[Asymptomatic bacteriuria in women. Epidemiological, pathologic and therapeutic study]

Abstract

Objectives: To perform an epidemiological, pathologic and therapeutic study of asymptomatic bacteriuria (AB) in a population of outpatient women.

Methods: Transversal study for detection of AB in 1718 outpatient women 14-year-old or older. All patients complied with the inclusion/exclusion criteria for the study. Two groups of patients, with AB (n = 113) and controls without AB (n = 200), underwent: 1) urine analysis: urine sediment, biochemical analysis, and culture; 2) blood tests: hemoglobin, red blood cell count, urea, creatinine, sedimentation rate velocity, C reactive protein, immunoglobulins (IgA, IgM, and IgG), HLA-A3, blood group and Rh. The therapeutic management for AB was analyzed. Comparative statistical analyses of data were performed.

Results: AB prevalence was 6.34%. The most frequently isolated germ was E. coli (77.87%). Diabetes mellitus was detected in 27.43% of patients with AB and 7.01% without AB (27.43% vs. 7.01%); coronary arterial disease and other heart disorders (9.73% vs. 4%, p = 0.0206); general cardiovascular disorders excluding hypertension (46.9% vs. 31%, p = 0.0025). Urine analysis showed leukocyturia in 81.41% of the patients with AB and 17.5% without AB (p = 0.0002); positive nitrites (77.87% vs. 0%, p < 0.001); urine sediment showed bacteriuria in 86.72% of patients with AB and 0% of non-AB patients (p < 0.0001), leukocytes (93.80% vs. 6%, p < 0.0001), and pyuria (19.46% vs. 2.5%). Low water intake (50.44% vs. 9.5%, p < 0.0001) was the most significant urinary tract infection hygienic-dietetic predisposing factor. Higher levels of IgA (15% vs. 2%, p = 0.004). Positive HLA-A 3 (5% vs. 0%, p = 0.039), Rh negative (16.66% vs. 13.33%), and increased C reactive protein (15% vs. 10%). Renal abnormalities detected by radiological tests (10.29% vs. 1.47%, p = 0.014). AB disappeared after treatment with cefuroxime, ceftibuten, trimetropin/sulfametoxazole and amoxicillin in 100% of the patients receiving treatment. Topical vaginal estrogen therapy was effective in 38.09% of the patients.

Conclusions: The prevalence of AB increases with age. The most frequent germ is Escherichia coli. A statistically significant greater number of coronary artery disease, other heart diseases, and cardiovascular disorders were found among patients with AB in comparison with non-AB controls. Immunoglobulins levels disturbances, and HLA-A3 positivity suggest an immune systemic imbalance in certain patients with recurrent AB. Other therapeutic alternatives such as vaginal topical estrogens, fruit juices intake, vaccinations, etc. should be pursued in addition to antimicrobial therapy.