Asymptomatic bacteriuria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2], Usama Talib, BSc, MD [3]
Overview
Urine is normally sterile. Asymptomatic bacteriuria is a condition in which a significant number of bacteria appear in the urine, without the presence of typical symptoms of a urinary tract infection. Examples of such symptoms include burning during urination, frequent urination (frequency) and urgency. Presence of >10 leukocytes/mm³ is considered as pyuria but not asymptomatic bacteriuria unless the number exceeds ≥105 colony forming units(cfu)/mL.[1][2]
Definitions
According to the Infectious Disease Society of America (IDSA), asymptomatic bacteriuria is defined as the presence of ≥105 cfu/mL of bacteria in clean catch urine specimen of an asymptomatic person with respect to symptoms urinary tract infection. By definition, one positive sample is enough to confirm asymptomatic bacteriuria in men, whereas in women two consecutive samples with same organism are required to diagnose asymptomatic bacteriuria. In men or women who are catheterized and are asymptomatic, identification of ≥102 cfu/mL of a single organism in the catheterized specimen is defined as asymptomatic bacteriuria.[3][4]
Historical Perspective
- In 1950s, Kass et al. proposed a quantitative culture method for the microbiological diagnosis of urinary tract infections.[5]
- About 105 bacteria per milliliter must be present in the urine specimen to be consistently read as positive, which is seen in 95% of samples from patients with pyelonephritis.[6][7]
Pathophysiology
Microbial Virulence
- Symptomatic urinary tract infections require attachment, multiplication and spread of bacteria in the urinary tract. Fimbriae are very helpful in attachment of the bacteria inside the urinary tract. It has been discovered that the pathogenic strains that have a decreased ability of making fimbriae, have a greater ability to multiply and thus are responsible for causing asymptomatic bacteriuria.[8]
- Asymptomatic bacteriuria may also be due to the decreased virulence of some strains that gather in the bladder but do not cause a symptomatic appearance. Some strains isolated from patients with asymptomatic bacteriuria in the setting of spinal cord injury have decreased capability of causing hemolysis.[9][10]
Host Factors
- Another possibility is the defective host response. A decreased expression of Toll-like receptor (TLR) 4 on the neutrophils in children with asymptomatic bacteriuria predisposes them to asymptomatic bacteriuria.[11][12]
Causes
Most common organism
Escherichia coli is the single most common cause of asymptomatic bacteriuria.[13][14][15][16]
Other common causes of asymptomatic bacteriuria include:
Common
Causes |
Less Common
Causes |
GU abnormalities
& Hospitalization |
Long Term Catheterisation[17][18] |
---|---|---|---|
Enterococcus[19] | Chromobacterium violaceum[20] | E.Coli[17][21] | Pseudomonas aeruginosa |
Enterobacteriaceae[22] | Staphylococci[23] | P. mirabilis | |
Klebsiella[24] | Gardnerella vaginalis[25][26] | Proteus mirabilis[17][27] | Providencia stuartii |
Pseudomonas aeruginosa[28] | Elizabethkingia meningoseptica[29] | Morganella morganii | |
Group B Streptococcus[30][31] |
Differentiating Asymptomatic Bacteriuria From Other Diseases
UTI
As the name signifies, asymptomatic bacteriuria has no symptomatic presentation. It can be easily differentiated from other urinary tract infections in that they are identified by the presence of urinary symptoms including dysuria, hematuria, urgency, frequency and flank pain. Fever is also an important finding accompanying other urinary tract infections.
