healthcare-associated infections (hai) program

U.S. Antibiotic Awareness Week 2026

Takes All of Us

U.S. Antibiotic Awareness Week is an opportunity to raise awareness about the importance of appropriate antibiotic use in improving patient care and limiting resistance. This year, CDPH is focusing on reducing inappropriate urine testing and reducing treatment of asymptomatic bacteriuria (ASB).

For Patients and Families: What You Should Know

Some people have bacteria in their urine but do not have symptoms of a urinary tract infection (UTI).

This is called asymptomatic bacteriuria.

This finding is common and usually harmless. It is especially common in nursing home residents, older adults, people with diabetes, and people with urinary catheters.
It should not be treated with antibiotics, except for special situations like pregnancy.
Antibiotic treatment for bacteria in the urine without UTI symptoms:

Does not help people feel better.
Does not prevent people from getting sick.
Does not prevent future UTIs.

Antibiotic treatment can cause harm like allergic reactions, severe diarrhea or “C. diff”, and increased risk of infections being resistant to antibiotics and harder to treat.
Urine testing for UTI should usually only be done for people that have UTI symptoms.

Common UTI symptoms are pain, burning, or urgency.

Cloudy urine, strong-smelling urine, falls, or feeling tired are not UTI symptoms on their own.
Talk with your healthcare provider if you have concerns.

Learn more at Using Antibiotics Safely: Help for Patients and Families

For Healthcare Providers and Facility Staff

The clinical information below is intended for healthcare providers and facility staff.

Asymptomatic Bacteriuria Basics

Asymptomatic Bacteriuria: defined as ≥10⁵ CFU/mL of one or more bacterial species in the urine, in a patient without urinary symptoms, regardless of pyuria.

Pyuria: defined as the presence of white blood cells in the urine.

Pyuria does not always indicate a urinary tract infection (UTI).
Lack of pyuria often helps rule out a UTI.

ASB is common, especially among older adults, residents of long-term care facilities, individuals with diabetes, and individuals with indwelling urinary catheters.
ASB is not the same as a UTI. ASB indicates colonization of the urinary tract, not an infection.
Antibiotics are generally not recommended for ASB and often prescribed unnecessarily.
Inappropriate ASB treatment does not improve outcomes and can lead to antibiotic resistance, Clostridioides difficile infections, increased healthcare costs, and patient harms.

Common Myths About UTIs (and Facts)

Myth: Cloudy or odorous urine suggests a UTI.

Fact: Urine color, clarity, and odor are poor indicators of a UTI. Odorous urine is often due to dehydration.

Myth: Finding bacteria in the urine (especially from a catheterized sample) is diagnostic of a UTI.

Fact: UTI diagnosis should typically be symptom-based. ASB usually should not be treated.

Myth: Finding leukocyte esterase, pyuria, or nitrites on a urinalysis is diagnostic of a UTI.

Fact: These markers are, by themselves, not specific for a UTI. They can be found in other conditions such as ASB. If a patient has no UTI symptoms, treatment is generally not recommended. Conversely, for most patients if pyuria is absent, a UTI is unlikely.

Myth: High numbers of epithelial cells in a urinalysis can be disregarded if culture results are positive.

Fact: High epithelial cell counts often indicate sample contamination. You may need a repeat clean-catch sample (or catheterized sample) for more reliable culture results.

Myth: Untreated ASB will progress to a UTI if not treated.

Fact: Treating ASB does not prevent UTIs but can cause patient harm. ASB is common and expected in many populations.

Myth: In elderly patients, falls or acute mental status changes are indications to test for a UTI.

Fact: These symptoms have many possible causes and are usually not due to a UTI. UTI testing should generally not be performed solely for behavior changes, falls, or functional decline. SHEA guidelines advise testing for infection only after confirming delirium by formal assessment.

Myth: Finding yeast or Candida in a urine culture is diagnostic of a UTI, especially in patients with catheters.

Fact: Candida in the urine usually reflects contamination or catheter colonization. For most patients, IDSA guidelines recommend against treating asymptomatic Candiduria.