細菌尿
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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/09 15:27:03」(JST)
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| Bacteriuria |
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Multiple rod-shaped bacteria shown between the larger white blood cells at urinary microscopy from a patient with urinary tract infection.
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| Classification and external resources |
| MedlinePlus |
000520 |
In medicine, bacteriuria denotes the presence of bacteria in urine (but not if the bacteria's presence is due to contamination from urine sample collection.)
Contents
- 1 Overview
- 2 Diagnosis
- 3 Treatment
- 4 See also
- 5 References
Overview
Bacteria in the urine, especially gram-negative rods, usually indicate a urinary tract infection (either cystitis or pyelonephritis), although bacteriuria can also occur in prostatitis. Escherichia coli is the most common bacterium isolated from urine samples.
Asymptomatic bacteriuria is bacteriuria without accompanying symptoms of a urinary tract infection (such as frequent urination, painful urination or fever). It is more common in women, in the elderly, in residents of long-term care facilities, and in patients with diabetes, bladder catheters and spinal cord injuries. Patients with a long-term Foley catheter uniformly show bacteriuria.
Chronic asymptomatic bacteriuria without Urinary tract infection symptoms is prevalent in as high as 50% of the population in long-term care.[1]
Prevalences of asymptomatic bacteriuria[2]
| Group |
Prevalence (in %) |
| Healthy premenopausal women |
1.0 to 5.0 |
| Pregnant women |
1.9 to 9.5 |
| Postmenopausal women (50 to 70 years of age) |
2.8 to 8.6 |
| Patients with diabetes mellitus |
Women |
9.0 to 27.0 |
| Men |
0.7 to 1.0 |
| Older community-dwelling patients |
Women (older than
70 years) |
> 15.0 |
| Men |
3.6 to 19.0 |
| Older long-term care residents |
Women |
25.0 to 50.0 |
| Men |
15.0 to 40.0 |
| Patients with spinal cord injury |
Intermittent catheter |
23.0 to 89.0 |
Sphincterotomy and
condom catheter |
57.0 |
| Patients undergoing hemodialysis |
28.0 |
Patients with an indwelling
urinary catheter |
Short-term |
9.0 to 23.0 |
| Long-term |
100 |
Diagnosis
Bacteria can be detected with a urine dipstick test for urinary nitrite or by urinary microscopy, although bacterial culture remains the most specific and formal test (the gold standard). Bacteriuria can be confirmed if a single bacterial species is isolated in a concentration greater than 100,000 colony forming units per millilitre of urine in clean-catch midstream urine specimens (one for men, two consecutive specimens with the same bacterium for women). For urine collected via bladder catheterisation, the threshold is 100 colony forming units of a single species per millilitre. The threshold is also 100 colony forming units of a single species per millilitre for women displaying UTI symptoms.[3]
Treatment
The presence of simultaneous pyuria does not warrant treatment by itself.
- Screening for asymptomatic bacteriuria with urine culture and treatment with antibiotics is recommended during pregnancy, because it significantly reduces symptomatic urinary tract infections, low birth weight, and preterm delivery.[4][5]
- This has not been proven for older people or people with diabetes, bladder catheters or spinal cord injuries.[6][7]
- Kidney transplant recipients, children with vesicoureteral reflux or others with structural abnormalities of the urinary tract, people with infected kidney stones and those who are having urological procedures might be more likely to benefit from treatment with antibiotics for asymptomatic bacteriuria.[8]
- The overuse of antibiotic therapy to treat asymptomatic bacteriuria leads to an increased risk of diarrhea, resistant organisms and infection due to Clostridium difficile.[1]
See also
References
- ^ a b AMDA – The Society for Post-Acute and Long-Term Care Medicine (February 2014), "Ten Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (AMDA – The Society for Post-Acute and Long-Term Care Medicine), retrieved 20 April 2015
- ^ [1] Colgan, R.; Nicolle, L. E.; McGlone, A.; Hooton, T. M. (2006). "Asymptomatic bacteriuria in adults". American family physician 74 (6): 985–990. PMID 17002033. edit
- ^ Sam, Amir H.; James T.H. Teo (2010). Rapid Medicine. Wiley-Blackwell. ISBN 1-4051-8323-3.
