Infection (2018) 46:293–301
Evaluation and management of Staphylococcus aureus
bacteriuria: an updated review
· Dimitra Kalemaki
Received: 21 September 2017 / Accepted: 3 November 2017 / Published online: 11 November 2017
© Springer-Verlag GmbH Germany, part of Springer Nature 2017
is lacking and there are severalgaps in the current literature.
These are discussed in this review.
Keywords Staphylococcus aureus · Bacteriuria ·
Bacteremia · Infection · Evaluation · Management
Staphylococcus aureus is an uncommon isolate in urine cul-
tures (0.13–1% of all urine cultures and 0.5–6% of positive
urine cultures [1–7]). However, it may be more common
in certain populations. For example, in a series of elderly
patients with indwelling urinary catheters, S. aureus was
isolated from 9% of single-species positive urine cultures
and 16% of dual-species positive cultures . Furthermore,
among elderly bacteremic UTI patients S. aureus was iso-
lated from 13.1% of positive urine cultures , while in
series of patients with S. aureus bacteremia (SAB), concom-
itant S. aureus bacteriuria (SABU) was present in 7–34%
[5, 10–17]. The urinary tract has also been demonstrated
to be a common site of infection and colonization among
patients with hospital-acquired MRSA (methicillin resistant
S. aureus) . The following risk factors for SABU have
been identiﬁed: long-term care, urinary tract catheterization,
urologic surgical procedures, urinary tract obstruction, older
age, hospital exposure and malignancy [3–5, 14, 19–23]. Of
note is that some studies, mostly from African countries,
have reported a high rate of asymptomatic SABU in preg-
nant women (up to 72% of positive urine cultures [24, 25])
and in the general population (26% of positive cultures ),
suggesting that SABU may be more prevalent in some areas.
However, it has been hypothesized that specimen contami-
nation may have contributed to the very high prevalence of
Background and aims There is little guidance regarding the
evaluation and management of patients with Staphylococcus
aureus bacteriuria (SABU). Here, we aimed to provide an
up-to-date review of the literature.
Methods We searched PubMed, Scopus, and clinical trial
registries for articles evaluating the epidemiology of SABU,
risk factors of SABU, the association of SABU with urinary
tract infection, bacteremia and invasive S. aureus infections,
and the management of patients with SABU.
Results S. aureus is an uncommon isolate in urine cultures.
It is more common among certain patients, e.g., patients
with indwelling urinary tract devices or prior urinary tract
instrumentation. SABU may represent asymptomatic bac-
teriuria, primary urinary tract infection, or hematogenous
seeding of the urinary tract associated with other foci of
infection. SABU may also serve as the focus for subsequent
bacteremia and invasive infections. We did not ﬁnd any clini-
cal trials regarding the management of patients with SABU.
Conclusions Based on our review, we suggest an algo-
rithmic approach for the evaluation and management of
patients with SABU. However, evidence from clinical trials
Electronic supplementary material The online version of
this article (https://doi.org/10.1007/s15010-017-1100-6) contains
supplementary material, which is available to authorized users.
* Stamatis Karakonstantis
Internal Medicine Department B, General Hospital
of Heraklion Venizeleio-Pananeio, Leoforos Knossou,
71409 Heraklion, Greece
General Medicine, University Hospital of Heraklion,