Asymptomatic bacteriuria in patients receiving SGLT2 inhibitors: methodological considerations and clinical implications.

Hussain et al. reported a higher prevalence of culture-detected asymptomatic bacteriuria (ASB) among sodium-glucose cotransporter-2 inhibitor (SGLT2i) users than among non-users with type 2 diabetes mellitus. This observation is important but requires cautious interpretation. Culture-detected ASB is distinct from symptomatic urinary tract infection (UTI), and evidence from randomized trials and real-world studies has generally not shown a clinically meaningful increase in symptomatic UTI with SGLT2i use. Moreover, the single-time-point assessment cannot distinguish transient, persistent, or incident bacteriuria, and a single voided urine specimen may not confirm ASB in women. Unmeasured differences in background antidiabetic therapy and lower urinary tract risk factors may also have contributed to the observed association. Most importantly, the study did not determine whether detecting ASB predicts clinically significant infection or improves patient-important outcomes. Therefore, the available findings do not support routine urine screening in asymptomatic SGLT2i users.