Asymptomatic bacteriuria: Difference between revisions
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==Definitions== | ==Definitions== | ||
According to the Infectious Disease Society of America (IDSA) asymptomatic bacteriuria is the presence of a ≥10<sup>5</sup>cfu/mL of bacteria in clean catch urine specimen of an asymptomatic person with respect to [[urinary tract infection]]. By definition one positive sample defines asymptomatic bacteriuria in men, where as in women two consecutive sample with same organism and ≥10<sup>5</sup>cfu/mL are required to diagnose asymptomatic bacteriuria. Where as in men or woe=men who are catheterised and are asymptomatic, identification of ≥10<sup>5</sup>cfu/mL of a single organism 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== | ||
Revision as of 16:29, 2 February 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]
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 such as burning during urination, frequent urination or frequency, urgency or frequent urination. Presence of >10 leukocytes/mm³ is considered as pyuria but not asymptomatic bacteriuria unloaded the number exceeds ≥105cfu/mL.[1][2]
Definitions
According to the Infectious Disease Society of America (IDSA) asymptomatic bacteriuria is the presence of a ≥105cfu/mL of bacteria in clean catch urine specimen of an asymptomatic person with respect to urinary tract infection. By definition one positive sample defines asymptomatic bacteriuria in men, where as in women two consecutive sample with same organism and ≥105cfu/mL are required to diagnose asymptomatic bacteriuria. Where as in men or woe=men who are catheterised and are asymptomatic, identification of ≥105cfu/mL of a single organism is defined as asymptomatic bacteriuria.[3][4]
Historical Perspective
- In 1950s, Kass et al. proposed a quantitative culture method for the microbiologic diagnosis of urinary tract infections.[5]
- About 105 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.[6][7]
Epidemiology
Bacteriuria is commonly found in certain populations with variable prevalence including pregnant women,[8] elderly people,[8] diabetics,[9] patients with spinal cord injuries,[10][11] patients undergoing hemodialysis,[12] patients with indwelling urethral catheters, and patients with genitourinary abnormalities.[13]
Pathophysiology
Microbiology
Host Factors
Screening
Screening for asymptomatic subjects is deemed appropriate 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.[4]
Diagnosis
Laboratory Findings
Pyuria
Pyuria is defined as increased numbers of polymorphonuclear leukocytes in the uirne and is evidence of an inflammatory response in the urinary tract.[14] An operational definition of pyuria is the presence of ≥15 leukocytes per 400x microscopic field in the sediment of first-void urine. Although pyuria is prevalent among people with asympatomatic bacteriuria,[10][15][16][17][18] its presence or degree has not been shown to correlate with the prognosis and should not affect clinical decisions about antibiotics.[19][20][21] Pyuria accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment.[4]
Diagnostic Criteria
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:[22]
- 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.
- A single, clean-catch, voided urine specimen with 1 bacterial species isolated in a quantitative count of ≥105 CFU/mL identifies bacteriuria in asymptomatic men.
- A single catheterized urine specimen with 1 bacterial species isolated in a quantitative count of ≥102 CFU/mL identifies bacteriuria in women or men.
Presumptive Etiologies
Most common organism
Escherichia coli is the single most common cause of asymptomatic bacteriuria.[23][24][25]
Patients with abnormal genitourinary tract or institutionalized elderly:
E.Coli remain common cause, but in men Proteus mirabilis is more common.[26]
Long term urologic device in place
Polymicrobial including Pseudomonas aeruginosa,P. mirabilis, Providencia stuartii, and Morganella morganii (urease-producing organisms).[26] [27]
Other organisms
- Coagulase-negative staphylococci, especially in men.
- Enterococcus species.
- Group B streptococci
Treatment
Antimicrobial Regimen
- 1. Empiric antimicrobial therapy
- Treatment of asymptomatic bacteriuria is not recommended for the following persons:
- Premenopausal, nonpregnant women
- Diabetic women
- Older persons residing in the community
- Elderly, institutionalized subjects
- Persons with spinal cord injury
- Catheterized patients while the catheter remains in situ
- Note: Pyuria accompanying asymptomatic bacteriuria is not indicated for antibiotic therapy.
- 2. Specific considerations
- 2.1 Men
- Screening for or treatment of asymptomatic bacteriuria among men is not recommended.
- 2.2 Women, premenopausal, nonpregnant
- Screening for or treatment of asymptomatic bacteriuria in premenopausal, nonpregnant women is not indicated.
