Asymptomatic bacteriuria: Difference between revisions
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'''In early pregnancy, both screening for asymptomatic bacteriuria by urine culture and treatment of positive results are recommended.''' | '''In early pregnancy, both screening for asymptomatic bacteriuria by urine culture and treatment of positive results are recommended.''' | ||
*Single screening with urine culture<ref name="-1990">{{Cite journal | title = Screening for asymptomatic bacteriuria, hematuria and proteinuria. The U.S. Preventive Services Task Force. | journal = Am Fam Physician | volume = 42 | issue = 2 | pages = 389-95 | month = Aug | year = 1990 | doi = | PMID = 2200247 }}</ref> | *Single screening with urine culture<ref name="-1990">{{Cite journal | title = Screening for asymptomatic bacteriuria, hematuria and proteinuria. The U.S. Preventive Services Task Force. | journal = Am Fam Physician | volume = 42 | issue = 2 | pages = 389-95 | month = Aug | year = 1990 | doi = | PMID = 2200247 }}</ref>in the first trimester | ||
<ref name="Stenqvist-1989">{{Cite journal | last1 = Stenqvist | first1 = K. | last2 = Dahlén-Nilsson | first2 = I. | last3 = Lidin-Janson | first3 = G. | last4 = Lincoln | first4 = K. | last5 = Odén | first5 = A. | last6 = Rignell | first6 = S. | last7 = Svanborg-Edén | first7 = C. | title = Bacteriuria in pregnancy. Frequency and risk of acquisition. | journal = Am J Epidemiol | volume = 129 | issue = 2 | pages = 372-9 | month = Feb | year = 1989 | doi = | PMID = 2912046 }}</ref> | |||
proved to be effective. | |||
<ref name="Wadland-1989">{{Cite journal | last1 = Wadland | first1 = WC. | last2 = Plante | first2 = DA. | title = Screening for asymptomatic bacteriuria in pregnancy. A decision and cost analysis. | journal = J Fam Pract | volume = 29 | issue = 4 | pages = 372-6 | month = Oct | year = 1989 | doi = | PMID = 2794885 }}</ref> | |||
*Antibiotics treatment has shown a significant decrease in the risk of subsequent [[pyelonephritis]](from 25-30% to 1-4%).<ref name="pmid11405965">{{cite journal| author=Smaill F| title=Antibiotics for asymptomatic bacteriuria in pregnancy. | journal=Cochrane Database Syst Rev | year= 2001 | volume= | issue= 2 | pages= CD000490 | pmid=11405965 | doi=10.1002/14651858.CD000490 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11405965 }} </ref> It also reduce the frequency of [[premature birth|preterm deliveries]] and [[low birth weight]].<ref name="pmid1533541">{{cite journal| author=Mittendorf R, Williams MA, Kass EH| title=Prevention of preterm delivery and low birth weight associated with asymptomatic bacteriuria. | journal=Clin Infect Dis | year= 1992 | volume= 14 | issue= 4 | pages= 927-32 | pmid=1533541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1533541 }} </ref> <ref name="pmid2927852">{{cite journal| author=Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins JC, Bracken M| title=Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. | journal=Obstet Gynecol | year= 1989 | volume= 73 | issue= 4 | pages= 576-82 | pmid=2927852 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2927852 }} </ref> | *Antibiotics treatment has shown a significant decrease in the risk of subsequent [[pyelonephritis]](from 25-30% to 1-4%).<ref name="pmid11405965">{{cite journal| author=Smaill F| title=Antibiotics for asymptomatic bacteriuria in pregnancy. | journal=Cochrane Database Syst Rev | year= 2001 | volume= | issue= 2 | pages= CD000490 | pmid=11405965 | doi=10.1002/14651858.CD000490 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11405965 }} </ref> It also reduce the frequency of [[premature birth|preterm deliveries]] and [[low birth weight]].<ref name="pmid1533541">{{cite journal| author=Mittendorf R, Williams MA, Kass EH| title=Prevention of preterm delivery and low birth weight associated with asymptomatic bacteriuria. | journal=Clin Infect Dis | year= 1992 | volume= 14 | issue= 4 | pages= 927-32 | pmid=1533541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1533541 }} </ref> <ref name="pmid2927852">{{cite journal| author=Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins JC, Bracken M| title=Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. | journal=Obstet Gynecol | year= 1989 | volume= 73 | issue= 4 | pages= 576-82 | pmid=2927852 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2927852 }} </ref> | ||
*The duration of antimicrobial therapy is 3-7 days. | *The duration of antimicrobial therapy is 3-7 days. |
Revision as of 10:39, 15 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Asymptomatic bacteriuria is a condition in which a significant number of bacteria appear in the urine occurring without typical symptoms such as burning during urination or frequent urination.[1]
Diagnostic Criteria
The diagnostic criteria depend on the way the urine specimen is being sampled, the goal is to avoid contamination and limit the period between taking the sample and testing it (avoidance of false positivity due to bacterial growth).
Clean catch, midstream voided urine specimen
For asymptomatic women:two consecutive voided urine specimens with the same bacterial strain isolated in a quantitative count of ≥105cfu/mL.[2]
For asymptomatic men :a single clean catch voided urine specimen with 1 bacterial species strain isolated in a quantitative count of ≥105cfu/mL.
OR
Bladder catheterization
A single catheterized urine specimen with isolation of species of bacterial strain in a quantitative count of ≥100 cfu/mL in both men and women.[3] [4]
Presumptive Etiologies
Most common organism
Escherichia coli is the single most common cause of asymptomatic bacteriuria.[5] [6] [7]
Patients with abnormal genitourinary tract or institutionalized elderly:
E.Coli remain common cause, but in men Proteus mirabilis is more common.[8]
Long term urologic device in place
Polymicrobial including Pseudomonas aeruginosa,P. mirabilis, Providencia stuartii, and Morganella morganii (urease-producing organisms).[8] [9]
Other organisms
- Coagulase-negative staphylococci especially in men .
- Enterococcus species.
- Group B streptococci
Management
Premenopausal, Nonpregnant Women
No screening or treatment recommended for healthy, bacteriuric women.
Although asymptomatic bacteriuria increases the risk of urinary tract infection but has no effect on the long term adverse outcomes like CKD, genitourinary cancer or overall survival.[12] [7]
Studies' results indicated that the treatment wouldn't decrease the frequency for asymptomatic bacteriuria or the risk of developing symptomatic urinary tract infection.[13]
Pregnant Women
[15] proved to be effective. [16]
Diabetic WomenAsymptomatic bacteriuria screening or treatment is not recommended for diabetic women.
Older Persons Residing in the CommunityRoutine screening and treatment for asymptomatic bacteriuria is not indicated.
Elderly Institutionalized SubjectsNo recommendation for screening for or treatment of asymptomatic bacteriuria.
Subjects with Spinal Cord InjuriesNo benefit from screening for or treatment of asymptomatic bacteriuria Although the high prevalence of asymptomatic bacteriuria in patients with spinal cord injuries, but antimicrobial therapy harm outweigh benefit because of recurrent infections with more resistant strains.. Patients with Indwelling Urethral CathetersIt is not recommended to screen for or treat asymptomatic bacteriuria or fungiuria, but antimicrobial therapy can be used for women with persistent bacteriuria 48 hours after removal of the urethral catheter.
Urologic Interventions
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