Bacteria in urine: what does it mean?

Various pathologies of internal organs, in particular of the kidneys, urinary tract, are accompanied by the fact that bacteria in the urine of women and men begin to multiply intensively. As a result, the bacteriological analysis of urine becomes positive, which is considered a negative sign, since normally urine should remain a sterile biological fluid.

The rate of bacteria in urine in women and men

In women, no bacteria should normally be found in the urine, since urine is a biological sterile fluid that does not contain microflora. The presence of microorganisms indicates the development of an infectious and inflammatory process and requires mandatory treatment. Several studies demonstrate that urine contains communities of living bacteria that make up the resident microbiota of female urine.[1]

In men, bacteria should not normally be found in the urine, since urine is a sterile environment and should not contain microflora. The presence of bacteria indicates the development of a bacterial infection, a high risk of bacteremia and sepsis. [2], 

Epidemiology

Asymptomatic bacteriuria is the presence of bacteria in properly collected urine from a patient who has no signs or symptoms of a urinary tract infection. Asymptomatic bacteriuria is very common in clinical practice, and its frequency increases with age. The incidence is 15 percent or more in women and men between the ages of 65 and 80, and reaches 40-50 percent after 80 years. Most patients with asymptomatic bacteriuria will never develop symptomatic urinary tract infections, and asymptomatic bacteriuria will not have adverse consequences. [3], [4]

Causes of the bacteria in urine

There are a wide variety of reasons that can lead to the development of bacteria in the urine. But conditionally, all these reasons can be divided into two large groups: autoinfection and infection from external sources. So, autoinfection means that there is a focus of infection in the body, a certain inflammatory and infectious process develops.

The primary focus of infection can be localized anywhere: lungs, gastrointestinal tract, bronchi, liver. Gradually, the infection can spread throughout the body, form secondary foci of infection. Of these, the infection enters the kidneys, urinary tract, ureters, and, accordingly, can cause inflammation in them. Urinalysis in this case shows the presence of bacteria in the urine. In this case, it is advisable to talk about the descending route of infection, in which the infection descends from the kidneys to the urinary tract and external genitals. [5]

With regard to an external source of infection, this implies that the infection enters the body from the outside. The ascending route of infection is considered to be the main one, in which the infection rises from the external genital organs, colonizing the mucous membranes, urinary tract, ureters, and finally penetrates the kidneys, where the main focus of infection subsequently develops. [6]

Risk factors

The risk group includes people who have recently had acute diseases of an infectious genesis, as well as people with a history of chronic diseases. People with acute and chronic diseases of the kidneys, urinary tract, people who have recently undergone antibiotic therapy, chemotherapy are at significant risk, since they have a sharp decrease in immunity, which entails various disorders of the microbiocenosis.

It is worth noting that hormonal disorders, decreased immunity, immunity tension, high viral load, latent infections or persistent infection in the blood are also risk factors, since all this directly or indirectly reflects on the state of the mucous membranes. The factors listed above cause a decrease in colonization resistance, a violation of normocenosis, and, accordingly, an increase in the proportion of pathogenic and opportunistic microorganisms, which contributes to the development of inflammatory and infectious processes, the appearance of bacteria in the urine. [7]

Pathogenesis

Normally, urine is a sterile biological fluid that does not contain microorganisms. The penetration of bacteria into the urine occurs if there is an infection in the body, as well as a focus of an infectious or inflammatory process. In this case, we can speak of three scenarios for the development of events. There are cases when bacteria are not viable, and got into the urine accidentally from the external genital organs, for example, with thrush, or other infections of the genitourinary tract. This is the so-called "transient microflora", that is, those microorganisms that accidentally appeared in the urine. There should be few of them - a few units in the field of view. It is worth thinking about an infection of the external genital organs, conducting appropriate treatment, and consulting a doctor. It also indicates that the analysis was not collected correctly. It is necessary to more carefully observe the hygiene and toilet of the external genital organs before taking the analysis. 

The second option indicates bacteremia. In this case, single colonies of microorganisms are found in the urine. This indicates the development of a rather strong inflammatory and infectious process in the kidneys, urinary system, and reproductive organs. It is necessary to undergo treatment as soon as possible. Hospitalization may be required, since in this case we are talking about a significant excess of all possible indicators of the norm, as well as about the progression of the infectious process, the formation of new foci of infection. The risk of developing sepsis is high.

