Asymptomatic Bacteriuria - Causes, Symptoms, Diagnosis, and Treatment

What Is Asymptomatic Bacteriuria?

Asymptomatic bacteriuria is the presence of bacteria in the collected urine of a patient with no clinical features of a urinary tract infection. Asymptomatic bacteriuria is extremely common in clinical practice, and its incidence increases with age. For example, the incidence is 15 % or greater in females and males aged 65 to 80 and as elevated as 40 to 50 % after 80 years. Generally, patients with asymptomatic bacteriuria will never develop symptomatic urinary tract infections and can have no adverse effects from asymptomatic bacteriuria.

A widespread situation in clinical medicine is whether to treat asymptomatic patients who have bacteriuria. There are limited strategies in which antibiotic treatment of asymptomatic bacteriuria has been shown to improve patient results. Because of increasing antimicrobial resistance, it is significant not to treat patients with asymptomatic bacteriuria unless there is evidence of possible benefit. Pregnant women should be examined for asymptomatic bacteriuria in the first trimester and treated if positive. Treating asymptomatic bacteriuria in patients with diabetes, older persons, patients with or without catheters, or patients with spinal cord injuries has not been found to improve results.

What Causes Asymptomatic Bacteriuria?

Asymptomatic bacteriuria occurs in a lesser number of healthy people. It affects females more often than males. E.coli is the most common organism present in bacteria. The causes include-

• Having a urinary catheter placed in the body.

• Pregnant women.

• Older age.

• Recent history of surgical procedures in the urinary tract.

• Sexually active females.

• The presence of urinary tract obstructions like stones, cystoceles, and prostatic hypertrophy.

• Women are mostly affected by the fecal soiling of the perineum.

• Periodic instrumentation of the urinary tract.

What Are the Symptoms of Asymptomatic Bacteriuria?

As the name suggests, there are no symptoms of asymptomatic bacteriuria. But, the presence of symptoms can conclude a urinary tract infection but not asymptomatic bacteriuria. The symptoms of urinary tract infection include -

• Burning sensation during urination.

• Elevated urgency to urinate.

• Diuresis or increased frequency of urination.

How Is Asymptomatic Bacteriuria Diagnosed?

The presence of a considerable quantity of bacteria in a urine specimen collected from a person without symptoms or signs of a urinary tract infection characterizes asymptomatic bacteriuria. Quantitative standards for spotting significant bacteriuria in an asymptomatic person are -

• The presence of at least 100,000 colony-forming units (CFUs) per mL of urine in a voided midstream sample.

• The presence of at least 100 CFUs per mL of urine from a catheterized sample.

Urinalysis -

A urine dipstick for leukocyte esterase can detect the presence of bacteria, but it is not specific for asymptomatic bacteriuria. Puss cells in urine or pyuria may happen from other inflammatory disorders of the genitourinary tract as well. Urinary dipstick for nitrites is also insufficient because of infection with non-nitrite-producing organisms, the delay between collection and testing of the specimen, and insufficient time since the last abolition for nitrites to be produced at detectable levels. The combination of the dipstick for leukocyte esterase and nitrites is more certain for asymptomatic bacteriuria than either test alone.

Urinalysis with the microscopic exam for bacteria is a useful but non-quantitative method to identify bacteriuria. Pregnant women need to be examined for asymptomatic bacteriuria with a urine culture. The timing and frequency of screening urine cultures in pregnancy have not been organized, but obtaining a screening urine culture at the end of the first trimester of pregnancy is advised.

How to Enhance the Diagnosis and Management of Asymptomatic Bacteriuria?

The management of asymptomatic bacteriuria needs clinical experience. When meeting such patients, an interprofessional strategy with an infectious disease professional, emergency department physician, nurse practitioner, internist, pharmacist, and nurse is advised. Children, patients with diabetes, spinal cord injuries, and urinary catheters do not profit from treatment with antibiotics for asymptomatic bacteriuria. Treatment in these patients does not reduce the chance of symptomatic urinary tract infections or enhance survival. Still, it does increase the likelihood of adverse effects of antibiotics and the development of antibiotic-resistant bacteria. In contrast, the treatment of pregnant women with asymptomatic bacteriuria has been proven to be useful.

There is proof that treatment of asymptomatic bacteriuria in these patients reduces the risk of symptomatic urinary tract infection. The nurse should concentrate on promoting patient education and helping the family in learning to help the patient. The pharmacist may provide advice to the clinician regarding medication options as needed and help avoid drug-drug interactions. The clinical team of pharmacists, nurses, and clinicians working together to teach and encourage the patient and family will result in the best results.

How to Treat Asymptomatic Bacteriuria?

• Most patients with asymptomatic bacteriuria have no adverse outcomes and benefit less from antibiotic therapy. Few exceptions, such as pregnant patients, should be screened or treated for asymptomatic bacteriuria.

• Children, patients with diabetes, spinal cord injuries, and patients with urinary catheters do not succeed in treatment with antibiotics for asymptomatic bacteriuria.

• Treatment in these patients does not reduce the incidence of symptomatic urinary tract infections or increase survival. Nevertheless, it does increase the likelihood of adverse consequences from antibiotics and the growth of antibiotic-resistant bacteria.

• In discrepancy, the treatment of pregnant women with asymptomatic bacteriuria has been shown to be effective. Antimicrobial treatment of asymptomatic bacteriuria in pregnancy reduces the hazard of pyelonephritis, low-birthweight infants, and preterm delivery.

• Patients sustaining urologic procedures in which mucosal bleeding is expected, such as with resection of the prostate, and patients who are in the first three months following renal transplantation should possibly be treated. There is an indication that treatment of asymptomatic bacteriuria in these patients reduces the risk of symptomatic urinary tract infection.

• Treatment should be followed by the results of urine culture and sensitivity. Amoxicillin, Amoxicillin-Clavulanate, Cefuroxime, Cephalexin, and Nitrofurantoin are found safe for use in pregnancy. Treatment duration should be for three to seven days for pregnant women, and at least one follow-up urine culture needs to be performed.

Conclusion:

Asymptomatic bacteriuria is the presence of bacteria in the urine without any symptoms of urinary tract infection. It is generally seen in women more than men. There are no symptoms to detect asymptomatic bacteriuria. Diagnosis is made based on urinalysis and urine culture. Antibiotic treatment in asymptomatic bacteriuria urea is still questioned. However, there are certain conditions where antibiotic treatment is beneficial. For example, pregnancy, advanced age, presence of a urinary catheter, or patients with spinal cord injuries.