Pyuria
Asymptomatic bacteriuria should be differentiated from pyuria, which also signifies presence of an inflammatory response. Pyuria is the presence of excessive leukocytes in the urine. Less than 5 leukocytes are a normal finding in the urine whereas >15 leukocytes per 400x microscopic field in the urine sample are considered to be pyuria. Pyuria is not defined on the basis of colony forming units of the organism but exclusive on the number of leukocytes. Pyuria usually accompanies asymptomatic bacteriuria.[32]
Epidemiology
Prevalance
- The prevalence of bacteriuria is more in sexually active women (4.6%) as compared to sexually inactive women (0.7%).[33]
- The prevalence of bacteriuria in women increase with age.[34]
Age
- Asymptomatic bacteriuria is more common in elderly and its prevalence increase with age.[35]
- The prevalence of asymptomatic bacteriuria in women greater than 80 years old is >20%.[36][37]
- The prevalence of asymptomatic bacteriuria in men greater than 75 year old is 6 to 15%.[38]
- Asymptomatic bacteriuria is present in 3-5% of the women population between 38-60 years of age. It was identified in 5% of women in universities and 6% of women in groups related to health maintenance organisations.[39][40]
Gender
- Asymptomatic bacteriuria is more prevalent in females as compared to males. Asymptomatic bacteriuria is rare among healthy men.[41][42]
- Asymptomatic bacteriuria has a prevalence of 8 to 14% in diabetic women.[43]
Race
- Asymptomatic bacteriuria has been slightly more common in black population.[44]
Risk Factors
Asymptomatic bacteriuria has risk factors similar to symptomatic bacteriuria. Some of these include:[45][46]
General Risk Factors
- Sexual intercourse
- Use of diaphragm plus spermicide
Disease Conditions
- BPH
- Renal stones
- Pregnancy[47]
- Elderly [47]
- Diabetes mellitus[48]
- Patients with spinal cord injuries[49][50]
- Patients undergoing hemodialysis[51]
- Patients with indwelling urethral catheters[52]
- Patients with genitourinary abnormalities[52][53]
Natural History, Complications and Prognosis
Natural History
- If left untreated asymptomatic bacteriuria normally cures on its own and active treatment is not required except in those who are pregnant, require renal transplantation or are supposed to undergo a urinary tract procedure. Asymptomatic bacteriuria should also be treated in the presence of a structural defect of the urinary tract.[54]
- In case of pregnancy in patients who acquire asymptomatic bacteriuria early in their pregnancy, there is a minute chance of issues related pregnancy like low birth weight etc or pyelonephritis. Most cases resolve postpartum.[55]
Complications
Asymptomatic bacteriuria rarely leads to complications. These may include
Complications in Pregnancy
- Pyelonephritis later in pregnancy[60]
Prognosis
Asymptomatic bacteriuria has a good prognosis and completely resolves with treatment.[61]
Screening
Screening for asymptomatic subjects is considered if bacteriuria is associated with preventable adverse outcomes such as symptomatic urinary infection, progression to chronic kidney disease or hypertension, development of urinary tract cancer, and decreased duration of survival.[4]
Individuals requiring screening
The following should be screened for asymptomatic bacteriuria[62][54]
- Pregnant
- Requiring urologic procedures like transurethral resection of the prostate i.e TURP
- Post renal transplant
Catheter Associated Asymptomatic Bacteriuria
It is not recommended to screen for or treat asymptomatic bacteriuria or fungiuria for short or long term catheters,[63] exceptions are catheterized pregnant women and women with persistent bacteriuria 48 hours after removal of the urethral catheter. Prophylaxis can also be used also with patients undergoing urological procedures.[64]
- No benefit of therapy of asymptomatic bacteriuria due to similar recurrence rates with more resistance to antibiotics.[65][66]
- Significant improvement has been shown with women treated for bacteriuria that existed 48 hours after removal of indwelling urethral catheters.[67]
Diagnosis
Diagnostic Criteria
The diagnosis of bacteriuria in an asymptomatic individual is based on the culture results of urine collected in a manner that minimizes the possibility of contamination and limits the period between sampling and testing the specimen to avoid false positivity due to bacterial growth.
The quantitative definition for significant bacteriuria is:[68]
- For asymptomatic women, bacteriuria is defined as 2 consecutive voided urine specimens with isolation of the same bacterial strain in quantitative counts of ≥105 CFU/mL.
- A single, clean-catch, voided urine specimen with 1 bacterial species isolated in a quantitative count of ≥105 CFU/mL identifies bacteriuria in asymptomatic men.
- A single catheterized urine specimen with 1 bacterial species isolated in a quantitative count of ≥102 CFU/mL identifies bacteriuria in women or men.
Laboratory Findings
- Urinalysis
- Urinalysis along with microscopic examination of the sample is useful in identifying bacteriuria. Pyuria can also be identified on urinalysis.[69]
- Urine culture
- Urine culture is done to confirm the presence of the causative bacterial species and to see if it meets the criteria for asymptomatic bacteriuria i.e ≥105CFU/mL.[70]
Pyuria
Pyuria is defined as increased numbers of polymorphonuclear leukocytes in the uirne and is evidence of an inflammatory response in the urinary tract.[32] An operational definition of pyuria is the presence of ≥10 leukocytes per 400x microscopic field in the sediment of first-void urine. Although pyuria is prevalent among people with asympatomatic bacteriuria,[49][71][72][73][74] its presence or degree has not been shown to correlate with the prognosis and should not affect clinical decisions about antibiotics.[75][76][77] Pyuria accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment.[4]
Click here for more details about pyuria.
X-ray
Xray is not required to diagnose asymptomatic bacteriuria.
CT
CT is not required to diagnose asymptomatic bacteriuria.
MRI
MRI is not required to diagnose asymptomatic bacteriuria.
