Nitrites in urine which bacteria

When in doubt, treat aggressively for possible upper urinary tract disease. Diagnosis of a urinary tract infection is a combination of signs, symptoms, and urinalysis results confirmed with urine cultures. Be careful of literature that is based on the results of the urinalysis of asymptomatic patients.

Patients with permanent indwelling Foley catheters or suprapubic tubes will sometimes tend to have vague symptoms that may include an elevated WBC count and fever. Most patients withi catheters will have pyuria and elevated bacterial colony counts in the urine. This is not a true urinary tract infection and should not be treated unless there are also symptoms of pain, hematuria or other abnormal bladder activity. A good, clean, urinalysis UA specimen is vital to the workup.

A clean catch specimen in non-obese women is preferred. Most obese women cannot give a clean specimen, and epithelial cells in the UA means the urine sample was exposed to the genital surface and did not come directly out of the urethra. Get a clean sample, with very few epithelial cells. This might require a quick catheterization. Men should start the urine stream to clean the urethra and then obtain a midstream sample.

Urine should be sent to the lab immediately or refrigerated because bacteria grow rapidly when the sample is left at room temperature, causing an overestimate of the infection's severity. Do not base the diagnosis of a UTI upon visual inspection of the urine. Cloudy urine can be aseptic; the cloudiness can come from protein or calcium phosphate debris in the sample, not necessarily from an infection.

Crystal clear urine can be grossly infected. All urines undergo dipstick testing, which can be done at the bedside. Helpful values are pH, nitrites, leukocyte esterase, and blood. Remember that in patients with symptoms of a UTI, a negative dipstick does not rule out the UTI, but positive findings can suggest and help make the diagnosis.

Normal urine pH is slightly acidic, with usual values of 6. A urine pH of 8. The most accurate dipstick test is the nitrite test because bacteria must be present in the urine to convert nitrates to nitrites. This takes 6 hours and is why urologists often request the first-morning urine for testing, particularly in males.

This is direct confirmation of bacteria in the urine, which is a UTI by definition in patients with symptoms.

Several bacteria do not convert the nitrates to nitrites, but those are usually involved in complicated UTIs, such as those involving Enterococcus, Pseudomonas , and Acinetobacter. Hematuria can be helpful because bacterial infections of the transitional cell lining of the bladder can cause bleeding. This helps distinguish UTI from vaginitis and urethritis which do not cause blood in the urine. In many labs, the presence of nitrites or leukocyte esterase will automatically trigger a microscopic evaluation of the urine for bacteria, WBCs, and RBCs.

On microscopy, there should be no bacteria in uninfected urine, so any bacteria on Gram-stained urine under high field microscopy is highly correlated to UTIs. Urine cultures are not usually needed in uncomplicated UTI but are recommended due to increasing antibiotic resistance and to help differentiate recurrent from relapsing infections. Urine should be cultured in all men and all patients with diabetes mellitus, who are immunosuppressed, and women who are pregnant.

Classic teaching on urine culture sets the gold standard for infected urine at greater than 10 colony forming units CFU. Recent literature states that a patient who presents with symptoms and greater than 10 CFU is diagnostic of infection. Urine cultures rarely help in the emergency department, except with recurrent UTI, but can make subsequent treatment easier if patients do not respond to the initial antibiotic used. Collecting urine is key. Midstream voided specimens are very accurate as long as the correct technique is followed.

The presence of lactobacilli and squamous cells indicates contamination and a catheterized specimen may be necessary. In young children and those with spinal cord injuries, suprapubic aspiration may need to be done to collect a urine specimen. The treatment has varied historically from 3 days to 6 weeks. First-generation cephalosporins are good choices for mini-dose therapy.

Nitrofurantoin is a good choice for uncomplicated UTI, but it is bacteriostatic, not bacteriocidal, and must be used for 5 to 7 days. Fluoroquinolones have high resistance but are a favorite of urologists because of high tissue penetration levels, especially in the prostate. For this reason, fluoroquinolones are not preferred except for complicated infections and those involving the prostate. Recent precautions from the FDA about fluoroquinolone side effects should be heeded.