The third option is when not single, but multiple colonies of microorganisms of various sizes and shapes are found in the urine. In this case, we are talking about sepsis - infection of biological sterile fluids. Emergency hospitalization, urgent care is required. There is a severe infectious process, with a tendency to a purulent-necrotic pathological process, progression and uncontrolled spread of infection, infection of biological sterile fluids, including blood. If the appropriate measures are not taken, it can be fatal.

Symptoms of the bacteria in urine

Pathology can develop both with symptoms and asymptomatic. In the first case, a person, as a rule, has all the signs of inflammatory processes in the kidneys and genitourinary organs, in particular, in the ureters, urinary tract, bladder, and the kidneys itself. [8]

There may be a violation of the processes of urination, frequent or false urge to urinate, pain both during urination and at other times. Often there is pain in the lower back, during movement, pain in the kidney area. As for the asymptomatic course of the pathology, the person does not feel any discomfort or problems, only when passing the analysis, the presence of an infection in the urine is randomly detected. This is also quite common and requires a comprehensive examination, since it can be a sign of a serious pathology that is hidden. [9]

Mucus and bacteria in urine in women and men

Mucus indicates the presence of an inflammatory process. The presence of bacteria in the urine indicates the development of a urinary tract infection. In women, the infection develops much faster than in men, so you need to pay special attention to this. The severity of the pathological process depends on the quantitative indicators of microorganisms. In any case, a mandatory doctor's consultation is required, since it is necessary to accurately determine the source of the infection. It can be infectious and inflammatory processes in the kidneys - nephritis, pyelonephritis, , glomerulonephritis , and other kidney pathologies. It can also be extrarenal pathologies, for example, cystitis , gynecological diseases. Treatment depends on which microflora prevails, as well as on the source of the infection and its quantitative indicators. Additional tests will be required, in particular, bacteriological examination of urine , urinary sediment. [10]

Mucus is the main sign of the inflammatory process, the presence of bacteria indicates the infectious nature of the inflammation. In men, this can be a sign of kidney disease, or extrarenal apparatus. It can develop against the background of inflammatory and infectious diseases: nephritis, pyelonephritis, cystitis, urethritis. Less commonly, it may indicate prostatitis, adenoma, and other pathologies of the male reproductive system. The risk of developing sepsis and bacteremia is quite high, therefore, compulsory treatment is required. The sooner it is started, the more efficiently and faster the result will be achieved. 

Many bacteria in the urine of women and men

Laboratory and clinical diagnostics is a fairly exact science that does not tolerate such conventional concepts as "a lot". Of course, the more bacteria are found in a woman's urine, the more severe the pathological process. It is necessary to know the exact quantitative indicator that allows you to judge the severity of the pathological process. Normally, bacteria should not be present in the urine, so any of their appearance indicates a pathology.

Speaking rather conditionally, we can say that there are "few" bacteria - this is an indicator of 101-105 CFU / ml. Accordingly, any reading above 105 CFU / ml can be considered as “many” bacteria in the urine. Regardless of how many bacteria are found in a woman's urine, treatment is mandatory, since, unfortunately, self-healing does not occur. Diseases can only progress, and the number of microorganisms will only grow without appropriate therapy.

In bacteriology and laboratory science, there are no such concepts as "a lot" and "a little". You need to know the exact number of bacteria found in the urine of a man in order to be able to judge the severity of the pathological process. Any appearance of bacteria in the urine indicates an abnormality. The more quantitative indicators, the more severe the pathological process. Conventionally, the concept of "a lot" can be attributed to indicators over 105 CFU / ml, which is quite dangerous and requires waste treatment. [11]

Nitrite and bacteria in urine in women and men

Indicate the development of an inflammatory process in the kidneys or urinary organs. In women, it can also be a sign of gynecological diseases. Nitrites also indicate the development of an inflammatory and infectious process in the kidneys, and most often indicate the presence of gram-negative microflora. Sometimes this can be a sign of the development of neoplasms in the urinary or reproductive system: it indicates the development of both benign and malignant tumors.

Nitrite and bacteria are closely related. So, nitrites found in the urine of a man are products of the breakdown of nitrates. In the presence of dysbiosis with a predominance of gram-negative microflora, nitrates under the influence of specific enzymes of these bacteria are not excreted, but enter the urine in a modified form (in the form of nitrites). But there are a number of other factors that can lead to this phenomenon. Therefore, the consultation of a competent specialist is required.