- ^ Lin K, Fajardo K (July 2008). "Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement". Ann. Intern. Med. 149 (1): W20–4. doi:10.7326/0003-4819-149-1-200807010-00009-w1. PMID 18591632.
- ^ Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2007;(2):CD000490. PMID 17443502
- ^ Colgan R, Nicolle LE, McGlone A, Hooton TM. Asymptomatic bacteriuria in adults. Am Fam Physician. 2006;74(6):985-90. PMID 17002033
- ^ For information about older people only, American Geriatrics Society, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Geriatrics Society), retrieved August 1, 2013 , which cites
- Nordenstam, G. R.; Brandberg, C. Å.; Odén, A. S.; Svanborg Edén, C. M.; Svanborg, A. (1986). "Bacteriuria and Mortality in an Elderly Population". New England Journal of Medicine 314 (18): 1152–1156. doi:10.1056/NEJM198605013141804. PMID 3960089.
- Nicolle, L. E.; Mayhew, W. J.; Bryan, L. (1987). "Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women". The American journal of medicine 83 (1): 27–33. doi:10.1016/0002-9343(87)90493-1. PMID 3300325.
- Juthani-Mehta, M. (2007). "Asymptomatic Bacteriuria and Urinary Tract Infection in Older Adults". Clinics in Geriatric Medicine 23 (3): 585–594, vii. doi:10.1016/j.cger.2007.03.001. PMID 17631235.
- Nicolle, L. E.; Bradley, S.; Colgan, R.; Rice, J. C.; Schaeffer, A.; Hooton, T. M. (2005). "Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults". Clinical Infectious Diseases 40 (5): 643–654. doi:10.1086/427507. PMID 15714408.
- ^ Asymptomatic bacteriuria from Medline Plus. Updated May 26, 2006, retrieved January 28, 2008.
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Abnormal clinical and laboratory findings from a urine test (R80–R82, 791)
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| Red blood cells |
- Hematuria (Microscopic hematuria)
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| White blood cells |
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| Proteinuria |
- Albuminuria/Microalbuminuria
- Myoglobinuria
- Hemoglobinuria
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| Small molecules |
- Glycosuria
- Ketonuria
- Bilirubinuria
- Hyperuricosuria/Hypouricosuria
- Aminoaciduria
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| Pathogens |
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| Other |
- Chyluria
- Crystalluria
- osmolality (Isosthenuria, Hypersthenuria)
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Index of the urinary system
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| Description |
- Anatomy
- Physiology
- Development
- Cells
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| Disease |
- Electrolyte and acid-base
- Congenital
- Neoplasms and cancer
- Other
- Symptoms and signs
- Urine tests
- Blood tests
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| Treatment |
- Procedures
- Drugs
- Intravenous fluids
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UpToDate Contents
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English Journal
- Reducing Antimicrobial Therapy for Asymptomatic Bacteriuria Among Noncatheterized Inpatients: A Proof-of-Concept Study.
- Leis JA1, Rebick GW, Daneman N, Gold WL, Poutanen SM, Lo P, Larocque M, Shojania KG, McGeer A.Author information 1Division of Infectious Diseases, Department of Medicine, University of Toronto.AbstractThis proof-of-concept study demonstrates that no longer routinely reporting urine culture results from noncatheterized medical and surgical inpatients can greatly reduce unnecessary antimicrobial therapy for asymptomatic bacteriuria without significant additional laboratory workload. Larger studies are needed to confirm the generalizability, safety, and sustainability of this model of care.
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.Clin Infect Dis.2014 Apr;58(7):980-3. doi: 10.1093/cid/ciu010. Epub 2014 Feb 26.
- This proof-of-concept study demonstrates that no longer routinely reporting urine culture results from noncatheterized medical and surgical inpatients can greatly reduce unnecessary antimicrobial therapy for asymptomatic bacteriuria without significant additional laboratory workload. Larger studies
- PMID 24577290
- Editorial commentary: doing the right thing for asymptomatic bacteriuria: knowing less leads to doing less.