Treatment
Treatment is not required in otherwise healthy individuals unless it is associated with a urinary tract infection. Some other conditions that might require the asymptomatic bacteriuria to be treated are: [78][79][80]
- Pregnancy
- Requiring urinary tract procedure e.g transurethral prostatic resection
- Renal Transplant follow-up
Antimicrobial Regimen
- 1. Empiric antimicrobial therapy
- Treatment of asymptomatic bacteriuria is not recommended for the following persons:
- Premenopausal, nonpregnant women
- Diabetic women
- Older persons residing in the community
- Elderly, institutionalized subjects
- Persons with spinal cord injury
- Catheterized patients while the catheter remains in situ
- Note: Pyuria accompanying asymptomatic bacteriuria is not indicated for antibiotic therapy.
- 2. Specific considerations[54]
- 2.1 Women, pregnant[83]
- Preferred regimen (1): Nitrofurantoin 100 mg PO bid for 3–5 days (avoid in glucose-6-phosphate dehydrogenase deficiency)
- Preferred regimen (2): Amoxicillin 500 mg PO tid for 3–5 days
- Preferred regimen (3): Amoxicillin-Clavulanate 500 mg PO bid for 3–5 days
- Preferred regimen (4): Cephalexin 500 mg PO tid for 3–5 days
- Preferred regimen (5): Fosfomycin 3 g PO single dose
- Preferred regimen (6): Trimethoprim 200 mg PO bid for 3–5 days (only after first trimester)
- Note (1): Pregnant women should be screened for bacteriuria by urine culture at least once in early pregnancy, and they should be treated if the results are positive.
- Note (2): Periodic screening for recurrent bacteriuria should be undertaken after therapy.
- Note (3): Infectious Disease Society of America (IDSA) guidelines recommend 3–7 days of antimicrobial therapy.
- 2.2 Patients with indwelling urethral catheters
- Screening for or treatment of asymptomatic bacteriuria in patients with indwelling urethral catheters is not recommended.
- Note: Antimicrobial treatment of asymptomatic women with catheter-acquired bacteriuria that persists 48 hours after catheter removal may be considered.
- 2.3 Urologic interventions[84]
- Screening for or treatment of asymptomatic bacteriuria before transurethral resection of the prostate is recommended
- Preferred regimen: Trimethoprim-Sulfamethoxazole DS 1 tab PO bid for 3 days after obtaining urine cultures
- Screening for or treatment of asymptomatic bacteriuria after a renal transplant is recommended
- 2.5 Catheter Associated Asymptomatic Bacteriuria
- Regimen : TMP-SMX DS 1 tab bid x 3 days
Followup
- A large proportion of women with asymptomatic bacteriuria in pregnancy have a recurrence after a short duration of therapy and for this reason a followup is done one week after completing the therapy and then monthly until the birth due to a higher chance of recurrence.[88]
Primary Prevention
Primary preventive measure for asymptomatic bacteriuria include[89][90]
- Proper glycemic control
- Safe sexual practice
- Adequate hydration
Secondary Prevention
Secondary preventive measures for asymptomatic bacteriuria include
References
- ↑ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001548/
- ↑ T. M. Hooton, D. Scholes, A. E. Stapleton, P. L. Roberts, C. Winter, K. Gupta, M. Samadpour & W. E. Stamm (2000). "A prospective study of asymptomatic bacteriuria in sexually active young women". The New England journal of medicine. 343 (14): 992–997. doi:10.1056/NEJM200010053431402. PMID 11018165. Unknown parameter
|month=
ignored (help) - ↑ Rubin, RH.; Shapiro, ED.; Andriole, VT.; Davis, RJ.; Stamm, WE. (1992). "Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration". Clin Infect Dis. 15 Suppl 1: S216–27. PMID 1477233. Unknown parameter
|month=
ignored (help) - ↑ 4.0 4.1 4.2 Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM; et al. (2005). "Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults". Clin Infect Dis. 40 (5): 643–54. doi:10.1086/427507. PMID 15714408.
- ↑ KASS, EH. (1956). "Asymptomatic infections of the urinary tract". Trans Assoc Am Physicians. 69: 56–64. PMID 13380946.
