bacteriuria

Asymptomatic bacteriuria is bacteriuria without accompanying symptoms of a urinary tract infection and is commonly caused by the bacterium Escherichia coli. Other potential pathogens are Klebsiella spp., and group B streptococci. It is more common in women, in the elderly, in residents of long-term care facilities, and in people with diabetes, bladder catheters, and spinal cord injuries.{{cite journal | vauthors = Coussement J, Scemla A, Abramowicz D, Nagler EV, Webster AC | title = Antibiotics for asymptomatic bacteriuria in kidney transplant recipients | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD011357 | date = February 2018 | issue = 2 | pmid = 29390169 | pmc = 6491324 | doi = 10.1002/14651858.CD011357.pub2 }} People with a long-term Foley catheter always show bacteriuria. Chronic asymptomatic bacteriuria occurs in as many as 50% of the population in long-term care.{{Citation|title=Ten Things Physicians and Patients Should Question|date=February 2014|url=http://www.choosingwisely.org/doctor-patient-lists/amda/|author1=AMDA – The Society for Post-Acute and Long-Term Care Medicine|author1-link=AMDA – The Society for Post-Acute and Long-Term Care Medicine|work=Choosing Wisely: an initiative of the ABIM Foundation|publisher=AMDA – The Society for Post-Acute and Long-Term Care Medicine|access-date=20 April 2015}}

There is an association between asymptomatic bacteriuria in pregnant women with low birth weight, preterm delivery, cystitis, infection of the newborn and fetus death.{{Cite journal |last1=Smaill |first1=Fiona M. |last2=Vazquez |first2=Juan C. |date=2019-11-25 |title=Antibiotics for asymptomatic bacteriuria in pregnancy |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=11 |doi=10.1002/14651858.CD000490.pub4 |issn=1469-493X |pmc=6953361 |pmid=31765489}}{{cite journal | vauthors = Szweda H, Jóźwik M | title = Urinary tract infections during pregnancy - an updated overview | journal = Developmental Period Medicine | volume = 20 | issue = 4 | pages = 263–272 | date = 2016 | pmid = 28216479 }}However, most of these studies were graded as poor quality. Bacteriuria in pregnancy also increases the risk of preeclampsia.

{{Main|Urinary tract infection}}

Symptomatic bacteriuria is bacteriuria with the accompanying symptoms of a urinary tract infection (such as frequent urination, painful urination, fever, back pain, abdominal pain and blood in the urine) and includes pyelonephritis or cystitis. The most common cause of urinary tract infections is Escherichia coli.{{cn|date=March 2023}}

Testing for bacteriuria is usually performed in people with symptoms of a urinary tract infection. Certain populations that cannot feel or express symptoms of infection are also tested when showing nonspecific symptoms. For example, confusion or other changes in behaviour can be a sign of an infection in the elderly. Screening for asymptomatic bacteriuria in pregnancy is a common routine in many countries, but controversial.{{cn|date=March 2023}}

• The gold standard for detecting bacteriuria is a bacterial culture which identifies the concentration of bacterial cells in the urine. The culture is usually combined with subsequent testing using biochemical methods or MALDI-TOF, which allows to identify the {{Citation needed span|causal|date=April 2021}} bacterial species, and antibiotic susceptibility testing. Urine culture is quantitative and very reliable, but can take at least one day to obtain a result and it is expensive.{{cite journal | vauthors = Bonkat G, Braissant O, Cai T, Köves B, Bjerklund Johansen TE, Pickard R, Veeratterapillay R | title = Non-molecular Methods to Detect Bacteriuria Prior to Urological Interventions: A Diagnostic Accuracy Systematic Review | language = English | journal = European Urology Focus | volume = 3 | issue = 6 | pages = 535–537 | date = December 2017 | pmid = 29627196 | doi = 10.1016/j.euf.2018.03.004 }} Miniaturization of bacterial culture within dipstick format, Digital Dipstick,{{cite journal | vauthors = Iseri E, Biggel M, Goossens H, Moons P, van der Wijngaart W | title = Digital dipstick: miniaturized bacteria detection and digital quantification for the point-of-care | journal = Lab on a Chip | volume = 20 | issue = 23 | pages = 4349–4356 | date = November 2020 | pmid = 33169747 | doi = 10.1039/D0LC00793E | doi-access = free }} allows bacterial detection, identification and quantification for bacteriuria within 10–12 hours at the point-of-care. Clinicians will often treat symptomatic bacteriuria based on the results of the urine dipstick test while waiting for the culture results.{{cn|date=March 2023}}
• Bacteriuria can usually be detected using a urine dipstick test. The nitrite test detects nitrate-reducing bacteria if growing in high numbers in urine. A negative dipstick test does not exclude bacteriuria, as not all bacteria which can colonise the urinary tract are nitrate-reducing. The leukocyte esterase test indirectly detects the presence of leukocytes (white blood cells) in urine which can be associated with a urinary tract infection. In the elderly, the leukocyte esterase test is often positive even in the absence of an infection.{{Citation needed|date=April 2021}} The urine dipstick test is readily available and provides fast, but often unreliable results. Some organisms such as chlamydia and Ureaplasma urealyticum will produce a negative leukocyte esterase reaction.
• Microscopy can also be used to detect bacteriuria. It is rarely used in clinical routine since it requires more time and equipment and does not allow reliable identification or quantification of the causal bacterial species.{{cn|date=March 2023}}

