Bacteriuria, asymptomatic

Nosocomial UTI is the most common infection in hospitals and nursing homes and 80% is associated with the use of urethral catheters. An incidence of bacteriuria of 3-10%/day makes the duration of catheterization the most important risk factor for bacteriuria. Asymptomatic bacteriuria should not be treated. However, up to 30% of patients with catheter-associated bacteriuria will develop fevers or other symptoms of UTI. In long term catheterization Providencia stmrtii and Candida species are the most common responsible organisms. Exchange of the catheter under therapy is advised in chronic cases. 

From a therapeutic point of view, it is essential to confirm the presence of bacteriuria (a condition in which there are bacteria in the urine) since symptoms alone are not a reliable method of documenting infection. This applies particularly to bladder infection where the symptoms of burning micturition (dysuria) and frequency can be associated with a variety of non-bacteriuric conditions. Patients with symptomatic bacteriuria should always be treated. However, the necessity to treat asymptomatic bacteriuric patients varies with age and the presence or absence of underlying urinary tract abnormalities. In the pre-school child it is essential to treat all urinary tract infections and maintain the urine in a sterile state so that normal kidney maturation can proceed. Likewise in pregnancy there is a risk of infection ascending from the bladder to involve the kidney. This is a serious complication and may result in premature labour. Other indications for treating asymptomatic bacteriuria include the presence of underlying renal abnormalities such as stones which may be associated with repeated infections caused by Proteus spp. 

Recommend a pharmacotherapy regimen for asymptomatic bacteriuria in a pregnant female that is likely to be safe and effective. 

Bacteriuria. Often asymptomatic in pregnancy. Diagnosed by positive urine culture. 

It is known that an association exists between maternal UTI during pregnancy and fetal death, mental retardation, and developmental delay.24 Because of this known association, and because up to 7% of pregnant women have an asymptomatic bacteriuria that may progress to pyelonephritis, screening is necessary. In patients with significant bacteriuria, whether symptomatic or asymptomatic, treatment is recommended to avoid the complications discussed above. In the majority... 

The approach in the setting of a patient with bacteriuria and an indwelling urinary catheter follows two paths. The first, in asymptomatic patients with catheterization, is to hold antibiotics and remove the catheter if possible. The second as in the above-described patient who subsequently becomes symptomatic, antibiotics should then commence with removal of the catheter if possible. In both of the above situations, if discontinuation of the catheter is not possible, the patient should be re-catheterized with a new urinary catheter if the previous catheter is greater than 2 weeks old. 

Asymptomatic bacteriuria Bacteria present in the urine in a patient without signs or symptoms of a urinary tract infection. 

Treatment of asymptomatic bacteriuria is necessary to reduce the risk of pyelonephritis and premature delivery. A course of 7 to 10 days of treatment is common. A repeat culture 10 days after completion of treatment is recommended. 

The therapeutic management of UTIs is best accomplished by first categorizing the type of infection acute uncomplicated cystitis, symptomatic abacteriuria, asymptomatic bacteriuria, complicated UTIs, recurrent infections, or prostatitis. 

The management of asymptomatic bacteriuria depends on the age of the patient and, if female, whether she is pregnant. In children, treatment should consist of conventional courses of therapy, as described for symptomatic infections. 

Most clinicians feel that asymptomatic bacteriuria in the elderly is a benign disease and may not warrant treatment. The presence of bacteriuria can be confirmed by culture if treatment is considered. 

In patients with significant bacteriuria, symptomatic or asymptomatic, treatment is recommended in order to avoid possible complications during the pregnancy. Therapy should consist of an agent with a relatively low adverse-effect potential (a sulfonamide, cephalexin, amoxicillin, amoxicillin/clavulanate, nitrofurantoin) administered for 7 days. 

When bacteriuria occurs in the asymptomatic, short-term catheterized patient (less than 30 days), the use of systemic antibiotic therapy should be withheld and the catheter removed as soon as possible. If the patient becomes symptomatic, the catheter should again be removed, and treatment as described for complicated infections should be started. 

