-
Journal of Clinical Microbiology Apr 2020This minireview focuses on the microbiologic evaluation of patients with asymptomatic bacteriuria, as well as indications for antibiotic treatment. Asymptomatic... (Review)
Review
This minireview focuses on the microbiologic evaluation of patients with asymptomatic bacteriuria, as well as indications for antibiotic treatment. Asymptomatic bacteriuria is defined as two consecutive voided specimens (preferably within 2 weeks) with the same bacterial species, isolated in quantitative counts of ≥10 CFU/ml in women, including pregnant women; a single voided urine specimen with one bacterial species isolated in a quantitative count ≥10 CFU/ml in men; and a single catheterized urine specimen with one or more bacterial species isolated in a quantitative count of ≥10 CFU/ml in either women or men (or ≥10 CFU/ml of a single bacterial species from a single catheterized urine specimen). Any urine specimen with ≥10 CFU/ml group B is significant for asymptomatic bacteriuria in a pregnant woman. Asymptomatic bacteriuria occurs, irrespective of pyuria, in the absence of signs or symptoms of a urinary tract infection. The two groups with the best evidence of adverse outcomes in the setting of untreated asymptomatic bacteriuria include pregnant women and patients who undergo urologic procedures with risk of mucosal injury. Screening and treatment of asymptomatic bacteriuria is not recommended in the following patient populations: pediatric patients, healthy nonpregnant women, older patients in the inpatient or outpatient setting, diabetic patients, patients with an indwelling urethral catheter, patients with impaired voiding following spinal cord injury, patients undergoing nonurologic surgeries, and nonrenal solid-organ transplant recipients. Renal transplant recipients beyond 1 month posttransplant should not undergo screening and treatment for asymptomatic bacteriuria. There is insufficient evidence to recommend for or against screening of renal transplant recipients within 1 month, patients with high-risk neutropenia, or patients with indwelling catheters at the time of catheter removal. Unwarranted antibiotics place patients at increased risk of adverse effects (including diarrhea) and contribute to antibiotic resistance. Methods to reduce unnecessary screening for and treatment of asymptomatic bacteriuria aid in antibiotic stewardship.
Topics: Antimicrobial Stewardship; Bacteriuria; Child; Female; Humans; Laboratories; Male; Pregnancy; Pyuria; Urinary Tract Infections
PubMed: 32051261
DOI: 10.1128/JCM.00518-18 -
Journal of Feline Medicine and Surgery Oct 2022A urine culture is often pursued in cats with acute kidney injury (AKI) to screen for bacterial growth in the urine, but it can be cost prohibitive. The aim of the study...
OBJECTIVES
A urine culture is often pursued in cats with acute kidney injury (AKI) to screen for bacterial growth in the urine, but it can be cost prohibitive. The aim of the study was to determine the ability of a urinalysis and lower urinary tract signs (LUTS) to predict urine culture results in cats with AKI.
METHODS
Ninety-seven cats with AKI were included in this study. This was a retrospective, observational study. Medical records from 2008 to 2018 were reviewed to identify cats with AKI that had a paired urinalysis and urine bacterial culture. The sensitivity, specificity, positive predictive value and negative predictive values of microscopic bacteriuria, pyuria, hematuria and the presence of LUTS for predicting urine culture results was calculated.
RESULTS
Thirty-two percent of cats (n = 31) had a positive urine culture. Of these, 28 (90%) had bacteriuria, 21 (68%) had pyuria, 13 (42%) had hematuria and 10 (32%) had LUTS. Of the 42 cats without hematuria or pyuria, seven had a positive urine culture (17%). Bacteriuria had a high sensitivity (90%) and specificity (92%) for predicting urine culture bacterial growth. The absence of bacteriuria had a high negative predictive value for no bacterial growth (95%). The odds of a positive urine culture were increased with bacteriuria (odds ratio [OR] 114, 95% confidence interval [CI] 29-621; <0.001), pyuria (OR 21, 95% CI 7-70; <0.001) and LUTS (OR 5, 95% CI 1.7-16; = 0.004). Hematuria was not associated with a positive culture (sensitivity 42%, specificity 52%).
