Asymptomatic Bacteriuria: A Qualitative Exploration of Barriers to Acceptance

Importance – Asymptomatic bacteriuria (ASB) is common, particularly among women as they age, yet awareness is low and patient education materials are often limited in quality. Objectives – We conducted a qualitative study to assess patient feedback on existing ASB information and identify gaps in understanding to guide future educational efforts. Study Design – We convened 5 focus groups among postmenopausal women with previous experience of treatment for urinary tract infections. Participants were asked to describe their experiences of urinary symptoms, reflect on a handout describing ASB, and make recommendations on how to improve patient education. Three team members read deidentified transcripts of the focus groups, developed a thematic codebook following Conventional Content Analysis guidelines, and coded the data using NVivo software. Results – Twenty women participated in 5 focus groups. The average age of participants was 69.1 years (SD 10.8). Three participants (15.0%) identified as Black and the remaining participants identified as White. Many had postsecondary education, 12 with some college (60.0%) and 7 with graduate-level education (35.0%). Five overarching themes emerged: (1) ASB confusion, (2) presence of bacteria must indicate infection, (3) diagnosis requires treatment, (4) antibiotics as a “cure-all, ” and (5) in favor of antimicrobial stewardship. Quotations illustrated both persistent misconceptions and openness to learning, highlighting opportunities to improve communication and reduce inappropriate antibiotic use. Conclusions – Among postmenopausal women, there is a lack of awareness surrounding ASB and the concept that bacteriuria could exist without requiring antibiotics. While misconceptions are common, willingness to learn suggests potential for targeted, plain-language educational materials as we seek to improve understanding of ASB and support antibiotic stewardship.