Can I Find Out Why My Cbc Needed Smear Review

Q: An older friend, who is in her 90s, has been having bacteria in her urine, but no symptoms. Despite treatment with antibiotics, she was even so having leaner in the urine, so the doc recommended chronic antibiotics and a referral to urology.

What can be done when an elderly woman has bacteria in her urine just no symptoms? Tin can a urology consultation help?

A: This is a great question. Y'all are describing something called asymptomatic bacteriuria, which means having urine bacteria without symptoms.

Every older person and family unit caregiver should know about asymptomatic bacteriuria. Hither's why:

• It's very common in older adults. This condition is plant in an estimated 20% of women anile 80 or older, and also affects older men. The older the person, the more common it is.

• It'due south often confused with a urinary tract infection (UTI).  This can pb to unnecessary — and potentially harmful — treatment with antibiotics.

• It unremarkably does NOT need to exist treated with antibiotics. Equally I'll explain below, research shows that people don't live better or longer when asymptomatic bacteriuria is treated. In fact, such treatment can be harmful: one study plant that handling increased the take a chance of future (real) UTIs, and increased the take a chance of infection with antibiotic-resistant leaner.

• It's mutual for older adults to inappropriately be given antibiotics to care for this condition. Part of why this happens is that distinguishing this condition from a existent UTI cannot just be done with a urine exam. Instead, health providers must accept the time to talk to the patient — or family caregiver — and ask near whether symptoms are present. In a busy clinical surroundings, this step is all-also-often neglected.

In short, this is another 1 of those mutual crumbling health issues that can easily exist mismanaged, unless older adults and family caregivers know to ask actress questions.

Because it's and then mutual for antibiotics to exist inappropriately prescribed for this condition, "Don't treat asymptomatic bacteriuria with antibiotics" is the number one "Choosing Wisely" recommendation from the Infectious disease Society of America. The American Elderliness Society also includes this recommendation on its Choosing Wisely list.

Now, allow's try to equip you to sympathize this common condition. This will assist y'all — and your older loved ones — avoid unnecessary testing and antibiotic treatment. Specifically, in this commodity I'll cover:

• What is asymptomatic bacteriuria?
• How common is asymptomatic bacteriuria?
• How to tell the divergence between asymptomatic bacteriuria and a UTI
• Why asymptomatic bacteriuria usually doesn't warrant antibiotics

I'll close with some applied tips for older adults and family caregivers concerned about UTIs and/or bacteria in the urine.

What is asymptomatic bacteriuria?

Asymptomatic bacteriuria means having significant quantities of bacteria in the urine, but no clinical signs of inflammation or infection.

In other words, in asymptomatic bacteriuria, a urine culture volition be positive. (This means that if your healthcare provider takes a sample of urine and a clinical laboratory incubates it, within 1-two days, a sizeable quantity of leaner volition abound.)

When leaner are nowadays in the bladder only non provoking an inflammatory reaction, this tin also exist called bacterial "colonization" of the bladder.

How common is asymptomatic bacteriuria?

Asymptomatic bacteriuria is more mutual in older adults than many people — including practicing clinicians — may realize:

• In women aged 80 or older, 20% or more may take this condition.
• In salubrious men aged 75 or older, half dozen-15% have been found to have leaner with no UTI symptoms.
• Studies of nursing abode residents have constitute that upward to 50% may have asymptomatic bacteriuria.

This status also affects two-7% of premenopausal women, and is more common in people with diabetes.

Asymptomatic bacteriuria becomes more mutual as people get older, in part because information technology is related to changes in the immune system, which tends to become less vigorous as people age or get frailer.

Studies have found that in older adults, asymptomatic bacteriuria does sometimes go away on its own, but it also ofttimes comes back or persists.

How to tell the difference between asymptomatic bacteriuria and a UTI

By definition, in asymptomatic bacteriuria, there should be no UTI symptoms present.

The post-obit signs and symptoms can be caused by UTI:

• Called-for or pain with urination
• Increased frequency or urgency of urination
• Encarmine urine
• Pain in the low abdomen, flank, or fifty-fifty back
• Fever

(What about "cloudy" or "foul-smelling" urine? In the absenteeism of other symptoms, no written report has shown that this is a good way to detect a possible UTI. Meet hither: Cloudy, Foul-Smelling Urine Not a Criteria for Diagnosis of Urinary Tract Infection in Older Adults.")

Whether or not an older person has a clinical UTI, the urine dipstick may be abnormal, in part considering sure aberrant results suggestive of UTI may in fact only reflect bacterial colonization of the bladder. So one should not rely on urine dipsticks or related urine assay tests (which measure the number of white blood cells in the urine, amongst other things) as the sole justification for diagnosing a UTI. Symptoms are necessary!

The thing is, some older adults may only evidence vague or non-specific symptoms when they get a UTI, such equally defoliation or weakness. (That "confusion" would exist delirium.) This is especially true of aging adults who are frail, or are quite old, or have Alzheimer's or some other dementia.

For this reason, it can be hard to determine whether a frail or cognitively impaired older person is having UTI symptoms that warrant treatment.

Experts are currently debating whether it's justified to treat for possible UTI, for those cases in which an older person with asymptomatic bacteriuria shows signs of delirium, simply no other UTI symptoms.

Why asymptomatic bacteriuria ordinarily doesn't warrant antibiotics

Clinical studies overwhelming observe that in most people, treating asymptomatic bacteriuria with antibiotics does not improve health outcomes.

(The exceptions: significant women and men about to undergo urological procedures practise do good from screening for and handling of asymptomatic bacteriuria.)