Complications and consequences

The most dangerous consequences of the appearance of bacteria in the urine are the progression of the infectious process, the spread and increase in the amount of infection, its penetration into the kidneys and other organs, and the formation of new (secondary) foci of infection. The most dangerous complications should be considered bacteremia and sepsis, which can be fatal. [12]

Diagnostics of the bacteria in urine

Diagnostics consists in the accurate identification of the qualitative and quantitative characteristics of the detected bacteria. That is, it is necessary to determine which microorganisms are present in the urine (their generic and generic affiliation), and also to determine their number. Additionally, an antibiotic susceptibility test can be performed. That is, you can choose a drug that will be effective in treating a bacterial infection. For this, laboratory methods are used. Instrumental methods may also be required, which will allow tracing the features of pathological changes in the body, identifying the focus of inflammation and infection. [13]

Analyzes

The main test is urine culture. Most often, the Gould culture method is used (but it all depends on the equipment and capabilities of the laboratory in which the analysis is carried out). After sowing on the medium, place the Petri dish in a thermostat under optimal conditions, incubate the culture for 3 to 5 days, then subculture on selective nutrient media and isolate a pure culture. The pure culture is identified according to the Bergey determinant.

According to the characteristics of growth on a selective medium, the growth rate, other significant parameters are determined, biochemical and serological tests are carried out, which ultimately make it possible to determine the exact quantitative and qualitative characteristics of the identified microorganism.

Quite often, an additional analysis is carried out for the antibiotic sensitivity of the isolated microorganism. For this, the disc diffusion method or the method of serial dilution is used. The bottom line is that they determine the antibiotic that is most effective against the identified microorganism, and also determine its optimal concentration, which will get rid of the infection.

Routine clinical examinations of blood, urine, and feces are also prescribed by protocol. They can be quite informative and can be a source of valuable information, allow you to consider a more expanded picture of pathology, to determine the features of the course of the pathological process and its localization. But the main method that allows you to make a final diagnosis is precisely seeding.

Additional tests, which are prescribed according to indications, can be an immunogram, virological studies, rheumatic tests. Tests for the level of interferons, immunoglobulins, sometimes allergy tests. Microbiological screening and testing for dysbiosis may also be required.

Instrumental diagnostics

The main diagnostic method is laboratory diagnostics (bacteriological research). Instrumental methods are used as additional, refining methods. For example, rheography may be required, which allows examining the functional state of the kidneys , urodynamics. Ultrasound, X-ray examination of the urinary tract, abdominal and pelvic organs, are prescribed if necessary. Computed tomography or magnetic resonance imaging may be required. With the combined pathology of the digestive tract organs, gastroscopy, colonoscopy, irigoscopy, gastroduodenoscopy, endoscopy, and other methods are used.

Differential diagnosis

With the help of differential diagnosis, it is possible to differentiate signs from one disease from signs of another disease. For example, it is important to differentiate kidney disease from cystitis, since both pathologies are accompanied by the presence of bacteria in the urine, but the treatment is radically different. It is also important to differentiate the bacteria that are found in the urine. For this, a bacteriological study is carried out, which makes it possible to clearly isolate and identify the type of bacteria and determine their number. 

Other diseases with which it is necessary to differentiate bacteria in the urine:

• Acute pyelonephritis.
• Bladder cancer .
• Chlamydia (chlamydial genitourinary infections).
• Cystitis (non-bacterial).
• Herpes simplex.
• Interstitial cystitis .
• Inflammatory diseases of the pelvic organs.
• Renal and perirenal abscess.
• Urethritis .
• Vaginitis.

Treatment of the bacteria in urine

Bacteria in the urine of both men and women can only be eliminated with antibiotic therapy. What exactly to treat - the doctor will tell you. The choice of one or another antibiotic depends on a number of factors, including the type of bacteria found in urine and their quantity. Also, in many respects, therapy is determined by the individual characteristics of the organism, the state of its immune system, local and systemic immunity.

Treatment should be guided by urine culture and sensitivity. Amoxicillin, amoxicillin / clavulanate, cefuroxime, cephalexin, and nitrofurantoin are considered safe to use during pregnancy. [14]The  [15]  duration of treatment should be 3 to 7 days, and at least one control urine culture should be performed. 

The most versatile antibiotics prescribed for the treatment of many infections, including co-infection, are broad-spectrum antibiotics. They can have both bacteriostatic and bactericidal effects, that is, antibiotics can either partially inhibit the growth of microorganisms, or completely kill them. There are also special uroseptics that are used to treat diseases of the infectious nature of the urogenital tract. They have a targeted effect on those pathogens that contribute to the development of diseases of the urinary system.

