In an older adult with delirium but no urinary symptoms, fever or instability, evaluate other causes and reassess. Incidental bacteriuria or pyuria does not by itself justify antibiotics or repeated urine cultures. New localizing symptoms or systemic illness changes the assessment; suspected sepsis needs prompt treatment while its source is investigated. Interpret the collection method and colony count together. Pregnancy and selected endourologic procedures with mucosal trauma have specific screening/treatment recommendations.
IDSA asymptomatic bacteriuria guidance · IDSA guideline — PubMed
Andrew Bland, MD, FACP, FAAP