information – definition]

Equality and diversity considerations

Assessing symptoms for some older people who are experiencing difficulties making decisions due to their health condition may be difficult. Reasonable adjustments should be made to help such people take an active part in an assessment of their symptoms. These can include longer appointments to allow enough time for discussions, using a range of communication tools and including family members, carers, or an advocate in line with the person's needs and preferences.