CONCLUSIONS AND RELEVANCE
Microscopic bacteriuria and pyuria on urine sediment evaluation and LUTS can be helpful for predicting bacterial culture results in cats with AKI and in settings where submitting a urine culture may not be financially feasible.
Topics: Acute Kidney Injury; Animals; Bacteriuria; Cat Diseases; Cats; Pyuria; Urinalysis; Urinary Tract Infections; Urine
PubMed: 35748789
DOI: 10.1177/1098612X221105309 -
Journal of Veterinary Internal Medicine Nov 2016Bacterial urinary tract infections are uncommon in cats in general but the prevalence increases to 29% in older cats with comorbidities (Veterinary Clinical Pathology...
BACKGROUND
Bacterial urinary tract infections are uncommon in cats in general but the prevalence increases to 29% in older cats with comorbidities (Veterinary Clinical Pathology 2008, 37, 317; Journal of Feline Medicine & Surgery 2007, 9, 124; Veterinary Microbiology 2009, 136, 130). Frequently, the infections are subclinical. The clinical relevance of subclinical bacteriuria (SB) is uncertain, and the optimal treatment requires clarification.
OBJECTIVE
Prospective, observational study to: (i) identify the prevalence and incidence count of SB in older (≥7 years), nonazotemic cats, (ii) evaluate specific risk factors for SB, and (iii) investigate the potential relationship between untreated SB and survival.
ANIMALS
Sixty-seven, nonazotemic cats were tested on 5 occasions over 3 years.
METHODS
Urine samples were obtained by cystocentesis for quantitative urine culture and blood samples for measurement of serum creatinine concentration. Episodes of SB were not treated. Serum creatinine concentration, body weight, urine specific gravity, sex, and age were evaluated as potential risk factors for a positive urine culture. The association between urine culture results and survival was evaluated with Cox's proportional hazard model.
RESULTS
A total of 256 urine samples was obtained. The prevalence of SB varied between 10 and 13%, and incident infections were uncommon. Female cats were 21 times more likely to have a positive urine culture than were male cats (odds ratio [OR], 21.2; confidence interval [CI], 4.1-110; P = .00028). Subclinical bacteriuria was not significantly associated with survival.
CONCLUSION AND CLINICAL IMPORTANCE
Subclinical bacteriuria is common in nonazotemic, older cats. Although antimicrobial treatment was withheld, the presence of SB was not adversely associated with survival.
Topics: Age Factors; Animals; Bacteriuria; Cat Diseases; Cats; Creatinine; Female; Male; Prospective Studies; Sex Factors; Survival Analysis; Urinalysis
PubMed: 27859751
DOI: 10.1111/jvim.14598 -
Australian Family Physician Oct 2011To identify the prevalence of asymptomatic bacteriuria in the elderly population and to examine associated risk factors, complications and natural history, and whether... (Review)
Review
AIM
To identify the prevalence of asymptomatic bacteriuria in the elderly population and to examine associated risk factors, complications and natural history, and whether treatment improves prognosis.
METHODS
A literature search of MEDLINE, PubMed and the Cochrane Library was undertaken of studies published from 1980 to 2009. A total of 70 articles were identified. Emphasis was given to randomised controlled trials, review articles and more recent publications.
RESULTS
Asymptomatic bacteriuria is common in the elderly, especially among institutionalised or hospitalised patients. Risk factors include cognitive impairment, diabetes mellitus, structural urinary tract abnormalities and indwelling catheters. Antimicrobial therapy does not result in improved survival or genitourinary morbidity and may potentially cause avoidable side effects and the emergence of resistant organisms.
CONCLUSION
Bacteriuria is common in functionally impaired elderly patients. In the absence of symptoms or signs of infection, routine dipstick screening and subsequent antimicrobial therapy is not recommended.
