Asymptomatic bacteriuria: Difference between revisions

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{{SI}}
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| [[File:Siren.gif|30px|link=Urinary tract infection resident survival guide]]|| <br> || <br>
| [[File:Siren.gif|link=Urinary tract infection resident survival guide|41x41px]]|| <br> || <br>
| [[Urinary tract infection resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
| [[Urinary tract infection resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{SI}}
'''To view the Urinary Tract Infections main page [[Urinary tract infection|click here]].'''
'''To view the Urinary Tract Infections main page [[Urinary tract infection|click here]].'''


{{CMG}}; {{AE}} {{USAMA}}, {{AK}}
{{CMG}}; {{AE}} {{USAMA}}, {{AK}}, {{SSH}}


==Overview==
==Overview==
 
[[Urine]] is normally sterile. Asymptomatic bacteriuria is a condition in which a significant number of [[bacteria]] appear in the [[urine]], without the presence of typical symptoms of a [[urinary tract infection]]. Presence of >10 [[leukocytes]]/mm³ is considered as [[pyuria]] but not asymptomatic bacteriuria unless the number exceeds  ≥10<sup>5</sup> colony forming units(cfu)/mL. There are two main pathogenesis that might be responsible for asymptomatic bacteriuria which include [[Virulence factor|microbial virulence]] and [[Host factor|host factors]]. ''[[Escherichia coli]]'' is the single most common cause of asymptomatic bacteriuria. Asymptomatic bacteriuria is more common in [[elderly]] and its [[prevalence]] increase with age. Asymptomatic bacteriuria has been slightly more common in black population. Asymptomatic bacteriuria has [[risk factors]] similar to symptomatic bacteriuria such as [[pregnancy]], aging, [[diabetes mellitus]], sexual intercourse, using [[Diaphragm (contraceptive)|diaphragm]] plus [[spermicide]], [[BPH]], [[Kidney stone|renal stones]], or patients with [[spinal cord injuries]], [[hemodialysis]], indwelling [[urethral]] [[catheters]], [[genitourinary]] abnormalities. [[Screening]] for asymptomatic subjects is considered if [[bacteriuria]] is associated with preventable adverse outcomes such as symptomatic [[urinary infection]], progression to [[chronic kidney disease]] or [[hypertension]], development of urinary tract [[cancer]], and decreased duration of survival. If left untreated asymptomatic bacteriuria normally cures on its own and active treatment is not required except in those who are [[pregnant]], require [[renal transplantation]] or are supposed to undergo a [[urinary tract]] procedure. In patients who acquire asymptomatic bacteriuria early in their pregnancy, there is a minute chance of issues related to [[pregnancy]] like [[low birth weight]] etc or [[pyelonephritis]]. Most cases resolve [[postpartum]]. The [[diagnosis]] of bacteriuria in an asymptomatic individual is based on the culture results of [[urine]] collected in a manner that minimizes the possibility of contamination and limits the period between [[sampling]] and testing the specimen to avoid false positivity due to [[bacterial growth]]. Treatment is not required in otherwise healthy individuals unless it is associated with a [[urinary tract infection]]. Conditions that might require the asymptomatic bacteriuria to be treated are [[pregnancy]], before [[Transurethral resection of the prostate|transurethral prostatic resection]], and [[Kidney transplantation|renal transplant]] follow-up.
[[Urine]] is normally sterile. Asymptomatic bacteriuria is a condition in which a significant number of [[bacteria]] appear in the [[urine]], without the presence of typical symptoms of a [[urinary tract infection]]. Examples of such symptoms include [[burning during urination]], [[frequent urination]] ([[frequency]]) and [[urgency]]. Presence of >10 [[leukocytes]]/mm³ is considered as [[pyuria]] but not asymptomatic bacteriuria unless the number exceeds  ≥10<sup>5</sup> colony forming units(cfu)/mL.<ref>http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001548/</ref><ref>{{Cite journal
| author = [[T. M. Hooton]], [[D. Scholes]], [[A. E. Stapleton]], [[P. L. Roberts]], [[C. Winter]], [[K. Gupta]], [[M. Samadpour]] & [[W. E. Stamm]]
| title = A prospective study of asymptomatic bacteriuria in sexually active young women
| journal = [[The New England journal of medicine]]
| volume = 343
| issue = 14
| pages = 992–997
| year = 2000
| month = October
| doi = 10.1056/NEJM200010053431402
| pmid = 11018165
}}</ref>
 
==Definitions==
According to the Infectious Disease Society of America (IDSA), asymptomatic bacteriuria is defined as the presence of  ≥10<sup>5</sup> cfu/mL of [[bacteria]] in clean catch [[Urine|urine specimen]] of an asymptomatic person with respect to symptoms [[urinary tract infection]]. By definition, one positive sample is enough to confirm asymptomatic bacteriuria in men, whereas in women two consecutive samples with same organism are required to diagnose asymptomatic bacteriuria. In men or women who are [[Catheterization|catheterized]] and are asymptomatic, identification of ≥10<sup>2</sup> cfu/mL of a single organism in the [[Catheterization|catheterized]] specimen is defined as asymptomatic bacteriuria.<ref name="Rubin-1992">{{Cite journal  | last1 = Rubin | first1 = RH. | last2 = Shapiro | first2 = ED. | last3 = Andriole | first3 = VT. | last4 = Davis | first4 = RJ. | last5 = Stamm | first5 = WE. | title = Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration. | journal = Clin Infect Dis | volume = 15 Suppl 1 | issue =  | pages = S216-27 | month = Nov | year = 1992 | doi =  | PMID = 1477233 }}</ref><ref name="pmid15714408">{{cite journal| author=Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM et al.| title=Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. | journal=Clin Infect Dis | year= 2005 | volume= 40 | issue= 5 | pages= 643-54 | pmid=15714408 | doi=10.1086/427507 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15714408  }} </ref>


==Historical Perspective==
==Historical Perspective==
*In 1950s, Kass et al. proposed a [[quantitative]] culture method for the [[microbiological]] diagnosis of [[urinary tract infection]]s.<ref name="KASS-1956">{{Cite journal  | last1 = KASS | first1 = EH. | title = Asymptomatic infections of the urinary tract. | journal = Trans Assoc Am Physicians | volume = 69 | issue =  | pages = 56-64 | month =  | year = 1956 | doi =  | PMID = 13380946 }}</ref>
*In 1950s, Kass et al. proposed a [[quantitative]] culture method for the [[microbiological]] diagnosis of [[urinary tract infection]]s.<ref name="KASS-1956">{{Cite journal  | last1 = KASS | first1 = EH. | title = Asymptomatic infections of the urinary tract. | journal = Trans Assoc Am Physicians | volume = 69 | issue =  | pages = 56-64 | month =  | year = 1956 | doi =  | PMID = 13380946 }}</ref>
*About 10<sup>5</sup> bacteria per milliliter must be present in the [[urine]] specimen to be consistently read as positive, which is seen in 95% of samples from patients with [[pyelonephritis]].<ref name="KASS-1957">{{Cite journal  | last1 = KASS | first1 = EH. | title = Bacteriuria and the diagnosis of infections of the urinary tract; with observations on the use of methionine as a urinary antiseptic. | journal = AMA Arch Intern Med | volume = 100 | issue = 5 | pages = 709-14 | month = Nov | year = 1957 | doi =  | PMID = 13468815 }}</ref><ref>{{Cite journal
*About 10<sup>5</sup> bacteria per milliliter must be present in the [[urine]] specimen to be consistently read as positive, which is seen in 95% of samples from patients with [[pyelonephritis]].<ref name="KASS-1957">{{Cite journal  | last1 = KASS | first1 = EH. | title = Bacteriuria and the diagnosis of infections of the urinary tract; with observations on the use of methionine as a urinary antiseptic. | journal = AMA Arch Intern Med | volume = 100 | issue = 5 | pages = 709-14 | month = Nov | year = 1957 | doi =  | PMID = 13468815 }}</ref><ref>{{Cite journal
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  | pmid = 14454174
  | pmid = 14454174
}}</ref>
}}</ref>
==Classification==
According to the Infectious Disease Society of America (IDSA), asymptomatic bacteriuria is defined as the presence of  ≥10<sup>5</sup> cfu/mL of [[bacteria]] in clean catch [[Urine|urine specimen]] of an asymptomatic person with respect to symptoms [[urinary tract infection]]. By definition, one positive sample is enough to confirm asymptomatic bacteriuria in men, whereas in women two consecutive samples with same organism are required to diagnose asymptomatic bacteriuria. In men or women who are [[Catheterization|catheterized]] and are asymptomatic, identification of ≥10<sup>2</sup> cfu/mL of a single organism in the [[Catheterization|catheterized]] specimen is defined as asymptomatic bacteriuria. The [[prevalence]] of [[bacteriuria]] is more in sexually active women (4.6%) as compared to sexually inactive women (0.7%) or men.


==Pathophysiology==
==Pathophysiology==
* There are two main pathogenesis that might be responsible for asymptomatic bacteriuria which include [[Virulence factor|microbial virulence]] and [[Host factor|host factors]].
===[[Virulence factor|Microbial Virulence]]===
===[[Virulence factor|Microbial Virulence]]===
*Symptomatic [[urinary tract infections]] require attachment, multiplication and spread of [[bacteria]] in the [[urinary tract]]. [[Fimbriae]] are very helpful in attachment of the [[bacteria]] inside the [[urinary tract]]. It has been discovered that the pathogenic strains that have a decreased ability of making [[fimbriae]], have a greater ability to multiply and thus are responsible for causing asymptomatic bacteriuria.<ref>{{Cite journal
*Symptomatic [[urinary tract infections]] require attachment, multiplication, and spread of [[bacteria]] in the [[urinary tract]]. [[Fimbriae]] are very helpful in attachment of the [[bacteria]] inside the [[urinary tract]]. It has been discovered that the pathogenic strains that have a decreased ability of making [[fimbriae]], have a greater ability to multiply and thus are responsible for causing asymptomatic bacteriuria.<ref>{{Cite journal
  | author = [[Viktoria Roos]], [[Eva M. Nielsen]] & [[Per Klemm]]
  | author = [[Viktoria Roos]], [[Eva M. Nielsen]] & [[Per Klemm]]
  | title = Asymptomatic bacteriuria Escherichia coli strains: adhesins, growth and competition
  | title = Asymptomatic bacteriuria Escherichia coli strains: adhesins, growth and competition
Line 79: Line 68:
}}</ref>
}}</ref>


===[[Host factor|Host Factors]]===
===Host Factors===
*Another possibility is the defective host response. A decreased [[expression]] of [[Toll-like receptors|Toll-like receptor (TLR) 4]] on the [[neutrophils]] in children with asymptomatic bacteriuria predisposes them to asymptomatic bacteriuria.<ref>{{Cite journal
*Another possibility is the defective host response. A decreased [[expression]] of [[Toll-like receptors|Toll-like receptor (TLR) 4]] on the [[neutrophils]] in children with asymptomatic bacteriuria predisposes them to asymptomatic bacteriuria.<ref>{{Cite journal
  | author = [[Bryndis Ragnarsdottir]], [[Martin Samuelsson]], [[Mattias C. U. Gustafsson]], [[Irene Leijonhufvud]], [[Diana Karpman]] & [[Catharina Svanborg]]
  | author = [[Bryndis Ragnarsdottir]], [[Martin Samuelsson]], [[Mattias C. U. Gustafsson]], [[Irene Leijonhufvud]], [[Diana Karpman]] & [[Catharina Svanborg]]
Line 107: Line 96:


