Asymptomatic bacteriuria

Introduction Asymptomatic bacteriuria, also known as occult bacteriuria, is a occult urinary tract infection, which means that the patient has true bacterial urine (quantitative culture of urinary bacteria in the middle of cleaning is more than 105/ml in two consecutive times, and the two strains are the same, And the false positives of the results were excluded without any symptoms of urinary tract infection, but in some cases, mild symptoms were found after careful inquiry. Its bacteria come from the kidneys or from the bladder. Asymptomatic bacterial urine has a higher incidence than symptomatic patients. The incidence rate is 4% in women aged 16 to 65 and 0.5% in men. Although 1/4 of bacteriuria disappears in female patients, New bacterial urine is also constantly occurring, so the incidence of 4% is quite constant. Urinary tract infection is the most common urinary system disease (the incidence rate accounts for 0.91% of the total population of China), mainly caused by bacteria, of which E. coli is the most common (accounting for 60% of urinary tract infections), others are E. coli, Proteus, Klebsiella, Streptococcus faecalis, Pseudomonas aeruginosa, and the like. Because the female urethra is short and wide, and the urethral opening is close to the anus and menstruation, sexual life, pregnancy and other factors, women are prone to urinary tract infections. Fields over 50 years old are often induced by prostatic hypertrophy and poor urine flow. It is worth noting that some female patients have true bacterial urine, but no frequent urination, urgency, dysuria or fever, nausea and other symptoms, called asymptomatic bacteriuria. Asymptomatic bacteriuria is easily overlooked, and it is easy to cause kidney damage in children, pregnant women, etc. For example, in infants and young children with asymptomatic bacterial urine, if not detected and treated in time, there may be renal scar formation. According to the scientific literature, this asymptomatic bacterial urine is often associated with refluxing kidney disease. When the patient develops oliguria, nocturia, fatigue, and other renal dysfunction, it will be late. If pregnant women have asymptomatic bacterial urine, acute pyelonephritis can often occur in the late pregnancy, and it has adverse effects on the fetus and pregnant women. Therefore, in pregnant women, it should be checked early for asymptomatic bacterial urine. If found, it should be immediately Give treatment. In addition, the original chronic kidney disease, diabetes, indwelling catheter and urinary tract obstruction, etc., asymptomatic bacterial urine can also lead to kidney damage. Asymptomatic bacteriuria: Asymptomatic bacteriuria are common in pregnant women, women, and girls. Among pregnant women in the census, the incidence of bacterial urine was found to be 4.5%, and 82% of them were asymptomatic bacterial urine. About 50% of these asymptomatic bacterial urine patients are pyelonephritis. Asymptomatic bacteriuria showed no urinary tract infection, only mild fever and fatigue, but multiple urinary bacterial cultures were positive. In the past, this was considered a benign process and no treatment was needed. A large number of studies have confirmed that long-term asymptomatic bacteriuria can also impair kidney function, so the treatment should be the same as symptomatic urine. Especially in children, because of the presence of bladder-ureteral reflux; pregnant women, often easy to develop acute pyelonephritis and lead to sepsis; early pregnancy began prophylactic treatment, immediately after sexual intercourse, taking furantan 0.05g, cefoxitin 0.25g can It effectively prevents urinary sensation and has no effect on the mother and fetus. Asymptomatic bacteriuria is a type of urinary sensation that can occur in an acute, symptomatic urinary tract infection over a long period of time. About half of asymptomatic bacterial urine has the potential to develop symptomatic urinary tract infections. Pregnancy bacteriuria can bring more harm. For the fetus, it can cause miscarriage, premature birth, intrauterine growth retardation, respiratory distress syndrome, congenital malformation, etc., and increase the risk of fetal death. For pregnant women, bacteriuria may also be associated with pregnancy-induced hypertension and anemia. Bacterial urinary tract can cause acute pyelonephritis, and further development can cause septic shock, acute renal dysfunction and even renal failure. Once with true bacteriuria, 60% will develop a symptomatic infection and 30% will develop pyelonephritis if left untreated. Even after the postpartum, 30% of patients will have bacteriuria or urinary tract infections again, while women with sterile urine during pregnancy have an infection rate of only 5%. During the pregnancy, bacteriuria is generally not easy to be detected. Patients often go to the hospital for symptoms such as fever, chills, nausea, vomiting and other acute pyelonephritis. To this end, experts recommend that pregnant women in the early, middle and late pregnancy and prenatal, should routinely clean the bacteria in the middle of the urine to understand the presence of sterile urine.

