Detection Of Asymptomatic Bacteriuria Research Articles

Бессимптомная бактериурия у беременных: всегда ли оправдана антибиотикотерапия?

Introduction. Asymptomatic bacteriuria (ABU) occurs in 2–15% of pregnant women, but opinions about ABU in pregnant women are controversial. The aim of the study was to assess the outcomes of delivery in pregnant women with ABU, depending on the therapy and urological history. Material and methods. The histories of childbirth of 46 women with ABU detected during prenatal screening, were analyzed. The outcomes of pregnancies were analyzed, and the relationship between the presence of ABU, the type of therapy, the presence of pyelonephritis in history and the development (exacerbation) of pyelonephritis during pregnancy was determined. Results. The structure of uropathogens was typical: E. coli was found in 36 cases (78.3%), Enterococcus faecalis - in 10 cases (21.7%). Seven women (15.2%) had a history of chronic pyelonephritis, 4 (8.7%) had chronic cystitis. The remaining 35 pregnant women (76.1%) had no any urological diseases. More than half of pregnant women with ABU (32/69.6%) received Сanephron; all of them had normal delivery. The average weight of newborns was 3768±101.9 grams. The rest of the 14 (30.4%) pregnant women with ABU, including 7 patients with a history of pyelonephritis, received amoxicillin with clavulonic acid. In more than half of the them (4/57.1%) gestational pyelonephritis developed. Correlational analysis showed that the low weight of the newborn, the development of gestational pyelonephritis and the likelihood of preterm birth did not depend on the therapy for ABU (antibacterial or herbal medicine), but on the presence of chronic pyelonephritis in the pregnant woman. Conclusion. The detection of ABU in a healthy pregnant woman without urological history is not a convincing basis for prescribing antibiotics. Preventive phytotherapy with the drug «Canephron» in such women was sufficient; none of the cases developed gestational pyelonephritis or preterm labor

Asymptomatic Bacteriuria among Pregnant Women in Addis Ababa, Ethiopia: Prevalence, Causal Agents, and Their Antimicrobial Susceptibility.

Asymptomatic bacteriuria (ASBU) is an important health problem among pregnant women, particularly in low-income countries. This study aimed to estimate the prevalence of ASBU and potential risk factors among pregnant women attending antenatal care centers in Addis Ababa. It also aimed to identify causal bacterial pathogens and to assess their antimicrobial susceptibility. A health facility-based cross-sectional study was conducted from March to June 2019. Urine samples from a total of 281 pregnant women with no symptoms of urinary tract infection were tested for ASBU. Women whose urine samples carried greater than or equal to 105 colony-forming units (CFU) of bacteria per milliliter of urine when grown on plate count agar were considered positive for ASBU. Bacterial pathogens were isolated from urine samples of women with ASBU using standard microbiological techniques. Antimicrobial susceptibility of isolates was investigated using the Kirby–Bauer disk diffusion method on Muller–Hinton agar plates. Of 281 pregnant women examined, 44 (15.7%) were positive for ASBU. Logistic regression analysis of the putative risk factors tested in the current study showed that none of them were significantly associated with the occurrence of ASBU (p > 0.05). The most frequently isolated bacterial species were Escherichia coli 17 (30.2%), Proteus 13 (23.2%), and Enterococcus 11 (19.6%). All of the E. coli, Citrobacter, and Klebsiella isolates and 84.6% of Proteus were resistant to ampicillin. All bacterial isolates were resistant to at least one of the antimicrobials tested. Resistance to three or more antimicrobials was detected in 15 (88.2%) of E. coli, 13 (100%) of Proteus, and 8 (72.7%) of Enterococcus isolates. Resistance to as many as 7 antimicrobials among E. coli, 8 antimicrobials among Proteus, and 7 antimicrobials among Enterococcus isolates was recorded. Detection of ASBU in a substantial number of pregnant women in this study warrants the need for a detailed study on possible risks of developing symptomatic urinary tract infection (UTI) and associated complications. Multidrug resistance to several antimicrobials was observed in the majority of bacterial isolates. Regular assessment of antimicrobial susceptibility of uropathogens to commonly prescribed antimicrobials and implementation of prudent use of antimicrobials are recommended.

Asymptomatic Bacteriuria — to Treat or Not to Treat?

Over the past few decades, the opinion of scientists regarding the need for antibiotic therapy to detect asymptomatic bacteriuria has changed several times. At the present stage, the leading doctors of the world have not come to an unequivocal opinion — whether asymptomatic bacteriuria is worth treating or not. This condition means the presence of microorganisms in the organs of the urinary system, detected during bacteriological examination of urine in the absence of clinical symptoms of damage to the urinary organs. Most often with asymptomatic bacteriuria, Escherichia coli and various types of enterococci, Proteus, Klebsiella act as such bacteria. As a result of studying this issue, it was found that antibiotic therapy in such cases does not always lead to the desired effect, but it can lead to the development of candidiasis while taking antibacterial drugs. Some studies have shown that the presence of conditionally pathogenic microflora in the urinary tract prevents the development of urinary tract infections caused by more aggressive pathogens. On the other hand, asymptomatic bacteriuria during pregnancy is a source of increased risk in terms of the occurrence of gestational pyelonephritis, which dictates the need for preventive and therapeutic measures in this category of patients. Thus, each case of the detection of asymptomatic bacteriuria requires an individual approach and the choice of appropriate treatment tactics [2].

