Bacteria in urine: diagnosis, treatment

Bacteria in urine is an extremely unfavorable sign, which indicates a severe inflammatory and infectious process affecting the kidneys, urinary tract, and possibly even the blood and other body systems. Normally, urine is sterile, that is, it should not contain any microorganisms. Any appearance of bacteria in urine is a pathology. Depending on the number of bacteria, this may indicate both a severe infectious lesion of the urinary system and the development of bacteremia, sepsis. [ 1 ]

Diagnostics bacteria in the urine

To make a diagnosis, you need to see a nephrologist, or if you don’t have one, a urologist. As a last resort, you can see your local therapist, who will refer you to the appropriate specialist. The diagnosis is based on determining the type of bacteria found in the urine, as well as determining their quantitative indicators. Indirectly, based on the clinical picture, you can roughly guess what kind of microorganism is in the urine, but the only possible way to make a diagnosis is the results of laboratory tests, which will indicate the species and generic name of the detected microorganisms, and their exact concentration, calculated per 1 ml of urine (bacteriological examination, bacteriological culture). [ 2 ]

Tests

The main method for diagnosing bacteria in urine is urine analysis. Various types of urine analysis are used:

• clinical or general urine analysis – allows to reveal the general picture of the pathology, the direction of the main processes, indicates pronounced pathologies and shifts.
• urine analysis according to Necheporenko – counting the number of leukocytes in urine, allows us to judge the severity and expression of the inflammatory, bacterial process.
• bacteriological examination (urine culture according to Gould) - an analysis that allows identifying the quantitative and qualitative characteristics of the microflora, the causative agent of the disease,
• microscopy of urinary sediment – allows to identify additional structures, inclusions in urine, and also to detect cells (erythrocytes, leukocytes, or platelets), which can also have diagnostic value.

Other methods are also used, but we will focus only on the most common ones, with the help of which research is carried out in ordinary clinics, without taking into account specialized departments and hospitals. [ 3 ], [ 4 ]

The main methods are still considered to be bacteriological methods (bacteriological culture), in which urine is taken and cultured on selective nutrient media. Then it is placed in optimal conditions (thermostat), the culture is incubated, a pure culture (pathogen) is isolated, its concentration (quantity) is determined. Using an analysis of antibiotic sensitivity, further treatment is selected for the isolated microorganism, aimed at eliminating this pathogen. It is possible to select not only the drug itself, but also determine its optimal dosage, which will make the treatment as effective as possible. [ 5 ]

Instrumental diagnostics

Rarely used. Instrumental examination methods are used only if there are concomitant pathologies, complications. For example, if bacteria have caused inflammation, a purulent-septic process, and others. Or, if it is assumed that there are other foci and sources of infection that the doctor wants to detect and take timely measures. Then the methods can be varied:

• rheography
• X-ray
• CT
• MRI
• Ultrasound.

As for bacteria in urine, their presence is confirmed by bacteriological testing. [ 6 ]

Flow cytometry

This is a fairly accurate and highly effective laboratory test method that allows you to examine a urine sample received by the laboratory. After the urine is received by the laboratory, the laboratory technician independently selects the method by which he or she will conduct a particular study. The choice is made in favor of the method that will allow you to solve the tasks set faster and more effectively. All methods are standardized, the techniques are strictly prescribed. Flow cytofluorometry is recommended for use in examining urine samples with suspected bacterial infection. This method is much faster than bacteriological culture, since you do not need to wait for the culture to grow. But at the same time, this method has a significantly higher probability of error, and slightly lower reliability indicators. Faster. This is a method that allows you to get preliminary results if there is no time to wait for bacteriological culture. If possible, it is better to additionally confirm the diagnosis using culture. [ 7 ]

Differential diagnosis

To establish a differential diagnosis, it is usually enough to consult a nephrologist or bacteriologist. The doctor will conduct an examination and look at the tests. It is necessary to differentiate, first of all, a bacterial infection from other types of diseases. This is quite easy to do - the analysis results indicate the species, generic name of the microorganism (it shows whether it is a virus or a bacteria). This is the first stage of differential diagnosis.

The second stage is to determine the quantitative indicators of the microorganism. This is essentially also the task of the laboratory technician who performs the analysis. The results will indicate the quantitative characteristics (the concentration of bacteria in one milliliter of urine). If necessary, the doctor will refer you for additional consultation with other specialists. If necessary, additional research methods can be prescribed: X-ray of the genitourinary tract, kidneys, computer, magnetic resonance tomography. The data will help to clarify the diagnosis, differentiate it if there are doubts.