- Naik AD1, Trautner BW.Author information 1Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center.KEYWORDS: asymmetric paternalism, asymptomatic bacteriuria, behavioral economics, clinical practice guidelines, decision psychology
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.Clin Infect Dis.2014 Apr;58(7):984-5. doi: 10.1093/cid/ciu011. Epub 2014 Feb 26.
- PMID 24577289
- Should antibiotics be given prior to outpatient cystoscopy? A plea to urologists to practice antibiotic stewardship.
- Herr HW.Author information Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Electronic address: herrh@mskcc.org.AbstractBACKGROUND: Antimicrobial resistance is a major health problem, caused primarily by overuse of antibiotics in clinical situations in which they are not necessary. Practice guidelines recommend that antibiotics be given before outpatient cystoscopy to prevent symptomatic urinary tract infection (UTI).
- European urology.Eur Urol.2014 Apr;65(4):839-42. doi: 10.1016/j.eururo.2013.08.054. Epub 2013 Aug 30.
- BACKGROUND: Antimicrobial resistance is a major health problem, caused primarily by overuse of antibiotics in clinical situations in which they are not necessary. Practice guidelines recommend that antibiotics be given before outpatient cystoscopy to prevent symptomatic urinary tract infection (UTI)
- PMID 24012206
Japanese Journal
- 無症候性細菌尿/カテーテル関連尿路感染症 (特集 抗菌薬の選択と上手な使い方! : 私の処方箋)
- 重村 克巳,荒川 創一,藤澤 正人
- 臨床泌尿器科 = Japanese journal of clinical urology 69(8), 652-655, 2015-07
- NAID 40020513790
- Ten Cases of Colovesical Fistula due to Sigmoid Diverticulitis
- Miyaso Hideaki,Iwakawa Kazuhide,Hamada Yuki,Yasui Nanako,Nishii Gou,Akai Masaaki,Kawada Kengo,Nonoshita Takashi,Kajioka Hiroki,Isoda Kenta,Kitada Kouji,Nishie Manabu,Hamano Ryosuke,Tokunaga Naoyuki,Tsunemitsu Yosuke,Otsuka Shinya,Inagaki Masaru,Iwagaki Hiromi
- Hiroshima Journal of Medical Sciences 64(1-2), 9-13, 2015-06
- … Preoperative urinalysis showing bacteriuria (100%) was the most common presentation, followed by fecaluria (40%), abdominal pain (40%), pneumaturia (30%), hematuria (30%), pain on urination (30%), pollakiuria (10%), and dysuria (10%). …
- NAID 120005619818
- 木全 貴久,辻 章志,金子 一成
- 日本小児腎臓病学会雑誌 27(2), 105-116, 2014
- 小児の尿路感染症（UTI）は，一般的な感染症で，臨床的に上部UTI，下部UTI，無症候性細菌尿に大別される。乳幼児の上部UTI に対しては，しばしば適切な診断がなされないままに，抗菌薬が投与される。不適切な抗菌薬の投与は耐性菌を増加させ，高率に合併する膀胱尿管逆流現象（VUR）などの先天性腎尿路奇形の発見を妨げ，UTI の反復や腎の瘢痕化をきたし，腎不全に至ることもある。したがって私達小児科医は乳 …
- NAID 130005067566
Related Links
- All patients with long-term catheters will develop a chronic bacteriuria; infection arises at the rate of about 5 - 10 % per day. Consider systemic antibiotics only during short term ( 3-14 days ) in patients at high risk for complications of ...
- bac·te·ri·uria noun \bak-ˌ tir-ē-ˈ y u r-ē-ə\ Definition of BACTERIURIA: the presence of bacteria in the urine Origin of BACTERIURIA New Latin First Known Use: 1900 bac·te·ri·uria noun \bak-ˌ tir-ē-ˈ (y) u r-ē-ə\ (Medical Dictionary) ...
Related Pictures
★リンクテーブル★
[★]
- 英
- bacilluria, bacteriuria
- 関
- 尿沈渣
- 顕微鏡にて細菌尿と診断できる最低限の菌体量は10^5/mlらしい。
[★]
- 英
- bacteriuria
- 関
- 細菌尿