Topics: Aged; Aged, 80 and over; Asymptomatic Infections; Bacteriuria; Humans; Prevalence; Risk Factors
PubMed: 22003486
DOI: No ID Found -
International Journal of Nursing Studies Oct 2022Antimicrobial resistance is a global health threat. To slow resistance and preserve antibiotics, stewardship interventions are increasingly promoted and mandated. Urine... (Review)
Review
BACKGROUND
Antimicrobial resistance is a global health threat. To slow resistance and preserve antibiotics, stewardship interventions are increasingly promoted and mandated. Urine cultures are the most common microbiological test in the outpatient setting. Contamination most likely occurs during urine collection from surrounding vaginal, perineal, and epidermal flora. Sample contamination can lead to incorrect diagnosis, unnecessary or inappropriate treatment, poor patient outcomes, and higher costs. Therefore, ensuring proper collection of urinary samples serves as a prime diagnostic stewardship target, one that international nursing societies increasingly endorse as an opportunity for nurse involvement.
OBJECTIVES
Determine the prevalence, predictors, and antibiotic prescribing associated with contaminated urine cultures in primary care clinics.
DESIGN
Cross-sectional study.
SETTING
Two adult safety-net clinics in Houston, Texas.
PARTICIPANTS
1265 clinical encounters among 1114 primary care patients.
METHODS
We reviewed charts from office visits among patients who had a urine culture ordered between November 2018 and March 2020. Patient demographics, culture results and prescription orders were captured for each visit. Culture results were defined as no growth, contaminated (i.e., mixed flora, non-uropathogens, or ≥3 bacterial species isolated), or low-count (10-10 colony forming units (CFU)/mL) or high-count (>10 CFU/mL) uropathogen-positive. We performed multinomial logistic regression to identify predictors independently associated with contaminated cultures.
RESULTS
Our study evaluated 1265 cultures from 1114 patients that were primarily female (84 %), of Hispanic/Latino (74.4 %) or Black/African American (18.9 %) race/ethnicity with a mean age of 43 years. Out of 1265 urine cultures, 264 (20.9 %) had no growth, 694 (54.9 %) were contaminated, 159 (12.6 %) were low-count positive, and 148 (11.7 %) were high-count positive. Female sex, pregnancy, and obesity were associated with contaminated cultures (multinomial adjusted odds ratios: 15.89, 14.34, 1.93, respectively; 95 % confidence intervals: 10.25-24.61, 8.03-25.61, 1.32-2.81, respectively). Antibiotic prescribing was significantly higher among symptomatic patients with contaminated cultures compared to those with no growth.
CONCLUSION
Urine culture contamination occurred frequently in our clinics, and obesity, female sex and pregnancy were independent risk factors for contamination. The association of pregnancy and contamination is particularly concerning as pregnant females are routinely screened and treated for asymptomatic bacteriuria in the United States. Culture contamination may obscure underlying uropathogens, leading to pyelonephritis or potential neonatal infection if untreated. Conversely, overtreatment of false positive bacteriuria could lead to adverse effects from antibiotics and increased risk for antibiotic resistance. As nurses play a prominent role in patient education, diagnostic stewardship interventions may want to utilize nurses' educational capabilities to improve urine culture collection.
TWEETABLE ABSTRACT
55 % of urine cultures collected in primary care clinics were contaminated, revealing a major opportunity for nurse-driven diagnostic stewardship interventions.
Topics: Adult; Anti-Bacterial Agents; Bacteriuria; Cross-Sectional Studies; Female; Humans; Infant, Newborn; Obesity; Pregnancy; Prevalence; Primary Health Care; Urinary Tract Infections
PubMed: 35914376
DOI: 10.1016/j.ijnurstu.2022.104325 -
Journal of Veterinary Internal Medicine 2023The ability to detect bacteriuria in dogs with a point-of-care test might improve medical care and antimicrobial stewardship.
BACKGROUND
The ability to detect bacteriuria in dogs with a point-of-care test might improve medical care and antimicrobial stewardship.