Cause

Asymptomatic bacterial urine is common in pregnant women, mothers and girls. Among pregnant women in the census, the incidence of bacterial urine was found to be 4.5%, and 82% of them were asymptomatic bacterial urine. About 50% of these asymptomatic bacterial urine patients are pyelonephritis. Asymptomatic bacteriuria showed no urinary tract infection, only mild fever and fatigue, but multiple urinary bacterial cultures were positive. It is mainly caused by bacteria, among which Escherichia coli is the most common (accounting for 60% of urinary tract infections), and the others are Escherichia coli, Proteus, Klebsiella, Streptococcus faecalis, Pseudomonas aeruginosa and the like.

an examination

Related inspection

Urine routine urine microscopy

Asymptomatic bacteriuria can evolve from symptomatic urinary sensation, that is, symptomatic urinary sensation disappears naturally or after treatment, leaving only bacterial urine and can last for many years. Some bacteria and urine can have no history of acute urinary sensation. In addition, the urinary sensation that occurs after the use of urinary tract devices and on the basis of chronic kidney disease often has no obvious symptoms.

Differential diagnosis

True bacterial urine refers to: 1 bladder puncture urine culture, bacterial growth, or colony number > 102 / ml. 2 urinary bacteria quantitative culture 105 / ml. 3 clean middle-stage urine quantitative culture 105/ml, one time accuracy 80%; the same strain was obtained twice in two consecutive cultures, the number of colonies was 105/ml, and the accuracy was 95%;

Bacterial urinary: Normally, the urine is sterile, but the lower third of the urethra and the urethra are bacteriological. Therefore, urine discharged from the human body can contaminate the upper part of the bacteria. However, the amount of bacteria in the middle of the cleansing should not exceed 105/ml. If the test contains more than or equal to 105/ml of bacteria and is the same strain, and there is no urinary tract infection (frequent urination, urgency or lower abdominal discomfort), it can be diagnosed as true bacteriuria, also known as no Symptomatic bacteriuria.

Renal glucosuria: refers to a disease of diabetes caused by a decrease in glucose function in the proximal tubules when the blood glucose concentration is normal or lower than the normal renal sugar threshold. Clinically divided into primary renal glucosuria and secondary renal glucosuria.

White blood cell urine: refers to freshly centrifuged urine. There are more than 5 white blood cells per high power microscope field, or more than 400,000 white urine cells per hour or more than 1 million urine in 12 hours.

Hyperoxaluria: Primary hyperoxaluria is a rare hereditary disease. There are two clinical types, type I and type II hyperoxaluria, which are autosomal recessive. There was no significant difference in clinical manifestations between the two types. The ratio of male to female incidence was about 1.3:1, and about 12% of patients developed symptoms before the age of one. 65% were ill before the age of 5. The main manifestations of this disease are kidney stones, renal calcium deposition and extrarenal calcium deposition. The patient has recurrent renal colic and hematuria, often with pyelonephritis and hydronephrosis. Extrarenal tissue calcium deposits occur mostly in the heart, male reproductive organs and bones. Calcium oxalate crystals can settle on the vessel wall. The disease progresses rapidly, and uremia gradually develops. At this time, secondary hyperparathyroidism can be combined. Infants who died in infants died before the age of 20, and the prognosis of adult patients was relatively good.

Asymptomatic bacteriuria can evolve from symptomatic urinary sensation, that is, symptomatic urinary sensation disappears naturally or after treatment, leaving only bacterial urine and can last for many years. Some bacteria and urine can have no history of acute urinary sensation. In addition, the urinary sensation that occurs after the use of urinary tract devices and on the basis of chronic kidney disease often has no obvious symptoms.

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