May 18, 2012
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Bacteriuria - A human condition wherein svezhevypuschennoy in urine are detected microbes under investigation by microscopy.
We fully healthy human urine is sterile. However, infection of the kidneys or urinary tract occurs getting germs in the bladder, where there is a proliferation of them.
Contact with bacteria in urine is caused by pathologic processes in which there is impairment of renal filter. There are hard numbers that can detect bacteriuria. If the bacteriological identification of the number of colonies of bacteria is not more than 105 per 1 ml, then it is a dirty urine. If you exceed a specified number should speak of bacteriuria.
Features bacteriuria
Penetration of bacteria in urine can occur in several ways. They can get there downward method, i.e. of inflammatory foci in bladder, kidney, glands, urethra, prostate gland. Another way ingress of bacteria in the urine - ascending . In this case, getting the bacteria is due to all sorts of instrumental intervention (catheterisation, probing, cystoscopy, lithoclasty). It is also possible lymphohematogenous way of getting germs - from the intestine, genital organs; hematogenous - Of the centers of infection.
To distinguish true bacteriuria , In which the proliferation of microbes in the urinary tract, as well false bacteriuria In which there is a passage of microbes from the blood into the urine via the kidney, but they do not reproduce.
When bacteriuria urine can be observed quite different flora - it Escherichia coli . streptococci . staphylococci . Pseudomonas aeruginosa . Proteus and others. As a rule, the manifestation of bacteriuria is a sign of inflammation of the kidneys, or a certain area of the urinary system. Very often bacteriuria is seen in people who have recently moved infectious diseases. Bacteriuria also identify patients who are suffering from long standing constipation As well as in humans with diseases of the colon , from fissure . proctitis .
If the human body there are other foci of infection, the manifestation of bacteriuria is also possible: the germs enter the urinary tract and kidney hematogenous or lymphogenous way.
Often the occurrence of bacteriuria occurs similar to cystitis and pyelonephritis . The patient temperature rises to subfebrile indicators. A person who is diagnosed bacteriuria, notes that the need to urinate become more frequent, and the urine - muddy, sometimes it appears in the sediment. Urine becomes turbid due to the large number of microbes.
Quite often bacteriuria detect and completely healthy people, as in the urethra is always a microflora.
Diagnosis of bacteriuria
In the process of diagnosis of this condition is used several different methods. This nitrite Griess test, the so-called TTC test (test recovery triphenyltetrazolium chloride), a pressure reducing glucose test.
When the diagnosis in a clinic used chemical tests, which allow to get quick results. Quantitative bacteriological methods makes it possible to know the number of colonies of microbes. This allows you to know the exact degree of bacteriuria. Yet it should be noted that the possible negative results of such tests arising from copious drinking, eating, etc. uroseptikov If positive results of the test, the next step is to determine the type of bacteria, as well as their sensitivity to antibiotics and sulfonamides.
Detection of bacteriuria is a very important moment in the process of comprehensive diagnosis urinary tract diseases having an inflammatory character. Usually, a high degree of bacteriuria is accompanied by severe urological diseases.
Asymptomatic bacteriuria
If the patient's urine detecting bacteria, sometimes in combination with leukocytes But in this case a person does not have any complaints, then the asymptomatic bacteriuria . Asymptomatic bacteriuria can be diagnosed, if the number of bacteria in the urine, which corresponds to the true bacteriuria is found in at least two samples. Thus the symptoms of infection in the body are completely absent. According to statistics, asymptomatic bacteriuria is often defined as the same for pregnant and non-pregnant women.
Most often asymptomatic bacteriuria is common in healthy women, and, the older a woman is, the greater the risk of her manifestations of this condition. Men asymptomatic bacteriuria seen in the elderly. In some cases, this condition is accompanied by diabetes .
Diagnosis of asymptomatic bacteriuria
Research to identify asymptomatic bacteriuria is performed for patients who have the highest risk of various complications. First of all, pregnant women, the optimal period for the study of which is the sixteenth week pregnancy . Also subject to the investigation of people who have had invasive urological procedures, patients with immunocompromised . fevers Having unknown origin. It is also necessary to carry out tests to children with symptomatic urinary tract infection, which was not yet six years.
Treatment of asymptomatic bacteriuria
Treatment of asymptomatic bacteriuria do not need people who suffer from diabetes, patients with permanent urinary catheter, the elderly, as well as students who have no organic changes in the urinary tract. As treatment of this condition, it is important, above all, to eliminate pockets of infection in the body, to increase its reactive forces fix disorders passage of urine. In some cases, patients demonstrated a spa treatment and compliance diet .