P159: Identifying the cause for inappropriate urine cultures in a Canadian urban academic emergency department

Introduction: Inspired by the Choosing Wisely® campaign, St. Michaels Hospital (SMH) launched an initiative to reduce unnecessary tests, treatments and procedures that may cause patient harm. Stakeholder engagement identified inappropriate ordering of urine culture & sensitivities (C&S) in the emergency department (ED) as a focus area. Inappropriate urine C&S increase workload, healthcare costs and detection of asymptomatic bacteriuria which can lead to unnecessary antibiotics. The project’s purposes were to describe the scope of inappropriately ordered urine C&S in the SMH ED and to conduct a root-cause analysis to inform future quality improvement interventions. Methods: Criteria for determining appropriateness was developed a priori using evidence-based guidelines from the University Health Network together with additional literature review. A retrospective chart review was performed on all urine C&S ordered in the ED from Jun 1 Aug 30, 2016. Each chart was reviewed for order appropriateness, demographic information and ordering provider. All inappropriate urine C&S were reviewed to identify root causes which were then grouped into common themes. A pareto chart was constructed to analyze the frequency of causes. Results: Of 425 urine C&S ordered, 75 (17.7%) were inappropriate. The top 3 reasons were: inappropriate urosepsis work-ups (53%), order processing errors (17%) and inappropriate work-ups for weakness (16%). Inappropriate urosepsis work-ups were defined as urine C&S that were ordered empirically despite there being a clear focus for infection elsewhere (i.e. cough, cellulitis) and in the absence of urinary symptoms. Order processing errors were defined as urine C&S which were sent despite there being no documented order. Inappropriate testing was more likely to occur overnight, in females and when a urine routine and microscopy was not ordered prior to C&S. 29% of patients with inappropriate C&S received antibiotics. Conclusion: 17.7% of urine C&S ordered in the SMH ED during the 3-month study period were inappropriate. The top cause was septic patients who were empirically tested despite having another source for infection identified from the outset. A possible reason for this is the recent ED emphasis on early recognition of sepsis which may encourage early use of antibiotics and empiric urine C&S. One question to resolve is whether a 17.7% overutilization rate is sufficient to make it a target for change. Interventions designed to reduce inappropriate urine C&S may inadvertently increase the number of missed cultures in patients admitted with sepsis not yet diagnosed. Next steps involve discussions between the ED, Internal Medicine, Infectious Disease and Microbiology, and patient partners to identify patient-centered change ideas and sustainable strategies. This may involve establishing guidelines for ordering urine C&S and incorporating lab services to provide oversight into urine C&S processing.

A prospective study of prevalence, risk factors, isolates & antimicrobial sensitivity pattern in Asymptomatic Bacteriuria among Antenatal women in Rajarajeswari Medical College & Hospital

Introduction: Urinary tract infections are one of the common infections during pregnancy. Asymptomatic bacteriuria is one of the risk factor and clinical manifestation of urinary tract infections. Detection of asymptomatic bacteriuria during pregnancy is important as subsequently 25% of infected women progress to chronic urinary tract infections resistant to chemotherapy. These infections leads to various pregnancy associated maternal complications like pregnancy induced hypertension, maternal anemia, preterm labor and fetal complication like low birth weight which can be prevented by detecting and treating asymptomatic bacteriuria. Aims and Objectives: This study was carried out to detect the prevalence of asymptomatic bacteriuria in antenatal women attending outpatient department in Rajarajeswari Medical College & Hospital, to identify the common causative organisms responsible for asymptomatic bacteriuria and antimicrobial sensitivity pattern of pathogens isolated. Material and Methods: 500 asymptomatic pregnant women who attended outpatient clinic in Ob & G department Rajarajeswari Medical College & Hospital Bangalore, Karnataka, India were enrolled. Mid stream of urine was collected by clean catch technique into a sterile container and then subjected to culture& antimicrobial sensitivity test. Results: Our study showed 12% (60/500) prevalence of asymptomatic bacteriuria among antenatal women. Insignificant bacteriuria in 4% (20/500), growth of contaminants 6% (30/500) and sterile urine 78% (390/500) were seen in samples cultured. Lower socio-economic status, lower level of education, multiparity, advancing maternal age and advancing gestation period were associated with high risk for asymptomatic bacteriuria. The most common organism grown was Escherichia coli (E. coli) in 40/60 cases (66.66%), followed by Klebsiella in 8/60 cases (13.66%), Enterococcus in 7/60 (11.66%) and Staphylococcus aureus in 3/60 cases (5%). The most effective antimicrobial agent agai

Urine Cultures among Hospitalized Veterans: Casting Too Broad a Net?

