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PubMed1978

The association between Staphylococcus aureus bacteremia and bacteriuria.

The relationship between Staphylococcus aureus bacteremia and bacteriuria was studied over a five year period in three hospitals. In a Veterans Administration Hospital, 59 patients with Staph, aureus bacteremia had a urine culture within 48 hours of a positive blood culture. In 16 of 59 (27 per cent), greater than 10(5) Staph. aureus was recovered from the urine in pure culture. Six of these patients had apparent primary staphylococcal urinary tract infection. Clinical and laboratory parameters in the patients with staphylococcal bacteremia and bacteriuria were compared with those in 31 patients with staphylococcal bacteremia and sterile urine cultures. The two groups differed only in the more frequent occurrence of pyuria and proteinuria in the bacteriuric patients. In two other hospitals, staphylococcal bacteriuria occurred in 7 per cent of patients with Staph. aureus bacteremia and in 13 per cent of cases of staphylococcal endocarditis. Review of autopsy records for 33 patients who died within one month of their bacteremia failed to show a correlation between bacteriuria and the presence of renal abscess. Staphylococcal bacteriuria is a frequent and unexplained concomitant of Staph. aureus bactremia.

Abscess↗
PubMed1976

Asymptomatic bacteriuria in pregnancy: antibody-coated bacteria, renal function, and intrauterine growth retardation.

Asymptomatic bacteriuria (greater than 100,000 microorganisms per milliliter) was found in 70 of 1,400 pregnant women without symptoms referable to the urinary tract (five per cent). With the fluorescent antibody (FA) tests, antibody-coated bacteria were demonstrated in specimens from 35 patients (50 per cent), indicating silent renal bacteriuria. Although confirmation by direct localization methods was not feasible in this group of patients, indirect evidence of renal function impairment associated with the presence of antibody-coated bacteria was suggested by results of the serum creatinine and creatinine clearance tests. The outcome of the pregnancy was compared for patients with bacteriuria (FA-negative or FA-positive tests). An association between the presence of asymptomatic renal bacteriuria and intrauterine growth retardation was noted. Thus, the patient with asymptomatic bacteriuria and a positive FA test is at greater risk of delivering an intrauterine growth-retarded infant.

Bacteriuria↗
PubMed1981

Bladder versus renal bacteriuria during pregnancy: recurrence after treatment.

Localization of bacteriuria has been shown to correlate with the pattern of recurrence after treatment. The immunofluorescent technique was used to localize infection in 233 pregnant women with asymptomatic bacteriuria to determine whether this would identify those who were at greater risk for recurrence. In both an indigent and a military population, the incidence of renal bacteriuria was 42%. Regardless of the site of infection, after one course of short-term (10-day) or long-term (21-day) antimicrobial therapy, almost two thirds of these women were abacteriuric for the remainder of gestation. Women given short-term treatment were more likely to have a recurrence within 2 weeks of completion of therapy than were women given long-term therapy (P less than 0.001). Moreover, these early recurrences were more frequent in women given short-term treatment for renal bacteriuria (P less than 0.05). Conversely, recurrences 6 or more weeks after completion of therapy, and regardless of site of infection, were more common in women given long-term treatment (P less than 0.01). Although the timing of recurrence varied significantly in relation to duration of treatment and site of infection, the ultimate risk of recurrence was not related to either. The conclusion is that localization of asymptomatic bacteriuria does not contribute to the management of pregnant women, since overall recurrence rates are independent of the site of infection.

Anti-Infective Agents, Urinary↗
PubMed1989

Postpartum bacteriuria. A multicenter evaluation of different screening procedures and a controlled short-course treatment trial with amoxycillin.