Treatment bacteria in the urine

The treatment is standard - antibiotic therapy. That is, antibiotics are used that suppress or completely stop the growth and reproduction of bacteria in the urine. For this, various groups of antibiotics are used. The doctor should make the appointments. [ 8 ], [ 9 ]

Of primary importance is the need to stop the inflammatory, infectious, purulent-septic process, to prevent the formation of new foci of infection, its spread throughout the genitourinary tract. It is especially important to prevent infection from getting into the kidneys and other internal organs.

Symptomatic treatment aimed at eliminating the current symptoms is also used: pain relief, swelling, inflammation, hyperemia. Anti-inflammatory, analgesic, and decongestant drugs are used. There are systemic drugs aimed at the entire body as a whole, there are local agents, drugs with targeted, local action. Such drugs include, for example, uroseptics, which stop the infectious and inflammatory process only at the level of the genitourinary system, kidneys, and act in a targeted, selective manner. They exhibit high activity specifically against those bacteria that can act as causative agents of diseases of the genitourinary system, and do not act on other bacteria.

What to do if bacteria are found in urine?

If bacteria are found in urine, the first thing to do is to see a doctor (nephrologist, urologist, bacteriologist). Of course, it is better to contact a bacteriologist immediately, since he specializes directly in the treatment of bacterial infections, bacteria. Both in urine. And in any other biological fluid and system. But not all clinics have such a doctor.

After you have consulted a doctor, he will look at the test results, conduct an additional survey, examination, draw conclusions, and prescribe appropriate treatment. First, drug therapy is used (antibiotics, antibacterial drugs, uroseptics). Phytotherapy is an excellent and effective addition to drug treatment methods. Many herbal decoctions, infusions, are used for douching, medicinal baths, compresses, for internal use in order to relieve inflammation, eliminate the infectious process, and stimulate immunity. [ 10 ]

Medicines

Antibiotics are used to treat bacterial infections. This is the main and only means of eliminating the infection. Other drugs can only be used as auxiliary ones, such as painkillers, anti-inflammatory drugs.

• Tetracycline

Dosage: from 500 mg to 2 grams per day, depending on the severity of the pathological process and the concentration of bacteria in the urine.

Precautions: Use with caution in patients with kidney and liver pathologies, as the drug is toxic to these organs.

Side effects: kidney and liver disease.

• Amoxicillin (possibly commercial name - Flemoxin)

Dosage: one tablet (500 mg) once a day, 3-5 days.

Precautions: May cause allergies. In people with a tendency to severe allergic reactions, it may cause anaphylactic shock. Fatal cases of anaphylaxis from the administration of the drug have been described.

Side effects: allergic reactions, anaphylaxis, Quincke's edema.

• Ciprofloxacin (commercial names - tsiprobay, tsifran, tsiprinol, ciprofloxacin)

Dosage: one tablet (500 mg) once a day, 5-7 days.

Precautions: Do not prescribe to patients with ulcers, ulcerative gastritis, gastric bleeding.

Side effects: exacerbation of gastritis, ulcer perforation.

• Biseptol

Dosage: 480 mg per day (divided into 2 doses). In case of severe inflammation, the dosage can be doubled to 960 mg per day.

Precautions: Do not take during pregnancy or lactation.

Side effects: none.

• Streptomycin

Dosage: 500–1000 mg per day, for 7 to 10 days.

Precautions: ototoxic, do not take if you have ear diseases or hearing impairment.

Side effects: hearing impairment, even complete deafness.

• Furamag

The active substance is furazidin (50 mg). It is prescribed as an antimicrobial agent. It belongs to the nitrofuran group. It has a high degree of antimicrobial activity, relieves spasms, eliminates inflammation, and prevents complications. Resistance develops extremely slowly. It is prescribed for urogenital infections, when bacteria are detected in urine, for gynecological and some venereal diseases, and for soft tissue infections. Adults are recommended to take 50-100 mg per day. Children from 5 to 18 years old - 25-50 mg. The course of treatment is 7-10 days. In case of a severe infection, the course can be extended to 14-15 days.

Tablets for bacteria in urine

Three groups of antibacterial tablets are prescribed for bacteria in urine:

1. Sulfonamides
2. Nitrofurans
3. Antibiotics.

Each group has its own advantages and disadvantages.

Sulfanilamide drugs are derivatives of sulfanilic acid that have an antibacterial effect on the body. They are powders that are poorly soluble in water. They are effective against streptococci, staphylococci, gonococci, meningococci. They are ineffective on their own. But in combination with other drugs, they can have a powerful antibacterial effect. Today, they are either not used in medicine or are used in combination with other antibacterial drugs. This group includes drugs such as streptocide, norsulfazole, ingalipt, phthalazole. [ 11 ], [ 12 ]

The nitrofuranol group includes substances with antibacterial action, effective against various cocci, trichomonads, lamblia. They are widely used as part of complex therapy. They are especially effective in the treatment of diseases of the genitourinary system, to eliminate bacteria in the urine. This includes such drugs as furacilin, furaplast, fastin.

