Department of Internal Medicine and Medical Microbiology, University of Manitoba, Health Sciences Centre, Room GG443-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada.
Pathogens. 2016 Apr 19;5(2):38. doi: 10.3390/pathogens5020038.
Asymptomatic bacteriuria, also called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract. The characterization and introduction of the quantitative urine culture in the 1950s first allowed the reliable recognition of asymptomatic bacteriuria. The observations that a substantial proportion of patients with chronic pyelonephritis at autopsy had no history of symptomatic urinary infection, and the high frequency of pyelonephritis observed in pregnant women with untreated asymptomatic bacteriuria, supported a conclusion that asymptomatic bacteriuria was harmful. Subsequent screening and long term follow-up programs for asymptomatic bacteriuria in schoolgirls and women reported an increased frequency of symptomatic urinary tract infection for subjects with asymptomatic bacteriuria, but no increased morbidity from renal failure or hypertension, or increased mortality. Treatment of asymptomatic bacteriuria did not decrease the frequency of symptomatic infection. Prospective, randomized, comparative trials enrolling premenopausal women, children, elderly populations, patients with long term catheters, and diabetic patients consistently report no benefits with antimicrobial treatment of asymptomatic bacteriuria, and some evidence of harm. Several studies have also reported that antimicrobial treatment of asymptomatic bacteriuria increases the short term risk of pyelonephritis. Current investigations are exploring the potential therapeutic intervention of establishing asymptomatic bacteriuria with an avirulent Escherichia coli strain to prevent symptomatic urinary tract infection for selected patients.
无症状菌尿，也称无症状尿路感染，是健康女性和存在泌尿生殖道异常的女性及男性中常见的现象。20 世纪 50 年代，定量尿液培养的特征描述和引入首次可靠地识别出无症状菌尿。尸检发现，相当一部分慢性肾盂肾炎患者并无症状性尿路感染病史，且未经治疗的无症状菌尿孕妇中肾盂肾炎的发生率很高，这些观察结果支持无症状菌尿有害的结论。随后对少女和女性进行的无症状菌尿筛查和长期随访项目报告称，无症状菌尿患者发生症状性尿路感染的频率增加，但肾功能衰竭、高血压或死亡率无增加。无症状菌尿的治疗并未降低症状性感染的频率。前瞻性、随机、对照试验招募绝经前妇女、儿童、老年人群、长期留置导管的患者和糖尿病患者，结果一致显示，无症状菌尿的抗菌治疗无获益，反而有一定的危害证据。一些研究还报告称，无症状菌尿的抗菌治疗会增加短期肾盂肾炎的风险。目前的研究正在探索用无毒性大肠杆菌菌株建立无症状菌尿的潜在治疗干预，以预防特定患者的症状性尿路感染。
