Bacteriuria
Bacteriuria | |
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Synonym | Bacteruria |
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Multiple rod-shaped bacteria shown between the larger white blood cells at urinary microscopy from a person with urinary tract infection. | |
Specialty | Emergency medicine, Infectious disease |
Types | Asymptomatic, symptomatic[1][2] |
Diagnostic method | Urinalysis, urine culture[3] |
Differential diagnosis | Contamination[1] |
Treatment | Based on symptoms or risk factors[4][3] |
Frequency |
Asymptomatic: 3% (middle aged women), up to 50% (women in nursing homes)[5] Symptomatic: up to 10% of women a year[6][7] |
Bacteriuria is the presence of bacteria in urine.[1] It is divided into two main types, those with symptoms (urinary tract infection) and those without (asymptomatic bacteriuria).[1][2] Diagnosis is by urinalysis or urine culture.[3] Escherichia coli is the most common bacterium found.[1] Most people without symptoms should not be tested for the condition.[3] Differential diagnosis include contamination.[1] Using special techniques certain non-disease causing bacteria have also been found in the urine of healthy people.[8] These are part of the resident microbiota.[8]
If symptoms are present treatment is generally with antibiotics.[3] Bacteriuria without symptoms generally does not require treatment.[4] Exceptions include during pregnancy, those who have had a recent kidney transplant, young children with significant vesicoureteral reflux, and in those undergoing surgery of the urinary tract.[4][3]
Bacteriuria without symptoms is present in about 3% of otherwise healthy middle aged women.[5] Among those in nursing homes rates are as high as 50% among women and 40% in men.[5] In those with a long term indwelling urinary catheter rates are 100%.[5] Up to 10% of women have a urinary tract infection in a given year and half of women having at least one infection at some point in their lives.[6][7]
Signs and symptoms
Asymptomatic bacteriuria
Asymptomatic bacteriuria is bacteriuria without accompanying symptoms of a urinary tract infection. It is more common in women, in the elderly, in residents of long-term care facilities, and in people with diabetes, bladder catheters and spinal cord injuries. People with a long-term Foley catheter uniformly show bacteriuria. Chronic asymptomatic bacteriuria without urinary tract infection symptoms occurs in as many as 50% of the population in long-term care.[9]
In pregnant women bacteriuria is associated with low birth weight, preterm delivery, and infection of the newborn.[10][11] Bacteriuria in pregnancy also increase the risk of preeclampsia.[11]
Symptomatic bacteriuria
Symptomatic bacteriuria is bacteriuria with the accompanying symptoms of a urinary tract infection (such as frequent urination, painful urination, fever, back pain). Symptomatic bacteriuria can be indicative of a urinary tract infection like pyelonephritis or cystitis. The most common type of bacteriuria associated with urinary tract infections is Escherichia coli which is a gram-negative rod-shaped bacteria.
Diagnosis
Testing for bacteriuria is often performed in those with symptoms of a urinary tract infection. Testing is often done in other scenarios as in failure to thrive of a newborn or confusion in the elderly. Screening for bacteriuria is recommended in pregnancy as there is evidence that asymptomatic bacteriuria can lead to low birth weight and preterm delivery.
- Bacteriuria can be detected by urine dipstick test. The urinary nitrite test will be able to detect any nitrate-reducing bacteria in the urine. The leukocyte esterase test detects the presence of leukocytes (white blood cells) in the urine which can be associated with a urinary tract infection.The urine dipstick test is readily available and provides fast results.
- Microscopy can also be used to detect bacteriuria. It is more specific, especially when used with gram staining, but requires more time and equipment.
- The gold standard for detecting bacteriuria is a bacterial culture which identifies the actual organism. This test is more specific but can take several days to obtain a result. As a result, clinicians will often treat a bacteriuria based on the results of the urine dipstick test while waiting for the culture results. The culture will often provide antibiotic sensitivity.