The third group – antibiotics – is the most numerous and diverse. It includes a large number of antibacterial drugs of various pharmacological action. For example, penicillin, macrolides, tetracyclines, the streptomycin group, and other drugs.

Antibiotics for bacteria in urine

The main way to treat bacteria in urine is to take antibiotics. They kill bacteria completely or prevent their further reproduction, reduce their numbers. Let's look at the main drugs.

• Co-trimoxazole

Dosage: 80 mg per day, 10-14 days.

Precautions: Do not take during pregnancy, lactation, children under 12 years of age. Has anticoagulant activity, thins the blood, causes inhibition of liver metabolism (prescribed together with anticoagulants).

Side effects: blood thinning, decreased blood viscosity, liver disorders.

• Ampicillin

Dosage: 500 mg per day, 3 days.

Precautions: May cause allergic reactions.

Side effects: allergy.

• Levomycetin

Dosage: 1-2 tablets per day, for at least 7 days.

Precautions: Do not take during pregnancy or lactation.

Side effects: headache, nausea.

• Erythromycin

Dosage: from 500 mg to 1 gram per day.

Precautions: Do not take during pregnancy, breastfeeding, or for persons under 3 years of age.

Side effects: dysbacteriosis, digestive disorders, bowel disorders, loss of appetite.

• Amoxiclav Quiktab

Dosage: one tablet (500 mg) once a day, 5-7 days.

Precautions: the preparation contains substances that provide protection for the stomach. Recommended for people with diseases of the digestive tract (after consultation with a gastroenterologist).

Side effects: digestive disorders, allergies.

• Co-trimoxazole (commercial name - biseptol, bactrim, septril)

Dosage: 80 mg per day, 10-14 days.

Precautions: Do not take during pregnancy, lactation, children under 12 years of age. Has anticoagulant activity (thins the blood, prevents blood clots, reduces blood clotting). Take with caution in people with low blood clotting, any diseases of the circulatory system and heart. The drug is strictly contraindicated in hemophilia, a tendency to spontaneous bleeding, peptic ulcer, in the postoperative period. It is recommended to refrain from taking women during menstruation, as well as after invasive (surgical or diagnostic interventions).

Side effects: blood thinning, decreased blood viscosity, blood clotting disorders, impaired functional state of the liver and heart.

• Ampicillin

Dosage: 500 mg per day, 3 days.

Precautions: May cause allergic reactions.

Side effects: allergy.

• Chloramphenicol (commercial name - levomycetin)

Dosage: 1-2 tablets per day, for at least 7 days.

Precautions: Do not take during pregnancy or lactation.

Side effects: headache, nausea, vomiting, intoxication.

• Doxycycline (trade name: Vibramycin)

Dosage: from 500 mg to 1 gram per day, depending on the concentration of bacteria in the urine.

Precautions: Use with caution in patients with kidney and liver pathology, as the drug is toxic to these organs. It is recommended to take it in combination with hepatoprotectors. If side effects occur, it is recommended to reduce the dosage.

Side effects: kidney disease, liver disease, vomiting, diarrhea, heartburn.

• Clarithromycin (Klacid)

Dosage: one tablet (500 mg) once a day, 5-7 days.

Precautions: Do not prescribe if you have an ulcer, liver disease, or heart failure.

Side effects: exacerbation of gastritis, ulcer perforation, increased heart rate, arrhythmia, liver and gallbladder disease.

• Canephron

Canephron is a remedy that includes centaury herb, lovage and rosemary leaves (water-alcohol solution). Refers to diuretic agents. It has an anti-inflammatory, anti-infective effect on the body, relieves spasms. It is prescribed for the treatment of acute and chronic diseases of the kidneys and urinary tract. Adults are prescribed 50 drops, children from 12 to 18 years old - 25-30 drops, children from 1 to 12 years old - 15 drops. Dissolve in a small amount of water, or wash down. The duration of treatment is at least 3-4 weeks, better - a full 28 days (a full biochemical cycle). Prescribed three times a day.

Vitamins

If bacteria are found in the urine, taking vitamins is contraindicated. This is due to the fact that any vitamins act as a nutrient substrate, growth factors for microflora. That is, on the contrary, they stimulate the growth and reproduction of bacteria. Therefore, if we take vitamins, the infection will only progress.