- ↑ KASS, EH. (1957). "Bacteriuria and the diagnosis of infections of the urinary tract; with observations on the use of methionine as a urinary antiseptic". AMA Arch Intern Med. 100 (5): 709–14. PMID 13468815. Unknown parameter
|month=
ignored (help) - ↑ E. H. KASS (1962). "Pyelonephritis and bacteriuria. A major problem in preventive medicine". Annals of internal medicine. 56: 46–53. PMID 14454174. Unknown parameter
|month=
ignored (help) - ↑ Viktoria Roos, Eva M. Nielsen & Per Klemm (2006). "Asymptomatic bacteriuria Escherichia coli strains: adhesins, growth and competition". FEMS microbiology letters. 262 (1): 22–30. doi:10.1111/j.1574-6968.2006.00355.x. PMID 16907735. Unknown parameter
|month=
ignored (help) - ↑ R. A. Hull, D. C. Rudy, I. E. Wieser & W. H. Donovan (1998). "Virulence factors of Escherichia coli isolates from patients with symptomatic and asymptomatic bacteriuria and neuropathic bladders due to spinal cord and brain injuries". Journal of clinical microbiology. 36 (1): 115–117. PMID 9431932. Unknown parameter
|month=
ignored (help) - ↑ R. A. Hull, D. C. Rudy, W. H. Donovan, I. E. Wieser, C. Stewart & R. O. Darouiche (1999). "Virulence properties of Escherichia coli 83972, a prototype strain associated with asymptomatic bacteriuria". Infection and immunity. 67 (1): 429–432. PMID 9864249. Unknown parameter
|month=
ignored (help) - ↑ Bryndis Ragnarsdottir, Martin Samuelsson, Mattias C. U. Gustafsson, Irene Leijonhufvud, Diana Karpman & Catharina Svanborg (2007). "Reduced toll-like receptor 4 expression in children with asymptomatic bacteriuria". The Journal of infectious diseases. 196 (3): 475–484. doi:10.1086/518893. PMID 17597463. Unknown parameter
|month=
ignored (help) - ↑ Hans Fischer, Masahiro Yamamoto, Shizuo Akira, Bruce Beutler & Catharina Svanborg (2006). "Mechanism of pathogen-specific TLR4 activation in the mucosa: fimbriae, recognition receptors and adaptor protein selection". European journal of immunology. 36 (2): 267–277. doi:10.1002/eji.200535149. PMID 16385628. Unknown parameter
|month=
ignored (help) - ↑ Evans DA, Williams DN, Laughlin LW, Miao L, Warren JW, Hennekens CH; et al. (1978). "Bacteriuria in a population-based cohort of women". J Infect Dis. 138 (6): 768–73. PMID 368263 Check
|pmid=
value (help). - ↑ Kunin CM, McCormack RC (1968). "An epidemiologic study of bacteriuria and blood pressure among nuns and working women". N Engl J Med. 278 (12): 635–42. doi:10.1056/NEJM196803212781201. PMID 4866351.
- ↑ Bengtsson C, Bengtsson U, Björkelund C, Lincoln K, Sigurdsson JA (1998). "Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden". Scand J Urol Nephrol. 32 (4): 284–9. PMID 9764457.
- ↑ Joseph Ayodeji Olamijulo, Chris Olu Adewale & Olalekan Olaleye (2016). "Asymptomatic bacteriuria among antenatal women in Lagos". Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 36 (6): 722–725. doi:10.3109/01443615.2016.1148675. PMID 26960990. Unknown parameter
|month=
ignored (help) - ↑ 17.0 17.1 17.2 Nicolle LE (1997). "Asymptomatic bacteriuria in the elderly". Infect Dis Clin North Am. 11 (3): 647–62. PMID 9378928.
- ↑ Warren JW, Tenney JH, Hoopes JM, Muncie HL, Anthony WC (1982). "A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters". J Infect Dis. 146 (6): 719–23. PMID 6815281.
- ↑ A.-K. Labi, A. E. Yawson, G. Y. Ganyaglo & M. J. Newman (2015). "Prevalence and Associated Risk Factors of Asymptomatic Bacteriuria in Ante-Natal Clients in a Large Teaching Hospital in Ghana". Ghana medical journal. 49 (3): 154–158. PMID 26693190. Unknown parameter
|month=
ignored (help) - ↑ Narayan Dutt Pant, Manisha Sharma & Saroj Khatiwada (2015). "Asymptomatic Bacteriuria Caused by Chromobacterium violaceum in an Immunocompetent Adult". Case reports in medicine. 2015: 652036. doi:10.1155/2015/652036. PMID 26504464.
- ↑ Joseph Ayodeji Olamijulo, Chris Olu Adewale & Olalekan Olaleye (2016). "Asymptomatic bacteriuria among antenatal women in Lagos". Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 36 (6): 722–725. doi:10.3109/01443615.2016.1148675. PMID 26960990. Unknown parameter
|month=
ignored (help) - ↑ A.-K. Labi, A. E. Yawson, G. Y. Ganyaglo & M. J. Newman (2015). "Prevalence and Associated Risk Factors of Asymptomatic Bacteriuria in Ante-Natal Clients in a Large Teaching Hospital in Ghana". Ghana medical journal. 49 (3): 154–158. PMID 26693190. Unknown parameter
|month=
ignored (help) - ↑ A. P. Roberts & R. Phillips (1979). "Bacteria causing symptomatic urinary tract infection or asymptomatic bacteriuria". Journal of clinical pathology. 32 (5): 492–496. PMID 381327. Unknown parameter
|month=
ignored (help) - ↑ Joseph Ayodeji Olamijulo, Chris Olu Adewale & Olalekan Olaleye (2016). "Asymptomatic bacteriuria among antenatal women in Lagos". Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 36 (6): 722–725. doi:10.3109/01443615.2016.1148675. PMID 26960990. Unknown parameter
|month=
ignored (help) - ↑ Lipsky BA, Inui TS, Plorde JJ, Berger RE (1984). "Is the clean-catch midstream void procedure necessary for obtaining urine culture specimens from men?". Am J Med. 76 (2): 257–62. PMID 6695949.