=== Most common organism ===
=== Most common organism ===
''[[Escherichia coli]]'' is the single most common cause of asymptomatic bacteriuria.<ref name="pmid368263‎">{{cite journal| author=Evans DA, Williams DN, Laughlin LW, Miao L, Warren JW, Hennekens CH et al.| title=Bacteriuria in a population-based cohort of women. | journal=J Infect Dis | year= 1978 | volume= 138 | issue= 6 | pages= 768-73 | pmid=368263‎ | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=368263  }} </ref><ref name="pmid4866351">{{cite journal| author=Kunin CM, McCormack RC| title=An epidemiologic study of bacteriuria and blood pressure among nuns and working women. | journal=N Engl J Med | year= 1968 | volume= 278 | issue= 12 | pages= 635-42 | pmid=4866351 | doi=10.1056/NEJM196803212781201 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4866351  }} </ref><ref name="pmid9764457">{{cite journal| author=Bengtsson C, Bengtsson U, Björkelund C, Lincoln K, Sigurdsson JA| title=Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden. | journal=Scand J Urol Nephrol | year= 1998 | volume= 32 | issue= 4 | pages= 284-9 | pmid=9764457 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9764457  }} </ref><ref>{{Cite journal
* ''[[Escherichia coli]]'' is the single most common cause of asymptomatic bacteriuria.<ref name="pmid368263‎">{{cite journal| author=Evans DA, Williams DN, Laughlin LW, Miao L, Warren JW, Hennekens CH et al.| title=Bacteriuria in a population-based cohort of women. | journal=J Infect Dis | year= 1978 | volume= 138 | issue= 6 | pages= 768-73 | pmid=368263‎ | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=368263  }} </ref><ref name="pmid4866351">{{cite journal| author=Kunin CM, McCormack RC| title=An epidemiologic study of bacteriuria and blood pressure among nuns and working women. | journal=N Engl J Med | year= 1968 | volume= 278 | issue= 12 | pages= 635-42 | pmid=4866351 | doi=10.1056/NEJM196803212781201 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4866351  }} </ref><ref name="pmid9764457">{{cite journal| author=Bengtsson C, Bengtsson U, Björkelund C, Lincoln K, Sigurdsson JA| title=Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden. | journal=Scand J Urol Nephrol | year= 1998 | volume= 32 | issue= 4 | pages= 284-9 | pmid=9764457 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9764457  }} </ref><ref>{{Cite journal
  | author = [[Joseph Ayodeji Olamijulo]], [[Chris Olu Adewale]] & [[Olalekan Olaleye]]
  | author = [[Joseph Ayodeji Olamijulo]], [[Chris Olu Adewale]] & [[Olalekan Olaleye]]
  | title = Asymptomatic bacteriuria among antenatal women in Lagos
  | title = Asymptomatic bacteriuria among antenatal women in Lagos
Line 119: Line 108:
  | pmid = 26960990
  | pmid = 26960990
}}</ref>
}}</ref>
 
* Other causes of asymptomatic bacteriuria include:
Other common causes of asymptomatic bacteriuria include:
{|  
{| class="wikitable"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Common Causes
!Common  
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Less Common Causes
Causes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |GU abnormalities & Hospitalization
!Less Common
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Long Term Catheterisation<ref name="pmid9378928">{{cite journal| author=Nicolle LE| title=Asymptomatic bacteriuria in the elderly. | journal=Infect Dis Clin North Am | year= 1997 | volume= 11 | issue= 3 | pages= 647-62 | pmid=9378928 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9378928  }} </ref><ref name="pmid6815281">{{cite journal| author=Warren JW, Tenney JH, Hoopes JM, Muncie HL, Anthony WC| title=A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. | journal=J Infect Dis | year= 1982 | volume= 146 | issue= 6 | pages= 719-23 | pmid=6815281 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6815281  }} </ref>
Causes
!GU abnormalities  
&
Hospitalization
!Long Term Catheterisation<ref name="pmid9378928">{{cite journal| author=Nicolle LE| title=Asymptomatic bacteriuria in the elderly. | journal=Infect Dis Clin North Am | year= 1997 | volume= 11 | issue= 3 | pages= 647-62 | pmid=9378928 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9378928  }} </ref><ref name="pmid6815281">{{cite journal| author=Warren JW, Tenney JH, Hoopes JM, Muncie HL, Anthony WC| title=A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. | journal=J Infect Dis | year= 1982 | volume= 146 | issue= 6 | pages= 719-23 | pmid=6815281 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6815281  }} </ref>
|-
|-
|[[Enterococcus]]<ref>{{Cite journal
| align="center" style="background:#F5F5F5;" + |[[Enterococcus|''Enterococcus'']]<ref>{{Cite journal
  | author = [[A.-K. Labi]], [[A. E. Yawson]], [[G. Y. Ganyaglo]] & [[M. J. Newman]]
  | author = [[A.-K. Labi]], [[A. E. Yawson]], [[G. Y. Ganyaglo]] & [[M. J. Newman]]
  | title = Prevalence and Associated Risk Factors of Asymptomatic Bacteriuria in Ante-Natal Clients in a Large Teaching Hospital in Ghana
  | title = Prevalence and Associated Risk Factors of Asymptomatic Bacteriuria in Ante-Natal Clients in a Large Teaching Hospital in Ghana
Line 142: Line 126:
  | pmid = 26693190
  | pmid = 26693190
}}</ref>
}}</ref>
|[[Chromobacterium violaceum|Chromobacterium violaceum]]<ref>{{Cite journal
| align="center" style="background:#F5F5F5;" + |[[Chromobacterium violaceum|Chromobacterium violaceum]]<ref>{{Cite journal
  | author = [[Narayan Dutt Pant]], [[Manisha Sharma]] & [[Saroj Khatiwada]]
  | author = [[Narayan Dutt Pant]], [[Manisha Sharma]] & [[Saroj Khatiwada]]
  | title = Asymptomatic Bacteriuria Caused by Chromobacterium violaceum in an Immunocompetent Adult
  | title = Asymptomatic Bacteriuria Caused by Chromobacterium violaceum in an Immunocompetent Adult
Line 152: Line 136:
  | doi = 10.1155/2015/652036
  | doi = 10.1155/2015/652036
  | pmid = 26504464
  | pmid = 26504464
}}</ref>
}}</ref>''
| rowspan="2" |[[E.Coli|E.Coli]]<ref name="pmid9378928">{{cite journal| author=Nicolle LE| title=Asymptomatic bacteriuria in the elderly. | journal=Infect Dis Clin North Am | year= 1997 | volume= 11 | issue= 3 | pages= 647-62 | pmid=9378928 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9378928  }} </ref><ref>{{Cite journal
| align="center" style="background:#F5F5F5;" + |[[Escherichia coli|E.coli]]<ref name="pmid9378928">{{cite journal| author=Nicolle LE| title=Asymptomatic bacteriuria in the elderly. | journal=Infect Dis Clin North Am | year= 1997 | volume= 11 | issue= 3 | pages= 647-62 | pmid=9378928 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9378928  }} </ref><ref>{{Cite journal
  | author = [[Joseph Ayodeji Olamijulo]], [[Chris Olu Adewale]] & [[Olalekan Olaleye]]
  | author = [[Joseph Ayodeji Olamijulo]], [[Chris Olu Adewale]] & [[Olalekan Olaleye]]
  | title = Asymptomatic bacteriuria among antenatal women in Lagos
  | title = Asymptomatic bacteriuria among antenatal women in Lagos
Line 164: Line 148:
  | doi = 10.3109/01443615.2016.1148675
  | doi = 10.3109/01443615.2016.1148675
  | pmid = 26960990
  | pmid = 26960990
}}</ref>
}}</ref>''
|[[Pseudomonas aeruginosa]]
| align="center" style="background:#F5F5F5;" + |[[Pseudomonas aeruginosa|''Pseudomonas aeruginosa'']]
|-
|-
|[[Enterobacteriaceae]]<ref>{{Cite journal
| align="center" style="background:#F5F5F5;" + |[[Enterobacteriaceae]]<ref>{{Cite journal
  | author = [[A.-K. Labi]], [[A. E. Yawson]], [[G. Y. Ganyaglo]] & [[M. J. Newman]]
  | author = [[A.-K. Labi]], [[A. E. Yawson]], [[G. Y. Ganyaglo]] & [[M. J. Newman]]
  | title = Prevalence and Associated Risk Factors of Asymptomatic Bacteriuria in Ante-Natal Clients in a Large Teaching Hospital in Ghana
  | title = Prevalence and Associated Risk Factors of Asymptomatic Bacteriuria in Ante-Natal Clients in a Large Teaching Hospital in Ghana
Line 178: Line 162:
  | pmid = 26693190
  | pmid = 26693190
}}</ref>
}}</ref>
|[[Staphylococci]]<ref>{{Cite journal
| align="center" style="background:#F5F5F5;" + |[[Staphylococci]]<ref>{{Cite journal
  | author = [[A. P. Roberts]] & [[R. Phillips]]
  | author = [[A. P. Roberts]] & [[R. Phillips]]
  | title = Bacteria causing symptomatic urinary tract infection or asymptomatic bacteriuria
  | title = Bacteria causing symptomatic urinary tract infection or asymptomatic bacteriuria
Line 188: Line 172:
  | month = May
  | month = May
  | pmid = 381327
  | pmid = 381327
}}</ref>
}}</ref>''
|[[P. mirabilis]]
| align="center" style="background:#F5F5F5;" + |[[Proteus mirabilis|Proteus mirabilis]]<ref name="pmid9378928" /><ref>{{Cite journal
|-
|[[Klebsiella]]<ref>{{Cite journal
  | author = [[Joseph Ayodeji Olamijulo]], [[Chris Olu Adewale]] & [[Olalekan Olaleye]]
  | author = [[Joseph Ayodeji Olamijulo]], [[Chris Olu Adewale]] & [[Olalekan Olaleye]]
  | title = Asymptomatic bacteriuria among antenatal women in Lagos
  | title = Asymptomatic bacteriuria among antenatal women in Lagos
Line 202: Line 184:
  | doi = 10.3109/01443615.2016.1148675
  | doi = 10.3109/01443615.2016.1148675
  | pmid = 26960990
  | pmid = 26960990
}}</ref>
}}</ref>''
|[[Gardnerella vaginalis|Gardnerella vaginalis]]<ref name="pmid6695949">{{cite journal| author=Lipsky BA, Inui TS, Plorde JJ, Berger RE| title=Is the clean-catch midstream void procedure necessary for obtaining urine culture specimens from men? | journal=Am J Med | year= 1984 | volume= 76 | issue= 2 | pages= 257-62 | pmid=6695949 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6695949  }} </ref><ref name="pmid2246458">{{cite journal| author=Mims AD, Norman DC, Yamamura RH, Yoshikawa TT| title=Clinically inapparent (asymptomatic) bacteriuria in ambulatory elderly men: epidemiological, clinical, and microbiological findings. | journal=J Am Geriatr Soc | year= 1990 | volume= 38 | issue= 11 | pages= 1209-14 | pmid=2246458 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2246458  }} </ref>
| align="center" style="background:#F5F5F5;" + |[[P. mirabilis|''P. mirabilis'']]
|[[Proteus mirabilis|Proteus mirabilis]]<ref name="pmid9378928">{{cite journal| author=Nicolle LE| title=Asymptomatic bacteriuria in the elderly. | journal=Infect Dis Clin North Am | year= 1997 | volume= 11 | issue= 3 | pages= 647-62 | pmid=9378928 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9378928  }} </ref><ref>{{Cite journal
|-
| align="center" style="background:#F5F5F5;" + |[[Klebsiella]]<ref>{{Cite journal
  | author = [[Joseph Ayodeji Olamijulo]], [[Chris Olu Adewale]] & [[Olalekan Olaleye]]
  | author = [[Joseph Ayodeji Olamijulo]], [[Chris Olu Adewale]] & [[Olalekan Olaleye]]
  | title = Asymptomatic bacteriuria among antenatal women in Lagos
  | title = Asymptomatic bacteriuria among antenatal women in Lagos
Line 215: Line 198:
  | doi = 10.3109/01443615.2016.1148675
  | doi = 10.3109/01443615.2016.1148675
  | pmid = 26960990
  | pmid = 26960990
}}</ref>
}}</ref>''
|[[Providencia stuartii]]
| align="center" style="background:#F5F5F5;" + |[[Gardnerella vaginalis|Gardnerella vaginalis]]<ref name="pmid6695949">{{cite journal| author=Lipsky BA, Inui TS, Plorde JJ, Berger RE| title=Is the clean-catch midstream void procedure necessary for obtaining urine culture specimens from men? | journal=Am J Med | year= 1984 | volume= 76 | issue= 2 | pages= 257-62 | pmid=6695949 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6695949  }} </ref><ref name="pmid2246458">{{cite journal| author=Mims AD, Norman DC, Yamamura RH, Yoshikawa TT| title=Clinically inapparent (asymptomatic) bacteriuria in ambulatory elderly men: epidemiological, clinical, and microbiological findings. | journal=J Am Geriatr Soc | year= 1990 | volume= 38 | issue= 11 | pages= 1209-14 | pmid=2246458 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2246458  }} </ref>''
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |[[Providencia stuartii|''Providencia stuartii'']]
|-
|-
|[[Pseudomonas aeruginosa|Pseudomonas aeruginosa]]<ref>{{Cite journal
| align="center" style="background:#F5F5F5;" + |[[Pseudomonas aeruginosa|Pseudomonas aeruginosa]]<ref>{{Cite journal
  | author = [[Richard Colgan]], [[Lindsay E. Nicolle]], [[Andrew McGlone]] & [[Thomas M. Hooton]]
  | author = [[Richard Colgan]], [[Lindsay E. Nicolle]], [[Andrew McGlone]] & [[Thomas M. Hooton]]
  | title = Asymptomatic bacteriuria in adults
  | title = Asymptomatic bacteriuria in adults
Line 228: Line 213:
  | month = September
  | month = September
  | pmid = 17002033
  | pmid = 17002033
}}</ref>
}}</ref>''
| rowspan="2" |[[Elizabethkingia meningoseptica|Elizabethkingia meningoseptica]]<ref>{{Cite journal
| align="center" style="background:#F5F5F5;" + |[[Elizabethkingia meningoseptica|Elizabethkingia meningoseptica]]<ref>{{Cite journal
  | author = [[Zhiyong Zong]]
  | author = [[Zhiyong Zong]]
  | title = Elizabethkingia meningoseptica as an unusual pathogen causing healthcare-associated bacteriuria
  | title = Elizabethkingia meningoseptica as an unusual pathogen causing healthcare-associated bacteriuria
Line 239: Line 224:
  | month =  
  | month =  
  | pmid = 25130129
  | pmid = 25130129
}}</ref>
}}</ref>''
|
| align="center" style="background:#F5F5F5;" + |
|[[Morganella morganii]]  
| align="center" style="background:#F5F5F5;" + |[[Morganella morganii|''Morganella morganii'']]  
|-
|-
|[[Group B Streptococcus]]<ref>{{Cite journal
| align="center" style="background:#F5F5F5;" + |[[Group B Streptococcus]]<ref>{{Cite journal
  | author = [[Richard Colgan]], [[Lindsay E. Nicolle]], [[Andrew McGlone]] & [[Thomas M. Hooton]]
  | author = [[Richard Colgan]], [[Lindsay E. Nicolle]], [[Andrew McGlone]] & [[Thomas M. Hooton]]
  | title = Asymptomatic bacteriuria in adults
  | title = Asymptomatic bacteriuria in adults
Line 263: Line 248:
  | doi = 10.1155/2015/652036
  | doi = 10.1155/2015/652036
  | pmid = 26504464
  | pmid = 26504464
}}</ref>
}}</ref>''
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|}
|}