HYPOTHESIS AND OBJECTIVE
A rapid immunoassay (RIA; RapidBac) will provide acceptable sensitivity and specificity for diagnosis of bacteriuria.
ANIMALS
Forty-four client-owned dogs with a clinical indication for urinalysis and aerobic bacterial urine culture.
METHODS
Prospective study. Urine, collected by cystocentesis, was submitted for urinalysis and culture at a diagnostic laboratory. Owners completed an enrollment questionnaire regarding their dogs' clinical signs. The RIA was performed according to the manufacturer's guidelines. Results were compared to culture.
RESULTS
Forty-four urine specimens were evaluated from 44 dogs. The sensitivity and specificity of the RIA test to detect bacteriuria compared to urine culture were 81.8% (95% CI, 65.7%-97.9%) and 95.5% (95% CI, 86.8%-99.9%), respectively. For cultures yielding ≥10 CFU/mL, sensitivity increased to 90.0% (95% CI, 76.9%-100%) and specificity was similar at 95.2% (95% CI, 86.1%-99.9%). Malodorous urine, bacteriuria, and pyuria were more likely to be present in dogs with positive RIA or urine culture results compared to dogs with negative results.
CONCLUSIONS AND CLINICAL IMPORTANCE
The RIA was easy to perform and had good sensitivity and excellent specificity in this group of dogs. The RIA might be a useful screening test for decision-making regarding antimicrobial therapy in dogs with a clinical indication for urine culture. Consideration could be given to amending the International Society for Companion Animal Infectious Disease definition of bacterial cystitis as the presence of signs of lower urinary tract disease together with positive culture or a positive RIA.
Topics: Dogs; Animals; Bacteriuria; Prospective Studies; Urinalysis; Bacterial Infections; Radioimmunoassay; Urinary Tract Infections; Dog Diseases
PubMed: 37084042
DOI: 10.1111/jvim.16684 -
Disease Markers 2022To investigate the clinical diagnostic value of differential flora as biomarkers in patients with symptomatic urinary tract infection (UTI) and asymptomatic bacteriuria...
Screening Biomarkers and Constructing a Predictive Model for Symptomatic Urinary Tract Infection and Asymptomatic Bacteriuria in Patients Undergoing Cutaneous Ureterostomy: A Metagenomic Next-Generation Sequencing Study.
OBJECTIVES
To investigate the clinical diagnostic value of differential flora as biomarkers in patients with symptomatic urinary tract infection (UTI) and asymptomatic bacteriuria (ASB) undergoing cutaneous ureterostomy based on metagenomic next-generation sequencing and construct predictive models to provide a scientific reference for clinical diagnosis and treatment. . According to standard procedures, samples were taken from each patient for routine tests (urine, ureteral stent, and skin swab around the stoma). Cytokine levels in the blood were also detected. Urinary microflora were measured by mNGS, and potential biomarkers for distinguishing UTI and ASB were identified by differential flora. Finally, we generated the predictive models for ASB and UTI using the Lasso method and cytokine levels.
RESULTS
Urine culture was performed for 50 patients with cutaneous ureterostomy; 44 of these patients developed bacteriuria. The incidence of symptomatic bacteriuria was 54.55%. Biomarker analysis showed that , , , , and all had good predictive performance and were combined in a single model. The predictive model exhibited good prediction performance (area under the curve (AUC) = 0.8729, sensitivity = 80%, specificity = 83.3%, and cutoff = 1.855). We also identified a significant negative correlation between the weight sum of the abundance for these five characteristic pathogens (Sum_weighted_Reads) and levels of the cytokine IL-6 and IL-1 ( < 0.05).
CONCLUSION
mNGS had a higher positive detection rate for pathogens in urine samples. The selected differential bacteria can be used as biomarkers of ASB and UTI, and the prediction model has good predictive performance. Analysis also showed that the occurrence of symptoms was related to individual immunity. Combined with the Sum_weighted_Reads cutoff and cytokine levels (IL-6 and IL-1) of differential flora, it was possible to judge the severity of symptoms in cutaneous ureterostomy patients with bacteriuria and provide new insights for the treatment and intervention of ASB and UTI.