- ↑ Mims AD, Norman DC, Yamamura RH, Yoshikawa TT (1990). "Clinically inapparent (asymptomatic) bacteriuria in ambulatory elderly men: epidemiological, clinical, and microbiological findings". J Am Geriatr Soc. 38 (11): 1209–14. PMID 2246458.
- ↑ Joseph Ayodeji Olamijulo, Chris Olu Adewale & Olalekan Olaleye (2016). "Asymptomatic bacteriuria among antenatal women in Lagos". Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 36 (6): 722–725. doi:10.3109/01443615.2016.1148675. PMID 26960990. Unknown parameter
|month=
ignored (help) - ↑ Richard Colgan, Lindsay E. Nicolle, Andrew McGlone & Thomas M. Hooton (2006). "Asymptomatic bacteriuria in adults". American family physician. 74 (6): 985–990. PMID 17002033. Unknown parameter
|month=
ignored (help) - ↑ Zhiyong Zong (2014). "Elizabethkingia meningoseptica as an unusual pathogen causing healthcare-associated bacteriuria". Internal medicine (Tokyo, Japan). 53 (16): 1877–1879. PMID 25130129.
- ↑ Richard Colgan, Lindsay E. Nicolle, Andrew McGlone & Thomas M. Hooton (2006). "Asymptomatic bacteriuria in adults". American family physician. 74 (6): 985–990. PMID 17002033. Unknown parameter
|month=
ignored (help) - ↑ Narayan Dutt Pant, Manisha Sharma & Saroj Khatiwada (2015). "Asymptomatic Bacteriuria Caused by Chromobacterium violaceum in an Immunocompetent Adult". Case reports in medicine. 2015: 652036. doi:10.1155/2015/652036. PMID 26504464.
- ↑ 32.0 32.1 Stamm, WE. (1983). "Measurement of pyuria and its relation to bacteriuria". Am J Med. 75 (1B): 53–8. PMID 6349345. Unknown parameter
|month=
ignored (help) - ↑ C. M. Kunin & R. C. McCormack (1968). "An epidemiologic study of bacteriuria and blood pressure among nuns and working women". The New England journal of medicine. 278 (12): 635–642. doi:10.1056/NEJM196803212781201. PMID 4866351. Unknown parameter
|month=
ignored (help) - ↑ Lindsay E. Nicolle (2003). "Asymptomatic bacteriuria: when to screen and when to treat". Infectious disease clinics of North America. 17 (2): 367–394. PMID 12848475. Unknown parameter
|month=
ignored (help) - ↑ Lindsay E. Nicolle (2003). "Asymptomatic bacteriuria: when to screen and when to treat". Infectious disease clinics of North America. 17 (2): 367–394. PMID 12848475. Unknown parameter
|month=
ignored (help) - ↑ T. M. Hooton, D. Scholes, A. E. Stapleton, P. L. Roberts, C. Winter, K. Gupta, M. Samadpour & W. E. Stamm (2000). "A prospective study of asymptomatic bacteriuria in sexually active young women". The New England journal of medicine. 343 (14): 992–997. doi:10.1056/NEJM200010053431402. PMID 11018165. Unknown parameter
|month=
ignored (help) - ↑ Lindsay E. Nicolle (2015). "Asymptomatic Bacteriuria and Bacterial Interference". Microbiology spectrum. 3 (5). doi:10.1128/microbiolspec.UTI-0001-2012. PMID 26542046. Unknown parameter
|month=
ignored (help) - ↑ Lindsay E. Nicolle (2003). "Asymptomatic bacteriuria: when to screen and when to treat". Infectious disease clinics of North America. 17 (2): 367–394. PMID 12848475. Unknown parameter
|month=
ignored (help) - ↑ C. Bengtsson, U. Bengtsson, C. Bjorkelund, K. Lincoln & J. A. Sigurdsson (1998). "Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden". Scandinavian journal of urology and nephrology. 32 (4): 284–289. PMID 9764457. Unknown parameter