Bacteriuria can be confirmed if a single bacterial species is isolated in a concentration greater than 100,000 colony forming units per millilitre of urine in clean-catch midstream urine specimens (one for men, two consecutive specimens with the same bacterium for women).[12] For urine collected via bladder catheterization in men and women, a single urine specimen with greater than 100,000 colony forming units of a single species per millilitre is considered diagnostic.[12] The threshold is also 100 colony forming units of a single species per millilitre for women displaying UTI symptoms.[13]
Screening
One time screening for bacteriuria is tentatively recommended during early pregnancy.[14]
Treatment
The decision to treat bacteriuria depends on the presence of accompany symptoms and comorbidities.
Asymptomatic bacteriuria
Asymptomatic bacteriuria generally does not require treatment.[4] Exceptions include during pregnancy and in those undergoing surgery of the urinary tract.[4][15] Children with vesicoureteral reflux or others with structural abnormalities of the urinary tract.[16]
There is no indication to treat asymptomatic bacteriuria in diabetics, renal transplant recipients, and in those with spinal cord injuries.[17]
The overuse of antibiotic therapy to treat asymptomatic bacteriuria has many adverse effect[18] as it increases the risk of diarrhea, antimicrobial resistance, and infection due to Clostridium difficile. Other effects include increased financial burdens and overreporting of mandated catheter-associated urinary tract infection.
Symptomatic bacteriuria
Symptomatic bacteriuria is typically treated as a urinary tract infection with antibiotics. Common choices include nitrofurantoin, and trimethoprim/sulfamethoxazole.
Epidemiology
Group | Prevalence (in %) | |
---|---|---|
Healthy premenopausal women | 1.0 to 5.0 | |
Pregnant women | 1.9 to 9.5 | |
Postmenopausal women (50 to 70 years of age) | 2.8 to 8.6 | |
People with diabetes mellitus | Women | 9.0 to 27.0 |
Men | 0.7 to 1.0 | |
Older community-dwelling people | Women (older than 70 years) | > 15.0 |
Men | 3.6 to 19.0 | |
Older long-term care residents | Women | 25.0 to 50.0 |
Men | 15.0 to 40.0 | |
People with spinal cord injury | Intermittent catheter | 23.0 to 89.0 |
Sphincterotomy and condom catheter | 57.0 | |
People undergoing hemodialysis | 28.0 | |
People with an indwelling urinary catheter | Short-term | 9.0 to 23.0 |
Long-term | 100 |
References
- 1 2 3 4 5 6 Das, K. V. Krishna; Das, KV Krishna (2017). Textbook of Medicine: Two Volume Set. JP Medical Ltd. p. 1250. ISBN 9789386056108.
- 1 2 Sendi, P; Borens, O; Wahl, P; Clauss, M; Uçkay, I (2017). "Management of Asymptomatic Bacteriuria, Urinary Catheters and Symptomatic Urinary Tract Infections in Patients Undergoing Surgery for Joint Replacement: A Position Paper of the Expert Group". Journal of bone and joint infection. 2 (3): 154–159. doi:10.7150/jbji.20425. PMC 5592375. PMID 28894690.
- 1 2 3 4 5 6 "Bacterial Urinary Tract Infections (UTIs)". Merck Manuals Professional Edition. May 2016. Retrieved 12 December 2017.
- 1 2 3 4 5 Köves, B; Cai, T; Veeratterapillay, R; Pickard, R; Seisen, T; Lam, TB; Yuan, CY; Bruyere, F; Wagenlehner, F; Bartoletti, R; Geerlings, SE; Pilatz, A; Pradere, B; Hofmann, F; Bonkat, G; Wullt, B (25 July 2017). "Benefits and Harms of Treatment of Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis by the European Association of Urology Urological Infection Guidelines Panel". European Urology. 72 (6): 865–868. doi:10.1016/j.eururo.2017.07.014. PMID 28754533.