Topics: Bacteriuria; Biomarkers; Female; High-Throughput Nucleotide Sequencing; Humans; Interleukin-6; Male; Ureterostomy; Urinary Tract Infections
PubMed: 35531475
DOI: 10.1155/2022/7056517 -
Endocrine Nov 2023The prevalence of type 2 diabetes mellitus (T2DM) is increasing each year and has become one of the most prominent health concerns worldwide. Patients with T2DM are... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The prevalence of type 2 diabetes mellitus (T2DM) is increasing each year and has become one of the most prominent health concerns worldwide. Patients with T2DM are prone to infectious diseases, and urinary tract infections are also widespread. Despite a comprehensive understanding of urinary tract infection (UTI), there is a lack of research regarding primary prevention strategies for asymptomatic bacteriuria (ASB).
OBJECTIVE
To clarify the incidence and risk factors of asymptomatic urinary tract infection in patients with T2DM by meta-analysis to provide evidence for preventing UTI. Help patients, their families, and caregivers to identify the risk factors of patients in time and intervene to reduce the incidence of ASB in patients with T2DM. Fill in the gaps in existing research.
STUDY DESIGN
Meta-analyses were conducted in line with PRISMA guidelines.
METHODS
Eleven databases were systematically searched for articles about ASB in T2DM, and the retrieval time was selected from the establishment of the database to February 5, 2023. Literature screening, quality evaluation, and meta-analysis were independently performed by two researchers according to the inclusion and exclusion criteria, and a meta-analysis was performed using Stata 17.0.
RESULTS
Fourteen articles were included, including cohort and case-control studies. A meta-analysis of 4044 patients with T2DM was included. The incidence of ASB in patients with T2DM was 23.7%(95% CI (0.183, 0.291); P < 0.001). After controlling for confounding variables, the following risk factors were associated with ASB in patients with T2DM: age (WMD = 3.18, 95% CI (1.91, 4.45), I = 75.5%, P < 0.001), female sex (OR = 1.07, 95% CI(1.02, 1.12), I = 79.3%, P = 0.002), duration of type 2 diabetes (WMD = 2.54, 95% CI (1.53, 5.43), I = 80.7%, P < 0.001), HbA1c (WMD = 0.63, 95% CI (0.43, 0.84), I = 62.6,%. P < 0.001), hypertension (OR = 1.59, 95% CI (1.24, 2.04), I = 0%, <0.001), hyperlipidemia (OR = 1.66, 95% CI (1.27, 2.18), I = 0%, P < 0.001), Neuropathy (OR = 1.81, 95% CI (1.38, 2.37), I = 0%, P < 0.001), proteinuria (OR = 3.00, 95% CI (1.82, 4.95), I = 62.7%, P < 0.001).
CONCLUSION
The overall prevalence of ASB in T2DM is 23.7%. Age, female sex, course of T2DM, HbA1C, hypertension, hyperlipidemia, neuropathy, and proteinuria were identified as related risk factors for ASB in T2DM. These findings can provide a robust theoretical basis for preventing and managing ASB in T2DM.
Topics: Humans; Female; Bacteriuria; Diabetes Mellitus, Type 2; Incidence; Glycated Hemoglobin; Risk Factors; Urinary Tract Infections; Proteinuria; Hyperlipidemias; Hypertension
PubMed: 37599328
DOI: 10.1007/s12020-023-03469-6 -
Journal of Veterinary Internal Medicine Nov 2017Paralysis is a known risk factor for urinary tract infections (UTI), sepsis, and death in paralyzed people, but there are no data available on diagnostic criteria for...
BACKGROUND
Paralysis is a known risk factor for urinary tract infections (UTI), sepsis, and death in paralyzed people, but there are no data available on diagnostic criteria for UTI versus bacteriuria, their frequency, or clinical implications in chronically paralyzed dogs.
