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词条 Bacteriuria
释义

  1. Signs and symptoms

      Asymptomatic bacteriuria    Symptomatic bacteriuria  

  2. Diagnosis

  3. Screening

  4. Treatment

     Asymptomatic bacteriuria  Symptomatic bacteriuria 

  5. Epidemiology

  6. References

  7. External links

{{Use dmy dates|date=December 2017}}{{Use American English|date=December 2017}}{{Infobox medical condition (new)
| name = Bacteriuria
| image = Bacteriuria pyuria 4.jpg
| caption = Multiple rod-shaped bacteria shown between the larger white blood cells at urinary microscopy from a person with urinary tract infection.
| pronounce =
| synonym = Bacteruria
| field = Emergency medicine, infectious disease
| synonyms =
| symptoms =
| complications =
| onset =
| duration =
| types = Asymptomatic, symptomatic[1][2]
| causes =
| risks =
| diagnosis = Urinalysis, urine culture[3]
| differential = Contamination[1]
| prevention =
| treatment = Based on symptoms or risk factors[5][3]
| medication =
| prognosis =
| frequency = Asymptomatic: 3% (middle aged women), up to 50% (women in nursing homes)[7]
Symptomatic: up to 10% of women a year[8][9]
| deaths =
}}Bacteriuria is the presence of bacteria in urine.[1] Bacteriuria accompanied by symptoms is a urinary tract infection while that without is known as asymptomatic bacteriuria.[1][2] Diagnosis is by urinalysis or urine culture.[3] Escherichia coli is the most common bacterium found.[1] People without symptoms should generally not be tested for the condition.[3] Differential diagnosis include contamination.[1]

If symptoms are present treatment is generally with antibiotics.[3] Bacteriuria without symptoms generally does not require treatment.[3] Exceptions may include pregnant women, those who have had a recent kidney transplant, young children with significant vesicoureteral reflux, and those undergoing surgery of the urinary tract.[3][4]

Bacteriuria without symptoms is present in about 3% of otherwise healthy middle aged women.[7] In nursing homes rates are as high as 50% among women and 40% in men.[7] In those with a long term indwelling urinary catheter rates are 100%.[5] Up to 10% of women have a urinary tract infection in a given year and half of all women have at least one infection at some point in their lives.[6][7]

Signs and symptoms

Asymptomatic bacteriuria

Asymptomatic bacteriuria is bacteriuria without accompanying symptoms of a urinary tract infection. 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. 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.[8]

There is an association between asymptomatic bacteriuria in pregnant women with low birth weight, preterm delivery, and infection of the newborn.[9][10] However, most of these studies were graded as poor quality.[9] Bacteriuria in pregnancy also increase the risk of preeclampsia.[10]

Symptomatic bacteriuria

{{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) and includes pyelonephritis or cystitis. The most common cause of urinary tract infections is Escherichia coli.

Diagnosis

Testing for bacteriuria is usually performed in people with symptoms of a urinary tract infection. Certain populations which are not able to feel or express symptoms of an infection are also tested when showing unspecific 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 common routine in many countries, but controversial.

  • The gold standard for detecting bacteriuria is a bacterial culture which identifies the actual concentration of bacterial cells in the urine. The culture is usually combined with subsequent MALDI-TOF, which allows to identify the causal bacterial species, and antibiotic susceptibility testing. Urine culture is quantitative and very reliable, but takes at least one day to obtain a result. Therefore clinicians will often treat symptomatic bacteriuria based on the results of the urine dipstick test while waiting for the culture results.
  • 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 elderly, the leukocyte esterase test is often positive even in the absence of an infection. The urine dipstick test is readily available and provides fast, but often unreliable results.
  • 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.

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.[11] 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.[11] 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.[12][13]

Using special techniques certain non-disease causing bacteria have also been found in the urine of healthy people.[14] These are part of the resident microbiota.[14]

Screening

Although controversial, in many countries a one time screening for bacteriuria is tentatively recommended during early pregnancy.[15]

Treatment

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

Asymptomatic bacteriuria

Asymptomatic bacteriuria generally does not require treatment.[3] Exceptions include those undergoing surgery of the urinary tract, children with vesicoureteral reflux or others with structural abnormalities of the urinary tract.[16][3][17]{{medrs|date=October 2017}} In many countries, regional guidelines recommend treatment of pregnant women.[9]

There is no indication to treat asymptomatic bacteriuria in diabetics, renal transplant recipients, and in those with spinal cord injuries.[18]

The overuse of antibiotics to treat asymptomatic bacteriuria has many adverse effects[19] such as an increased risk of diarrhea, the spread of antimicrobial resistance, and infection due to Clostridium difficile.