- 2.3 Women, pregnant[32]
- Preferred regimen (1): Nitrofurantoin 100 mg PO bid for 3–5 days (avoid in glucose-6-phosphate dehydrogenase deficiency)
- 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 (4): Cephalexin 500 mg PO tid for 3–5 days
- 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)
- Note (1): Pregnant women should be 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 (3): IDSA guidelines recommend 3–7 days of antimicrobial therapy.
- 2.4 Women, diabetic
- Screening for or treatment of asymptomatic bacteriuria among diabetic women is not recommended.
- 2.5 Older persons residing in the community
- Screening for or treatment of asymptomatic bacteriuria among older persons residing in the community is not recommended.
- 2.6 Elderly institutionalized subjects
- Screening for or treatment of asymptomatic bacteriuria among elderly institutionalized residents of long-term care facilities is not recommended.
- 2.7 Subjects with spinal cord injuries
- Screening for or treatment of asymptomatic bacteriuria among subjects with spinal cord injuries is not recommended.
- 2.8 Patients with indwelling urethral catheters
- Screening for or treatment of asymptomatic bacteriuria in patients with indwelling 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.
- 2.9 Urologic interventions[33]
- Screening for or treatment of asymptomatic bacteriuria before transurethral resection of the prostate is recommended
- Preferred regimen: Trimethoprim-Sulfamethoxazole DS 1 tab PO bid for 3 days after obtaining urine cultures
References
- ↑ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001548/
- ↑ T. M. Hooton, D. Scholes, A. E. Stapleton, P. L. Roberts, C. Winter, K. Gupta, M. Samadpour & W. E. Stamm (2000). "A prospective study of asymptomatic bacteriuria in sexually active young women". The New England journal of medicine. 343 (14): 992–997. doi:10.1056/NEJM200010053431402. PMID 11018165. Unknown parameter
|month=ignored (help) - ↑ Rubin, RH.; Shapiro, ED.; Andriole, VT.; Davis, RJ.; Stamm, WE. (1992). "Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration". Clin Infect Dis. 15 Suppl 1: S216–27. PMID 1477233. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 4.2 Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM; et al. (2005). "Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults". Clin Infect Dis. 40 (5): 643–54. doi:10.1086/427507. PMID 15714408.
- ↑ KASS, EH. (1956). "Asymptomatic infections of the urinary tract". Trans Assoc Am Physicians. 69: 56–64. PMID 13380946.
- ↑ KASS, EH. (1957). "Bacteriuria and the diagnosis of infections of the urinary tract; with observations on the use of methionine as a urinary antiseptic". AMA Arch Intern Med. 100 (5): 709–14. PMID 13468815. Unknown parameter
|month=ignored (help) - ↑ E. H. KASS (1962). "Pyelonephritis and bacteriuria. A major problem in preventive medicine". Annals of internal medicine. 56: 46–53. PMID 14454174. Unknown parameter
|month=ignored (help) - ↑ 8.0 8.1 Nicolle, LE. (2003). "Asymptomatic bacteriuria: when to screen and when to treat". Infect Dis Clin North Am. 17 (2): 367–94. PMID 12848475. Unknown parameter
|month=ignored (help) - ↑ Zhanel, GG.; Harding, GK.; Nicolle, LE. "Asymptomatic bacteriuria in patients with diabetes mellitus". Rev Infect Dis. 13 (1): 150–4. PMID 2017615.
- ↑ 10.0 10.1 Nicolle, LE. (1997). "Asymptomatic bacteriuria in the elderly". Infect Dis Clin North Am. 11 (3): 647–62. PMID 9378928. Unknown parameter
|month=ignored (help) - ↑ Waites, KB.; Canupp, KC.; DeVivo, MJ. (1993). "Epidemiology and risk factors for urinary tract infection following spinal cord injury". Arch Phys Med Rehabil. 74 (7): 691–5. PMID 8328888. Unknown parameter
|month=ignored (help) - ↑ Bakke, A.; Digranes, A. (1991). "Bacteriuria in patients treated with clean intermittent catheterization". Scand J Infect Dis. 23 (5): 577–82. PMID 1767253.
