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Asymp Bacteriuria A.almuhrij
Asymp Bacteriuria A.almuhrij
Abdulrahman A. AlMuhrij, MD
Urology resident
November 2015
Focus points
Asymptomatic Bacteriuria:
Non-catheterized patients.
Pregnant patients.
Diabetic patients.
Elderly patients.
Catheterized patients.
Definitions
Urinary tract infection:
UTI symptoms.
Pyuria (leukocyte esterase, WBC on UA).
Urine culture.
> 38 C
Lethargy /
confusion
chills
Pain
dysuria
Incontinence
frequency
Definitions
Asymptomatic Bacteriuria :
Bacteriuria.
Voided cultures 10^5 colony forming unit.
Single catheterized urine specimen with 10^2.
Symptoms free.
Antibiotics resistant.
Treatment side effect.
Disease.
Complications.
Reinfection.
Epidemiology
Prevalence:
men:
68-79: 0%.
90-103: 5.4%
Hospitalized: 30-34%
Women:
Premenopausal: 1-5%
68-79: 13.6%
90-103: 22.4%
Hospitalized: 42-50%
Risk Factors
Microbiology
pathophysiology
Urinary mucosa.
P-fimbriated (E coli).
Lipopolysaccharides.
Hemolysin and cytotoxic necrotizing factor 1.
Pregnant Patients
Is it a risk factor for ASB?
Incidence:
ASB: 2-10%.
Lower UTI: 1-2%.
Upper UTI: <1%.
Should we treat ASB?
Similar organisms.
Risk factors for pyelonephritis:
Young, nulliparity, SCD, DM, progression of pregnancy, immuno
suppression.
Pregnant Patients
Pregnant Patients
Kidneys :
Increase renal length (1 cm).
Increase GFR (30-50%).
Collecting system:
Decrease peristalsis.
Ureters:
Decrease peristalsis.
Mechanical obstruction.
Bladder:
Smooth muscle relaxation.
Increased capacity, urinary stasis.
Pregnant Patients
Recommended to screen ASB:
Early in pregnancy:
2-16 gestation week.
First prenatal visit.
Urine C/S.
Screening
Pregnant Patients
Treatment
Fetal toxicity
route
penicillins
Low risk
Oral, IV
cephalosporins
Low risk
Oral, IV
imipenem
Limited data
IV
meropenem
Limited data
IV
clindamycin
Low risk
Oral, IV
nitrofurantoin
controvesial
Oral
TMP/SMX
Risk of
teratogenesis
Oral, IV
gentamicin
Ototixicity/nephrot
oxicity
IV
ciprofloxacin
arthropathy
Oral, IV
Tetracycline,
doxycycline
Risk of
teratogenicity
Oral
Elderly Patients
Patients aged => 65 yo.
UTI:
15.5% (hospitalized patients).
6.2% disease related deaths.
ASB:
65-90 yo: 16%,21% (M,F)
Elderly Patients
Treatment
Women, no symptoms:
Hydration, work-up.
Mild symptoms:
Delay treatment till culture result.
Cystitis:
(1st line) Nitrofurantoin or TMP/SMX:
Women 3-5 days, Men 7-14 days.
(2nd line) Cipro or levo.
Fosfomycin (single dose).
Amoxacillin-clavulanate.
Elderly Patients
Treatment
Pyelonephritis:
No hospitalization:
TMP/SMX (14 days).
Flouroquinolone (5-7 days)
Hospitalized patient:
Aminoglycoside (+- cipro/ampicillin)
Catheterized Patients
7% per day of catheterization.
Microbiology:
Biofilm organisms:
Proteus mirabilis,
Providencia stuartii,
Pseudomonas aerginosa,
Candida.
Diabetic Patients
Hypothesis?
Is DM a risk factor?
Blood sugar level correlate with ASB?
Antimicrobial
Prophylaxis fo
r Urologic Pro
cedures
Prevention
Increase fluid intake?
Low dose AB:
Nitro (50-100 mg).
TMP/SMX (half strength).
Self treatment.
Flouroquinolone or TMP/SMX .
Proanthocyanidin.
D-mannose.
Oral estrogen?
C.I.C. and condom catheter use.
References
CAMPBELL-WALSH. Urology. Tenth edition.
Keri et al. Bacteriuria and urinary tract infections in the elderly.
Alexander P. et al. Urinary tract infection and bacteriuria in pregnanc
y.
Matthew Ferroni et al. Asymptomatic bacteriuria in non catheterized
adults.