|month=
ignored (help) - ↑ T. M. Hooton, D. Scholes, A. E. Stapleton, P. L. Roberts, C. Winter, K. Gupta, M. Samadpour & W. E. Stamm (2000). "A prospective study of asymptomatic bacteriuria in sexually active young women". The New England journal of medicine. 343 (14): 992–997. doi:10.1056/NEJM200010053431402. PMID 11018165. Unknown parameter
|month=
ignored (help) - ↑ C. M. Kunin & R. C. McCormack (1968). "An epidemiologic study of bacteriuria and blood pressure among nuns and working women". The New England journal of medicine. 278 (12): 635–642. doi:10.1056/NEJM196803212781201. PMID 4866351. Unknown parameter
|month=
ignored (help) - ↑ B. A. Lipsky (1989). "Urinary tract infections in men. Epidemiology, pathophysiology, diagnosis, and treatment". Annals of internal medicine. 110 (2): 138–150. PMID 2462391. Unknown parameter
|month=
ignored (help) - ↑ G. G. Zhanel, L. E. Nicolle & G. K. Harding (1995). "Prevalence of asymptomatic bacteriuria and associated host factors in women with diabetes mellitus. The Manitoba Diabetic Urinary Infection Study Group". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 21 (2): 316–322. PMID 8562738. Unknown parameter
|month=
ignored (help) - ↑ R. Mittendorf, M. A. Williams & E. H. Kass (1992). "Prevention of preterm delivery and low birth weight associated with asymptomatic bacteriuria". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 14 (4): 927–932. PMID 1533541. Unknown parameter
|month=
ignored (help) - ↑ T. M. Hooton, D. Scholes, A. E. Stapleton, P. L. Roberts, C. Winter, K. Gupta, M. Samadpour & W. E. Stamm (2000). "A prospective study of asymptomatic bacteriuria in sexually active young women". The New England journal of medicine. 343 (14): 992–997. doi:10.1056/NEJM200010053431402. PMID 11018165. Unknown parameter
|month=
ignored (help) - ↑ Konstanze Angelescu, Barbara Nussbaumer-Streit, Wiebke Sieben, Fulop Scheibler & Gerald Gartlehner (2016). "Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review". BMC pregnancy and childbirth. 16 (1): 336. doi:10.1186/s12884-016-1128-0. PMID 27806709. Unknown parameter
|month=
ignored (help) - ↑ 47.0 47.1 Nicolle, LE. (2003). "Asymptomatic bacteriuria: when to screen and when to treat". Infect Dis Clin North Am. 17 (2): 367–94. PMID 12848475. Unknown parameter
|month=
ignored (help) - ↑ Zhanel, GG.; Harding, GK.; Nicolle, LE. "Asymptomatic bacteriuria in patients with diabetes mellitus". Rev Infect Dis. 13 (1): 150–4. PMID 2017615.
- ↑ 49.0 49.1 Nicolle, LE. (1997). "Asymptomatic bacteriuria in the elderly". Infect Dis Clin North Am. 11 (3): 647–62. PMID 9378928. Unknown parameter
|month=
ignored (help) - ↑ Waites, KB.; Canupp, KC.; DeVivo, MJ. (1993). "Epidemiology and risk factors for urinary tract infection following spinal cord injury". Arch Phys Med Rehabil. 74 (7): 691–5. PMID 8328888. Unknown parameter
|month=
ignored (help) - ↑ Bakke, A.; Digranes, A. (1991). "Bacteriuria in patients treated with clean intermittent catheterization". Scand J Infect Dis. 23 (5): 577–82. PMID 1767253.
