A 94 year old lady with bacteria in urine
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Asymptomatic bacteruria (ABU)
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A 94 year old lady with bacteria in urine
- 1. A 94 year old lady with bacteriruria in urine Md. Shahidul Islam, M.D., Ph.D Associate professor, Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Senior Consultant, Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
- 2. Day 1 Woman 94 year • ”Medicine patient” admitted in an Ear-Nose-Throat department, (for the second time in less than a month) for ”dizziness”, and high blood pressure (215/100 mmHg) • She was discharged from the hospital 14 days back •
- 3. Day 1, continued • Blood pressure normalized • One nurse and one doctor noted ”foul smelling ” urine • No urinary tract symptoms • No fever • No urinary catheter
- 4. Day 2 • Follow up of ”foul smelling urine” • No symptom from the urinary tracts. The nurse wtites ”should not be treated if there are no symptoms” • Urine Dipstick Analysis: leucocytes 4+, nitrite positive • Blood tests: CRP: 1.1 mg/ml. Leucocytes: 6.7 x 10(9)/liter • Urine culture ordered
- 5. Day 7 • report of urine culture: Growth of E. Coli. > 100 000 colonies / ml • no urinary tract symptom, no fever, normal CRP, and leucocytes in blood • doctor prescribes pivmecillinam, and changes later on to trimethoprim, both according to the culture report • discharged home with diagnosis ”urinary tract infection” and ”benign positional vertigo”
- 6. Asymptomatic bacteriuria (ABU) • Women: > 105 CFL /mL of same type of bacteria in TWO consecutive culture without urinary tract symptoms (contamination of urine is more common i women) • Men: > 105 CFL /mL of same type of bacteria in ONE culture without urinary tract symptoms • ABU is more common specially in the elderly women (22%) • ABU is common in people with spinal cord injury (50%) • ABU is 100% in patients who has CAD (Cathéter à Demeure)
- 7. Asymptomatic bacteriuria (ABU), continued • Low virulent bacteria • Protects against infection by more virulent bacteria • Can continue many years without giving rise to symptomatic urinary tract infection • Often disappears spontaneously. Sometimes gives cystitis.
- 8. Asymptomatic bacteriuria (ABU), continued • Treatment of ABU does not reduce incidence of bacteruria • Treatment of ABU INCREASES symptomatic urinary tract infection with resistant bacteria • Untreated ABU does not increase the incidence of renal failure or mortality • Treat ABU only if the patient is pregnant or is likely to undergo traumatic urinary tract interventions
- 9. Screen for ABU… • During pregnancy • After treatment of ABU in pregnancy • Before transurethral resection of prostate • Before other urinary tract intervention with risk for traumatic mucous membrane bleeding
- 10. Do not screen for ABU in … • Patients with CAD • Elderly individuals • Pepole who are not pregnant • People with diabetes • People with spinal cod injury