Renal Case: 52-year-old Woman Noted to Have Bacteriuria

00:01 All right, let's move on to another clinical case.

00:04 52 year old woman is noted to have bacteruria by urine analysis with a clean catch voided urine specimen culture E.coli greater than a hundred thousand colony forming units per mil.

00:15 She provides a second urine specimen five days later and cultures the same organism and count.

00:20 Her urine analysis is a microscopy show about 10 to 20 white blood cells for high-power field.

00:26 She's asymptomatic.

00:28 No dysuria, no frequency to void or suprapubic pain.

00:31 She denies any flank pain and she hasn't had any fevers or chills.

00:35 Her exam is unremarkable.

00:37 She's afebrile normotensive and she has no CVA tenderness to percussion and no suprapubic pain.

00:42 So the question is, does this patient need to be treated with antibiotics? Let's go through our clinical case and see if we can answer that question.

00:53 First thing to note, she has a culture that's positive for E.coli.

00:56 And it's greater than a hundred thousand colony forming units.

01:00 On a second specimen five days later, she cultured the same organism.

01:05 But she has no symptoms.

01:07 She has no signs on exam that would actually indicate an active infection.

01:13 She's healthy.

01:14 She has no risk factors for immunosuppression.

01:18 So in answer to does this patient need to be treated with antibiotics.

01:23 No, this is what we call asymptomatic bacteriuria.

01:29 Now what if that same patient was pregnant with that patient need to be treated with antibiotics? The answer here is yes, because that's one of the exceptions and indications to treat asymptomatic bacteriuria.