A 55-year-old woman presents to the office with bloody urine and dysuria of 12-hour duration. She was recently married and has never had similar symptoms. She denies chills and fever. On physical examination she is afebrile, has normal vital signs, and has mild tenderness in the midline above the pubis. Her urinalysis shows too many to count (TNTC) red blood

1. What is the definition of bacteriuria?

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2. What additional history do you need to make a diagnosis?

3. What diagnostic studies would you order and why?


1. Bacteriuria is the presence of bacteria in urine.  Bacteriuria accompanied by symptoms is a urinary tract infection while that without is known as asymptomatic  bacteriuria.

2.frequency, urgency and suprapubic pain when urinating,fatigue, irritability, malaise, nausea, headache, abdominal discomfort, and back pain.

3.An evaluation of numerous reported studies indicated that the most useful screening tests for significant bacteriuria appear to be a nitrite test (modified by adding nitrate and incubating at 37 C), the triphenyltetrazolium chloride (TTC) test, and microscopic examination for bacteria. A study of 1,151 urine specimens submitted for routine culture showed that microscopic examination of the centrifuged deposit for organisms or pus cells, or both, was a more sensitive test for significant bacteriuria than the modified nitrite test. Microscopic examination detected 98% of 175 urine specimens with significant gram negative bacilluria, and 17 of 20 with significant numbers of gram positive cocci. The false positive rate was 13%. Microscopy may be better than the chemical screening tests in the selection of urine specimens for cultural examination.


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