If the patient asymptomatic bacteriuria offline immunosuppression, and no structural changes in the urinary tract, the treatment of such a condition is not required. Moreover, in certain situations with antimicrobial treatment promotes the substitution less virulent flora more pathogenic bacteria.
Treat bacteriuria, which is asymptomatic, it must be the representatives of some groups. This newborn babies, preschoolers, men who are under sixty years (it is important to exclude chronic prostatitis ). Women are encouraged to take a single antimicrobial agent.
If necessary, treatment of asymptomatic bacteriuria should take drugs with antimicrobial effect for seven days. Such treatment is necessary for pregnant women, people with changes in the urinary tract of an organic nature, prior to the operations of the genitourinary system, and after the elections. Also, people need treatment with a single or a kidney transplant. Treatment of asymptomatic bacteriuria in patients who underwent catheterization, performed a single dose antibiotics .
In most cases of bacteriuria experts expressed favorable prognosis.
Asymptomatic bacteriuria in pregnant women
Bacteriuria in pregnant women is shown, according to various estimates, in 4-9% of cases. The danger of this condition is that the presence of asymptomatic bacteriuria markedly increases the risk of urinary tract infections and pyelonephritis later development. In addition, pregnant women can occur if bacteriuria ureterectasia . nephrolithiasis . This is especially true in the third trimester of pregnancy . Another important point - the increased risk of having a baby with low birth weight or very preterm birth in pregnant women who do not treat asymptomatic bacteriuria. With the right approach to the treatment of bacteriuria in pregnancy in most cases it is possible to prevent possible complications.
There are several factors that contribute to the development of bacteriuria in pregnant women. All of them are due to the action of the hormone progesterone muscle tone ureters, and also because of the mechanical impact on them of the uterus, which is growing rapidly. These are the factors is the slow speed of passage of urine, which is suspended due to decreased motility and tone of the ureter; the formation of a physiological hydronephrosis in pregnant women; decreased tone
bladder and a copious amount of residual urine; changes in the physical and chemical characteristics of urine, which ultimately contribute to the growth of bacteria.
Diagnosing asymptomatic bacteriuria in pregnancy is possible even when the first survey conducted in the earliest stages of pregnancy. Only 1% of cases of bacteriuria takes place at a later date. The study is important to note that the manifestation of asymptomatic bacteriuria is sometimes a sign of bacterial vaginosis Who was not identified before pregnancy.
When choosing a drug for the treatment of this condition in the expectant mother, it is important to be sure to take into account the fact that the agent must be harmless to the child. Consequently, fluoroquinolones Which is used to treat urinary tract infections, pregnant women are contraindicated.
In the treatment of bacteriuria in pregnancy is used Amoxicillin And amoxicillin in combination with clavulanate . This treatment is continued for seven days.
If there is a massive bacteriuria, sometimes your doctor may prescribe treatment fosfomycin trometamol Which lasts no more than one day. However, such treatment is appropriate only in those situations where its benefits outweigh the possible risk to the child.
But usually, the treatment of bacteriuria in pregnancy was conducted using a single dose of medication, because such therapy is mainly not give the desired effect. Often the doctor prescribes treatment cephalosporins . nitrofurans . ampicillin for one or more weeks.
After the end of treatment it is important to conduct regular urine to avoid the recurrence of the disease. If bacteriuria in pregnant women occurs again, you should assign the maintenance treatment up to the birth. After birth, this treatment continues for another two weeks. Such treatment is carried out with the use of antimicrobials, as well as uroseptikov.
In addition to medical treatment for pregnant women with bacteriuria it is recommended to take measures to enhance the passage of urine, reducing the pH of the urine. To do this, you can enter into the overall diet are some products, such as regularly drinking cranberry juice.
Prophylaxis of asymptomatic bacteriuria
For pregnant women, it is important to take all possible measures to prevent manifestations of bacteriuria. Periodically, during a visit to the doctor expectant mother must necessarily pass urine and blood for clinical and biochemical analyzes. Be sure to also conducted urine culture. If necessary, your doctor may prescribe an ultrasound of the kidneys. Also sometimes must be treated with antimicrobial drugs to reduce the risk of a pregnant woman purulent pyelonephritis , and fetal malnutrition and premature birth. At the first visit to the antenatal clinic for the prevention of a woman immediately sent for urine culture.
If you have met all the preventive measures, the childbirth pass time and vaginally.
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