Bacteria in the urine (bacterial infection): causes, meaning of the result and what to do

The bacteriuria corresponds to the presence of bacteria in the urinary tract, which may be due to an inadequate collection of the urinary bladder, with contamination of the sample or due to a urinary infection, also being observed in these situations, other changes in the examination of orina, with the presence of leukocytes, epithelial cells, and in some cases, red blood cells.

The presence of bacteria in the urine is evaluated through a general urine test, in which its presence is identified through a microscope. However, the doctor must also evaluate other parameters of the exam, such as the presence of leukocytes, cylinders and/or red blood cells, as well as the pH, the odor and the color of the urine.

According to the result of the urine test, the general practitioner, urologist or gynecologist may indicate the most appropriate treatment or may request complementary examinations, in cases where it is considered necessary.

How to identify bacteriuria

The bacteriuria is identified through the visualization of a sample of urine under a microscope, allowing to identify the presence or number of bacteria, being indicated in the report of the examination and the results below:

• absent bacteriawhen no bacteria are observed;
• Rare bacteria or +when 1 to 10 bacteria are visualized, in 10 observed microscopic fields;
• Some bacteria o ++when between 4 and 50 bacteria are observed;
• Frequent bacteria or +++when up to 100 bacteria are observed, in 10 readable fields;
• Numerous bacteria o ++++when more than 100 bacteria are identified in the observed microscopic fields.

In the presence of bacteriuria, the doctor who requested the examination must evaluate the urine examination as a whole, observing any other changes present in the report, in order to be able to reach a diagnosis and start the treatment. In general, when the report indicates the presence of rare bacteria or some bacteria, it is indicative of the normal microbiota of the urinary system, and the start of treatment is not a cause for concern.

Normally, in the presence of bacteria in the urine, a urine culture is ordered, especially if the person has symptoms, to identify the species of bacteria, number of colonies formed and the resistance and sensitivity profile of the bacteria, this information being important so that the doctor can recommend the most appropriate antibiotic for the treatment. Know how the urine culture is carried out with antibiogram.

What can mean bacteria in the orina

The main causes of bacteriuria are:

1. Sample contamination

Contamination of the sample is one of the most frequent causes of bacteria in the urine, especially when several epithelial cells and absence of leukocytes are observed. This contamination occurs at the time of the collection, when the person does not perform the correct hygiene for the collection or when the first urine is not required. In these cases, most of the times, the bacteria identified are part of the urinary system and do not represent a risk to health.

What to do: in situations in which other changes in the urine test have not been identified, the doctor may not take into account the increase in the number of bacteria, however, in some cases, it may be possible to request a new collection, being important this time to carry out correct hygiene of the intimate region, select the first ear and bring it to the laboratory until 60 minutes after the collection for your evaluation.

2. Urinary infections

When it is not a case of contamination of the sample, the presence of bacteria in the urinary tract, especially when frequent or numerous bacteria are observed, is indicative of infection of the urinary system. In addition to the bacteriuria, some or numerous epithelial cells can be verified, as well as several or numerous leukocytes, depending on the microorganism responsible for the infection and its cant.

To confirm the urinary infection, mainly when there are symptoms, the doctor usually indicates the performance of urine culture to identify the bacteria responsible for the infection and the cantiness, being normally indicative of infection when there is more than 1,000,000 cfu/mL. Find out more about the uroculture.

What to do: The antibiotic treatment of urinary infections, in general, is only indicated when the person has symptoms related to the infection, such as pain or burning when urinating, urination with blood or feeling of heaviness in the bladder, for example. In these cases, the doctor, urologist or gynecologist can indicate the use of antibiotics according to the bacteria identified and its sensitivity profile.

However, when no symptoms are observed, the use of antibiotics is generally not indicated, as they can induce bacterial resistance, which makes the treatment more complicated.

See how to recognize the symptoms of urinary infection and how to avoid it.

3. Tuberculosis

Although it is rare, it is possible that in systemic tuberculosis it is possible to find bacteria in the urinary tract and because of this, the doctor may request an examination of the urinary tract, to search for Mycobacterium tuberculosiswhich is the bacterium responsible for tuberculosis.

Usually, the investigation of Mycobacterium tuberculosis at the orina, it is only carried out as a way of accompanying the patient and the response to treatment, being the diagnosis carried out by means of the sputum or tuberculin prueba, known as PPD. Know how the diagnosis of tuberculosis is performed.

What to do: When the presence of bacteria in the urinary tract of a patient with tuberculosis is verified, the doctor must evaluate whether the treatment is being carried out correctly or if the bacteria is resistant to the indicated drug, being able to indicate a change in the antibiotic or in the therapeutic regimen . The treatment for tuberculosis is carried out with antibiotics and must continue when the person has more symptoms, since not all the bacteria can be eliminated.

4. Stress and Anxiety

Stress and anxiety are factors that can cause imbalances in the bacterial flora and favor the proliferation of microorganisms, because they directly interfere with the functioning of the immune system, reducing its activity. This could generate an increase in the number of bacteria in the urine, which occurs with the objective of preventing possible infections.

What to do: In case the increase in the bacterial flora occurs due to stress or anxiety, it is important that strategies are adopted that help to relax, so that it is possible to regulate the bacterial flora and promote a feeling of well being.

Therefore, it is recommended that the person rest, practice physical activity or relaxing activities, such as meditation and yoga, in addition to maintaining a healthy diet, increasing the intake of foods rich in probiotics and that help to strengthen the immune system. See how to manage stress and anxiety.

5. Inadequate hygiene

Inadequate hygiene of the genital region before the collection of the urinary bladder for the examination can also cause the bacterial flora to appear increased in the urinary bladder. This is due to the fact that, despite the fact that it is recommended to leave a well of urine to be salted first and then collect the sample, it is possible that the microorganisms naturally present in the genital region cannot be effectively eliminated, being released in greater quantity in the orina, thus affecting the result.

What to do: In this case, it is necessary to confirm that the alteration in the exam was due to inadequate hygiene at the time of collecting the sample, recommending the repetition of the exam. Before returning to collect the sample, the person must wash the genital region with water and neutral soap.