A total of 10,909 puerperal women from 6 different hospitals were screened for bacteriuria by culture of voided midstream urine (MSU), and a significant growth was found in 881 patients (8.1%). In 731 cases the urine was reexamined by using suprapubic aspiration (SPA), and in only 354 (48%) of the samples the diagnosis of bacteriuria was confirmed. The contamination rate of the MSU samples varied from 46 to 69% between the different hospitals, indicating that in the postpartum period positive MSU findings would necessitate more thorough examination in order to confirm the diagnosis of urinary tract infection. In our study, suprapubic aspiration was found to be a simple and acceptable method without any side effects. Confirmed bacteriuria occurred in 3.2% of the women. Operative delivery (Cesarean section, forceps and vacuum extractor delivery), epidural anesthesia and bladder catheterization increased the risk of bacteriuria in the postpartum period. Only 27% of the women with positive bladder urine complained of dysuria and this symptom was significantly more common in women who had been catheterized. 230 patients with confirmed bacteriuria with amoxycillin-sensitive bacterias participated in a randomized short-course treatment trial: 114 women received 3 days treatment with amoxycillin (1.5 g/day), 116 received the traditional 10 days therapy (750 mg amoxycillin/day). Both antibiotic regimens were observed to be effective with a cure rate of 96 and 98%, respectively. Short-course antibiotic treatment should thus be recommended to puerperal women with urinary tract infections since this avoids prolonged drug exposure to the lactating mother.

Amoxicillin↗
PubMed1992

Characteristics of bacteriuria in a homogeneous maternity hospital population.

Bacteriuria and urinary tract infection are a common cause of morbidity in pregnancy. Recent evidence has, however, questioned the magnitude of this risk and the effectiveness of therapy in reducing it. To clarify matters, a prospective study on 3123 ante-natal women was carried out. Screening for bacteriuria was carried out by culturing a mid-stream specimen of urine. Treatment was given to all patients with a positive culture and was based on antibiotic sensitivity testing. Repeat culture was performed 1 week after completion of therapy. The prevalence of bacteriuria in our population was 4.74%. Over half of these patients were asymptomatic. 67% of those with bacteriuria at screening were symptomatic or had a past history of urinary tract infection. Escherichia coli was the predominant organism cultured. The most effective antibiotic was Nitrofurantoin, which was sensitive in over 90% of isolates. Late urinary tract infection occurred in 3.52% of patients. There was no increase in maternal or foetal complications amongst those with bacteriuria. We concluded that it might be more cost-effective to confine screening to those patients who are symptomatic or have a past history of urinary tract infection.

Adult↗
PubMed1995

Screening and treatment of asymptomatic bacteriuria of pregnancy to prevent pyelonephritis: a cost-effectiveness and cost-benefit analysis.

OBJECTIVE: To compare the effectiveness, benefits, and costs of two asymptomatic bacteriuria screening and treatment strategies to prevent pyelonephritis in pregnancy. METHODS: A decision analytic model was created to compare strategies based on either 1) a leukocyte esterase-nitrite dipstick, or 2) on urine culture, with a policy of no screening or treatment. A literature search was conducted to generate probability estimates. Cost estimates were based on a local pharmacy and laboratory survey and supplemented by recent literature estimates. Sensitivity analyses were performed over wide ranges of probability and cost estimates. RESULTS: Under baseline assumptions, no screening resulted in 23.2 cases of pyelonephritis per 1000 pregnancies, versus 16.2 cases with the dipstick strategy and 11.2 with the culture strategy. The cost of screening and treatment of asymptomatic bacteriuria per 1000 pregnancies was $1968 with dipstick and $19,264 with culture. The cost of treating pyelonephritis with no screening was $57,562, versus $40,257 with dipstick and $27,832 with culture. Therefore, both the dipstick strategy and the culture strategy were cost-beneficial (based on a pyelonephritis cost of $2485) when compared with no screening. However, because it cost $3492 to prevent each additional case of pyelonephritis with culture that was not prevented by dipstick, the culture strategy was not cost-beneficial compared with the dipstick strategy. These results were sensitive to varying estimates for the prevalence of asymptomatic bacteriuria, the rate of progression of asymptomatic bacteriuria to pyelonephritis, the sensitivity of the dipstick, culture costs, and the cost of a case of pyelonephritis. CONCLUSION: When compared with a policy of no screening, screening for and treatment of asymptomatic bacteriuria to prevent pyelonephritis in pregnancy is cost-beneficial whether based on the leukocyte esterase-nitrite dipstick or on urine culture. However, the culture strategy is not cost-beneficial when compared with the dipstick strategy.

Bacteriological Techniques↗
PubMed1991

Prevention of catheter-associated bacteriuria: clinical trial of methods to block three known pathways of infection.

