Why Is There a High Level of Bacteria?

Bacterial overgrowth in urine tests generally refers to an elevated bacterial count during urinalysis, which may indicate the presence of a urinary tract infection or contamination of the sample. If there is only a simple increase in bacterial count without any symptoms experienced by the patient, no special treatment is required. However, if symptoms such as frequent urination and urgency are present, it is likely due to a urinary tract infection and requires prompt treatment.

There are two main scenarios for bacterial overgrowth in urine tests:

1. The presence of a urinary tract infection, such as acute or chronic cystitis, acute or chronic pyelonephritis, and other related diseases. These inflammatory diseases can lead to the proliferation of large numbers of bacteria in the urinary tract. If patients experience symptoms such as frequent urination, urgency, and pain during urination, they may have an infection.

2. The elevation of bacterial count may also be due to contamination of the urine sample by bacteria. However, if the patient does not have any subjective symptoms, such as urinary irritation, incomplete urination, back pain, fever, etc., it is possible that the urine is contaminated.

If the bacterial count is elevated in a single urine routine test, the first step is to rule out contamination, which may occur due to bacterial contamination of the external urethral orifice and the perineal area. If contamination is not present, further examination such as ultrasonography of the urinary system is needed to rule out conditions like stones, tumors, and other diseases. Bacterial culture and sensitivity testing should be performed to select sensitive antibiotics for treatment. Commonly used antibiotics include cephalosporins, quinolones, such as cefradine and levofloxacin.

Clinical Manifestations:

1. Acute uncomplicated cystitis usually occurs suddenly, and in women, the onset is often related to sexual activity. The main manifestations are bladder irritation symptoms, including frequent urination, urgency, and painful urination, discomfort in the bladder area or perineum, and a burning sensation in the urethra. The frequency of urination varies, and severe cases may lead to urgent incontinence. The urine may be cloudy and contain white blood cells, with terminal hematuria being common, sometimes even with the passage of blood clots. Generally, there are no obvious systemic infection symptoms, and the body temperature is normal or slightly elevated.

2. Acute uncomplicated pyelonephritis:

(1) Urinary system symptoms include frequent urination, urgency, painful urination, and other bladder irritation symptoms; hematuria; pain in the affected side or both sides of the waist; and tenderness or percussion pain in the costovertebral angle on the affected side.

(2) Systemic infection symptoms such as chills, high fever, headache, nausea, vomiting, loss of appetite, etc., often accompanied by an increase in white blood cell count and accelerated erythrocyte sedimentation rate.

3. Asymptomatic bacteriuria is a subclinical urinary tract infection that is more common in elderly women and pregnant women. Patients do not have any symptoms of urinary tract infection, and the incidence rate increases with age.