A 2015 clinical research written report constitute that treatment of asymptomatic bacteriuria in women was associated with a much higher chance of developing a UTI afterwards on, and that these UTIs were more likely to involve antibody-resistant bacteria.

Even for frail nursing home residents, at that place is no proof that treating asymptomatic bacteriuria improves outcomes, simply it does increase the presence of antibiotic-resistant bacteria.

Despite the expert consensus that this condition doesn't warrant antibiotics, inappropriate treatment remains very common. A 2014 review article on this topic notes overtreatment rates of up to 83% in nursing homes.

Is there a part for cranberry to treat or manage urine bacteria?

The utilize of cranberry juice or extract to prevent UTIs has been promoted by sure advocates over the years, and many patients do adopt a "natural" approach when one is possible.

Nevertheless, top quality clinical inquiry has not been able to prove that cranberry is effective for this purpose. In a 2016 written report of older women in nursing homes, one-half were given cranberry capsules daily. But this made no difference in the amount of bacteria or white blood cells in their urine.

In a related editorial titled "Cranberry for the Prevention of Urinary Tract Infection? Fourth dimension to Move On," which summarized many other studies of cranberry for the prevention of UTI, the author concluded:

The evidence is disarming that cranberry products should non be recommended as a medical intervention for the prevention of UTI. A person may, of course, choose to use cranberry juice or capsules for whatever reason she or he wishes. Withal, clinicians should not be promoting cranberry apply by suggesting that there is proven, or fifty-fifty possible, benefit. Clinicians who encourage such employ are doing their patients a disservice."

A 2012 systematic review of high-quality research studies of cranberry for UTI prevention also ended that cranberry products did not appear to be effective.

That said, many people really experience that cranberry supplements make a difference.

As cranberry is unlikely to cause damage to older adults, I don't object when an older person or family caregiver wants to use them. But I don't specially encourage it either.

Practical tips on urine leaner and possible UTIs in older adults

Given all this, what should you do if you are worried about bacteria in the urine, or a possible UTI?

Here are my tips for older adults and families:

• Realize that asymptomatic bacteriuria is mutual in older adults.
  • If you keep having positive urine cultures despite feeling fine, you lot may have asymptomatic bacteriuria.

• Know that treatment of asymptomatic bacteriuria is non going to help, and might lead to harm.
  • Unless you are having symptoms, it's pointless to try to "eradicate" leaner from the bladder. Studies show that this increases your risk of getting a real UTI later, and that you lot'll be more likely to exist infected with leaner that are resistant to antibiotics.
  • Antibody treatment also affects the "skillful bacteria" in your gut and elsewhere in the trunk. Research to assistance us sympathize the role of the body's usual bacteria (the "microbiota") is ongoing, merely suggests there can exist existent downsides to disrupting the trunk's bacteria. Then yous don't want to use antibiotics unless in that location'south a good reason to do so.

• Avoid getting a urine civilisation unless you're experiencing symptoms of probable UTI, such as pain with urination or low belly hurting.
  • Some healthcare providers will do a urine culture "just to cheque" for UTI. Or sometimes patients and family members request this. But this is a bad idea, since all y'all might exercise is uncover signs of asymptomatic bacteriuria (which then has a tendency to exist inappropriately treated with antibiotics).
  • Experts strongly recommend that urine tests for possible UTI only be done if an older person is experiencing symptoms.
  • If a health provider suggests a urine test and you aren't having UTI symptoms, inquire every bit to the purpose of the exam.

If y'all're caring for an older adult who has dementia or is otherwise prone to delirium:

• Realize that information technology can be tricky to decide whether the person is experiencing UTI symptoms.
  • The doctors should still attempt to do so before checking a urine culture or treating any leaner institute in the urine.
• Realize that some experts believe that increased confusion alone (meaning no fever or other signs of UTI) may not be a expert reason to treat a nursing home resident for a presumed UTI.
  • A geriatrician explains this fence in this very interesting commodity: "Urinary Tract Infection"—Requiem for a Heavyweight

In curt: I'd summarize the benefits and burdens of treating asymptomatic bacteriuria in a 90 woman as follows:

Benefits: No proven benefit to antibody treatment in someone who doesn't have clinical signs of a UTI.

Burdens: Antibiotics toll coin, and increase pill burden. There is a take a chance of side-effects, of interactions with other medications, of harming your body'southward "adept bacteria," and of developing an infection resistant to antibiotics. Also, the overuse of antibiotics in society means we are developing more resistant bugs all around us.

So at that place you lot take it. If an older person has a positive urine civilisation but no symptoms, think long and hard earlier like-minded to treatment. And inquire extra questions earlier spending time pursuing a urology consultation.

Call back, bacteria in the urine does Non equal a UTI.

So, ask your clinicians if this could be asymptomatic bacteriuria. Tell them you've heard that the Infectious disease Social club of America, the American Elderliness Society, and other experts say that this condition should non be treated in older adults. (Unless you're about to undergo a urological procedure.)

You tin can even share these peer-reviewed articles:

• Approach to a Positive Urine Civilisation in a Patient Without Urinary Symptoms
• Diagnosis and Management of Urinary Tract Infection in Older Adults
• "Urinary Tract Infection"—Requiem for a Heavyweight

This commodity was first published in 2015. It was reviewed and minor updates were made in March 2022. (The basics about asymptomatic bacteriuria and UTIs in crumbling adults don't change much!)

headlamcomay1975.blogspot.com

Source: https://betterhealthwhileaging.net/urine-bacteria-without-uti-in-elderly/

Share this post