==Differentiating Asymptomatic Bacteriuria From Other Diseases==
==Differentiating Asymptomatic Bacteriuria From Other Diseases==
===[[UTI]]===
Asymptomatic Bacteriuria must be differentiated from other diseases that might cause bacteriuria.<ref name="WiseLongo2015">{{cite journal|last1=Wise|first1=Gilbert J.|last2=Longo|first2=Dan L.|last3=Schlegel|first3=Peter N.|title=Sterile Pyuria|journal=New England Journal of Medicine|volume=372|issue=11|year=2015|pages=1048–1054|issn=0028-4793|doi=10.1056/NEJMra1410052}}</ref><ref name="Stamm1983">{{cite journal|last1=Stamm|first1=Walter E.|title=Measurement of pyuria and its relation to bacteriuria|journal=The American Journal of Medicine|volume=75|issue=1|year=1983|pages=53–58|issn=00029343|doi=10.1016/0002-9343(83)90073-6}}</ref><ref name="GroahPerez-Losada2015">{{cite journal|last1=Groah|first1=Suzanne|last2=Perez-Losada|first2=Marcos|last3=Caldovic|first3=Ljubica|last4=Ljungberg|first4=Inger|last5=Sprague|first5=Bruce|last6=Castro-Nallar|first6=Eduardo|last7=Shah|first7=Neel|last8=Hsieh|first8=Michael|last9=Pohl|first9=Hans|title=MP20-08 PYURIA AND ASYMPTOMATIC BACTERIURIA IS ASSOCIATED WITH NOVEL AND SPECIFIC URINE MICROBIOMES|journal=The Journal of Urology|volume=193|issue=4|year=2015|pages=e226|issn=00225347|doi=10.1016/j.juro.2015.02.980}}</ref><ref name="ShaikhShope2016">{{cite journal|last1=Shaikh|first1=N.|last2=Shope|first2=T. R.|last3=Hoberman|first3=A.|last4=Vigliotti|first4=A.|last5=Kurs-Lasky|first5=M.|last6=Martin|first6=J. M.|title=Association Between Uropathogen and Pyuria|journal=PEDIATRICS|volume=138|issue=1|year=2016|pages=e20160087–e20160087|issn=0031-4005|doi=10.1542/peds.2016-0087}}</ref>
As the name signifies, asymptomatic bacteriuria has no symptomatic presentation. It can be easily differentiated from other [[urinary tract infections]] in that they are identified by the presence of [[urinary symptoms]] including [[dysuria]], [[hematuria]], [[urgency]], [[frequency]] and [[flank pain]]. [[Fever]] is also an important finding accompanying other [[urinary tract infections]].


===[[Pyuria]]===
'''To review differential diagnosis of pyuria, click [[Pyuria#Pyuria Differential Diagnosis|here]].'''
Asymptomatic bacteriuria should be differentiated from [[pyuria]], which also signifies presence of an [[inflammatory response]]. [[Pyuria]] is the presence of excessive [[leukocytes]] in the [[urine]]. Less than 5 [[leukocytes]] are a normal finding in the [[urine]] whereas >15 [[leukocytes]] per 400x microscopic field in the urine sample are considered to be [[pyuria]]. [[Pyuria]] is not defined on the basis of colony forming units of the organism but exclusive on the number of [[leukocytes]]. [[Pyuria]] usually accompanies asymptomatic bacteriuria.<ref name="Stamm-1983">{{Cite journal | last1 = Stamm | first1 = WE. | title = Measurement of pyuria and its relation to bacteriuria. | journal = Am J Med | volume = 75 | issue = 1B | pages = 53-8 | month = Jul | year = 1983 | doi = | PMID = 6349345 }}</ref>
 
'''To review differential diagnosis of sterile pyuria, click [[Sterile pyuria differential diagnosis|here]].'''
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="5" |Category
! colspan="3" rowspan="5" |Disease
! colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestations
! colspan="8" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para−clinical findings
! colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard for diagnosis
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! colspan="7" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |N/V
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinary symptoms
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Electrolytes
! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinalysis
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urgency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gross hematuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cell
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cast
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bacteriuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Culture
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
|-
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infectious diseases
! rowspan="4" align="center" style="background:#DCDCDC;" + |[[Urinary tract infection|UTI]]<ref name="pmid18061020">{{cite journal |vauthors=Neal DE |title=Complicated urinary tract infections |journal=Urol. Clin. North Am. |volume=35 |issue=1 |pages=13–22; v |date=February 2008 |pmid=18061020 |doi=10.1016/j.ucl.2007.09.010 |url=}}</ref>
! rowspan="3" align="center" style="background:#DCDCDC;" + |[[Bacteria|Bacterial]]
! align="center" style="background:#DCDCDC;" + |[[Asymptomatic bacteriuria]]<ref name="Nicolle2014">{{cite journal|last1=Nicolle|first1=Lindsay E.|title=Asymptomatic bacteriuria|journal=Current Opinion in Infectious Diseases|volume=27|issue=1|year=2014|pages=90–96|issn=0951-7375|doi=10.1097/QCO.0000000000000019}}</ref><ref name="Nicolle2015">{{cite journal|last1=Nicolle|first1=Lindsay E.|title=Asymptomatic Bacteriuria and Bacterial Interference|journal=Microbiology Spectrum|volume=3|issue=5|year=2015|issn=2165-0497|doi=10.1128/microbiolspec.UTI-0001-2012}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Urine|Urinalysis]]
| align="left" style="background:#F5F5F5;" + |
*Increased risk in [[pregnancy]]
*Must be treated prior to an invasive urologic procedure
|-
! align="center" style="background:#DCDCDC;" + |[[Cystitis]]<ref name="pmid28613784">{{cite journal |vauthors=Sabih A, Leslie SW |title= |journal= |volume= |issue= |pages= |date= |pmid=28613784 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
*[[Nitrite]] +
*[[Leukocyte esterase]] +
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Urine|Urinalysis]]
| align="center" style="background:#F5F5F5;" + |NA
|-
! align="center" style="background:#DCDCDC;" + |[[Pyelonephritis]]<ref name="pmid28087935">{{cite journal |vauthors=Pietrucha-Dilanchian P, Hooton TM |title=Diagnosis, Treatment, and Prevention of Urinary Tract Infection |journal=Microbiol Spectr |volume=4 |issue=6 |pages= |date=December 2016 |pmid=28087935 |doi=10.1128/microbiolspec.UTI-0021-2015 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |WBC cast
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
*[[Nitrite]] +
*[[Leukocyte esterase]] +
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Urine|urinalysis]]
| align="center" style="background:#F5F5F5;" + |NA
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Prostatitis]]<ref name="pmid23519458">{{cite journal |vauthors=Wagenlehner FM, Pilatz A, Bschleipfer T, Diemer T, Linn T, Meinhardt A, Schagdarsurengin U, Dansranjavin T, Schuppe HC, Weidner W |title=Bacterial prostatitis |journal=World J Urol |volume=31 |issue=4 |pages=711–6 |date=August 2013 |pmid=23519458 |doi=10.1007/s00345-013-1055-x |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | Pelvic or perineal pain
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |
*Dribbling of urine
*Firm and tender [[prostate]]
| align="center" style="background:#F5F5F5;" + |
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |
*Cloudy urine
*Positive [[Gram staining|gram stain]]
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Urine|urinalysis]]
| align="center" style="background:#F5F5F5;" + |
*Increased risk of [[bacteremia]], prostatic abscess, and metastatic infection
*Might be acute or chronic infection
|-
! colspan="3" align="center" style="background:#DCDCDC;" + |[[Balanitis]]<ref name="pmid25596845">{{cite journal |vauthors=Hsu CY, Lin CL, Kao CH |title=Balanitis is a risk factor for herpes zoster |journal=Eur. J. Clin. Microbiol. Infect. Dis. |volume=34 |issue=5 |pages=985–90 |date=May 2015 |pmid=25596845 |doi=10.1007/s10096-015-2314-0 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Penile pain
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Pruritus]]
*Erythematous lesions on the glans and/or the foreskin
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |
*Associated with [[reactive arthritis]]
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Non−infectious diseases
! align="center" style="background:#DCDCDC;" + |[[Urinary tract|Urinary tract disorders]]
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Urinary catheter|Urinary catheterization]]<ref name="ForsterHaslam2017">{{cite journal|last1=Forster|first1=C.S.|last2=Haslam|first2=D.B.|last3=Jackson|first3=E.|last4=Goldstein|first4=S.L.|title=Utility of a routine urinalysis in children who require clean intermittent catheterization|journal=Journal of Pediatric Urology|volume=13|issue=5|year=2017|pages=488.e1–488.e5|issn=14775131|doi=10.1016/j.jpurol.2017.01.016}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
*[[Leukocytosis]] ±
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Leukocyte esterase]] ±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Urine|urinalysis]]
| align="left" style="background:#F5F5F5;" + |
*Predicting [[Urinary tract infection|UTI]] in children who required clean intermittent [[Catheter|catheterization]] by routine [[Urine|urinalysis]]
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |N/V
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urgency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gross hematuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other PE
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Electrolytes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cell
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cast
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bacteriuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Culture
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other UA findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard for diagnosis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|}


