Asymptomatic Bacteriuria does it stand good or not in Diagnosis of Urinary tract infections?
THINK HOW GOOD WE ARE REPORTING URINARY TRACT INFECTIONS?
Dr.T.V.Rao MD
Urinary tract infection (UTI) is one of the most common diseases, occurring from the neonate up to geriatric age groups. Forty to 50% of adult women have a history of at least one UTI, However UTI is a major cause of Gram-negative sepsis in hospitalized patients and after renal transplantation With prolongation of life with advances in Medicine and Technology we are certain to have more challenges when we evaluate chronic Urinary Tract Infections, If you with reporting on table difference of opinion of colleagues is high and everyone has his or her own interpretations, At least 15 to 20 % of the established growth on culture plate opinions differ, Although there are general guidelines concerning diagnosis and classification of urinary tract infections, there are wide variations in clinical practice. There are both errors which are frequently committed and mysteries that are still unsolved Practical test methods
Interpretation of Urine Culture: Bacteria are frequently noted on urinalysis and cultured from urine specimens. The presence of bacteria in the urine may indicate one of 3 conditions: 1) specimen contamination; 2) urinary tract infection (UTI); or 3) clinical significance of a urine culture these conditions must each be considered and classification should be based upon history and exam findings coupled with urine findings. Specimen contamination should always be considered as this is common, particularly in female patients. High numbers of squamous cells on the urinalysis (>20) suggests contamination and results of the culture should generally be ignored.
The term "significant bacteriuria" was intended by Kass to provide a means of differentiating between contamination in the voided specimen and true urinary infection. It was based on the reasonable assumption that... the common pathogens of the urinary tract multiply in the urine and, therefore, when bacteria are deposited in the urine, they tend to multiply to very large numbers, usually exceeding 106 colonies per milliliter The distinction between bacteriuria and contamination is "based on an analysis of the distribution of bacterial counts in nonbacteriuric and bacteriuric populations," so that, as Kass himself makes clear, there is no specific bacterial number for use in the detection of bacteriuria, but, rather, a degree of probability that a given colony count signifies either bacteriuria or contamination in a voided specimen. Thus, the concept of "significant bacteriuria" at the level of 100,000 colonies/ml is very useful in
The gold standard for a urine test is to perform a bacteriological urine culture, with identification of the pathogen, with quantification and sensitivity testing. To test whether the patient has a UTI at all, orientating indirect methods are often used in practice to detect the bacteria or inflammation (dip sticks). The bacterial count may be assessed by urine microscopy and immersion culture media.
Significant bacteriuria does it stand good or not is matter of interest. The utility and consistency of the criterion of ≥105 colony-forming units per milliliter (cfu. /ml) of clean-catch urine for the diagnosis of UTI has been validated repeatedly. In children, rapid and reliable diagnosis of UTI is mandatory. Here, UTI is defined as bacterial count ≥104 cfu. /ml urine, accompanied by microscopical examination of the urine to exclude vaginal contamination (because such contamination frequently results in false-positive culture tests).
Asymptomatic Bacteriuria
Patients with positive urine cultures who lack symptoms of a UTI have the diagnosis of asymptomatic bacteriuria. ASBU is more common in some patient populations and the prevalence increases with advancing age. It is also associated with sexual activity in young women. Patients with impaired urinary voiding or indwelling urinary devices have a much higher prevalence of ASBU.to screen and treat for asymptomatic bacteriuria:
• Pregnant women (at least once in early pregnancy)
• Patients prior to a urologic procedure for which mucosal bleeding is anticipated (i.e. TURP, etc.)
• Kidney transplant patients are a group where the data is unclear and no recommendation can
be made
Who not to screen or treat for asymptomatic bacteriuria?
• Premenopausal, non-pregnant women
• Diabetic women
Older persons living in the community
• Elderly institutionalized residents of long-term care facilities
• Spinal cord-injured patients
• Patients with an indwelling urethral catheter (do not treat asymptomatic funguria either ) Unfortunately many patients with ASBU receive treatment which they do not benefit from and in fact are likely harmed by. The unnecessary treatment of ASBU can lead to antibiotic resistance, adverse drug effects, C. difficile infection, and contribute unnecessarily to the costs of medical care.
HOWEVER, CLINICIANS TAKE THEIR OWN DECISION MAKING As Active management is important because under some circumstances urinary tract infections may cause permanent renal scarring. Imaging procedures are a cornerstone for critical evaluation of urinary tract infections.
References Common errors in diagnosis and management of urinary tract infection. I: Pathophysiology and diagnostic techniques Martina Franz Walter H. Hörl Nephrology Dialysis and Transplantation Oxford academic
Dr.T.V.Rao MD @ Created as online resource for Clinical Microbiology
THINK HOW GOOD WE ARE REPORTING URINARY TRACT INFECTIONS?