- ↑ 52.0 52.1 Chaudhry, A.; Stone, WJ.; Breyer, JA. (1993). "Occurrence of pyuria and bacteriuria in asymptomatic hemodialysis patients". Am J Kidney Dis. 21 (2): 180–3. PMID 8430679. Unknown parameter
|month=
ignored (help) - ↑ Lindsay E. Nicolle (2003). "Asymptomatic bacteriuria: when to screen and when to treat". Infectious disease clinics of North America. 17 (2): 367–394. PMID 12848475. Unknown parameter
|month=
ignored (help) - ↑ 54.0 54.1 54.2 USPSTF https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/asymptomatic-bacteriuria-in-adults-screening?ds=1&s=asymptomatic%20bacteriuria Accessed on Feb 3, 2017
- ↑ Kenneth Lin & Kevin Fajardo (2008). "Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement". Annals of internal medicine. 149 (1): W20–W24. PMID 18591632. Unknown parameter
|month=
ignored (help) - ↑ Anca Zalmanovici Trestioreanu, Adi Lador, May-Tal Sauerbrun-Cutler & Leonard Leibovici (2015). "Antibiotics for asymptomatic bacteriuria". The Cochrane database of systematic reviews. 4: CD009534. doi:10.1002/14651858.CD009534.pub2. PMID 25851268. Unknown parameter
|month=
ignored (help) - ↑ R. Romero, E. Oyarzun, M. Mazor, M. Sirtori, J. C. Hobbins & M. Bracken (1989). "Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight". Obstetrics and gynecology. 73 (4): 576–582. PMID 2927852. Unknown parameter
|month=
ignored (help) - ↑ F. Smaill & J. C. Vazquez (2007). "Antibiotics for asymptomatic bacteriuria in pregnancy". The Cochrane database of systematic reviews (2): CD000490. doi:10.1002/14651858.CD000490.pub2. PMID 17443502. Unknown parameter
|month=
ignored (help) - ↑ Kenneth Lin & Kevin Fajardo (2008). "Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement". Annals of internal medicine. 149 (1): W20–W24. PMID 18591632. Unknown parameter
|month=
ignored (help) - ↑ Lindsay E. Nicolle (2015). "Asymptomatic Bacteriuria and Bacterial Interference". Microbiology spectrum. 3 (5). doi:10.1128/microbiolspec.UTI-0001-2012. PMID 26542046. Unknown parameter
|month=
ignored (help) - ↑ Fiona M. Smaill & Juan C. Vazquez (2015). "Antibiotics for asymptomatic bacteriuria in pregnancy". The Cochrane database of systematic reviews (8): CD000490. doi:10.1002/14651858.CD000490.pub3. PMID 26252501. Unknown parameter
|month=
ignored (help) - ↑ Kenneth Lin & Kevin Fajardo (2008). "Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement". Annals of internal medicine. 149 (1): W20–W24. PMID 18591632. Unknown parameter
|month=
ignored (help) - ↑ Sobel, JD.; Kauffman, CA.; McKinsey, D.; Zervos, M.; Vazquez, JA.; Karchmer, AW.; Lee, J.; Thomas, C.; Panzer, H. (2000). "Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group". Clin Infect Dis. 30 (1): 19–24. doi:10.1086/313580. PMID 10619727. Unknown parameter
|month=
ignored (help) - ↑ Nicolle, LE.; Bradley, S.; Colgan, R.; Rice, JC.; Schaeffer, A.; Hooton, TM. (2005). "Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults". Clin Infect Dis. 40 (5): 643–54. doi:10.1086/427507. PMID 15714408. Unknown parameter
|month=
ignored (help) - ↑ Warren, JW.; Anthony, WC.; Hoopes, JM.; Muncie, HL. (1982). "Cephalexin for susceptible bacteriuria in afebrile, long-term catheterized patients". JAMA. 248 (4): 454–8. PMID 7045440. Unknown parameter
|month=
ignored (help) - ↑ Alling, B.; Brandberg, A.; Seeberg, S.; Svanborg, A. (1975). "Effect of consecutive antibacterial therapy on bacteriuria in hospitalized geriatric patients". Scand J Infect Dis. 7 (3): 201–7. PMID 809837.
- ↑ Harding, GK.; Nicolle, LE.; Ronald, AR.; Preiksaitis, JK.; Forward, KR.; Low, DE.; Cheang, M. (1991). "How long should catheter-acquired urinary tract infection in women be treated? A randomized controlled study". Ann Intern Med. 114 (9): 713–9. PMID 2012351. Unknown parameter
|month=
ignored (help) - ↑ Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE (1992). "Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration". Clin Infect Dis. 15 Suppl 1: S216–27. PMID 1477233.
- ↑ Richard Colgan, Lindsay E. Nicolle, Andrew McGlone & Thomas M. Hooton (2006). "Asymptomatic bacteriuria in adults". American family physician. 74 (6): 985–990. PMID 17002033. Unknown parameter
|month=
ignored (help) - ↑ T. M. Hooton, D. Scholes, A. E. Stapleton, P. L. Roberts, C. Winter, K. Gupta, M. Samadpour & W. E. Stamm (2000). "A prospective study of asymptomatic bacteriuria in sexually active young women". The New England journal of medicine. 343 (14): 992–997. doi:10.1056/NEJM200010053431402. PMID 11018165. Unknown parameter
|month=