The simultaneous use of methods to block all three known pathways of bacterial entry into the bladders of catheterized patients has been suggested because of the limited effectiveness of individual methods that block single pathways. We conducted a randomized controlled trial to assess the prevention of bacteriuria in patients, using a three-way system that included a hydrophilic polymer-coated and preconnected sealed catheter system, daily catheter care, and disinfection of the outflow tube of the drainage bag with povidone-iodine (i.e., methods to block bacterial entry at the urethral insertion site, at the catheter drainage tube junction, and at the outflow tube). Among treated patients, 14 (4.7%) of 300 acquired bacteriuria as compared with 15 (4.9%) of 306 who did not receive the protocol treatments. Only 3 of 29 episodes of bacteriuria occurred in patients whose meatal cultures did not contain gram-negative bacilli or enterococci; thus migration of bacteria in the periurethral mucous sheath appeared to be the most common pathway by which bacteria gained entry into the bladder in this study. Catheter care and disinfection of the drainage bag outflow tube as used in this study remain unproven methods of preventing catheter-associated bacteriuria. Preconnected catheters with junction seals were used in both treated and untreated patients and, on the basis of previous studies, appear to be effective in reducing junction disconnections and bacteriuria. Therefore we conclude that the use of several simultaneous measures to prevent catheter-associated urinary infections is no more effective than the use of preconnected catheters with junction seals alone and is clearly more expensive.

Bacteriuria↗
PubMed2007

Asymptomatic bacteriuria and symptomatic urinary tract infections during pregnancy.

Urinary tract infections are common complications of pregnancy; upper tract infections in particular may lead to significant morbidity for both the mother and fetus. Bacteriuria is a significant risk factor for developing pyelonephritis in pregnant women. Therefore, proper screening and treatment of bacteriuria during pregnancy is necessary to prevent complications. All women should be screened for bacteriuria in the first trimester, and women with a history of recurrent urinary tract infections or anomalies should have repeat bacteriuria screening throughout pregnancy. Treatment of bacteriuria should include 3-day therapy with appropriate antimicrobials, and women should be followed closely after treatment because recurrence may occur in up to one third of patients.

Anti-Infective Agents↗
PubMed1994

Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever.

Results of urinalysis and culture of 2181 urine specimens obtained by catheter from febrile children aged less than 24 months were analyzed to determine the following: (1) an optimal cutoff point in considering a bacterial colony count clinically "significant," (2) the accuracy of leukocyte esterase and nitrite tests in identification of pyuria and bacteriuria, and (3) the utility of pyuria (defined as > or = 10 leukocytes/mm3) in the discrimination of urinary tract infection from asymptomatic bacteriuria. Among 110 urine cultures with > or = 10,000 colony-forming units per milliliter, 92 (84%) had > or = 100,000 CFU/ml, 10 (9%) had 50,000 to 99,000 CFU/CFU/ml and 8 (7%) had 10,000 to 49,000 CFU/ml. Urine specimens with 1000 to 49,000 CFU/ml were more likely than specimens with > or = 50,000 CFU/ml to yield Gram-positive or mixed organisms (36/60 vs 7/109; p < 0.001). A count of < 10 leukocytes/mm3 was almost invariably associated with a sterile culture; a count of > or = 10 leukocytes/mm3 was found in 93 of 102 patients with > or = 50,000 CFU/ml. The dipstick leukocyte esterase test had sensitivities of 52.9% and 66.7% in detecting > or = 10 leukocytes/mm3 and > or = 20 leukocytes/mm3, respectively. The dipstick nitrite test had a sensitivity of 31.4% in detecting bacteriuria (> or = 50,000 CFU/ml). Acute pyelonephritis was diagnosed by a renal scan with dimercaptosuccinic acid labeled with technetium 99m in 50 (77%) of 65 patients with > or = 10 leukocytes/mm3 but in none of five patients with < 10 leukocytes/mm3 (p < 0.01). The findings in these five patients were consistent with colonization of the urinary tract rather than infection. For urine specimens obtained by catheter, we believe that urinary tract infection is best defined by both a leukocyte count > or 10/mm3 and a CFU count > or = 50,000/ml. This definition almost always discriminates among true urinary tract infection, bacteriuria resulting from contamination of the urine specimen, and asymptomatic bacteriuria.

Bacteriuria↗
PubMed1998

Urodynamic factors influence the duration of Escherichia coli bacteriuria in deliberately colonized cases.