==Epidemiology==
==Epidemiology and Demographics==


===Prevalance===
===Prevalance===
*The [[prevalence]] of [[bacteriuria]] is more in sexually active [[women]] (4.6%) as compared to sexually inactive [[women]] (0.7%).<ref>{{Cite journal
*The [[prevalence]] of [[bacteriuria]] is more in sexually active women (4.6%) as compared to sexually inactive women (0.7%).<ref>{{Cite journal
  | author = [[C. M. Kunin]] & [[R. C. McCormack]]
  | author = [[C. M. Kunin]] & [[R. C. McCormack]]
  | title = An epidemiologic study of bacteriuria and blood pressure among nuns and working women
  | title = An epidemiologic study of bacteriuria and blood pressure among nuns and working women
Line 290: Line 483:
  | pmid = 4866351
  | pmid = 4866351
}}</ref>
}}</ref>
*The [[prevalence]] of [[bacteriuria]] in [[women]] increase with age.<ref>{{Cite journal
*Asymptomatic bacteriuria has a [[prevalence]] of 8-14% in [[diabetic]] [[women]].<ref>{{Cite journal
| author = [[G. G. Zhanel]], [[L. E. Nicolle]] & [[G. K. Harding]]
| title = Prevalence of asymptomatic bacteriuria and associated host factors in women with diabetes mellitus. The Manitoba Diabetic Urinary Infection Study Group
| journal = [[Clinical infectious diseases : an official publication of the Infectious Diseases Society of America]]
| volume = 21
| issue = 2
| pages = 316–322
| year = 1995
| month = August
| pmid = 8562738
}}</ref>
 
===Age===
*Asymptomatic bacteriuria is more common in [[elderly]] and its [[prevalence]] increase with age.<ref>{{Cite journal
  | author = [[Lindsay E. Nicolle]]
  | author = [[Lindsay E. Nicolle]]
  | title = Asymptomatic bacteriuria: when to screen and when to treat
  | title = Asymptomatic bacteriuria: when to screen and when to treat
Line 300: Line 506:
  | month = June
  | month = June
  | pmid = 12848475
  | pmid = 12848475
}}</ref>
}}</ref><ref>{{Cite journal
 
===Age===
*Asymptomatic bacteriuria is more common in [[elderly]] and its [[prevalence]] increase with age.<ref>{{Cite journal
  | author = [[Lindsay E. Nicolle]]
  | author = [[Lindsay E. Nicolle]]
  | title = Asymptomatic bacteriuria: when to screen and when to treat
  | title = Asymptomatic bacteriuria: when to screen and when to treat
Line 314: Line 517:
  | pmid = 12848475
  | pmid = 12848475
}}</ref>
}}</ref>
*The [[prevalence]] of asymptomatic bacteriuria in [[women]] greater than 80 years old is >20%.<ref>{{Cite journal
*The [[prevalence]] of asymptomatic bacteriuria in women greater than 80 years old is >20%.<ref>{{Cite journal
  | author = [[T. M. Hooton]], [[D. Scholes]], [[A. E. Stapleton]], [[P. L. Roberts]], [[C. Winter]], [[K. Gupta]], [[M. Samadpour]] & [[W. E. Stamm]]
  | author = [[T. M. Hooton]], [[D. Scholes]], [[A. E. Stapleton]], [[P. L. Roberts]], [[C. Winter]], [[K. Gupta]], [[M. Samadpour]] & [[W. E. Stamm]]
  | title = A prospective study of asymptomatic bacteriuria in sexually active young women
  | title = A prospective study of asymptomatic bacteriuria in sexually active young women
Line 336: Line 539:
  | pmid = 26542046
  | pmid = 26542046
}}</ref>
}}</ref>
*The [[prevalence]] of asymptomatic bacteriuria in [[men]] greater than 75 year old is 6 to 15%.<ref>{{Cite journal
*The [[prevalence]] of asymptomatic bacteriuria in men greater than 75 year old is 6-15%.<ref>{{Cite journal
  | author = [[Lindsay E. Nicolle]]
  | author = [[Lindsay E. Nicolle]]
  | title = Asymptomatic bacteriuria: when to screen and when to treat
  | title = Asymptomatic bacteriuria: when to screen and when to treat
Line 347: Line 550:
  | pmid = 12848475
  | pmid = 12848475
}}</ref>
}}</ref>
*Asymptomatic bacteriuria is present in 3-5% of the [[women]] population between 38-60 years of age. It was identified in 5% of women in universities and 6% of [[women]] in groups related to health maintenance organisations.<ref>{{Cite journal
*Asymptomatic bacteriuria is present in 3-5% of the women population between 38-60 years of age. It was identified in 5% of women in universities and 6% of [[women]] in groups related to health maintenance organisations.<ref>{{Cite journal
  | author = [[C. Bengtsson]], [[U. Bengtsson]], [[C. Bjorkelund]], [[K. Lincoln]] & [[J. A. Sigurdsson]]
  | author = [[C. Bengtsson]], [[U. Bengtsson]], [[C. Bjorkelund]], [[K. Lincoln]] & [[J. A. Sigurdsson]]
  | title = Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden
  | title = Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden
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===Gender===
===Gender===
*Asymptomatic bacteriuria is more prevalent in [[females]] as compared to [[males]]. Asymptomatic bacteriuria is rare among healthy [[men]].<ref>{{Cite journal
*Asymptomatic bacteriuria is more prevalent in [[females]] as compared to [[males]].  
*Asymptomatic bacteriuria is rare among healthy men.<ref>{{Cite journal
  | author = [[C. M. Kunin]] & [[R. C. McCormack]]
  | author = [[C. M. Kunin]] & [[R. C. McCormack]]
  | title = An epidemiologic study of bacteriuria and blood pressure among nuns and working women
  | title = An epidemiologic study of bacteriuria and blood pressure among nuns and working women
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  | month = January
  | month = January
  | pmid = 2462391
  | pmid = 2462391
}}</ref>
*Asymptomatic bacteriuria has a [[prevalence]] of 8 to 14% in [[diabetic]] [[women]].<ref>{{Cite journal
| author = [[G. G. Zhanel]], [[L. E. Nicolle]] & [[G. K. Harding]]
| title = Prevalence of asymptomatic bacteriuria and associated host factors in women with diabetes mellitus. The Manitoba Diabetic Urinary Infection Study Group
| journal = [[Clinical infectious diseases : an official publication of the Infectious Diseases Society of America]]
| volume = 21
| issue = 2
| pages = 316–322
| year = 1995
| month = August
| pmid = 8562738
}}</ref>
}}</ref>


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*[[Renal stones]]
*[[Renal stones]]
*[[Pregnant|Pregnancy]]<ref name="Nicolle-2003">{{Cite journal  | last1 = Nicolle | first1 = LE. | title = Asymptomatic bacteriuria: when to screen and when to treat. | journal = Infect Dis Clin North Am | volume = 17 | issue = 2 | pages = 367-94 | month = Jun | year = 2003 | doi =  | PMID = 12848475 }}</ref>  
*[[Pregnant|Pregnancy]]<ref name="Nicolle-2003">{{Cite journal  | last1 = Nicolle | first1 = LE. | title = Asymptomatic bacteriuria: when to screen and when to treat. | journal = Infect Dis Clin North Am | volume = 17 | issue = 2 | pages = 367-94 | month = Jun | year = 2003 | doi =  | PMID = 12848475 }}</ref>  
*[[Elderly]] <ref name="Nicolle-2003">{{Cite journal  | last1 = Nicolle | first1 = LE. | title = Asymptomatic bacteriuria: when to screen and when to treat. | journal = Infect Dis Clin North Am | volume = 17 | issue = 2 | pages = 367-94 | month = Jun | year = 2003 | doi =  | PMID = 12848475 }}</ref>
*[[Elderly]]  
*[[diabetes|Diabetes mellitus]]<ref name="Zhanel-">{{Cite journal  | last1 = Zhanel | first1 = GG. | last2 = Harding | first2 = GK. | last3 = Nicolle | first3 = LE. | title = Asymptomatic bacteriuria in patients with diabetes mellitus. | journal = Rev Infect Dis | volume = 13 | issue = 1 | pages = 150-4 | month =  | year =  | doi =  | PMID = 2017615 }}</ref>  
*[[diabetes|Diabetes mellitus]]<ref name="Zhanel-">{{Cite journal  | last1 = Zhanel | first1 = GG. | last2 = Harding | first2 = GK. | last3 = Nicolle | first3 = LE. | title = Asymptomatic bacteriuria in patients with diabetes mellitus. | journal = Rev Infect Dis | volume = 13 | issue = 1 | pages = 150-4 | month =  | year =  | doi =  | PMID = 2017615 }}</ref>  
*Patients with [[spinal cord injuries]]<ref name="Nicolle-1997">{{Cite journal  | last1 = Nicolle | first1 = LE. | title = Asymptomatic bacteriuria in the elderly. | journal = Infect Dis Clin North Am | volume = 11 | issue = 3 | pages = 647-62 | month = Sep | year = 1997 | doi =  | PMID = 9378928 }}</ref><ref name="Waites-1993">{{Cite journal  | last1 = Waites | first1 = KB. | last2 = Canupp | first2 = KC. | last3 = DeVivo | first3 = MJ. | title = Epidemiology and risk factors for urinary tract infection following spinal cord injury. | journal = Arch Phys Med Rehabil | volume = 74 | issue = 7 | pages = 691-5 | month = Jul | year = 1993 | doi =  | PMID = 8328888 }}</ref>  
*Patients with [[spinal cord injuries]]<ref name="Nicolle-1997">{{Cite journal  | last1 = Nicolle | first1 = LE. | title = Asymptomatic bacteriuria in the elderly. | journal = Infect Dis Clin North Am | volume = 11 | issue = 3 | pages = 647-62 | month = Sep | year = 1997 | doi =  | PMID = 9378928 }}</ref><ref name="Waites-1993">{{Cite journal  | last1 = Waites | first1 = KB. | last2 = Canupp | first2 = KC. | last3 = DeVivo | first3 = MJ. | title = Epidemiology and risk factors for urinary tract infection following spinal cord injury. | journal = Arch Phys Med Rehabil | volume = 74 | issue = 7 | pages = 691-5 | month = Jul | year = 1993 | doi =  | PMID = 8328888 }}</ref>  
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}}</ref>
}}</ref>


== Natural History, Complications and Prognosis==
== Screening==
[[Screening]] for asymptomatic subjects is considered if [[bacteriuria]] is associated with preventable adverse outcomes such as symptomatic [[urinary infection]], progression to [[chronic kidney disease]] or [[hypertension]], development of urinary tract [[cancer]], and decreased duration of survival.<ref name="pmid15714408">{{cite journal| author=Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM et al.| title=Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. | journal=Clin Infect Dis | year= 2005 | volume= 40 | issue= 5 | pages= 643-54 | pmid=15714408 | doi=10.1086/427507 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15714408  }} </ref>
 
