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The bacteriuria is a condition of the person at which in svezhevypushcheny urine microbes in the course of research by means of microscopy are found.
At completely healthy person urine is sterile. However at infection of kidneys or an uric path there is a hit of microbes in a bladder where their proliferation is observed.
Hit of bacteria in urine arises owing to pathological processes at which there is a disturbance of the renal filter. There are exact figures which allow to reveal a bacteriuria. If at bacteriological identification the number of bacterial clumps makes no more than 105 in 1 ml, then it is about urine pollution. When exceeding of the specified quantity it is necessary to speak about a bacteriuria already.
Features of a bacteriuria
Penetration of bacteria into urine can happen in several ways. They can get in the descending way, that is from the inflammation centers in a bladder, kidneys, urethra glands, a prostate. One more way of hit of bacteria to urine — ascending. In this case hit of bacteria happens owing to any tool intervention (catheterization, bougieurage, a tsistoskopiya, lithotripsy). The limfogematogenny way of hit of microbes — from intestines, generative organs is also possible; hematogenous – from the infection centers.
It is accepted to distinguish a true bacteriuria in the course of which there is a reproduction of microbes in uric ways, and also a false bacteriuria at which passing of microbes from blood in urine through a kidney takes place, but at the same time they do not breed.
At bakteriuriiv to urine absolutely various flora can be observed is a colibacillus, streptococci, staphylococcus, a pyocyanic stick, proteas, etc. As a rule, manifestation of a bacteriuria is a sign of an inflammation of kidneys or a certain site of an urinary system. Very often the bacteriuria is shown at people who had infectious diseases recently. The bacteriuria is revealed also at patients who a long time suffer from constant locks, and also at people with diseases of a large intestine, with anal fissures, proctites.
If in a human body other centers of an infection take place, then manifestation of a bacteriuria is also possible: microbes get to uric ways and kidneys in the hematogenous or lymphogenous way.
Often course of a bacteriuria proceeds is similar to cystitis and pyelonephritis. At the patient temperature increases up to subfebrile indicators. The person for whom the bacteriuria is diagnosed, notes that desires to an urination become more frequent, and urine – muddy, sometimes in it appears a deposit. Muddy urine becomes in connection with a large number of microbes.
Rather often the bacteriuria is found also in completely healthy people as in an urethra there is always a microflora.
Diagnosis of a bacteriuria
In the course of diagnosis of this state several different methods are applied. It is the nitrite test of Gris, the so-called TTH-test (the test of recovery a chloride trifeniltetrazoliya), the reducing glucosic test.
At diagnosis in the conditions of policlinics chemical tests which allow to receive fast results are applied. Use of quantitative bacteriological methods gives the chance to learn quantity of colonies of microbes. It allows to learn exact degree of a bacteriuria. But nevertheless it is necessary to consider that also the false-negative results of such tests arising owing to plentiful drink, the use of uroseptik, etc. are possible. If positive takes of the test are received, then identification of species of bacteria, and also their sensitivity to streptocides and antibiotics will be the following step.
Detection of a bacteriuria is very important point in the course of complex diagnosis of diseases of the urinary ways having inflammatory character. As a rule, serious urological illnesses are followed by high degree of a bacteriuria.
If in urine of the patient bacteria, sometimes in combination with leukocytes are found, but at the same time the person has no complaints, then the asymptomatic bacteriuria takes place. The asymptomatic bacteriuria can be diagnosed if the quantity of bacteria in urine which corresponds to a true bacteriuria is found, at least, in two tests. At the same time symptoms of development of an infection in an organism completely are absent. Statistically, the asymptomatic bacteriuria is equally often defined both at pregnant women, and at nonpregnant women.
Most often the asymptomatic bacteriuria occurs at healthy women, and, than the woman is more senior, especially high risk of manifestation at it than this state. At men the asymptomatic bacteriuria is shown at advanced age. In certain cases this state accompanies a diabetes mellitus.
Diagnosis of an asymptomatic bacteriuria
Research with the purpose to reveal an asymptomatic bacteriuria is conducted that to patients at whom the high risk of development of various complications takes place. First of all, it is pregnant women whose most optimum term for research is the sixteenth week of pregnancy. Also people who transferred the invasive urological procedures sick with the immunodeficiencies, fevers having not clear genesis are subject to research. It is also necessary to carry out analyses to children with clinical displays of an infection of uric ways which were not six years old yet.
Treatment of an asymptomatic bacteriuria
Treatment of an asymptomatic bacteriuria is not required to people who are ill the diabetes mellitus sick with a constant uric catheter, to elderly people, and also school students who have no organic changes of uric ways. As treatment of this state it is important to eliminate, first of all, the infection centers in an organism, to increase its reactive forces, to eliminate disturbances of a passage of urine. In certain cases sanatorium treatment and observance of a diet is shown to patients.