PURPOSE: We evaluated the influence of urodynamic factors on the establishment of bacteriuria, after deliberate intravesical inoculation with Escherichia coli. MATERIALS AND METHODS: Nine women and 7 men with recurrent symptomatic urinary tract infections underwent intravesical injection of E. coli 83972. This strain had documented ability to persist in the urinary tract and it lacks expressed virulence factors associated with urinary tract infection. RESULTS: Successful long-term colonization (5 months to 3 years) was achieved in 6 of 12 patients with neurogenic bladder disorder, including normal or high bladder capacity, normal or low detrusor pressure and residual urine. Short-term bacteriuria (13 days) occurred in 1 but long-term bacteriuria was not established in the 4 patients with normal lower urinary tract function. Occasionally urine samples from the colonized patients contained other bacterial strains, which cleared spontaneously except for a Klebsiella strain that became established in 2 and subsequently eliminated E. coli 83972. CONCLUSIONS: E. coli 83972 bacteriuria could only be established in a subset of patients with defective bladder voiding, suggesting that urodynamic defects permit a nonvirulent strain to establish in the urinary tract, but that additional host factors determine if bacteriuria will persist.

Administration, Intravesical↗
PubMed1989

Socio-biological correlates of bacteriuria in Saudi pregnant women.

Prevalence and socio-biological correlates of bacteriuria in Saudi pregnant women were investigated at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. Midstream sample specimens of urine were used for identification of significant bacteriuria (greater than or equal to 10.5 organisms of single species per milliliter of urine). The prevalence of bacteriuria was found to be 14.2%. It was more common in women below 20 years of age and among the parous as against the nullipara women. Bacteriuria was significantly associated with socio-economic conditions. It was higher in those with a low family income, of large family size (10+) and living in over-crowded conditions. Only one-fourth (25.8%) of bacteriuric women were symptomatic. Almost half (45.8%) had a past history of urinary tract infection. To identify the problem of urinary tract infection in a vulnerable group of women, as well as to reduce the load on laboratory facilities, it is suggested that routine antenatal screening for bacteriuria should be advocated on a selective basis, i.e. for the young teenage parous women, those coming from disadvantaged socio-economic conditions and in patients with a past history of urinary tract infection.

Adult↗
PubMed2000

Clinical and economic consequences of nosocomial catheter-related bacteriuria.

Indwelling catheters are strongly associated with the development of bacteriuria, which can lead to significant morbidity in hospitalized patients. This report, a review of the literature, evaluates the infectious outcomes of patients with indwelling catheters to determine the precise clinical and economic impact of catheter-related infection. Statistical pooling was used to estimate the incidence of bacteriuria in hospitalized patients with indwelling catheters. In addition, the proportion of patients with catheter-related bacteriuria in whom symptomatic urinary tract infection and bacteremia will develop was estimated through quantitative synthesis of previous reports. Costs were estimated by using microcosting techniques. Of patients who have indwelling catheters for 2 to 10 days, bacteriuria is expected to develop in 26% (95% confidence interval [CI], 23% to 29%). Among patients with bacteriuria symptoms of urinary tract infection will develop in 24%, (95% CI, 16% to 32%), and bacteremia from a urinary tract source will develop in 3.6% (95% CI, 3.4% to 3.8%). Each episode of symptomatic urinary tract infection is expected to cost an additional $676, and catheter-related bacteremia is likely to cost at least $2836. Given the clinical and economic burden of urinary catheter-related infection, infection control professionals and hospital epidemiologists should use the latest infection control principles and technology to reduce this common complication.

Bacteriuria↗
PubMed2002

[Efficacy of two semiautomatic methods for bacteriuria detection].