===Individuals requiring screening===
The following should be screened for asymptomatic bacteriuria:<ref>{{Cite journal
| author = [[Kenneth Lin]] & [[Kevin Fajardo]]
| title = Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement
| journal = [[Annals of internal medicine]]
| volume = 149
| issue = 1
| pages = W20–W24
| year = 2008
| month = July
| pmid = 18591632
}}</ref><ref name="Asymptomatic bacteriuria" />
*[[Pregnant]]
*Requiring [[urologic procedures]] like [[transurethral resection of the prostate]] ([[TURP]])
*Post [[renal transplant]]
===Catheter Associated Asymptomatic Bacteriuria===
It is not recommended to [[Screening|screen]] for or treat asymptomatic bacteriuria or fungiuria for short or long term [[catheters]], exceptions are [[Catheterization|catheterized]] [[pregnant]] women and women with persistent [[bacteriuria]] 48 hours after removal of the [[Urethral catheterization|urethral catheter]]. Prophylaxis can also be used also with patients undergoing urological procedures.<ref name="Nicolle-2005">{{Cite journal  | last1 = Nicolle | first1 = LE. | last2 = Bradley | first2 = S. | last3 = Colgan | first3 = R. | last4 = Rice | first4 = JC. | last5 = Schaeffer | first5 = A. | last6 = Hooton | first6 = TM. | title = Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. | journal = Clin Infect Dis | volume = 40 | issue = 5 | pages = 643-54 | month = Mar | year = 2005 | doi = 10.1086/427507 | PMID = 15714408 }}</ref><ref name="Sobel-2000">{{Cite journal  |last1 = Sobel | first1 = JD. | last2 = Kauffman | first2 = CA. | last3 = McKinsey | first3 = D. | last4 = Zervos | first4 = M. | last5 = Vazquez | first5 = JA. |last6 = Karchmer | first6 = AW. | last7 = Lee | first7 = J. | last8 = Thomas | first8 = C. | last9 = Panzer | first9 = H. | title = Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group.| journal = Clin Infect Dis | volume = 30 | issue = 1 | pages = 19-24 | month = Jan | year = 2000 | doi = 10.1086/313580 | PMID = 10619727 }}</ref>
 
*No benefit of therapy of asymptomatic bacteriuria due to similar recurrence rates with more [[Drug resistance|resistance]] to [[antibiotics]].<ref name="Warren-1982">{{Cite journal  |last1 = Warren | first1 = JW. | last2 = Anthony | first2 = WC. | last3 = Hoopes | first3 = JM. | last4 = Muncie | first4 = HL. | title = Cephalexin for susceptible bacteriuria in afebrile, long-term catheterized patients. | journal = JAMA | volume = 248 | issue = 4 | pages = 454-8 | month = Jul | year = 1982|doi =  | PMID = 7045440 }}</ref><ref name="Alling-1975">{{Cite journal  | last1 = Alling | first1 = B. | last2 = Brandberg | first2 = A. | last3 = Seeberg|first3 = S. | last4 = Svanborg | first4 = A. | title = Effect of consecutive antibacterial therapy on bacteriuria in hospitalized geriatric patients. | journal = Scand J Infect Dis | volume = 7 | issue = 3 | pages = 201-7 | month =  | year = 1975 | doi =  | PMID = 809837 }}</ref>
*Significant improvement has been shown with women treated for [[bacteriuria]] that existed 48 hours after removal of indwelling [[Urethral catheterization|urethral catheters]].<ref name="Harding-1991">{{Cite journal  | last1 = Harding | first1 = GK. | last2 = Nicolle | first2 = LE. | last3 = Ronald | first3 = AR. | last4 = Preiksaitis|first4 = JK. | last5 = Forward | first5 = KR. | last6 = Low | first6 = DE. | last7 = Cheang | first7 = M. | title = How long should catheter-acquired urinary tract infection in women be treated? A randomized controlled study. | journal = Ann Intern Med | volume = 114 | issue = 9 | pages = 713-9 | month = May | year = 1991 | doi =  | PMID = 2012351 }}</ref>
 
== Natural History, Complications, and Prognosis==
===Natural History===
===Natural History===
*If left untreated asymptomatic bacteriuria normally cures on its own and active treatment is not required except in those who are [[pregnant]], require [[renal transplantation]] or are supposed to undergo a [[urinary tract]] procedure. Asymptomatic bacteriuria should also be treated in the presence of a structural defect of the [[urinary tract]].<ref name= "Asymptomatic bacteriuria"> USPSTF https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/asymptomatic-bacteriuria-in-adults-screening?ds=1&s=asymptomatic%20bacteriuria Accessed on Feb 3, 2017 </ref>
*If left untreated asymptomatic bacteriuria normally cures on its own and active treatment is not required except in those who are [[pregnant]], require [[renal transplantation]] or are supposed to undergo a [[urinary tract]] procedure. Asymptomatic bacteriuria should also be treated in the presence of a structural defect of the [[urinary tract]].<ref name="Asymptomatic bacteriuria">USPSTF https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/asymptomatic-bacteriuria-in-adults-screening?ds=1&s=asymptomatic%20bacteriuria Accessed on Feb 3, 2017 </ref>
*In case of [[pregnancy]] in patients who acquire asymptomatic bacteriuria early in their pregnancy, there is a minute chance of issues related [[pregnancy]] like [[low birth weight]] etc or [[pyelonephritis]]. Most cases resolve [[postpartum]].<ref>{{Cite journal
*In patients who acquire asymptomatic bacteriuria early in their pregnancy, there is a minute chance of issues related to [[pregnancy]] like [[low birth weight]] etc or [[pyelonephritis]]. Most cases resolve [[postpartum]].<ref>{{Cite journal
  | author = [[Kenneth Lin]] & [[Kevin Fajardo]]
  | author = [[Kenneth Lin]] & [[Kevin Fajardo]]
  | title = Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement
  | title = Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement
Line 482: Line 699:


===Complications===
===Complications===
Asymptomatic bacteriuria rarely leads to complications. These may include
Asymptomatic bacteriuria rarely leads to complications. These may include:
 
*Symptomatic [[UTI]]<ref>{{Cite journal
*Symptomatic [[UTI]]<ref>{{Cite journal
  | author = [[Anca Zalmanovici Trestioreanu]], [[Adi Lador]], [[May-Tal Sauerbrun-Cutler]] & [[Leonard Leibovici]]
  | author = [[Anca Zalmanovici Trestioreanu]], [[Adi Lador]], [[May-Tal Sauerbrun-Cutler]] & [[Leonard Leibovici]]
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  | pmid = 25851268
  | pmid = 25851268
}}</ref>
}}</ref>
 
*Complications in pregnancy such as:
====Complications in Pregnancy====
**[[Preterm birth]]<ref>{{Cite journal
*[[Preterm birth]]<ref>{{Cite journal
  | author = [[R. Romero]], [[E. Oyarzun]], [[M. Mazor]], [[M. Sirtori]], [[J. C. Hobbins]] & [[M. Bracken]]
  | author = [[R. Romero]], [[E. Oyarzun]], [[M. Mazor]], [[M. Sirtori]], [[J. C. Hobbins]] & [[M. Bracken]]
  | title = Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight
  | title = Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight
Line 508: Line 723:
  | pmid = 2927852
  | pmid = 2927852
}}</ref>
}}</ref>
   
**[[Low birth weight]]<ref>{{Cite journal
*[[Low birth weight]]<ref>{{Cite journal
  | author = [[F. Smaill]] & [[J. C. Vazquez]]
  | author = [[F. Smaill]] & [[J. C. Vazquez]]
  | title = Antibiotics for asymptomatic bacteriuria in pregnancy
  | title = Antibiotics for asymptomatic bacteriuria in pregnancy
Line 530: Line 744:
  | pmid = 18591632
  | pmid = 18591632
}}</ref>
}}</ref>
   
**[[Pyelonephritis]] later in [[pregnancy]]<ref>{{Cite journal
*[[Pyelonephritis]] later in [[pregnancy]]<ref>{{Cite journal
  | author = [[Lindsay E. Nicolle]]
  | author = [[Lindsay E. Nicolle]]
  | title = Asymptomatic Bacteriuria and Bacterial Interference
  | title = Asymptomatic Bacteriuria and Bacterial Interference
Line 555: Line 768:
  | pmid = 26252501
  | pmid = 26252501
}}</ref>
}}</ref>
==Screening==
[[Screening]] for asymptomatic subjects is considered if [[bacteriuria]] is associated with preventable adverse outcomes such as symptomatic [[urinary infection]], progression to [[chronic kidney disease]] or [[hypertension]], development of urinary tract cancer, and decreased duration of survival.<ref name="pmid15714408">{{cite journal| author=Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM et al.| title=Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. | journal=Clin Infect Dis | year= 2005 | volume= 40 | issue= 5 | pages= 643-54 | pmid=15714408 | doi=10.1086/427507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15714408  }} </ref>
===Individuals requiring screening===
The following should be screened for asymptomatic bacteriuria<ref>{{Cite journal
| author = [[Kenneth Lin]] & [[Kevin Fajardo]]
| title = Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement
| journal = [[Annals of internal medicine]]
| volume = 149
| issue = 1
| pages = W20–W24
| year = 2008
| month = July
| pmid = 18591632
}}</ref><ref name= "Asymptomatic bacteriuria"> USPSTF https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/asymptomatic-bacteriuria-in-adults-screening?ds=1&s=asymptomatic%20bacteriuria Accessed on Feb 3, 2017 </ref>
*[[Pregnant]]
*Requiring [[urologic procedures]] like [[transurethral resection of the prostate]] i.e [[TURP]]
*Post [[renal transplant]]
===Catheter Associated Asymptomatic Bacteriuria===
It is not recommended to [[Screening|screen]] for or treat asymptomatic bacteriuria or fungiuria for short or long term [[catheters]],<ref name="Sobel-2000">{{Cite journal  |last1 = Sobel | first1 = JD. | last2 = Kauffman | first2 = CA. | last3 = McKinsey | first3 = D. | last4 = Zervos | first4 = M. | last5 = Vazquez | first5 = JA. |last6 = Karchmer | first6 = AW. | last7 = Lee | first7 = J. | last8 = Thomas | first8 = C. | last9 = Panzer | first9 = H. | title = Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group.| journal = Clin Infect Dis | volume = 30 | issue = 1 | pages = 19-24 | month = Jan | year = 2000 | doi = 10.1086/313580 | PMID = 10619727 }}</ref>  exceptions are [[Catheterization|catheterized]] [[pregnant]] women and women with persistent [[bacteriuria]] 48 hours after removal of the [[Urethral catheterization|urethral catheter]]. Prophylaxis can also be used also with patients undergoing urological procedures.<ref name="Nicolle-2005">{{Cite journal  | last1 = Nicolle | first1 = LE. | last2 = Bradley | first2 = S. | last3 = Colgan | first3 = R. | last4 = Rice | first4 = JC. | last5 = Schaeffer | first5 = A. | last6 = Hooton | first6 = TM. | title = Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. | journal = Clin Infect Dis | volume = 40 | issue = 5 | pages = 643-54 | month = Mar | year = 2005 | doi = 10.1086/427507 | PMID = 15714408 }}</ref>
*No benefit of therapy of asymptomatic bacteriuria due to similar recurrence rates with more [[Drug resistance|resistance]] to [[antibiotics]].<ref name="Warren-1982">{{Cite journal  |last1 = Warren | first1 = JW. | last2 = Anthony | first2 = WC. | last3 = Hoopes | first3 = JM. | last4 = Muncie | first4 = HL. | title = Cephalexin for susceptible bacteriuria in afebrile, long-term catheterized patients. | journal = JAMA | volume = 248 | issue = 4 | pages = 454-8 | month = Jul | year = 1982|doi =  | PMID = 7045440 }}</ref><ref name="Alling-1975">{{Cite journal  | last1 = Alling | first1 = B. | last2 = Brandberg | first2 = A. | last3 = Seeberg|first3 = S. | last4 = Svanborg | first4 = A. | title = Effect of consecutive antibacterial therapy on bacteriuria in hospitalized geriatric patients. | journal = Scand J Infect Dis | volume = 7 | issue = 3 | pages = 201-7 | month =  | year = 1975 | doi =  | PMID = 809837 }}</ref>
*Significant improvement has been shown with [[women]] treated for [[bacteriuria]] that existed 48 hours after removal of indwelling [[Urethral catheterization|urethral catheters]].<ref name="Harding-1991">{{Cite journal  | last1 = Harding | first1 = GK. | last2 = Nicolle | first2 = LE. | last3 = Ronald | first3 = AR. | last4 = Preiksaitis|first4 = JK. | last5 = Forward | first5 = KR. | last6 = Low | first6 = DE. | last7 = Cheang | first7 = M. | title = How long should catheter-acquired urinary tract infection in women be treated? A randomized controlled study. | journal = Ann Intern Med | volume = 114 | issue = 9 | pages = 713-9 | month = May | year = 1991 | doi =  | PMID = 2012351 }}</ref>


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Study of Choice===


The [[diagnosis]] of bacteriuria in an asymptomatic individual is based on the culture results of [[urine]] collected in a manner that minimizes the possibility of contamination and limits the period between [[sampling]] and testing the specimen to avoid false positivity due to [[bacterial growth]].
The [[diagnosis]] of bacteriuria in an asymptomatic individual is based on the culture results of [[urine]] collected in a manner that minimizes the possibility of contamination and limits the period between [[sampling]] and testing the specimen to avoid false positivity due to [[bacterial growth]].
Line 591: Line 780:
* A single, clean-catch, voided [[urine]] specimen with 1 [[bacterial]] species isolated in a [[quantitative]] count of ≥10<sup>5</sup> [[Colony-forming unit|CFU]]/mL identifies [[bacteriuria]] in asymptomatic men.
* A single, clean-catch, voided [[urine]] specimen with 1 [[bacterial]] species isolated in a [[quantitative]] count of ≥10<sup>5</sup> [[Colony-forming unit|CFU]]/mL identifies [[bacteriuria]] in asymptomatic men.