Dr.T.V.Rao MD
Urinary tract infection (UTI) is one of the most common diseases, occurring from the neonate up to geriatric age groups. Forty to 50% of adult women have a history of at least one UTI, However UTI is a major cause of Gram-negative sepsis in hospitalized patients and after renal transplantation With prolongation of life with advances in Medicine and Technology we are certain to have more challenges when we evaluate chronic Urinary Tract Infections, If you with reporting on table difference of opinion of colleagues is high and everyone has his or her own interpretations, At least 15 to 20 % of the established growth on culture plate opinions differ, Although there are general guidelines concerning diagnosis and classification of urinary tract infections, there are wide variations in clinical practice. There are both errors which are frequently committed and mysteries that are still unsolved Practical test methods
Interpretation of Urine Culture: Bacteria are frequently noted on urinalysis and cultured from urine specimens. The presence of bacteria in the urine may indicate one of 3 conditions: 1) specimen contamination; 2) urinary tract infection (UTI); or 3) clinical significance of a urine culture these conditions must each be considered and classification should be based upon history and exam findings coupled with urine findings. Specimen contamination should always be considered as this is common, particularly in female patients. High numbers of squamous cells on the urinalysis (>20) suggests contamination and results of the culture should generally be ignored.
The term "significant bacteriuria" was intended by Kass to provide a means of differentiating between contamination in the voided specimen and true urinary infection. It was based on the reasonable assumption that... the common pathogens of the urinary tract multiply in the urine and, therefore, when bacteria are deposited in the urine, they tend to multiply to very large numbers, usually exceeding 106 colonies per milliliter The distinction between bacteriuria and contamination is "based on an analysis of the distribution of bacterial counts in nonbacteriuric and bacteriuric populations," so that, as Kass himself makes clear, there is no specific bacterial number for use in the detection of bacteriuria, but, rather, a degree of probability that a given colony count signifies either bacteriuria or contamination in a voided specimen. Thus, the concept of "significant bacteriuria" at the level of 100,000 colonies/ml is very useful in
The gold standard for a urine test is to perform a bacteriological urine culture, with identification of the pathogen, with quantification and sensitivity testing. To test whether the patient has a UTI at all, orientating indirect methods are often used in practice to detect the bacteria or inflammation (dip sticks). The bacterial count may be assessed by urine microscopy and immersion culture media.
Significant bacteriuria does it stand good or not is matter of interest. The utility and consistency of the criterion of ≥105 colony-forming units per milliliter (cfu. /ml) of clean-catch urine for the diagnosis of UTI has been validated repeatedly. In children, rapid and reliable diagnosis of UTI is mandatory. Here, UTI is defined as bacterial count ≥104 cfu. /ml urine, accompanied by microscopical examination of the urine to exclude vaginal contamination (because such contamination frequently results in false-positive culture tests).
Asymptomatic Bacteriuria
Patients with positive urine cultures who lack symptoms of a UTI have the diagnosis of asymptomatic bacteriuria. ASBU is more common in some patient populations and the prevalence increases with advancing age. It is also associated with sexual activity in young women. Patients with impaired urinary voiding or indwelling urinary devices have a much higher prevalence of ASBU.to screen and treat for asymptomatic bacteriuria:
• Pregnant women (at least once in early pregnancy)
• Patients prior to a urologic procedure for which mucosal bleeding is anticipated (i.e. TURP, etc.)
• Kidney transplant patients are a group where the data is unclear and no recommendation can
be made
Who not to screen or treat for asymptomatic bacteriuria?
• Premenopausal, non-pregnant women
• Diabetic women
Older persons living in the community
• Elderly institutionalized residents of long-term care facilities
• Spinal cord-injured patients
• Patients with an indwelling urethral catheter (do not treat asymptomatic funguria either ) Unfortunately many patients with ASBU receive treatment which they do not benefit from and in fact are likely harmed by. The unnecessary treatment of ASBU can lead to antibiotic resistance, adverse drug effects, C. difficile infection, and contribute unnecessarily to the costs of medical care.
HOWEVER, CLINICIANS TAKE THEIR OWN DECISION MAKING As Active management is important because under some circumstances urinary tract infections may cause permanent renal scarring. Imaging procedures are a cornerstone for critical evaluation of urinary tract infections.
References Common errors in diagnosis and management of urinary tract infection. I: Pathophysiology and diagnostic techniques Martina Franz Walter H. Hörl Nephrology Dialysis and Transplantation Oxford academic
Dr.T.V.Rao MD @ Created as online resource for Clinical Microbiology
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