HYPOTHESIS/OBJECTIVES
That chronically paralyzed dogs suffer frequent bacteriuria causing reduced duration of survival. We documented the frequency of bacteriuria, associated clinical signs, and survival rate in chronically paralyzed dogs.
ANIMALS
Forty-seven client-owned dogs paralyzed with no pelvic limb pain perception for >3 months and at least one urine culture (UC) performed.
METHODS
Retrospective, observational study. Medical records of dogs meeting inclusion criteria were reviewed for results of UC, urinalysis, and clinical signs. Outcome was compared between dogs with and without bacteriuria.
RESULTS
Thirty-five of 47 dogs had at least 1 positive UC, and 13 had recurrent bacteriuria. Rectal temperature and urinalysis results were extracted from records. Fever was present at time of UC in 5 of 68 observations, 2 with and 3 without bacteriuria. Pyuria was significantly associated with positive cultures (P < 0.001), cloudiness was not (P = 0.076). Survival data in 35 dogs (8 dead) showed no association between bacteriuria and survival (P = 0.69).
CONCLUSIONS AND CLINICAL IMPORTANCE
Bacteriuria is common in paralyzed dogs but does not cause fever; diagnostic criteria of UTI are unclear. We did not detect an association of bacteriuria with survival, but this needs further confirmation.
Topics: Animals; Bacteriuria; Dog Diseases; Dogs; Female; Fever; Male; Paraplegia; Pyuria; Retrospective Studies; Urinary Tract Infections
PubMed: 29031032
DOI: 10.1111/jvim.14854 -
Archives of Physical Medicine and... Jan 2024Inappropriate diagnosis and treatment of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are leading causes of antibiotic overuse but have not been...
OBJECTIVE
Inappropriate diagnosis and treatment of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are leading causes of antibiotic overuse but have not been well-studied in patients with risks for complicated UTI such as neurogenic bladder (NB). Our aim was to describe ASB and UTI management in patients with NB and assess factors associated with inappropriate management.
DESIGN
Retrospective cohort study.
SETTING
Four Department of Veteran's Affairs (VA) medical centers.
PARTICIPANTS
Adults with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis (MS), or Parkinson disease (PD) and encounters with an ASB or UTI diagnosis between 2017 and 2018. Clinical and encounter data were extracted from the VA Corporate Data Warehouse and medical record reviews for a stratified sample of 300 encounters from N=291 patients.
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
Prevalence of appropriate and inappropriate ASB and UTI diagnosis and treatment was summarized. Multivariable logistic regression models assessed factors associated with inappropriate management.
RESULTS
N=200 UTI and N=100 ASB encounters were included for the 291 unique patients (SCI/D, 39.9%; MS, 36.4%; PD, 23.7%). Most patients were men (83.3%), >65 years (62%), and used indwelling or intermittent catheterization (68.3%). Nearly all ASB encounters had appropriate diagnosis (98%). 70 (35%) UTI encounters had inappropriate diagnosis, including 55 (27.5%) with true ASB, all with inappropriate treatment. Among the remaining 145 UTI encounters, 54 (27%) had inappropriate treatment. Peripheral vascular disease, chronic kidney disease, and cerebrovascular disease were associated with increased odds of inappropriate management; indwelling catheter (aOR 0.35, P=.01) and Physical Medicine & Rehabilitation provider (aOR 0.29, P<.01) were associated with decreased odds.
CONCLUSION
Up to half of UTI encounters for patients with NB had inappropriate management, largely due to inappropriate UTI diagnosis in patients with true ASB. Interventions to improve ASB and UTI management in patients with NB should target complex patients with comorbidities being seen by non-rehabilitation providers.
Topics: Male; Adult; Humans; Female; Bacteriuria; Retrospective Studies; Urinary Bladder, Neurogenic; Urinary Tract Infections; Spinal Cord Injuries; Spinal Cord Diseases
PubMed: 37827486
DOI: 10.1016/j.apmr.2023.09.023