Symptomatic bacteriuria

Symptomatic bacteriuria is synonymous with urinary tract infection and typically treated with antibiotics. Common choices include nitrofurantoin and trimethoprim/sulfamethoxazole.

Epidemiology

Rates of asymptomatic bacteriuria[5]
GroupPrevalence (in %)
Healthy premenopausal women 1.0 to 5.0
Pregnant women 1.9 to 9.5
Postmenopausal women (50 to 70 years of age) 2.8 to 8.6
People with diabetes mellitus Women 9.0 to 27.0
Men 0.7 to 1.0
Older community-dwelling people Women (older than
70 years) 		> 15.0
Men 3.6 to 19.0
Older long-term care residents Women 25.0 to 50.0
Men 15.0 to 40.0
People with spinal cord injury Intermittent catheter 23.0 to 89.0
Sphincterotomy and
condom catheter 		57.0
People undergoing hemodialysis 28.0
People with an indwelling
urinary catheter		 Short-term 9.0 to 23.0
Long-term 100

References

1. ^1 2 3 4 5 {{cite book|last1=Das|first1=K. V. Krishna|last2=Das|first2=KV Krishna|title=Textbook of Medicine: Two Volume Set|date=2017|publisher=JP Medical Ltd|isbn=9789386056108|page=1250|url=https://books.google.ca/books?id=884nDwAAQBAJ&pg=PA1250|language=en}}
2. ^1 {{cite journal|last1=Sendi|first1=P|last2=Borens|first2=O|last3=Wahl|first3=P|last4=Clauss|first4=M|last5=Uçkay|first5=I|title=Management of Asymptomatic Bacteriuria, Urinary Catheters and Symptomatic Urinary Tract Infections in Patients Undergoing Surgery for Joint Replacement: A Position Paper of the Expert Group|journal=Journal of bone and joint infection|date=2017|volume=2|issue=3|pages=154–159|doi=10.7150/jbji.20425|pmid=28894690|pmc=5592375}}
3. ^1 2 3 4 {{cite journal|last1=Köves|first1=B|last2=Cai|first2=T|last3=Veeratterapillay|first3=R|last4=Pickard|first4=R|last5=Seisen|first5=T|last6=Lam|first6=TB|last7=Yuan|first7=CY|last8=Bruyere|first8=F|last9=Wagenlehner|first9=F|last10=Bartoletti|first10=R|last11=Geerlings|first11=SE|last12=Pilatz|first12=A|last13=Pradere|first13=B|last14=Hofmann|first14=F|last15=Bonkat|first15=G|last16=Wullt|first16=B|title=Benefits and Harms of Treatment of Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis by the European Association of Urology Urological Infection Guidelines Panel|journal=European Urology|volume=72|issue=6|pages=865–868|date=25 July 2017|doi=10.1016/j.eururo.2017.07.014|pmid=28754533}}
4. ^1 2 3 4 5 {{cite web|title=Bacterial Urinary Tract Infections (UTIs)|url=http://www.merckmanuals.com/en-ca/professional/genitourinary-disorders/urinary-tract-infections-utis/bacterial-urinary-tract-infections-utis|website=Merck Manuals Professional Edition|accessdate=12 December 2017|language=en-CA|date=May 2016}}
5. ^1 2 3 4 {{cite journal|last1=Colgan|first1=R|last2=Nicolle|first2=LE|last3=McGlone|first3=A|last4=Hooton|first4=TM|title=Asymptomatic bacteriuria in adults.|journal=American Family Physician|date=15 September 2006|volume=74|issue=6|pages=985–90|pmid=17002033}}
6. ^1 {{cite journal |vauthors=Salvatore S, Salvatore S, Cattoni E, Siesto G, Serati M, Sorice P, Torella M |title=Urinary tract infections in women.|journal=European Journal of Obstetrics, Gynecology, and Reproductive Biology|date=June 2011|volume=156|issue=2|pages=131–6|pmid=21349630|doi=10.1016/j.ejogrb.2011.01.028}}
7. ^1 {{cite journal|author=Nicolle LE|title=Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis|journal=Urol Clin North Am|volume=35|issue=1|pages=1–12, v|year=2008|pmid=18061019|doi=10.1016/j.ucl.2007.09.004}}
