Bacteriuria symptomatic

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. 

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. 

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. 

The presence of pyuria (more than 10 white blood cells/mm3) in a symptomatic patient correlates with significant bacteriuria. 

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. 

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. 

Uses Suppress/eluninate bacteriuria associated w/ chronic/recurrent UTI Action Converted to formaldehyde ammonia in acidic urine nonspecific bactericidal action Dose Adults. Hippurate 0.5-1 g bid. Mandelate 1 g qid PO pc hs Peds 6-12 y. Hippurate 25-50 mg/kg/d PO bid. Mandelate 50-75 mg/kg/d PO qid (take w/ food, ascorbic acid w/ adequate hydration) Caution [C, +] Contra Renal insuff, severe hepatic Dz, severe dehydration sulfonamide allergy Disp Tabs SE Rash, GI upset, dysuria, t LFTs EMS Monitor BP for hypovolemia and dehydration OD Sxs unknown symptomatic and supportive... 

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. 

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. 

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. 

The prevalence of UTIs varies with age and gender. In newborns and infants up to 6 months of age, the prevalence of bacteriuria is about 1 % and is more common in boys. Most of these infections are associated with structural or functional abnormalities of the urinary tract and have been correlated with the lack of circumcision. Between the ages of 1 and 5 years, UTIs occur more frequently in females. The prevalence of bacteriuria in females and males of this age group is 4.5% and 0.5%, respectively. Infections occurring in preschool boys usually are associated with congenital abnormalities of the urinary tract. These infections are difficult to recognize because of the age of the patient, but they often are symptomatic. In addition, it is believed that the majority of renal damage associated with UTI develops at this age. ... 

Microscopic examination of the urine for leukocytes is also used to determine the presence of pyuria. The presence of pyuria in a symptomatic patient correlates with significant bacteriuria. Pyuria is defined as a white blood cell (WBC) count of greater than 10 WBCs/mm of urine. A count of 5 to 10 WBCs/mm is accepted as the upper limit of normal. It should be emphasized that pyuria is nonspecific and signifies only the presence of inflammation and not necessarily infection. Thus patients with pyuria may or may not have infection. Sterile pyuria has long been associated with urinary tuberculosis, as well as chlamydial and fungal urinary infections. 

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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