* A single catheterized [[urine]] specimen with 1 bacterial species isolated in a [[quantitative]] count of ≥10<sup>2</sup> [[Colony-forming unit|CFU]]/mL identifies [[bacteriuria]] in [[women]] or [[men]].
* A single catheterized [[urine]] specimen with 1 bacterial species isolated in a [[quantitative]] count of ≥10<sup>2</sup> [[Colony-forming unit|CFU]]/mL identifies [[bacteriuria]] in women or men.
 
===History and Symptoms===
Patients with asymptomatic bacteriuria are asymptomatic.
 
=== Physical Examination ===
Patients with asymptomatic bacteriuria appear completely normal.


===Laboratory Findings===
===Laboratory Findings===


*[[Urinalysis]]
*[[Urinalysis]]
**[[Urinalysis]] along with [[microscopic]] examination of the sample is useful in identifying [[bacteriuria]]. [[Pyuria]] can also be identified on [[urinalysis|urinalysis.]]<ref>{{Cite journal
**[[Urinalysis]] along with [[microscopic]] examination of the sample is useful in identifying [[bacteriuria]].  
**[[Pyuria]] can also be identified on [[urinalysis|urinalysis.]]<ref>{{Cite journal
  | author = [[Richard Colgan]], [[Lindsay E. Nicolle]], [[Andrew McGlone]] & [[Thomas M. Hooton]]
  | author = [[Richard Colgan]], [[Lindsay E. Nicolle]], [[Andrew McGlone]] & [[Thomas M. Hooton]]
  | title = Asymptomatic bacteriuria in adults
  | title = Asymptomatic bacteriuria in adults
Line 607: Line 803:
  | pmid = 17002033
  | pmid = 17002033
}}</ref>
}}</ref>
**[[Pyuria]] is defined as increased numbers of [[polymorphonuclear leukocyte]]s in the urine and is evidence of an [[inflammatory response]] in the urinary tract.<ref name="Stamm-1983">{{Cite journal  | last1 = Stamm | first1 = WE. | title = Measurement of pyuria and its relation to bacteriuria. | journal = Am J Med | volume = 75 | issue = 1B | pages = 53-8 | month = Jul | year = 1983 | doi =  | PMID = 6349345 }}</ref> An operational definition of [[pyuria]] is the presence of ≥10 [[leukocyte]]s per 400x [[microscopic]] field in the sediment of first-void urine. Although [[pyuria]] is prevalent among people with asymptomatic bacteriuria, its presence or degree has not been shown to correlate with the [[prognosis]] and should not affect clinical decisions about [[antibiotics]].<ref name="Nicolle-1998">{{Cite journal  | last1 = Nicolle | first1 = LE. | last2 = Duckworth | first2 = H. | last3 = Brunka | first3 = J. | last4 = Urias | first4 = B. | last5 = Kennedy | first5 = J. | last6 = Murray | first6 = D. | last7 = Harding | first7 = GK. | title = Urinary antibody level and survival in bacteriuric institutionalized older subjects. | journal = J Am Geriatr Soc | volume = 46 | issue = 8 | pages = 947-53 | month = Aug | year = 1998 | doi =  | PMID = 9706881 }}</ref><ref name="Harding-2002">{{Cite journal  | last1 = Harding | first1 = GK. | last2 = Zhanel | first2 = GG. | last3 = Nicolle | first3 = LE. | last4 = Cheang | first4 = M. | title = Antimicrobial treatment in diabetic women with asymptomatic bacteriuria. | journal = N Engl J Med | volume = 347 | issue = 20 | pages = 1576-83 | month = Nov | year = 2002 | doi = 10.1056/NEJMoa021042 | PMID = 12432044 }}</ref><ref name="Darouiche-1993">{{Cite journal  | last1 = Darouiche | first1 = RO. | last2 = Cadle | first2 = RM. | last3 = Zenon | first3 = GJ. | last4 = Markowski | first4 = J. | last5 = Rodriguez | first5 = M. | last6 = Musher | first6 = DM. | title = Progression from asymptomatic to symptomatic urinary tract infection in patients with SCI: a preliminary study. | journal = J Am Paraplegia Soc | volume = 16 | issue = 4 | pages = 219-24 | month = Oct | year = 1993 | doi =  | PMID = 8270918 }}</ref><ref name="Nicolle-1997">{{Cite journal  | last1 = Nicolle | first1 = LE. | title = Asymptomatic bacteriuria in the elderly. | journal = Infect Dis Clin North Am | volume = 11 | issue = 3 | pages = 647-62 | month = Sep | year = 1997 | doi =  | PMID = 9378928 }}</ref><ref name="Zhanel-1995">{{Cite journal  | last1 = Zhanel | first1 = GG. | last2 = Nicolle | first2 = LE. | last3 = Harding | first3 = GK. | title = Prevalence of asymptomatic bacteriuria and associated host factors in women with diabetes mellitus. The Manitoba Diabetic Urinary Infection Study Group. | journal = Clin Infect Dis | volume = 21 | issue = 2 | pages = 316-22 | month = Aug | year = 1995 | doi =  | PMID = 8562738 }}</ref><ref name="Bachman-1993">{{Cite journal  | last1 = Bachman | first1 = JW. | last2 = Heise | first2 = RH. | last3 = Naessens | first3 = JM. | last4 = Timmerman | first4 = MG. | title = A study of various tests to detect asymptomatic urinary tract infections in an obstetric population. | journal = JAMA | volume = 270 | issue = 16 | pages = 1971-4 | month = Oct | year = 1993 | doi =  | PMID = 8411555 }}</ref><ref name="KINCAID-SMITH-1965">{{Cite journal  | last1 = KINCAID-SMITH | first1 = P. | last2 = BULLEN | first2 = M. | title = BACTERIURIA IN PREGNANCY. | journal = Lancet | volume = 1 | issue = 7382 | pages = 395-9 | month = Feb | year = 1965 | doi =  | PMID = 14238090 }}</ref><ref name="Hooton-2000">{{Cite journal  | last1 = Hooton | first1 = TM. | last2 = Scholes | first2 = D. | last3 = Stapleton | first3 = AE. | last4 = Roberts | first4 = PL. | last5 = Winter | first5 = C. | last6 = Gupta | first6 = K. | last7 = Samadpour | first7 = M. | last8 = Stamm | first8 = WE. | title = A prospective study of asymptomatic bacteriuria in sexually active young women. | journal = N Engl J Med | volume = 343 | issue = 14 | pages = 992-7 | month = Oct | year = 2000 | doi = 10.1056/NEJM200010053431402 | PMID = 11018165 }}</ref>
*[[Urine culture]]
*[[Urine culture]]
**[[Urine culture]] is done to confirm the presence of the causative [[bacterial]] species and to see if it meets the criteria for asymptomatic bacteriuria i.e  ≥10<sup>5</sup>[[Colony-forming unit|CFU]]/mL.<ref>{{Cite journal
**[[Urine culture]] is done to confirm the presence of the causative [[bacterial]] species and to see if it meets the criteria for asymptomatic bacteriuria i.e  ≥10<sup>5</sup> [[Colony-forming unit|CFU]]/mL.<ref>{{Cite journal
  | author = [[T. M. Hooton]], [[D. Scholes]], [[A. E. Stapleton]], [[P. L. Roberts]], [[C. Winter]], [[K. Gupta]], [[M. Samadpour]] & [[W. E. Stamm]]
  | author = [[T. M. Hooton]], [[D. Scholes]], [[A. E. Stapleton]], [[P. L. Roberts]], [[C. Winter]], [[K. Gupta]], [[M. Samadpour]] & [[W. E. Stamm]]
  | title = A prospective study of asymptomatic bacteriuria in sexually active young women
  | title = A prospective study of asymptomatic bacteriuria in sexually active young women
Line 621: Line 818:
}}</ref>
}}</ref>


====Pyuria====
===Electrocardiogram===
There are no ECG findings associated with asymptomatic bacteriuria.
 
===X-ray===
There are no x-ray findings associated with asymptomatic bacteriuria.
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with asymptomatic bacteriuria.


[[Pyuria]] is defined as increased numbers of [[polymorphonuclear leukocyte]]s in the uirne and is evidence of an [[inflammatory response]] in the urinary tract.<ref name="Stamm-1983">{{Cite journal  | last1 = Stamm | first1 = WE. | title = Measurement of pyuria and its relation to bacteriuria. | journal = Am J Med | volume = 75 | issue = 1B | pages = 53-8 | month = Jul | year = 1983 | doi =  | PMID = 6349345 }}</ref> An operational definition of [[pyuria]] is the presence of ≥10 [[leukocyte]]s per 400x [[microscopic]] field in the sediment of first-void urine. Although [[pyuria]] is prevalent among people with asympatomatic bacteriuria,<ref name="Nicolle-1997">{{Cite journal  | last1 = Nicolle | first1 = LE. | title = Asymptomatic bacteriuria in the elderly. | journal = Infect Dis Clin North Am | volume = 11 | issue = 3 | pages = 647-62 | month = Sep | year = 1997 | doi =  | PMID = 9378928 }}</ref><ref name="Hooton-2000">{{Cite journal  | last1 = Hooton | first1 = TM. | last2 = Scholes | first2 = D. | last3 = Stapleton | first3 = AE. | last4 = Roberts | first4 = PL. | last5 = Winter | first5 = C. | last6 = Gupta | first6 = K. | last7 = Samadpour | first7 = M. | last8 = Stamm | first8 = WE. | title = A prospective study of asymptomatic bacteriuria in sexually active young women. | journal = N Engl J Med | volume = 343 | issue = 14 | pages = 992-7 | month = Oct | year = 2000 | doi = 10.1056/NEJM200010053431402 | PMID = 11018165 }}</ref><ref name="Zhanel-1995">{{Cite journal  | last1 = Zhanel | first1 = GG. | last2 = Nicolle | first2 = LE. | last3 = Harding | first3 = GK. | title = Prevalence of asymptomatic bacteriuria and associated host factors in women with diabetes mellitus. The Manitoba Diabetic Urinary Infection Study Group. | journal = Clin Infect Dis | volume = 21 | issue = 2 | pages = 316-22 | month = Aug | year = 1995 | doi =  | PMID = 8562738 }}</ref><ref name="Bachman-1993">{{Cite journal  | last1 = Bachman | first1 = JW. | last2 = Heise | first2 = RH. | last3 = Naessens | first3 = JM. | last4 = Timmerman | first4 = MG. | title = A study of various tests to detect asymptomatic urinary tract infections in an obstetric population. | journal = JAMA | volume = 270 | issue = 16 | pages = 1971-4 | month = Oct | year = 1993 | doi =  | PMID = 8411555 }}</ref><ref name="KINCAID-SMITH-1965">{{Cite journal  | last1 = KINCAID-SMITH | first1 = P. | last2 = BULLEN | first2 = M. | title = BACTERIURIA IN PREGNANCY. | journal = Lancet | volume = 1 | issue = 7382 | pages = 395-9 | month = Feb | year = 1965 | doi =  | PMID = 14238090 }}</ref> its presence or degree has not been shown to correlate with the [[prognosis]] and should not affect clinical decisions about [[antibiotics]].<ref name="Nicolle-1998">{{Cite journal  | last1 = Nicolle | first1 = LE. | last2 = Duckworth | first2 = H. | last3 = Brunka | first3 = J. | last4 = Urias | first4 = B. | last5 = Kennedy | first5 = J. | last6 = Murray | first6 = D. | last7 = Harding | first7 = GK. | title = Urinary antibody level and survival in bacteriuric institutionalized older subjects. | journal = J Am Geriatr Soc | volume = 46 | issue = 8 | pages = 947-53 | month = Aug | year = 1998 | doi =  | PMID = 9706881 }}</ref><ref name="Harding-2002">{{Cite journal  | last1 = Harding | first1 = GK. | last2 = Zhanel | first2 = GG. | last3 = Nicolle | first3 = LE. | last4 = Cheang | first4 = M. | title = Antimicrobial treatment in diabetic women with asymptomatic bacteriuria. | journal = N Engl J Med | volume = 347 | issue = 20 | pages = 1576-83 | month = Nov | year = 2002 | doi = 10.1056/NEJMoa021042 | PMID = 12432044 }}</ref><ref name="Darouiche-1993">{{Cite journal  | last1 = Darouiche | first1 = RO. | last2 = Cadle | first2 = RM. | last3 = Zenon | first3 = GJ. | last4 = Markowski | first4 = J. | last5 = Rodriguez | first5 = M. | last6 = Musher | first6 = DM. | title = Progression from asymptomatic to symptomatic urinary tract infection in patients with SCI: a preliminary study. | journal = J Am Paraplegia Soc | volume = 16 | issue = 4 | pages = 219-24 | month = Oct | year = 1993 | doi =  | PMID = 8270918 }}</ref> [[Pyuria]] accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment.<ref name="pmid15714408">{{cite journal| author=Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM et al.| title=Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. | journal=Clin Infect Dis | year= 2005 | volume= 40 | issue= 5 | pages= 643-54 | pmid=15714408 | doi=10.1086/427507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15714408  }} </ref>
===CT scan===
There are no CT scan findings associated with asymptomatic bacteriuria.
===MRI===
There are no MRI findings associated with asymptomatic bacteriuria.