The spectrum of urinary tract infections (UTI) can vary from asymptomatic bacteriuria to cystitis to pyelonephritis to urosepsis. 

Is treatment with an antibiotic necessary Symptomatic patients always need treatment. Asymptomatic bacteriuria (=10 bacteria/ml in two separate urine cultures) only needs treatment in pregnancy, in children and in obstructions of the urinary tract. Obstmctions in urinary flow must be treated before an antibiotic is started. There is no clear evidence that hydration or acidification of urine improves the results of antimicrobial therapy. 

Antibiotics for asymptomatic patients with indwelling urinary catheters and bacteriuria. 

In contrast, asymptomatic bacteriuria does not require treatment in nonpregnant women and there is no evidence that treatment of asymptomatic bacteriuria reduces the risk of symptomatic episodes. Antibiotic treatment of bacteriuria in pregnant women, however, has been shown to reduce the risk of upper UTI, pre-term delivery and low birth weight babies and therefore asymptomatic bacteriuria detected during pregnancy should be treated with a 3-to 7-day course of antibiotics. 

Chemoprophylaxis is sometimes undertaken in patients liable to recurrent attacks or acute exacerbations of ineradicable infection. It may prevent progressive renal damage in children who are found to have asymptomatic bacteriuria on routine screening. Nitrofurantoin (50-100 mg/d), nalidixic acid (0.5-1.0 g/d) or trimethoprim (100 mg/d) are satisfactory. The drugs are best given as a single oral dose at night. 

Acute cystitis occurs in 0.3% to 1.3% of pregnancies. In addition to having significant amounts of bacteria in the urine, women with acute cystitis complain of urinary frequency and pain." The risks of low birth weight and preterm labor associated with acute cystitis have not been defined. Treatment for acute cystitis is the same as described for asymptomatic bacteriuria." ... 

A UTI is defined as the presence of microorganisms in the urinary tract that caimot he accounted for hy contamination. The organisms present have the potential to invade the tissues of the urinary tract and adjacent structures. Infection may he limited to the growth of bacteria in the urine, which frequently may not produce symptoms. A UTI can present as several syndromes associated with an inflammatory response to microbial invasion and can range from asymptomatic bacteriuria to pyelonephritis with bacteremia or sepsis. 

Asymptomatic bacteriuria is a common finding, particnlarly among those 65 years of age and older, when there is significant bacteriuria (>10 bacteria/mL of urine) in the absence of symptoms. Symptomatic abacteriuria or acute urethral syndrome consists of symptoms of frequency and dysuria in the absence of significant bacteriuria. This syndrome is commonly associated with Chlamydia infections. 

In the elderly, the ratio of bacteriuria in women and men is dramatically altered and is approximately equal in persons over the age of 65. ° The overall incidence of UTI increases substantially in this population, with the majority of infections being asymptomatic. The rate of infection increases further for elderly persons who are residing in nursing homes, particularly those who are hospitalized frequently. The increase is probably the result of a number of factors, including obstruction from prostatic hypertrophy in males, poor bladder emptying as a result of prolapse in females, fecal incontinence in demented patients, neuromuscular disease, including strokes, and increased urinary instrumentation (catheterization). 

Asymptomatic bacteriuria represents patients who, in the absence of urinary symptoms, are found to have two consecutive urine cultures... 

Patients with indwelling catheters acquire UTIs at a rate of 5% per day. The closed systems are capable of preventing bacteri-uria in most patients for up to 10 days with appropriate care. After 30 days of catheterization, however, there is a 78% to 95% incidence of bacteriuria despite use of a closed system. Unfortunately, UTI symptoms in catheterized patient are not clearly defined. Fever, peripheral leukocytosis, and urinary signs and symptoms may be of little predictive value. When bacteriuria occurs in the asymptomatic, short-term catheterized patient (<30 days), the use of systemic antibiotics should be withheld and the catheter removed as soon as possible. If the patient becomes symptomatic, the catheter should be removed and treatment as described for complicated infections started. The optimal duration of therapy is not known. In the long-term catheterized patient (>30 days), bacteriuria is inevitable. The administration of... 

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