Adjunctive therapy with phenazopyridine for several days may help provide additional symptom relief. The likelihood that a healthy female will develop acute pyelonephritis is very small. Asymptomatic bacteriuria is quite common and requires no treatment, except in pregnant women, those who are immunosuppressed, have had a transplant or recently underwent a urological, surgical procedure.

Even withproper antibiotic treatment, most UTI symptoms can last several days. In women with recurrent UTIs, the quality of life is poor. Factors that indicate a poor outlook include:.

While mortality rates are low, the morbidity of UTI is enormous. Besides the annoying symptoms, the cost of management is prohibitive. Missing work and school are common reasons and sometimes, hospital admission is required because of the severe symptoms. Although there is no proof of prevention, women should urinate after sexual intercourse because bacteria in the bladder can increase by ten-fold after intercourse.

After urination, women should wipe from front to back, not from the anal area forward, which seems to drag pathogenic organisms nearer to the urethra. Vigorous urine flow is helpful to prevention. Baths should be avoided in favor of showers. A gentle, liquid soap should be used in bathing such as Ivory or Dial or a liquid baby soap such as Johnson's baby shampoo which is very acceptable for the vagina.

The soap should be applied using a clean, soft cotton or microfiber washcloth and the vaginal area should be cleaned first to avoid unnecessary contamination of the area with germs. UTI is best managed in an interprofessional fashion, and besides physicians, most nurses will encounter a patient with a UTI.

The key to preventing recurrences is the education of the patient. Once a UTI has been diagnosed the patient should be encouraged to drink more fluids. Sexually active women should try to void right after sexual intercourse as this can help flush the bacteria out of the bladder. If you have symptoms of a UTI, your health care provider will also look at other results of your urinalysis, especially the white blood cell count.

A high white blood cell count in urine is another possible sign of an infection. To learn what your results mean, talk to your health care provider. Learn more about laboratory tests, reference ranges, and understanding results. If a urinalysis is part of your regular checkup, your urine will be tested for a variety of substances along with nitrites.

These include red and white blood cells, proteins, acid and sugar levels, cell fragments, and crystals in your urine. The information on this site should not be used as a substitute for professional medical care or advice.

Contact a health care provider if you have questions about your health. Nitrites in Urine. How do you test for nitrites in urine? What is it used for? Why do I need a nitrites in urine test?

Symptoms of a UTI may include: Frequent urge to urinate, but little urine comes out Painful urination Dark, cloudy, or reddish colored urine Bad smelling urine Weakness and fatigue , particularly in older women and men Fever.

What happens during a nitrites in urine test? Clean your genital area with a cleansing pad given to you by your provider. Men should wipe the tip of their penis. Women should open their labia and clean from front to back. Start to urinate into the toilet. Move the collection container under your urine stream. Collect at least an ounce or two of urine into the container, which should have markings to indicate the amounts.

Some types of bacteria have an enzyme that converts nitrates into nitrites. This is why the presence of nitrites in your urine is an indicator that you may have a UTI. UTIs are common in pregnancy and are dangerous. They can cause high blood pressure and premature delivery if left untreated.

UTIs during pregnancy are also more likely to spread to the kidneys. Nitrites in the urine are diagnosed with a test called a urinalysis. A urinalysis may be done for a variety of reasons including:. As you begin to urinate, first allow some of the urine to fall into the toilet. Then collect about two ounces of urine in the cup provided by your doctor. Avoid touching the inside of the container. You can then finish urinating into the toilet.

A positive test for nitrites in the urine is called nitrituria. If you have nitrituria, your doctor will likely want to send your urine sample to a laboratory for a urine culture test.

In a urine culture, your doctor can find out which specific type of bacteria are causing your UTI. A urine culture usually takes about two to three days to be completed, sometimes longer depending on the type of bacteria.

On average though, you should expect to see your results in three days. Keep in mind that not all bacteria are capable of converting nitrate to nitrite. So, you can have a negative nitrite test and still have a UTI. This is why your doctor considers the result of many tests, not just one test, when diagnosing a UTI.

Untreated UTIs become more severe as they spread toward the kidneys. An infection in the upper urinary tract is much more challenging to treat. Eventually, the infection can spread into your blood, causing sepsis. Sepsis can be life-threatening. Additionally, UTIs in pregnant women can be dangerous for the baby and mother. The treatment for nitrites in your urine usually involves a course of antibiotics.