Click here for more details about [[pyuria|'''''pyuria''''']]'''''.'''''
=== Other Imaging Findings ===
There are no other imaging findings associated with asymptomatic bacteriuria.


===X-ray===
=== Other Diagnostic Studies ===
[[X rays|Xray]] is not required to diagnose asymptomatic bacteriuria.
There are no other diagnostic studies associated with asymptomatic bacteriuria.
===CT===
[[CT]] is not required to diagnose asymptomatic bacteriuria.
===MRI===
[[MRI]] is not required to diagnose asymptomatic bacteriuria.


==Treatment==
==Treatment==
Treatment is not required in otherwise healthy individuals unless it is associated with a [[urinary tract infection]]. Some other conditions that might require the asymptomatic bacteriuria to be treated are: <ref>{{Cite journal
 
=== Medical Therapy ===
Treatment is not required in otherwise healthy individuals unless it is associated with a [[urinary tract infection]]. Some other conditions that might require the asymptomatic bacteriuria to be treated are:<ref>{{Cite journal
  | author = [[Lindsay E. Nicolle]], [[Suzanne Bradley]], [[Richard Colgan]], [[James C. Rice]], [[Anthony Schaeffer]] & [[Thomas M. Hooton]]
  | author = [[Lindsay E. Nicolle]], [[Suzanne Bradley]], [[Richard Colgan]], [[James C. Rice]], [[Anthony Schaeffer]] & [[Thomas M. Hooton]]
  | title = Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults
  | title = Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults
Line 666: Line 871:
  | month = October
  | month = October
  | pmid = 25920165
  | pmid = 25920165
}}</ref>
}}</ref><ref name="Asymptomatic bacteriuria" /><ref>{{Cite journal| doi = 10.1086/427507| issn = 1537-6591| volume = 40| issue = 5| pages = 643–654| last1 = Nicolle| first1 = Lindsay E.| last2 = Bradley| first2 = Suzanne| last3 = Colgan| first3 = Richard| last4 = Rice| first4 = James C.| last5 = Schaeffer| first5 = Anthony| last6 = Hooton| first6 = Thomas M.| last7 = Infectious Diseases Society of America| last8 = American Society of Nephrology| last9 = American Geriatric Society| title = Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2005-03-01| pmid = 15714408}}</ref><ref>{{Cite web | title = Guidelines on Urological Infections | url = http://uroweb.org/guideline/urological-infections/ }}</ref>
*[[Pregnancy]]
*[[Pregnancy]]
*Requiring [[urinary tract]] procedure e.g [[Transurethral resection of the prostate|transurethral prostatic resection]]
*Requiring [[urinary tract]] procedure e.g [[Transurethral resection of the prostate|transurethral prostatic resection]]
*[[Renal Transplant]] follow-up
*[[Kidney transplantation|Renal transplant]] follow-up
===Antimicrobial Regimen===
 
* '''Asymptomatic bacteriuria treatment'''<ref>{{Cite journal| doi = 10.1086/427507| issn = 1537-6591| volume = 40| issue = 5| pages = 643–654| last1 = Nicolle| first1 = Lindsay E.| last2 = Bradley| first2 = Suzanne| last3 = Colgan| first3 = Richard| last4 = Rice| first4 = James C.| last5 = Schaeffer| first5 = Anthony| last6 = Hooton| first6 = Thomas M.| last7 = Infectious Diseases Society of America| last8 = American Society of Nephrology| last9 = American Geriatric Society| title = Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2005-03-01| pmid = 15714408}}</ref><ref>{{Cite web | title = Guidelines on Urological Infections | url = http://uroweb.org/guideline/urological-infections/ }}</ref>
==== '''Asymptomatic bacteriuria treatment''' ====
:*1. '''Empiric antimicrobial therapy'''
:*1. '''Empiric antimicrobial therapy'''
::*  '''Treatment of asymptomatic bacteriuria is <u>not</u> recommended for the following persons:'''
::*  '''Treatment of asymptomatic bacteriuria is <u>not</u> recommended for the following persons:'''
Line 680: Line 885:
:::* Persons with [[spinal cord injury]]
:::* Persons with [[spinal cord injury]]
:::* [[Catheterization|Catheterized]] patients while the [[catheter]] remains in situ
:::* [[Catheterization|Catheterized]] patients while the [[catheter]] remains in situ
:::* Note: [[Pyuria]] accompanying asymptomatic bacteriuria is not indicated for antibiotic therapy.
:::* '''Note (1)''': [[Pyuria]] accompanying asymptomatic bacteriuria is not indicated for [[Antibiotic|antibiotic therapy]].
:*2. '''Specific considerations'''<ref name= "Asymptomatic bacteriuria"> USPSTF https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/asymptomatic-bacteriuria-in-adults-screening?ds=1&s=asymptomatic%20bacteriuria Accessed on Feb 3, 2017 </ref>
:*2. '''Specific considerations'''
::*2.1 '''Women, pregnant'''<ref>{{Cite web | title = Guidelines on Urological Infections | url = http://uroweb.org/guideline/urological-infections/ }}</ref>  
::*2.1 '''Women, pregnant'''  
:::* Preferred regimen (1): [[Nitrofurantoin]] 100 mg PO bid for 3–5 days (avoid in glucose-6-phosphate dehydrogenase deficiency)
:::* Preferred regimen (1): [[Nitrofurantoin]] 100 mg PO bid for 3–5 days (avoid in [[glucose-6-phosphate dehydrogenase deficiency]])<ref>{{Cite web | title = Guidelines on Urological Infections | url = http://uroweb.org/guideline/urological-infections/ }}</ref>
:::* Preferred regimen (2): [[Amoxicillin]] 500 mg PO tid for 3–5 days
:::* Preferred regimen (2): [[Amoxicillin]] 500 mg PO tid for 3–5 days
:::* Preferred regimen (3): [[Amoxicillin-Clavulanate]] 500 mg PO bid for 3–5 days
:::* Preferred regimen (3): [[Amoxicillin-Clavulanate]] 500 mg PO bid for 3–5 days
Line 689: Line 894:
:::* Preferred regimen (5): [[Fosfomycin]] 3 g PO single dose
:::* Preferred regimen (5): [[Fosfomycin]] 3 g PO single dose
:::* Preferred regimen (6): [[Trimethoprim]] 200 mg PO bid for 3–5 days (only after first trimester)
:::* Preferred regimen (6): [[Trimethoprim]] 200 mg PO bid for 3–5 days (only after first trimester)
:::* Note (1): [[Pregnant]] women should be [[Screening|screened]] for [[bacteriuria]] by [[urine culture]] at least once in early [[pregnancy]], and they should be treated if the results are positive.
:::* '''Note (1)''': [[Pregnant]] women should be [[Screening|screened]] for [[bacteriuria]] by [[urine culture]] at least once in early [[pregnancy]], and they should be treated if the results are positive.
:::* Note (2): Periodic [[screening]] for recurrent [[bacteriuria]] should be undertaken after therapy.
:::* '''Note (2)''': Periodic [[screening]] for recurrent [[bacteriuria]] should be undertaken after therapy.
:::* Note (3): Infectious Disease Society of America (IDSA) guidelines recommend 3–7 days of antimicrobial therapy.
:::* '''Note (3)''': Infectious Disease Society of America (IDSA) guidelines recommend 3–7 days of [[Antibiotic|antibiotic therapy]].
::*2.2 '''Patients with indwelling urethral catheters'''
::*2.2 '''Patients with indwelling urethral catheters'''
:::* [[Screening]] for or treatment of asymptomatic bacteriuria in patients with indwelling [[Urinary catheterization|urethral catheters]] is not recommended.
:::* [[Screening]] for or treatment of asymptomatic bacteriuria in patients with indwelling [[Urinary catheterization|urethral catheters]] is not recommended.
:::* Note: Antimicrobial treatment of asymptomatic women with catheter-acquired [[bacteriuria]] that persists 48 hours after catheter removal may be considered.
:::* '''Note (1)''': [[Antimicrobial]] treatment of asymptomatic women with catheter-acquired [[bacteriuria]] that persists 48 hours after catheter removal may be considered.
::*2.3 '''Urologic interventions'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::*2.3 '''Urologic interventions'''
:::* [[Screening]] for or treatment of asymptomatic bacteriuria before transurethral resection of the prostate is recommended
:::* [[Screening]] for or treatment of asymptomatic bacteriuria before [[transurethral resection of the prostate]] is recommended.<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:::* Preferred regimen: [[Trimethoprim-Sulfamethoxazole]] DS 1 tab PO bid for 3 days after obtaining urine cultures
:::* Preferred regimen (1): [[Trimethoprim-Sulfamethoxazole]] DS 1 tab PO bid for 3 days after obtaining urine culture
::*2.4 '''Renal transplant'''<ref>{{Cite journal
::*2.4 '''Renal transplant'''
:::* [[Screening]] for or treatment of asymptomatic bacteriuria after a [[Renal transplantation|renal transplant]] is recommended.<ref>{{Cite journal
  | author = [[D. ALEKSANDROW]], [[W. WYSZNACKA]], [[H. CHLEBUS]], [[S. FILIPECKI]], [[A. MICHAJLIK]] & [[M. RYCEROWA]]
  | author = [[D. ALEKSANDROW]], [[W. WYSZNACKA]], [[H. CHLEBUS]], [[S. FILIPECKI]], [[A. MICHAJLIK]] & [[M. RYCEROWA]]
  | title = &#91;Remote results of the treatment of pyelonephritis&#93;
  | title = &#91;Remote results of the treatment of pyelonephritis&#93;
Line 730: Line 936:
  | pmid = 24654771
  | pmid = 24654771
}}</ref>
}}</ref>
:::* [[Screening]] for or treatment of asymptomatic bacteriuria after a [[Renal transplantation|renal transplant]] is recommended
::*2.5 '''Catheter Associated Asymptomatic Bacteriuria'''
::*2.5 '''Catheter Associated Asymptomatic Bacteriuria'''
:::* Regimen : [[TMP-SMX]] DS 1 tab bid x 3 days
:::* Preferred regimen (1): [[Trimethoprim-Sulfamethoxazole]] DS 1 tab PO bid for 3 days
====Followup====
====Followup====
*A large proportion of [[women]] with asymptomatic bacteriuria in [[pregnancy]] have a recurrence after a short duration of therapy and for this reason a followup is done one week after completing the therapy and then monthly until the [[birth]] due to a higher chance of recurrence.<ref>{{Cite journal
*A large proportion of [[women]] with asymptomatic bacteriuria in [[pregnancy]] have a recurrence after a short duration of therapy and for this reason a followup is done one week after completing the therapy and then monthly until the [[birth]] due to a higher chance of recurrence.<ref>{{Cite journal
Line 746: Line 951:
}}</ref>
}}</ref>


==Primary Prevention==
===Surgery===
Primary preventive measure for asymptomatic bacteriuria include<ref>{{Cite journal
Surgical intervention is not recommended for the management of asymptomatic bacteriuria.
 