BACKGROUND: A quick and reliable method for detecting bacteriuria would allow to exclude the presence of microorganisms in the urine on the same day the sample is obtained.Objectives. Two semiautomatic methods have been evaluated for bacteriuria screening, taking the semiquantitative culture as reference method. MATERIAL AND METHOD: A prospective study of urine samples from patients suspected of having a urinary infection was designed. One method is based on bioluminescence that detects the presence of ATP liberated by the bacterial cell (Utiscreen-Coral Biomedical). The other semiautomatic method uses a nephelometry technique (Uro-quick). The results of each semiautomatic method were compared with the semiquantitative culture. Samples presenting counts > 104 UFC/ml of one or two microorganisms were considered as having urinary-tract infection (equivalent to significative bacteriuria). Cultures with counts < 5,000 UFC/ml or containing three or more microorganisms were classified as non-representative of significant bacteriuria. The nephelometric system allows to obtain results at two different times. Samples were divided into two groups to compare both situations. RESULTS: 1,090 urine samples, received consecutively, were considered. In the case of the bioluminescence system, the study was prolonged to 1,565 samples. The values obtained were: a) bioluminescence: general data, sensibilitiy (S) 5 94.4%; especificity (E) 5 72.8%; positive predictive value (PPV) 5 46.2% and negative predictive value (NPV) 5 98.2%; hospitalized patients only, S 5 97.5%; E 5 77.3%; PPV 5 61.2% and NPV 5 98.8%; and b) nephelometry: 195 min, S 5 96.7%; E 5 88.8%; PPV 5 67.9% and NPV 5 99.1%; 235 min, S 5 95.5%; E 5 81.0%; PPV 5 58.7% and NPV 5 98.4%. CONCLUSION: A negative predictive value from both methods under these conditions would allow them to be used in medical centers for the exclusion of bacteriuria.

Adenosine Triphosphate↗
PubMed1998

Asymptomatic bacteriuria in puppies with canine parvovirus infection: a cohort study.

This study aimed to investigate the possible association between canine parvoviral enteritis and asymptomatic bacteriuria. Forty-three puppies that were admitted to the outpatient service of the Animal Medical Clinic with clinical signs compatible with parvoviral enteritis formed the exposed group. The clinical diagnosis was subsequently confirmed by a positive fecal ELISA test (CITE test: IDDEX Lab., Westbrook, ME). Twenty-three (53.5%) of these puppies were males and 20 (46.5%) were females. Their age ranged from 1.5 to 5.5 months. Forty-eight clinically normal and age-matched puppies, that had been admitted to the clinic for vaccinations and had a negative result in the aforementioned ELISA test, were randomly selected to form the unexposed group. Urine samples were collected by antebupic cystocentesis from all puppies and submitted for bacterial culture. In the parvovirus exposed group, 11 of 43 puppies had detectable bacteriuria. The isolates were Escherichia coli alone (8/11-72.7%) Staphylococcus aureus alone (1/11-9.1%) and mixed cultures of E. coli and S. epidermitis (2/11-18.2%). In the unexposed group there were three puppies with detectable bacteriuria, one isolate each of E. coli, Enterococcus durans and Corynebacterium spp. Puppies with parvoviral enteritis had five (95% CI: 1.3-19.8) times higher odds of developing asymptomatic bacteriuria than puppies without the disease. The observed increased risk of asymptomatic bacteriuria among puppies with parvoviral enteritis was probably due to the fecal contamination of the external genitalia and the neutropenia these puppies exhibited.

Animals↗
PubMed1986

The epidemiology and risk factors for nosocomial catheter-associated bacteriuria caused by coagulase-negative staphylococci.

Studies of the risk factors for bacteriuria associated with the use of temporary indwelling urinary catheters have focused on gram-negative bacilli and enterococci, the predominant causes of nosocomial urinary tract infection. During a prospective study of 747 catheterized patients, bacteriuria with greater than or equal to 1,000 bacteria/mL were found in 96 patients. Coagulase-negative staphylococci (CNS) accounted for 19% of the episodes of bacteriuria, and S. epidermidis was the most frequent species of CNS. Significant risk factors for bacteriuria were a positive meatal culture for CNS, non-surgical illness, and no antibiotic therapy during catheterization. In contrast to the results of this and earlier studies that females were at greater risk factor for catheter-associated bacteriuria with gram-negative bacilli and enterococci, this was not a risk factor for acquisition of CNS. Possibly this is due to the more similar prevalence of meatal colonization with CNS of males and females compared to the striking difference in prevalence of meatal colonization with gram-negative bacilli and/or enterococci of males and females.

Adult↗
PubMed2001

Total joint arthroplasty and incidence of postoperative bacteriuria with an indwelling catheter or intermittent catheterization with one-dose antibiotic prophylaxis: a prospective randomized trial.

