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Strong evidence argues against treating asymptomatic bacteriuria (ASB) in most patients (NEJM JW Gen Med Oct 1 2019 and JAMA Intern Med 2019; 179:1519). Still, distinguishing ASB from urinary tract infections (UTIs) that do require treatment is tricky, especially among older patients.
Researchers in the Netherlands evaluated urinalysis results obtained from 63 older women (age, ≥65; mean age, 78) who received diagnoses of UTI based on at least two new-onset symptoms (most often frequency and dysuria), pyuria, and culture results. None were catheterized or had substantial cognitive impairment. The analysis expressed urinary white blood cell (WBC) count in cells/µL; the conversion from cells/µL to cells/high-power field (HPF) is about 5:1.
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