Since detection of asymptomatic bacteriuria among inpatients often leads to inappropriate antimicrobial treatment, we studied why urine cultures were ordered and correlates of treatment. Most cultures were obtained from patients without urinary complaints and a minority from asymptomatic patients. High-count bacteriuria, not clinical manifestations, appeared to trigger most antimicrobial use.

Is a chlorhexidine reaction test better than dipsticks to detect asymptomatic bacteriuria in pregnancy?

Detection of asymptomatic bacteriuria (ASB) in pregnancy is important to avert the attendant morbidities. Therefore, we assessed the use of chlorhexidine reaction to detect ASB in pregnancy. This was a prospective study, which compared chlorhexidine reaction with dipstick tests and urine culture in 150 asymptomatic pregnant women. Urine cultures detected bacteriuria in seven women (4.7%). Chlorhexidine detected ASB in 72 women (48%) and had sensitivity, specificity and accuracy of 100%, 54% and 56%, respectively. Leucocyte esterase (LE) and nitrite detected bacteriuria in 31 (20.7%) women and 12 (8.0%) women, respectively. Singly, LE had a sensitivity and specificity of 14.3% and 79%, respectively, while nitrite's sensitivity and specificity was 42.9% and 93.7%, respectively. Combined, LE and nitrite had better sensitivity (97.9%) and accuracy (94%). Since the accuracy of chlorhexidine is low, other than urine culture, combined dipstick urinalysis of leucocyte esterase and nitrite tests is good to detect asymptomatic bacteriuria in pregnancy.

Detection of asymptomatic bacteriuria in obstetric patients with a semiautomated urine screen

Urine specimens (1215) from obstetric patients were evaluated for the presence of significant bacteriuria by the Bac-T-Screen (Marion Scientific Division, Marion Laboratories, Inc., Kansas City, Missouri) and a conventional semiquantitative culture method. Seventy (5.8%) specimens were not processed successfully by the Bac-T-Screen because pigments interfered with interpretation or the test filters clogged. The remaining 1145 specimens screened by the Bac-T-Screen were compared with a conventional culture method. The sensitivity, specificity, positive predictive value, and negative predictive value for specimens containing ≥ 105 colony-forming units per milliliter were 97.4%, 70.4%, 19.0%, and 99.7%, respectively. These values for specimens containing ≥104 colony-forming units per milliliter were 92.2%, 71.6%, 24.1%, and 98.9%, respectively.

Asymptomatic bacteriuria in school girls. V. The clinical course and response to treatment.

The short-term prognosis of 116 school girls with asymptomatic bacteriuria (ABU) treated or left untreated is reported. In untreated girls a spontaneous remission was obtained in 11% within one year. A short course of nitrofurantoin eliminated the bacteriuria in 93% of the girls in the treatment group. The recurrence rate was 30% in one year in the patients that became abacteriuric spontaneously, after a bladder washout test or after treatment with penicillin or nitrofurantoin. The first recurrence occurred withn 3 months in 79% (19/24). Nineteen of the 24 patients with recurrences (79%) had a third infection within 9 months. In patients with parenchymal reduction or reflux the renal concentrating capacity increased significantly after treatment of the bacteriuria. All the girls left untreated had normal renal concentrating capacity on detection and this remained unchanged during the year of follow-up. One of 28 untreated girls attracted a symptomatic pyelonephritis caused by a strain different from that at detection of ABU. Of 81 girls cured from the bacteriuria 24 recurred, 5 with a symptomatic pyelonephritis and 3 with cystitis. It is concluded that strains isolated from girls with ABU do not commonly cause symptomatic pyelonephritis.

A “stick Test” for Detection of Asymptomatic Bacteriuria

A “stick Test” for Detection of Asymptomatic Bacteriuria

Detection of bacteriuria in women attending local authority antenatal clinics using the dip-inoculum transport medium spoon method.

Four hundred and seventy-eight pregnant women attending local authority clinics in Portsmouth were screened for bacteriuria using the dip-inoculum transport medium (DITM) spoon method. The detection of asymptomatic bacteriuria in 5% of the patients with a very low proportion of equivocal results (0.83%) suggests that this is an efficient method; and large numbers of urine specimens could be sampled with relatively little work for the laboratory. A cystine-MacConkey medium was devised for incorporation in the spoons. General practitioners treated the women with bacteriuria, and remained responsible for home delivery and postpartum examinations. The possibility of successful cooperation between non-hospital clinics, a bacteriological laboratory, and general practitioners is demonstrated.