If at an asymptomatic bacteriuria the patient has no immunosuppression, and there are no structural changes of urinary tract, then treatment of such state is not required. Besides in certain situations carrying out antimicrobic treatment promotes substitution of less virulent flora with more pathogenic bacteriums.
It is necessary to treat a bacteriuria which proceeds asymptomatically at representatives of some groups. These are newborn children, preschool children, men who sixty years were not executed yet (important to exclude chronic prostatitis). Women are recommended to accept a germicide once.
In need of treatment of an asymptomatic bacteriuria it is necessary to accept drugs with antimicrobic influence for seven days. Such treatment is necessary for pregnant women, people with changes of uric ways of organic character, before carrying out operations on urinogenital system, and also after their carrying out. Also therapy is necessary to people with the only or replaced kidney. Treatment of an asymptomatic bacteriuria at patients to whom bladder catheterization was carried out is carried out by one-time reception of antibiotics.
In most cases at a bacteriuria specialists state the favorable forecast.
Asymptomatic bacteriuria at pregnant women
The bacteriuria at pregnant women is shown, according to different data, in 4-9% of cases. Danger of it a state is that existence of an asymptomatic bacteriuria considerably increases risk of infection of urinary tract and afterwards development of pyelonephritis. Besides, at pregnant women at a bacteriuria the megaloureter, a nephrolithiasis can be shown. Especially often it occurs in the third trimester of pregnancy. One more important point – the increased risk of the birth of the child with too low weight or the premature beginning of childbirth at pregnant women who do not treat an asymptomatic bacteriuria. At the correct approach to therapy of a bacteriuria at pregnancy in most cases it is possible to prevent possible complications.
There is a number of factors which promote development of a bacteriuria in pregnant women. All of them arise owing to effect of hormone progesterone on a tone of muscles of ureters, and also in view of mechanical influence on them of a uterus which intensively grows. That factors is the slowed-down urine passage speed which stops owing to decrease in a vermicular movement and a tone of ureters; forming of a physiological hydronephrosis at pregnant women; reduced tone
bladder and more plentiful quantity of a residual urine; change of physical and chemical characteristics of urine that as a result of the bacteria promoting growth.
To diagnose an asymptomatic bacteriuria for pregnant women perhaps already at early researches which are conducted on the earliest durations of gestation. Only in 1% of cases development of a bacteriuria happens on later terms. In the course of research it is important to consider that manifestation of an asymptomatic bacteriuria sometimes is a symptom of a bacterial vaginosis which was not revealed before pregnancy.
Choosing medicine for treatment this states at future mother, it is important to consider surely and that means has to be harmless to the child. Therefore, ftorkhinolona which apply to treatment of infections of urinary tract are contraindicated to pregnant women.
In the course of treatment of a bacteriuria at pregnancy amoxicillin, and also amoxicillin in a complex with clavulanate is applied. Such treatment continues seven days.
If the massive bacteriuria takes place, then the doctor can sometimes appoint treatment fosfomitsin trometamoly which proceeds no more than one day. However such treatment is reasonable only in those situations when its advantage exceeds possible risk for the child.
But, as a rule, treatment of a bacteriuria at pregnant women is not carried out by means of a single dose of drugs as such therapy generally does not give desirable effect. Often the doctor appoints treatment cephalosporins, nitrofurans, ampicillin for one or several weeks.
After the end of therapy it is regularly very important to conduct urine researches to avoid palindromias. If the bacteriuria at the pregnant woman arises repeatedly, then it is necessary to appoint a maintenance therapy up to the childbirth. After the delivery such treatment continues two more weeks. Such treatment is carried out with use of antibacterial drugs, and also uroseptik.
Except drug treatment pregnant women with a bacteriuria are recommended to take measures for strengthening of a passage of urine, decrease in pH of urine. For this purpose it is possible to enter some products into the general food allowance, for example, regularly to drink cranberry drink.
Prevention of an asymptomatic bacteriuria
It is very important to take all possible measures directed to the prevention of manifestation of a bacteriuria for pregnant women. Periodically during visit to the attending physician future mother has to take without fail urine and a blood test for carrying out clinical and biochemical analyses. Bacteriological researches of urine are also surely conducted. If necessary the doctor can appoint carrying out ultrasonic research of kidneys. Also sometimes it is necessary to receive medical treatment for germicides for the purpose of decrease in risk of development in the pregnant woman of purulent pyelonephritis, and also a small-for-date fetus and the premature birth of the child. At the first visit to clinic for women for the purpose of prevention the woman is directed at once to bacteriological research of urine.
If all measures of prevention were observed, then childbirth passes in time and through natural patrimonial ways.