This study examined the difference in postoperative bacteriuria in total joint arthroplasty after use of either an indwelling catheter or intermittent catheterization. Previous studies showed a preference for an indwelling catheter over intermittent catheterization to resolve postoperative urinary retention in total joint arthroplasty, but these studies generally used 48 hours of antibiotic prophylaxis. Increasing awareness of costs and bacterial resistance to antibiotics have prompted many centers to reduce prophylaxis to only 1 preoperative dose A prospective, randomized, controlled trial was conducted in primary total hip and primary total knee arthroplasty patients. One dose of cefazolin, 1 g, was administered intravenously immediately preoperatively. Five of 13 (38%) men in the indwelling catheter group and 0 of 14 (0%) men in the intermittent catheterization group developed postoperative bacteriuria (P =.016), and 6 of 33 (18%) women in the indwelling catheter group and 3 of 39 (8%) women in the intermittent catheterization group developed postoperative bacteriuria (not significant). A total of 11 (24%) patients in the indwelling catheter group (n = 46) and 3 (6%) patients in the intermittent catheterization group (n = 53) developed postoperative bacteriuria (P =.018). In this setting with 1-dose antibiotic prophylaxis, intermittent catheterization resulted in a lower incidence of postoperative bacteriuria compared with an indwelling catheter. For men, this difference is significant.

Antibiotic Prophylaxis↗
PubMed1979

Natural history of bacteriuria in schoolgirls. A long-term case-control study.

To define better the natural history of bacteriuria in females, we followed 60 schoolgirls with bacteriuria and 38 matched controls for periods ranging from nine to 18 years. Among the schoolgirls with bacteriuria (greater than or equal to 10(5) organisms per milliliter in two or more consecutive cultures), reflux was repaired in five, nephrectomy was performed in two, and reduced inulin clearance was noted in one subject with atrophic pyelonephritis. Serum creatinine was slightly higher in cases than in controls. Renal scars or caliectasis occurred in 16 cases but in none of the controls. Blood pressure was similar in both groups. Episodes of bacteriuria in cases and controls were, respectively: five or more episodes, 21.7 and 2.6 per cent; and episodes during pregnancy, 63.8 and 26.7 per cent. Seven children of the cases but none of the children of controls showed urinary-tract infections. Bacteriuria among schoolgirls defines a group at great risk of recurrent symptomatic infections and renal scars and at low risk of reduced renal function.

Acute Disease↗
PubMed2000

Evaluation of the centrifuged and Gram-stained smear, urinalysis, and reagent strip testing to detect asymptomatic bacteriuria in obstetric patients.

OBJECTIVE: Our purpose was to compare the efficacy of the centrifuged and Gram-stained smear with the efficacy of both urinalysis and reagent strip testing for nitrites and leukocyte esterase in detecting asymptomatic bacteriuria in obstetric patients. STUDY DESIGN: A midstream urine specimen was evaluated in 528 patients either at the initial prenatal visit or at a visit because of possible preterm labor. Separate aliquots were tested by centrifugation (with a Cytospin Cytocentrifuge; Shandon, Inc, Pittsburgh, Pa) with Gram stain, by microscopic urinalysis for the presence of moderate to large numbers of bacteria or >10 leukocytes per high-power field, and by reagent strips for the presence of nitrites or leukocyte esterase activity. Results were compared with those of a quantitative urine culture obtained with blood and MacConkey agar plates. RESULTS: Thirty-six women (6.8%) had urine cultures showing 100,000 colony-forming units of a uropathogen per milliliter. The sensitivity and specificity of testing by centrifugation and Gram stain were 100% and 7.7%, respectively. Urinalysis and dipstick testing offered a sensitivity of 80.6% and 47.2%, respectively, with a specificity of 71.5% and 80.3%. No combination of tests, in series or in parallel, offered improved specificity over urinalysis alone. CONCLUSIONS: Centrifugation with Gram stain of a urine specimen offers excellent sensitivity but very poor specificity compared with microscopic urinalysis for the detection of asymptomatic bacteriuria and is not an acceptable screening test in an obstetric population. The false-negative rates of urinalysis (19.4%) and reagent strip testing (52.8%) preclude these from being excellent screening tests for asymptomatic bacteriuria. Given the potential sequelae of undiagnosed asymptomatic bacteriuria in an obstetric population, we conclude that urine cultures should be used for all pregnant patients to detect asymptomatic bacteriuria.

Adolescent↗