- ↑ Chaudhry, A.; Stone, WJ.; Breyer, JA. (1993). "Occurrence of pyuria and bacteriuria in asymptomatic hemodialysis patients". Am J Kidney Dis. 21 (2): 180–3. PMID 8430679. Unknown parameter
|month=ignored (help) - ↑ Stamm, WE. (1983). "Measurement of pyuria and its relation to bacteriuria". Am J Med. 75 (1B): 53–8. PMID 6349345. Unknown parameter
|month=ignored (help) - ↑ Hooton, TM.; Scholes, D.; Stapleton, AE.; Roberts, PL.; Winter, C.; Gupta, K.; Samadpour, M.; Stamm, WE. (2000). "A prospective study of asymptomatic bacteriuria in sexually active young women". N Engl J Med. 343 (14): 992–7. doi:10.1056/NEJM200010053431402. PMID 11018165. Unknown parameter
|month=ignored (help) - ↑ Zhanel, GG.; Nicolle, LE.; Harding, GK. (1995). "Prevalence of asymptomatic bacteriuria and associated host factors in women with diabetes mellitus. The Manitoba Diabetic Urinary Infection Study Group". Clin Infect Dis. 21 (2): 316–22. PMID 8562738. Unknown parameter
|month=ignored (help) - ↑ Bachman, JW.; Heise, RH.; Naessens, JM.; Timmerman, MG. (1993). "A study of various tests to detect asymptomatic urinary tract infections in an obstetric population". JAMA. 270 (16): 1971–4. PMID 8411555. Unknown parameter
|month=ignored (help) - ↑ KINCAID-SMITH, P.; BULLEN, M. (1965). "BACTERIURIA IN PREGNANCY". Lancet. 1 (7382): 395–9. PMID 14238090. Unknown parameter
|month=ignored (help) - ↑ Nicolle, LE.; Duckworth, H.; Brunka, J.; Urias, B.; Kennedy, J.; Murray, D.; Harding, GK. (1998). "Urinary antibody level and survival in bacteriuric institutionalized older subjects". J Am Geriatr Soc. 46 (8): 947–53. PMID 9706881. Unknown parameter
|month=ignored (help) - ↑ Harding, GK.; Zhanel, GG.; Nicolle, LE.; Cheang, M. (2002). "Antimicrobial treatment in diabetic women with asymptomatic bacteriuria". N Engl J Med. 347 (20): 1576–83. doi:10.1056/NEJMoa021042. PMID 12432044. Unknown parameter
|month=ignored (help) - ↑ Darouiche, RO.; Cadle, RM.; Zenon, GJ.; Markowski, J.; Rodriguez, M.; Musher, DM. (1993). "Progression from asymptomatic to symptomatic urinary tract infection in patients with SCI: a preliminary study". J Am Paraplegia Soc. 16 (4): 219–24. PMID 8270918. Unknown parameter
|month=ignored (help) - ↑ Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE (1992). "Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration". Clin Infect Dis. 15 Suppl 1: S216–27. PMID 1477233.
- ↑ Evans DA, Williams DN, Laughlin LW, Miao L, Warren JW, Hennekens CH; et al. (1978). "Bacteriuria in a population-based cohort of women". J Infect Dis. 138 (6): 768–73. PMID 368263 Check
|pmid=value (help). - ↑ Kunin CM, McCormack RC (1968). "An epidemiologic study of bacteriuria and blood pressure among nuns and working women". N Engl J Med. 278 (12): 635–42. doi:10.1056/NEJM196803212781201. PMID 4866351.
- ↑ Bengtsson C, Bengtsson U, Björkelund C, Lincoln K, Sigurdsson JA (1998). "Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden". Scand J Urol Nephrol. 32 (4): 284–9. PMID 9764457.
- ↑ 26.0 26.1 Nicolle LE (1997). "Asymptomatic bacteriuria in the elderly". Infect Dis Clin North Am. 11 (3): 647–62. PMID 9378928.
- ↑ Warren JW, Tenney JH, Hoopes JM, Muncie HL, Anthony WC (1982). "A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters". J Infect Dis. 146 (6): 719–23. PMID 6815281.
- ↑ Lipsky BA, Inui TS, Plorde JJ, Berger RE (1984). "Is the clean-catch midstream void procedure necessary for obtaining urine culture specimens from men?". Am J Med. 76 (2): 257–62. PMID 6695949.
- ↑ Mims AD, Norman DC, Yamamura RH, Yoshikawa TT (1990). "Clinically inapparent (asymptomatic) bacteriuria in ambulatory elderly men: epidemiological, clinical, and microbiological findings". J Am Geriatr Soc. 38 (11): 1209–14. PMID 2246458.
- ↑ Nicolle, Lindsay E.; Bradley, Suzanne; Colgan, Richard; Rice, James C.; Schaeffer, Anthony; Hooton, Thomas M.; Infectious Diseases Society of America; American Society of Nephrology; American Geriatric Society (2005-03-01). "Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 40 (5): 643–654. doi:10.1086/427507. ISSN 1537-6591. PMID 15714408.
- ↑ "Guidelines on Urological Infections".
- ↑ "Guidelines on Urological Infections".
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.