Why subclinical bacteriuria often shouldn't trigger antibiotics

Scott Weese is using a Winnie the Pooh line to make a serious antimicrobial stewardship point: when dogs or cats have subclinical bacteriuria — bacteria found on urine testing without clinical signs of urinary tract disease — the best response is often not to treat. In the background is the veterinary profession’s long-running shift away from reflexive antibiotics for positive urine cultures alone. The International Society for Companion Animal Infectious Diseases, or ISCAID, says subclinical bacteriuria should be distinguished from bacterial cystitis and that treatment is rarely indicated and discouraged. Related clinical guidance has also emphasized that if a dog or cat has no clinical signs of UTI, culture and susceptibility testing generally shouldn’t be performed when a positive result wouldn’t change management. (sciencedirect.com)

Why it matters: For veterinary professionals, this is a practical reminder that bacteriuria is not the same thing as infection requiring antibiotics. Reviews and guidance cited in the broader literature note there’s little evidence that subclinical bacteriuria increases the risk of clinical UTI or other infectious complications in dogs or cats, while treatment can lead to recolonization and contribute to antimicrobial resistance. At the same time, finding subclinical bacteriuria may still be clinically useful as a clue to underlying issues such as diabetes mellitus, chronic kidney disease, urinary tract abnormalities, catheter use, spinal cord injury, or immunosuppression. (journals.sagepub.com)

What to watch: Expect continued emphasis on urine culture stewardship, clearer differentiation between lower urinary tract signs and incidental bacteriuria, and more discussion about when bacteriuria should prompt a search for comorbidities rather than an antibiotic prescription. (sciencedirect.com)