Bacteriuria is assumed if a single bacterial species is isolated in a concentration greater than 100,000 colony forming units per millilitre of urine in clean-catch midstream urine specimens.{{cite journal | vauthors = Detweiler K, Mayers D, Fletcher SG | title = Bacteruria and Urinary Tract Infections in the Elderly | journal = The Urologic Clinics of North America | volume = 42 | issue = 4 | pages = 561–568 | date = November 2015 | pmid = 26475952 | doi = 10.1016/j.ucl.2015.07.002 | type = Review }} In urine samples obtained from women, there is a risk for bacterial contamination from the vaginal flora. Therefore, in research, usually a second specimen is analysed to confirm asymptomatic bacteriuria in women. For urine collected via bladder catheterization in men and women, a single urine specimen with greater than 100,000 colony forming units of a single species per millilitre is considered diagnostic. The threshold for women displaying UTI symptoms can be as low as 100 colony forming units of a single species per millilitre. However, bacteria below a threshold of 10000 colony forming units per millilitre are usually reported as "no growth" by clinical laboratories.{{cite journal | vauthors = Hooton TM | title = Clinical practice. Uncomplicated urinary tract infection | journal = The New England Journal of Medicine | volume = 366 | issue = 11 | pages = 1028–1037 | date = March 2012 | pmid = 22417256 | doi = 10.1056/NEJMcp1104429 }}{{Cite book |last1=Sam |first1=Amir H. |last2=Teo |first2=James T. H. |url=https://books.google.com/books?id=zx51NwAACAAJ |title=Rapid Medicine |oclc=874194395 |date=2010-09-20 |df=dmy-all |publisher=Wiley |isbn=9781405183239 }}

Using special techniques certain non-disease causing bacteria have also been found in the urine of healthy people.{{cite journal | vauthors = Schneeweiss J, Koch M, Umek W | title = The human urinary microbiome and how it relates to urogynecology | journal = International Urogynecology Journal | volume = 27 | issue = 9 | pages = 1307–1312 | date = September 2016 | pmid = 26811114 | doi = 10.1007/s00192-016-2944-5 | s2cid = 6272587 }} These are part of the resident microbiota.

Although controversial, many countries including the United States recommend a one time screening for bacteriuria during mid pregnancy.{{cite journal | vauthors = Moore A, Doull M, Grad R, Groulx S, Pottie K, Tonelli M, Courage S, Garcia AJ, Thombs BD | display-authors = 6 | title = Recommendations on screening for asymptomatic bacteriuria in pregnancy | journal = CMAJ | volume = 190 | issue = 27 | pages = E823–E830 | date = July 2018 | pmid = 29986858 | pmc = 6041243 | doi = 10.1503/cmaj.171325 }} The screening method is by urine culture. Screening non-pregnant adults is recommended against by the United States Preventive Task Force.{{cite journal | vauthors = Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Doubeni CA, Epling JW, Kubik M, Landefeld CS, Mangione CM, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB | display-authors = 6 | title = Screening for Asymptomatic Bacteriuria in Adults: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 322 | issue = 12 | pages = 1188–1194 | date = September 2019 | pmid = 31550038 | doi = 10.1001/jama.2019.13069 | doi-access = free }}

The decision to treat bacteriuria depends on the presence of accompanying symptoms and comorbidities.

Asymptomatic bacteriuria generally does not require treatment. Exceptions include those undergoing surgery of the urinary tract, children with vesicoureteral reflux or others with structural abnormalities of the urinary tract.{{cite journal | vauthors = Ramos JA, Salinas DF, Osorio J, Ruano-Ravina A | title = Antibiotic prophylaxis and its appropriate timing for urological surgical procedures in patients with asymptomatic bacteriuria: A systematic review | journal = Arab Journal of Urology | volume = 14 | issue = 3 | pages = 234–239 | date = September 2016 | pmid = 27547467 | pmc = 4983160 | doi = 10.1016/j.aju.2016.05.002 }} In many countries, regional guidelines recommend treatment of pregnant women.

There is no indication to treat asymptomatic bacteriuria in diabetics, renal transplant recipients, and in those with spinal cord injuries.{{cite journal | vauthors = Nicolle LE | title = Urinary tract infections in special populations: diabetes, renal transplant, HIV infection, and spinal cord injury | journal = Infectious Disease Clinics of North America | volume = 28 | issue = 1 | pages = 91–104 | date = March 2014 | pmid = 24484577 | doi = 10.1016/j.idc.2013.09.006 }}

The overuse of antibiotics to treat asymptomatic bacteriuria has many adverse effects{{cite journal | vauthors = Zalmanovici Trestioreanu A, Lador A, Sauerbrun-Cutler MT, Leibovici L | title = Antibiotics for asymptomatic bacteriuria | journal = The Cochrane Database of Systematic Reviews | volume = 4 | pages = CD009534 | date = April 2015 | issue = 6 | pmid = 25851268 | pmc = 8407041 | doi = 10.1002/14651858.CD009534.pub2 }} such as an increased risk of diarrhea, the spread of antimicrobial resistance, and infection due to Clostridioides difficile.

Symptomatic bacteriuria is synonymous with urinary tract infection and typically treated with antibiotics. Common choices include nitrofurantoin and trimethoprim/sulfamethoxazole.{{cn|date=March 2023}}

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{{Abnormal clinical and laboratory findings for urine}}

{{Clinical microbiology techniques}}

Category:Bacteria and humans

Category:Abnormal clinical and laboratory findings for urine

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