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Prenatal Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Gabriele Saccone, Kerri Sendek
Screening for bacteriuria is recommended at the first prenatal visit for all women. Pregnant women with asymptomatic bacteriuria are at an increased risk for symptomatic infection and pyelonephritis. There is also a positive relationship between untreated bacteriuria and LBW/PTB. Treatment of asymptomatic bacteriuria prevents these complications (see Chap. 18 in Maternal-Fetal Evidence Based Guidelines).
Sickle Cell Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Pregnant women with sickle cell trait should be screened with a hemoglobin electrophoresis if this has not been done before, and testing of the father and genetic counseling should be offered. They are at increased risk of urinary tract infections, and therefore should have a urine culture at first prenatal visit and in every trimester. Asymptomatic bacteriuria should be treated.
Urinary Tract Infections, Genital Ulcers and Syphilis
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Asymptomatic bacteriuria occurs in all populations but particularly pregnant women (of whom about 20% will get active infection), elderly patients, catheterised patients and those with transplants. Cystitis refers to infection or inflammation of the lower urinary tract, which can be caused by bacteria that cause urinary infections, Chlamydia or non-infectious causes (e.g. autoimmune, medication and radiation). Pyelonephritis can be acute or chronic and refers to infection or inflammation of the renal parenchyma.
Revisiting approaches to and considerations for urinalysis and urine culture reflexive testing
Published in Critical Reviews in Clinical Laboratory Sciences, 2022
Allison B. Chambliss, Tam T. Van
Despite guidelines recommending against treating asymptomatic bacteriuria, many providers appear to be compelled to prescribe antibiotics. Furthermore, once antibiotics have been initiated, often in the ED, for patients with abnormal urine test results, treatment is frequently continued even when the urine culture is reported as negative or growth of mixed flora [43]. A retrospective study evaluating factors associated with the treatment of asymptomatic bacteriuria at 46 hospitals found that >80% of patients received antibiotic therapy. A positive UA and growth of >100,000 CFU/mL bacteria were associated with treatment, and the length of stay for those treated was 37% longer than for untreated patients [47]. A survey of first to fourth-year residents at a tertiary hospital in Korea revealed that half of the respondents admitted to prescribing antibiotics for asymptomatic bacteriuria despite knowing it was unnecessary. The common reasons reported were concern about postoperative infections (38.6%) and abnormal UA results (29.5%) [48]. In more general terms, there may be numerous reasons for the deviation of physicians from clinical practice guidelines, including disagreement with a specific guideline and lack of awareness or familiarity with published guidelines [49]. Behavioral challenges, such as appeasement for patient satisfaction, may influence practice [49].
Meropenem/vaborbactam: a next generation β-lactam β-lactamase inhibitor combination
Published in Expert Review of Anti-infective Therapy, 2020
Andrea Novelli, Paola Del Giacomo, Gian Maria Rossolini, Mario Tumbarello
No failure at EOIVT in the M/V group was due to inefficacy but was secondary to adverse events (infusion-related reactions). In the TZP group, failures were mainly due to microbiological persistence or recurrence (n = 3) and to adverse events (n = 4). Overall response at the test of cure time-point (TOC; days 15–19) was considerably lower in both groups compared to the earlier assessment, but success remained numerically higher for M/V group (74.5% vs 70.3%). Lower overall success in both groups at TOC was driven by lower microbiological eradication rates (68.8% vs 62.1%). Lower microbiological eradication at later time points could likely reflect the high incidence of asymptomatic bacteriuria in patients with underlying urinary tract abnormalities. Only approximately half of patients with a nonremovable source of infection achieved microbial eradication at TOC underlying the importance of source control (M/V 51.4% vs TZP 53.5%).
The uncertainties of the diagnosis and treatment of a suspected urinary tract infection in elderly hospitalized patients
Published in Expert Review of Anti-infective Therapy, 2018
The prevalence of asymptomatic bacteriuria is also dependent on the definition of bacteriuria. A common definition of bacteriuria is ≥ 105 CFU/mL [1,3–5], but others have used lower cutoffs such as ≥ 104 and even ≥ 102 under certain circumstances. In 2012, the Society for Healthcare Epidemiology of America (SHEA) updated the surveillance definitions of infections in long-term care facilities and defined bacteriuria in cultures with only ≥ 102 CFU/mL [10] in a sample obtained by a urinary catheterization procedure. Recently, the Centers for Disease Control and Prevention however, revised the definition of a catheter associated urinary tract infection [41], increasing the minimum bacterial colony count from ≥ 104 to ≥ 105 CFU/mL. These are consensus decisions that are not evidence based because the proper cutoff for diagnosing significant bacteriuria that will best aid in the diagnosis and treatment of the elderly is uncertain.