8. ^{{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|page=|publisher=AMDA – The Society for Post-Acute and Long-Term Care Medicine|accessdate=20 April 2015}}
9. ^1 2 {{Cite journal|last=Smaill|first=Fiona M.|last2=Vazquez|first2=Juan C.|date=2015-08-07|title=Antibiotics for asymptomatic bacteriuria in pregnancy|journal=The Cochrane Database of Systematic Reviews|issue=8|pages=CD000490|doi=10.1002/14651858.CD000490.pub3|issn=1469-493X|pmid=26252501}}
10. ^1 {{Cite journal|last=Szweda|first=Hanna|last2=Jóźwik|first2=Marcin|date=2016|title=Urinary tract infections during pregnancy - an updated overview|journal=Developmental Period Medicine|volume=20|issue=4|pages=263–272|issn=1428-345X|pmid=28216479}}
11. ^1 {{cite journal|date=November 2015|title=Bacteruria and Urinary Tract Infections in the Elderly|journal=The Urologic Clinics of North America|type=Review|volume=42|issue=4|pages=561–8|doi=10.1016/j.ucl.2015.07.002|pmid=26475952|vauthors=Detweiler K, Mayers D, Fletcher SG}}
12. ^{{Cite journal|last=Hooton|first=Thomas M.|date=2012-03-15|title=Uncomplicated Urinary Tract Infection|journal=New England Journal of Medicine|volume=366|issue=11|pages=1028–1037|doi=10.1056/NEJMcp1104429|issn=0028-4793|pmid=22417256}}
13. ^{{cite book|title=Rapid Medicine|last=Sam|first=Amir H.|author2=James T.H. Teo|publisher=Wiley-Blackwell|year=2010|isbn=978-1-4051-8323-9|title-link=Rapid Medicine}}
14. ^1 {{cite journal | title=The human urinary microbiome and how it relates to urogynecology|authors=Schneeweiss J., Koch M., Umek W.|journal=Int Urogynecol J. |volume=27|issue=9|pages=1307–12| date=2016| doi =10.1007/s00192-016-2944-5|pmid= 26811114}}
15. ^{{cite journal |last1=Moore |first1=Ainsley |last2=Doull |first2=Marion |last3=Grad |first3=Roland |last4=Groulx |first4=Stéphane |last5=Pottie |first5=Kevin |last6=Tonelli |first6=Marcello |last7=Courage |first7=Susan |last8=Garcia |first8=Alejandra Jaramillo |last9=Thombs |first9=Brett D. |title=Recommendations on screening for asymptomatic bacteriuria in pregnancy |journal=Canadian Medical Association Journal |date=8 July 2018 |volume=190 |issue=27 |pages=E823–E830 |doi=10.1503/cmaj.171325|pmid=29986858 |pmc=6041243 }}
16. ^{{Cite journal|last=Ramos|first=Jorge A.|last2=Salinas|first2=Diego F.|last3=Osorio|first3=Johanna|last4=Ruano-Ravina|first4=Alberto|date=September 2016|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|doi=10.1016/j.aju.2016.05.002|issn=2090-598X|pmc=4983160|pmid=27547467}}
17. ^[https://www.nlm.nih.gov/medlineplus/ency/article/000520.htm Asymptomatic bacteriuria] from Medline Plus. Updated May 26, 2006, retrieved January 28, 2008.
18. ^{{Cite journal|last=Nicolle|first=Lindsay E.|title=Urinary Tract Infections in Special Populations|journal=Infectious Disease Clinics of North America|volume=28|issue=1|pages=91–104|doi=10.1016/j.idc.2013.09.006|pmid=24484577|year=2014}}
19. ^{{cite journal|last1=Zalmanovici Trestioreanu|first1=A|last2=Lador|first2=A|last3=Sauerbrun-Cutler|first3=MT|last4=Leibovici|first4=L|title=Antibiotics for asymptomatic bacteriuria.|journal=The Cochrane Database of Systematic Reviews|date=8 April 2015|volume=4|pages=CD009534|doi=10.1002/14651858.CD009534.pub2|pmid=25851268}}

External links

{{Medical resources
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}}{{Abnormal clinical and laboratory findings for urine}}Bacteriurie

3 : Bacteria and humans|Abnormal clinical and laboratory findings for urine|RTT
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