When using some drugs, additional drugs may be required, for example, probiotics, aimed at normalizing normal microflora. This is due to the fact that antibiotics, together with pathogenic microflora, can simultaneously kill representatives of normal microflora. Their deficiency must be replenished, otherwise a fungal infection will occur.

Hepatoprotective agents may also be needed, as some antibiotics can be toxic to the liver. Complex therapy is often presented simultaneously with antifungal agents and antibiotics. Sometimes immunomodulators are additionally included in the treatment regimen. But such appointments should be made by a purely doctor, since self-medication can be fraught with serious consequences, up to immune disorders.

Medicines

Medicines should only be prescribed by a doctor, based on research results. This is a basic precaution. This is due to the fact that otherwise numerous side effects may develop. It is necessary to strictly follow the treatment regimen. The main side effects are the development of dysbiosis, disorders of the immune system, disturbances in the normal state of the mucous membranes, the development of a fungal infection.

To eliminate bacteria (treat bacterial infections), antibiotic therapy is used. 

A broad-spectrum antibiotic, amoxiclav, has proven itself well. It belongs to the antibiotics of the penicillin series. It is active against both gram-positive and gram-negative microorganisms. Applied as a tablet per day (500 mg of active ingredient). The course of treatment is designed for three days. There are three tablets in the package.

Stronger is ciprofloxacin, which belongs to macrolides. It is also taken at 500 mg (one tablet) per day. Usually, the course of treatment ranges from 3 to 5 days, depending on the severity of the bacterial infection and the number of microorganisms detected in the urine. You can divide the daily dosage into 2 parts - take half a tablet (250 mg) twice a day.

Azitrox (azithromycin) is also prescribed at 500 mg per day, for three days.

Of the uroseptics, urolesan has proven itself well, which is prescribed on average in 10-25 drops, depending on the age, body weight of the patient. It is recommended to drink it with a little water, or drip it onto a small piece of sugar and eat it along with the sugar. This enhances its effect. [16], [17]

Vitamins

It is not recommended to take vitamins in case of a bacterial infection, since they act as growth factors for microorganisms, as a result of which their growth and reproduction intensifies, and the bacterial process also becomes heavier. The exception is vitamin C. On the contrary, it suppresses the growth of pathogenic microflora, stimulates the immune system, human defense mechanisms, which helps to increase the body's endurance, resistance to infectious and inflammatory agents. Vitamin C is prescribed in a double dosage - 1000 mg per day.

Physiotherapy treatment

The main means of physiotherapy are electrophoresis, light and heat treatment, UHF, laser treatment (for example, when removing stones, sand from the kidneys). Hallotherapy, balneotherapy, mud therapy, massage are sometimes prescribed. Physiotherapy treatment is effective as part of complex therapy. Physiotherapy alone is ineffective.

Alternative treatment

As means of alternative treatment, various balms, which include herbal ingredients and alcohol, have proven themselves well. Herbal ingredients have a therapeutic effect, alcohol has an antiseptic effect. Consider the most effective recipes used to eliminate a bacterial infection.

• Recipe number 1.

For cooking, take a tablespoon of calendula flowers, medicinal comfrey, medicinal lovage, prickly tartar, pour about 500 ml of red wine (for example, Cahors), then add half a teaspoon of ground ginger and ground calamus roots. All this is insisted for at least 3-4 days, they drink 50 ml per day. The course of treatment is at least 28 days (full biochemical cycle).

• Recipe number 2.

Take in equal shares the flowers of the violet tricolor, scumpia, rowan berries, gooseberry leaves, rose hips. Take about 2-3 tablespoons of each component, add about 2-3 tablespoons of honey, 500 ml of alcohol, insist for at least 5 days, drink in small quantities twice a day, 28 days.

• Recipe number 3.

Vodka or pure alcohol is taken as a basis. Then add about a tablespoon of the following components: ginseng, celery, peony, marsh calamus. Add a tablespoon of honey. Stir, insist for at least a day.

• Recipe number 4.

In cognac or cognac alcohol (500 ml) add a tablespoon of medicinal Dubrovnik, yellow water lily, medicinal sainfoin, Norway maple, medicinal rosemary, medicinal asparagus. Then add 2-3 drops of thuja or juniper essential oil. Drink a tablespoon twice a day.