- 1 2 3 4 5 Colgan, R; Nicolle, LE; McGlone, A; Hooton, TM (15 September 2006). "Asymptomatic bacteriuria in adults". American Family Physician. 74 (6): 985–90. PMID 17002033.
- 1 2 Salvatore S, Salvatore S, Cattoni E, Siesto G, Serati M, Sorice P, Torella M (June 2011). "Urinary tract infections in women". European journal of obstetrics, gynecology, and reproductive biology. 156 (2): 131–6. doi:10.1016/j.ejogrb.2011.01.028. PMID 21349630.
- 1 2 Nicolle LE (2008). "Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis". Urol Clin North Am. 35 (1): 1–12, v. doi:10.1016/j.ucl.2007.09.004. PMID 18061019.
- 1 2 Schneeweiss J., Koch M., Umek W. (2016). "The human urinary microbiome and how it relates to urogynecology". Int Urogynecol J. 27 (9): 1307–12. doi:10.1007/s00192-016-2944-5. PMID 26811114.
- ↑ AMDA – The Society for Post-Acute and Long-Term Care Medicine (February 2014), "Ten Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, AMDA – The Society for Post-Acute and Long-Term Care Medicine, retrieved 20 April 2015
- ↑ Smaill, Fiona M.; Vazquez, Juan C. (2015-08-07). "Antibiotics for asymptomatic bacteriuria in pregnancy". The Cochrane Database of Systematic Reviews (8): CD000490. doi:10.1002/14651858.CD000490.pub3. ISSN 1469-493X. PMID 26252501.
- 1 2 Szweda, Hanna; Jóźwik, Marcin (2016). "Urinary tract infections during pregnancy - an updated overview". Developmental Period Medicine. 20 (4): 263–272. ISSN 1428-345X. PMID 28216479.
- 1 2 Detweiler K, Mayers D, Fletcher SG (November 2015). "Bacteruria and Urinary Tract Infections in the Elderly". The Urologic Clinics of North America (Review). 42 (4): 561–8. doi:10.1016/j.ucl.2015.07.002. PMID 26475952.
- ↑ Sam, Amir H.; James T.H. Teo (2010). Rapid Medicine. Wiley-Blackwell. ISBN 978-1-4051-8323-9.
- ↑ Moore, Ainsley; Doull, Marion; Grad, Roland; Groulx, Stéphane; Pottie, Kevin; Tonelli, Marcello; Courage, Susan; Garcia, Alejandra Jaramillo; Thombs, Brett D. (8 July 2018). "Recommendations on screening for asymptomatic bacteriuria in pregnancy". Canadian Medical Association Journal. 190 (27): E823–E830. doi:10.1503/cmaj.171325. PMID 29986858.
- ↑ Ramos, Jorge A.; Salinas, Diego F.; Osorio, Johanna; Ruano-Ravina, Alberto (September 2016). "Antibiotic prophylaxis and its appropriate timing for urological surgical procedures in patients with asymptomatic bacteriuria: A systematic review". Arab Journal of Urology. 14 (3): 234–239. doi:10.1016/j.aju.2016.05.002. ISSN 2090-598X. PMC 4983160. PMID 27547467.
- ↑ Asymptomatic bacteriuria from Medline Plus. Updated May 26, 2006, retrieved January 28, 2008.
- ↑ Nicolle, Lindsay E. (2014). "Urinary Tract Infections in Special Populations". Infectious Disease Clinics of North America. 28 (1): 91–104. doi:10.1016/j.idc.2013.09.006. PMID 24484577.
- ↑ Zalmanovici Trestioreanu, A; Lador, A; Sauerbrun-Cutler, MT; Leibovici, L (8 April 2015). "Antibiotics for asymptomatic bacteriuria". The Cochrane Database of Systematic Reviews. 4: CD009534. doi:10.1002/14651858.CD009534.pub2. PMID 25851268.
External links
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