An exception is vitamin C (ascorbic acid), since this vitamin, on the contrary, prevents the growth and reproduction of microorganisms. It also has a positive effect on the macroorganism (human), stimulating the immune system, increasing endurance and resistance of the body. Vitamin C should be taken in double dosage - 1000 mg per day.

Physiotherapy treatment

It is rarely used. However, it is possible to use physiotherapy treatment as part of a complex therapy, which will enhance the effect of the main therapy or consolidate it. Electrophoresis, light therapy (ultrasound, microwave, UHF, infrared light) are used as the main means. Thermal treatment is also used. Sometimes, recreational opportunities of the natural environment and natural forces are used. For example, halotherapy, balneotherapy, mud therapy, massage, vacuum massage are prescribed. Basically, these means are used during spa treatment or at the stage of recovery after an illness. Most experts note that physiotherapy is effective as part of a complex therapy, but physiotherapy is ineffective as an independent means.

Folk remedies

Traditional medicine has long been used to treat bacteria not only in urine, but also in other biological fluids.

• Recipe No. 1.

Add a tablespoon of immortelle flowers, trefoil leaves, mint, and fennel to alcohol (200-250 ml). Let it steep for at least an hour, drink 30-40 grams 2 times a day, adding half a teaspoon of ground or finely grated ginger root to the bottom of the glass.

• Recipe No. 2.

To prepare the decoction, take a tablespoon of Icelandic moss, sage leaves, bran, pour 500 ml of beer (dark). Bring it all to a boil, set aside, leave for at least 3-4 hours, strain, use for compresses and lotions.

• Recipe No. 3.

Take equal parts of brown sugar, black radish, 200 grams of rendered lard. Pour a glass of warm milk, bring to a boil. Cook over low heat for 5-10 minutes. Remove from heat, cover with a lid, let it brew for 1-2 hours. Use a tablespoon per day.

• Recipe No. 4.

Boiled water (or distilled water) is used as a base. Bring to a boil, then add about a tablespoon of the following ingredients: wormwood, finely chopped banana peels, goose fat. Boil over low heat for 3-5 minutes. Stir, then set aside and allow to brew. To increase the body's endurance, drink a tablespoon 1-5 times a day.

Herbal treatment

An effective method for eliminating bacteria from urine is herbal treatment.

Birch leaves and buds (decoction) have antiseptic and anti-inflammatory properties. Drink 50 ml per day.

Lingonberry (juice, decoction of leaves) increases local immunity, normalizes, has antiviral, antibacterial properties. Drink as tea.

Coltsfoot normalizes local immunity, the condition of mucous membranes, and helps eliminate infections. Use a decoction (drink 50 ml).

Homeopathy has side effects (allergies, kidney and liver disease), so it is important to take precautions - always consult a doctor.

• Recipe No. 5.

To prepare, take pork fat, oats, barley (about 100 grams), pour about 500 ml of boiling water, then boil for 10-15 minutes, leave for at least 2-3 hours. Eat a glass per day, adding a teaspoon of bitter almonds and a tablespoon of honey beforehand. Significantly increases immunity, endurance of the body, kills bacteria.

• Recipe No. 6.

Take equal parts chicory and black coffee. Take about 2-3 tablespoons of each component, add 300 ml of bitter radish juice, stir until completely dissolved, leave for at least 1.5-2 hours. Drink 100 ml per day, adding honey to taste.

• Recipe No. 7.

As a base, take about 250-300 ml of sea buckthorn oil. Then add about a tablespoon of the following components: a head of garlic, grated through a fine grater, an egg yolk, mint and ivy grass (a tablespoon each). Mix, leave for at least an hour. I drink a tablespoon twice a day.

• Recipe No. 8.

Add rum (100 ml) to milk with honey (500 ml), add a tablespoon of ground ginger and cinnamon. Boil for 5-10 minutes, drink 50 ml before bed.

Surgical treatment

Surgical treatment methods are used when drug therapy is ineffective, and this is very rare. Basically, such a need arises in emergency cases, when a focus of a purulent-inflammatory process is detected (areas of necrosis, phlegmon). Especially if there is a risk of rupture, infection of the entire abdominal cavity (peritonitis). This can be observed in seriously ill patients, in people with immunodeficiency, in case of injuries, damage.

Prevention

Prevention is based on eliminating risk factors:

• compliance with hygiene rules
• timely detection of all foci of infection
• preventive examinations, tests.

In addition, proper nutrition, vitamin and mineral intake are required. Avoid overcooling.

Forecast

The course and prognosis depend on the timeliness of diagnosis and treatment. Bacteria in the urine can be cured with antibiotics. But it is important to understand that advanced cases cannot be cured - peritonitis, bacteremia, sepsis may develop. There are known cases of fatal outcome.