Herbal treatment

Sage is anti-inflammatory. Plantain has an antiseptic effect, reduces the number of bacteria in any biotopes and biological fluids. Stevia enhances immunity, has an antiviral effect, normalizes the state of normal microflora.

All these herbs are recommended to be taken in the form of a decoction. To prepare the broth, take about a tablespoon of each product, pour a glass of boiling water. Insist for at least 30-40 minutes. They drink a glass a day. You can prepare these herbs, both individually and in combination, as a herbal collection.

Homeopathy

Homeopathic remedies require mandatory compliance with precautions. So, when taking homeopathy, it is imperative to consult a doctor. He will help to effectively include funds in the complex therapy, select the optimal scheme, depending on the characteristics of the course of the pathology, the severity of the condition, the number of bacteria in the urine. Compliance with these elementary measures will avoid complications. Failure to comply often entails complications such as deterioration, progression of infection, and inflammation. The most dangerous complications are bacteremia and sepsis.

When a large number of bacteria appear in the urine, it is recommended to undergo a course of therapeutic baths. They are especially effective for concomitant kidney diseases, urolithiasis. You can take baths only if your body temperature is normal. Baths also help to relax, relieve muscle tension, spasm, which significantly reduces pain, if any.

• Recipe number 1.

To prepare the composition for baths, honey, cocoa butter and butter are taken as a base in equal proportions, all this is melted in a water bath, or over low heat until dissolved, with constant stirring. Add 2 tablespoons of hop cones, European dodder, forest anemones, Lesser periwinkle and Schisandra chinensis to the resulting mass. All this is mixed until a homogeneous consistency is formed. They remove the fire, give the opportunity to freeze. Add to the bath (at the rate of about 3 tablespoons per full bath - 300 liters of water). Store in a refrigerator (on the bottom shelf).

• Recipe number 2.

As a basis for preparing a bath gel, take about 100 ml of kombucha (chaga) diluted with hydrogen peroxide in a 1: 2 ratio. A mixture of the following plant components is prepared in advance in a refractory dish: parsnip, Voronov's snowdrop, Rhodiola rosea, fragrant rue, medicinal lungwort, garlic tincture (at the rate of about 2 tablespoons of each herb per 100 ml of infusion). Separately take butter (about 100 grams). The oil is heated over low heat (not boiling). As soon as the oil has warmed up strongly enough, but has not yet boiled, remove it from the heat, and pour in the herbs prepared in advance and the main infusion. Stir, cover with a lid on top, insist in a dark place for a day (at room temperature). The oil is then ready for use. It is recommended to add 2 tablespoons to a full bath.

• Recipe number 3.

As a basis, take a mixture of massage base oils: avocado oil and camphor oil in a ratio of 1: 2, add 2-3 drops of vitamins A and E. Mix. Add 2 drops of the following essential oils to the resulting mixture: dope ordinary, shandra, wormwood. Mix thoroughly, use to add to the bath at the rate of 10-15 grams per bath.

• Recipe number 4.

A well-proven balm for oral administration. It is recommended to take it during the bath, which will enhance the effect of the thermal procedure. Vodka or pure alcohol is taken as a basis. Then add about a tablespoon of the following components: river gravilat, wormwood, rose hips, lemongrass fruits, crushed St. John's wort flowers. Stir, insist for at least a day. Drink 2-3 tablespoons twice a day, for at least a month.

• Recipe number 5.

Add a tablespoon of chopped yarrow flowers, St. John's wort, chopped hemp seeds, dioecious nettle leaves to cognac or cognac alcohol (500 ml). Then add 2-3 drops of thuja essential oil. Drink a tablespoon twice a day.

Surgery

If bacteria are present in the urine, surgical treatments are not used. They may be required only if a concomitant pathology is identified that requires surgery, for example, a tumor of any genesis and localization. The main method of treating bacteria in urine is antibiotic therapy.

Prevention

Prevention is based on the need to eat right, include in the diet the required amount of vitamins and minerals, regularly undergo preventive examinations, and, if necessary, be treated in a timely manner. It is extremely important to maintain a high level of immunity, since the development of a bacterial infection is possible only with reduced immunity and impaired microflora. You also need to fight a viral infection, since the persistence of viruses in the blood creates a tension in the immune system and its further decrease. [18]

Forecast

In most cases, with proper and timely treatment, the prognosis will be favorable. Bacteria in the urine of women and men  are easily eliminated with antibiotic therapy. If left untreated, complications may arise. The main complication is bacteremia and sepsis, which can even be fatal.