ignored (help) - ↑ Hooton, TM.; Scholes, D.; Stapleton, AE.; Roberts, PL.; Winter, C.; Gupta, K.; Samadpour, M.; Stamm, WE. (2000). "A prospective study of asymptomatic bacteriuria in sexually active young women". N Engl J Med. 343 (14): 992–7. doi:10.1056/NEJM200010053431402. PMID 11018165. Unknown parameter
|month=
ignored (help) - ↑ Zhanel, GG.; Nicolle, LE.; Harding, GK. (1995). "Prevalence of asymptomatic bacteriuria and associated host factors in women with diabetes mellitus. The Manitoba Diabetic Urinary Infection Study Group". Clin Infect Dis. 21 (2): 316–22. PMID 8562738. Unknown parameter
|month=
ignored (help) - ↑ Bachman, JW.; Heise, RH.; Naessens, JM.; Timmerman, MG. (1993). "A study of various tests to detect asymptomatic urinary tract infections in an obstetric population". JAMA. 270 (16): 1971–4. PMID 8411555. Unknown parameter
|month=
ignored (help) - ↑ KINCAID-SMITH, P.; BULLEN, M. (1965). "BACTERIURIA IN PREGNANCY". Lancet. 1 (7382): 395–9. PMID 14238090. Unknown parameter
|month=
ignored (help) - ↑ Nicolle, LE.; Duckworth, H.; Brunka, J.; Urias, B.; Kennedy, J.; Murray, D.; Harding, GK. (1998). "Urinary antibody level and survival in bacteriuric institutionalized older subjects". J Am Geriatr Soc. 46 (8): 947–53. PMID 9706881. Unknown parameter
|month=
ignored (help) - ↑ Harding, GK.; Zhanel, GG.; Nicolle, LE.; Cheang, M. (2002). "Antimicrobial treatment in diabetic women with asymptomatic bacteriuria". N Engl J Med. 347 (20): 1576–83. doi:10.1056/NEJMoa021042. PMID 12432044. Unknown parameter
|month=
ignored (help) - ↑ Darouiche, RO.; Cadle, RM.; Zenon, GJ.; Markowski, J.; Rodriguez, M.; Musher, DM. (1993). "Progression from asymptomatic to symptomatic urinary tract infection in patients with SCI: a preliminary study". J Am Paraplegia Soc. 16 (4): 219–24. PMID 8270918. Unknown parameter
|month=
ignored (help) - ↑ Lindsay E. Nicolle, Suzanne Bradley, Richard Colgan, James C. Rice, Anthony Schaeffer & Thomas M. Hooton (2005). "Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 40 (5): 643–654. doi:10.1086/427507. PMID 15714408. Unknown parameter
|month=
ignored (help) - ↑ Kenneth Lin & Kevin Fajardo (2008). "Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement". Annals of internal medicine. 149 (1): W20–W24. PMID 18591632. Unknown parameter
|month=
ignored (help) - ↑ Andree Leduc (2014). "Reducing the treatment of asymptomatic bacteriuria in seniors in a long-term care facility". The Canadian nurse. 110 (7): 25–30. PMID 25920165. Unknown parameter
|month=
ignored (help) - ↑ Nicolle, Lindsay E.; Bradley, Suzanne; Colgan, Richard; Rice, James C.; Schaeffer, Anthony; Hooton, Thomas M.; Infectious Diseases Society of America; American Society of Nephrology; American Geriatric Society (2005-03-01). "Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 40 (5): 643–654. doi:10.1086/427507. ISSN 1537-6591. PMID 15714408.
- ↑ "Guidelines on Urological Infections".
- ↑ "Guidelines on Urological Infections".
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ D. ALEKSANDROW, W. WYSZNACKA, H. CHLEBUS, S. FILIPECKI, A. MICHAJLIK & M. RYCEROWA (1959). "[Remote results of the treatment of pyelonephritis]". Polskie Archiwum Medycyny Wewnetrznej. 29: 503–509. PMID 13792521.
- ↑ John R. Lee, Heejung Bang, Darshana Dadhania, Choli Hartono, Meredith J. Aull, Michael Satlin, Phyllis August, Manikkam Suthanthiran & Thangamani Muthukumar (2013). "Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection: a single-center report of 1166 kidney allograft recipients". Transplantation. 96 (8): 732–738. doi:10.1097/TP.0b013e3182a04997. PMID 23917724. Unknown parameter
|month=
ignored (help) - ↑ Ella J. Ariza-Heredia, Elena N. Beam, Timothy G. Lesnick, Fernando G. Cosio, Walter K. Kremers & Raymund R. Razonable (2014). "Impact of urinary tract infection on allograft function after kidney transplantation". Clinical transplantation. 28 (6): 683–690. doi:10.1111/ctr.12366. PMID 24654771. Unknown parameter
|month=
ignored (help) - ↑ T. F. Patterson & V. T. Andriole (1997). "Detection, significance, and therapy of bacteriuria in pregnancy. Update in the managed health care era". Infectious disease clinics of North America. 11 (3): 593–608. PMID 9378925. Unknown parameter
|month=
ignored (help) - ↑ Kenneth Lin & Kevin Fajardo (2008). "Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement". Annals of internal medicine. 149 (1): W20–W24. PMID 18591632. Unknown parameter
|month=
ignored (help) - ↑ H. H. Meyhoff, J. Nordling, P. A. Gammelgaard & R. Vejlsgaard (1981). "Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis?". Scandinavian journal of urology and nephrology. 15 (2): 81–83. PMID 7036332.