=== Primary Prevention ===
Primary preventive measure for asymptomatic bacteriuria include:<ref>{{Cite journal
  | author = [[Kenneth Lin]] & [[Kevin Fajardo]]
  | author = [[Kenneth Lin]] & [[Kevin Fajardo]]
  | title = Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement
  | title = Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement
Line 772: Line 980:
*Adequate hydration
*Adequate hydration


==Secondary Prevention==
===Secondary Prevention===
Secondary preventive measures for asymptomatic bacteriuria include  
Secondary preventive measures for asymptomatic bacteriuria include:
*[[Prophylactic]] [[antibiotics]]
*[[Prophylactic]] [[antibiotics]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}


[[Category:Disease]]
[[Category:Medicine]]
[[Category:Primary care]]
[[Category:Infectious disease]]
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[[Category:Nephrology]]
 
[[Category:Urology]]
[[Category:Urology]]
[[Category:Nephrology]][[Category:Disease]]
[[Category:Primary care]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Nephrology]]
[[Category:Urology]]

Latest revision as of 20:31, 29 July 2020



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To view the Urinary Tract Infections main page click here.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2], Abdurahman Khalil, M.D. [3], Sadaf Sharfaei M.D.[4]

Overview

Urine is normally sterile. Asymptomatic bacteriuria is a condition in which a significant number of bacteria appear in the urine, without the presence of typical symptoms of a urinary tract infection. Presence of >10 leukocytes/mm³ is considered as pyuria but not asymptomatic bacteriuria unless the number exceeds ≥105 colony forming units(cfu)/mL. There are two main pathogenesis that might be responsible for asymptomatic bacteriuria which include microbial virulence and host factors. Escherichia coli is the single most common cause of asymptomatic bacteriuria. Asymptomatic bacteriuria is more common in elderly and its prevalence increase with age. Asymptomatic bacteriuria has been slightly more common in black population. Asymptomatic bacteriuria has risk factors similar to symptomatic bacteriuria such as pregnancy, aging, diabetes mellitus, sexual intercourse, using diaphragm plus spermicide, BPH, renal stones, or patients with spinal cord injuries, hemodialysis, indwelling urethral catheters, genitourinary abnormalities. Screening for asymptomatic subjects is considered if bacteriuria is associated with preventable adverse outcomes such as symptomatic urinary infection, progression to chronic kidney disease or hypertension, development of urinary tract cancer, and decreased duration of survival. If left untreated asymptomatic bacteriuria normally cures on its own and active treatment is not required except in those who are pregnant, require renal transplantation or are supposed to undergo a urinary tract procedure. In patients who acquire asymptomatic bacteriuria early in their pregnancy, there is a minute chance of issues related to pregnancy like low birth weight etc or pyelonephritis. Most cases resolve postpartum. The diagnosis of bacteriuria in an asymptomatic individual is based on the culture results of urine collected in a manner that minimizes the possibility of contamination and limits the period between sampling and testing the specimen to avoid false positivity due to bacterial growth. Treatment is not required in otherwise healthy individuals unless it is associated with a urinary tract infection. Conditions that might require the asymptomatic bacteriuria to be treated are pregnancy, before transurethral prostatic resection, and renal transplant follow-up.

Historical Perspective

Classification

According to the Infectious Disease Society of America (IDSA), asymptomatic bacteriuria is defined as the presence of ≥105 cfu/mL of bacteria in clean catch urine specimen of an asymptomatic person with respect to symptoms urinary tract infection. By definition, one positive sample is enough to confirm asymptomatic bacteriuria in men, whereas in women two consecutive samples with same organism are required to diagnose asymptomatic bacteriuria. In men or women who are catheterized and are asymptomatic, identification of ≥102 cfu/mL of a single organism in the catheterized specimen is defined as asymptomatic bacteriuria. The prevalence of bacteriuria is more in sexually active women (4.6%) as compared to sexually inactive women (0.7%) or men.

Pathophysiology

Microbial Virulence

  • Asymptomatic bacteriuria may also be due to the decreased virulence of some strains that gather in the bladder but do not cause a symptomatic appearance. Some strains isolated from patients with asymptomatic bacteriuria in the setting of spinal cord injury have decreased capability of causing hemolysis.[5][6]

Host Factors

Causes

Most common organism

Common Causes Less Common Causes GU abnormalities & Hospitalization Long Term Catheterisation[13][14]
Enterococcus[15] Chromobacterium violaceum[16] E.coli[13][17] Pseudomonas aeruginosa
Enterobacteriaceae[18] Staphylococci[19] Proteus mirabilis[13][20] P. mirabilis
Klebsiella[21] Gardnerella vaginalis[22][23] Providencia stuartii
Pseudomonas aeruginosa[24] Elizabethkingia meningoseptica[25] Morganella morganii
Group B Streptococcus[26][27]

Differentiating Asymptomatic Bacteriuria From Other Diseases

Asymptomatic Bacteriuria must be differentiated from other diseases that might cause bacteriuria.[28][29][30][31]

To review differential diagnosis of pyuria, click here.

To review differential diagnosis of sterile pyuria, click here.

Category Disease Clinical manifestations Para−clinical findings Gold standard for diagnosis Associated findings
Symptoms Physical examination
Lab Findings Imaging
Pain Fever N/V Urinary symptoms BP Other CBC Electrolytes Urinalysis
Dysuria Frequency Urgency Gross hematuria Cell Cast Bacteriuria Culture Other
Infectious diseases UTI[32] Bacterial Asymptomatic bacteriuria[33][34] Nl Nl Nl ± + NA NA Urinalysis
  • Increased risk in pregnancy
  • Must be treated prior to an invasive urologic procedure
Cystitis[35] + + + Nl Nl Nl + + + NA Urinalysis NA
Pyelonephritis[36] + + + + + + Nl Nl + WBC cast + + NA Clinical manifestation + urinalysis NA
Prostatitis[37]  Pelvic or perineal pain + + + + + Nl or ↑
  • Dribbling of urine
  • Firm and tender prostate
Nl + ± + NA Clinical manifestation + urinalysis
  • Increased risk of bacteremia, prostatic abscess, and metastatic infection
  • Might be acute or chronic infection
Balanitis[38] Penile pain + + + + Nl
  • Pruritus
  • Erythematous lesions on the glans and/or the foreskin
Nl Nl + ± NA NA Clinical manifestation
Non−infectious diseases Urinary tract disorders Urinary catheterization[39] + + Nl Nl + + + Clinical manifestation + urinalysis
Disease Pain Fever N/V Dysuria Frequency Urgency Gross hematuria BP Other PE CBC Electrolytes Cell Cast Bacteriuria Culture Other UA findings Imaging Gold standard for diagnosis Associated findings

Epidemiology and Demographics

Prevalance

Age

  • Asymptomatic bacteriuria is more common in elderly and its prevalence increase with age.[42][43]
  • The prevalence of asymptomatic bacteriuria in women greater than 80 years old is >20%.[44][45]
  • The prevalence of asymptomatic bacteriuria in men greater than 75 year old is 6-15%.[46]
  • Asymptomatic bacteriuria is present in 3-5% of the women population between 38-60 years of age. It was identified in 5% of women in universities and 6% of women in groups related to health maintenance organisations.[47][48]

Gender

  • Asymptomatic bacteriuria is more prevalent in females as compared to males.
  • Asymptomatic bacteriuria is rare among healthy men.[49][50]

Race

  • Asymptomatic bacteriuria has been slightly more common in black population.[51]

Risk Factors

Asymptomatic bacteriuria has risk factors similar to symptomatic bacteriuria. Some of these include:[52][53]

General Risk Factors

Disease Conditions

Screening

Screening for asymptomatic subjects is considered if bacteriuria is associated with preventable adverse outcomes such as symptomatic urinary infection, progression to chronic kidney disease or hypertension, development of urinary tract cancer, and decreased duration of survival.[61]

Individuals requiring screening

The following should be screened for asymptomatic bacteriuria:[62][63]

Catheter Associated Asymptomatic Bacteriuria

It is not recommended to screen for or treat asymptomatic bacteriuria or fungiuria for short or long term catheters, exceptions are catheterized pregnant women and women with persistent bacteriuria 48 hours after removal of the urethral catheter. Prophylaxis can also be used also with patients undergoing urological procedures.[64][65]

Natural History, Complications, and Prognosis

Natural History

Complications

Asymptomatic bacteriuria rarely leads to complications. These may include:

Prognosis

Asymptomatic bacteriuria has a good prognosis and completely resolves with treatment.[75]

Diagnosis

Diagnostic Study of Choice

The diagnosis of bacteriuria in an asymptomatic individual is based on the culture results of urine collected in a manner that minimizes the possibility of contamination and limits the period between sampling and testing the specimen to avoid false positivity due to bacterial growth.

The quantitative definition for significant bacteriuria is:[76]

  • For asymptomatic women, bacteriuria is defined as 2 consecutive voided urine specimens with isolation of the same bacterial strain in quantitative counts of ≥105 CFU/mL.

History and Symptoms

Patients with asymptomatic bacteriuria are asymptomatic.

Physical Examination

Patients with asymptomatic bacteriuria appear completely normal.

Laboratory Findings

Electrocardiogram

There are no ECG findings associated with asymptomatic bacteriuria.

X-ray

There are no x-ray findings associated with asymptomatic bacteriuria.

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with asymptomatic bacteriuria.

CT scan

There are no CT scan findings associated with asymptomatic bacteriuria.

MRI

There are no MRI findings associated with asymptomatic bacteriuria.

Other Imaging Findings

There are no other imaging findings associated with asymptomatic bacteriuria.

Other Diagnostic Studies

There are no other diagnostic studies associated with asymptomatic bacteriuria.

Treatment

Medical Therapy

Treatment is not required in otherwise healthy individuals unless it is associated with a urinary tract infection. Some other conditions that might require the asymptomatic bacteriuria to be treated are:[87][88][89][63][90][91]

Asymptomatic bacteriuria treatment

  • 1. Empiric antimicrobial therapy
  • Treatment of asymptomatic bacteriuria is not recommended for the following persons:
  • 2. Specific considerations
  • 2.1 Women, pregnant
  • 2.2 Patients with indwelling urethral catheters
  • Screening for or treatment of asymptomatic bacteriuria in patients with indwelling urethral catheters is not recommended.
  • Note (1): Antimicrobial treatment of asymptomatic women with catheter-acquired bacteriuria that persists 48 hours after catheter removal may be considered.
  • 2.3 Urologic interventions
  • 2.4 Renal transplant
  • 2.5 Catheter Associated Asymptomatic Bacteriuria

Followup

  • A large proportion of women with asymptomatic bacteriuria in pregnancy have a recurrence after a short duration of therapy and for this reason a followup is done one week after completing the therapy and then monthly until the birth due to a higher chance of recurrence.[97]

Surgery

Surgical intervention is not recommended for the management of asymptomatic bacteriuria.

Primary Prevention

Primary preventive measure for asymptomatic bacteriuria include:[98][99]

Secondary Prevention

Secondary preventive measures for asymptomatic bacteriuria include:

References

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