Bacteriuria
| Bacteriuria | |
|---|---|
Multiple rod-shaped bacteria shown between the larger white blood cells at urinary microscopy from a patient with urinary tract infection.
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| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| MedlinePlus | 000520 |
| Patient UK | Bacteriuria |
In medicine, bacteriuria denotes the presence of bacteria in urine (but not if the bacteria's presence is due to contamination from urine sample collection.)
Overview
Bacteria in the urine, especially gram-negative rods, usually indicate a urinary tract infection (either cystitis or pyelonephritis), although bacteriuria can also occur in prostatitis. Escherichia coli is the most common bacterium isolated from urine samples.
Asymptomatic bacteriuria is bacteriuria without accompanying symptoms of a urinary tract infection (such as frequent urination, painful urination or fever). It is more common in women, in the elderly, in residents of long-term care facilities, and in patients with diabetes, bladder catheters and spinal cord injuries. Patients with a long-term Foley catheter uniformly show bacteriuria.
Chronic asymptomatic bacteriuria without urinary tract infection symptoms is prevalent in as high as 50% of the population in long-term care.[1]
| 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 | |
| Patients with diabetes mellitus | Women | 9.0 to 27.0 |
| Men | 0.7 to 1.0 | |
| Older community-dwelling patients | 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 | |
| Patients with spinal cord injury | Intermittent catheter | 23.0 to 89.0 |
| Sphincterotomy and condom catheter |
57.0 | |
| Patients undergoing hemodialysis | 28.0 | |
| Patients with an indwelling urinary catheter |
Short-term | 9.0 to 23.0 |
| Long-term | 100 | |
Diagnosis
Bacteria can be detected with a urine dipstick test for urinary nitrite or by urinary microscopy, although bacterial culture remains the most specific and formal test (the gold standard).
Per Infectious Disease Society of America guidelines, 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).[3] 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.[3] The threshold is also 100 colony forming units of a single species per millilitre for women displaying UTI symptoms.[4]
Treatment
The presence of simultaneous pyuria does not warrant treatment by itself.
- Screening for asymptomatic bacteriuria with urine culture and treatment with antibiotics is recommended during pregnancy, because it significantly reduces symptomatic urinary tract infections, low birth weight, and preterm delivery.[5][6]
- This has not been proven for older people or people with diabetes, bladder catheters or spinal cord injuries.[7][8]
- Kidney transplant recipients, children with vesicoureteral reflux or others with structural abnormalities of the urinary tract, people with infected kidney stones and those who are having urological procedures might be more likely to benefit from treatment with antibiotics for asymptomatic bacteriuria.[9]
- The overuse of antibiotic therapy to treat asymptomatic bacteriuria leads to an increased risk of diarrhea, resistant organisms and infection due to Clostridium difficile.[1]
See also
References
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- ↑ For information about older people only, Lua error in package.lua at line 80: module 'strict' not found., which cites
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- ↑ Asymptomatic bacteriuria from Medline Plus. Updated May 26, 2006, retrieved January 28, 2008.
