How do you treat lactobacillus (lactic acid bacteria) in urine?

Treatment of Lactobacillus in Urine

Lactobacillus species in urine generally do not require treatment as they are not considered clinically relevant urinary pathogens in otherwise healthy individuals. 1

Understanding Lactobacillus in Urine

Lactobacillus species are:

• Part of the normal bacterial flora of the vagina
• Typically considered contaminants when cultured from urine specimens, especially in female patients
• Not considered clinically relevant urine isolates for otherwise healthy individuals 1

Clinical Decision Algorithm

Step 1: Determine if Lactobacillus is a True Pathogen or Contaminant

• Most cases: Lactobacillus is a contaminant and does not require treatment
• Rare cases: Lactobacillus may be a true pathogen if ALL of the following are present:
  • Significant colony count (≥50,000 CFUs/mL)
  • Presence of pyuria (WBCs in urine)
  • Urinary symptoms
  • Absence of other pathogens
  • Immunocompromised state or urological abnormalities

Step 2: Assess for Risk Factors for True Lactobacillus UTI

• Diabetes mellitus
• Severe urinary stasis
• Urinary tract abnormalities
• Immunocompromised state
• Presence of urinary catheters or stents

Step 3: Management Based on Assessment

1. If Lactobacillus is determined to be a contaminant (MOST CASES):

   • No antibiotic treatment required
   • Consider vaginal estrogen with or without lactobacillus-containing probiotics in postmenopausal women with recurrent UTIs 1

2. If Lactobacillus is determined to be a true pathogen (RARE):

   • Treat with appropriate antibiotics based on susceptibility testing
   • Duration: 7-14 days 1
   • Address underlying risk factors

Special Considerations

Beneficial Role of Lactobacillus

Lactobacillus species are actually beneficial in preventing UTIs:

• They are used as probiotics to prevent recurrent UTIs in women 1, 2
• They help maintain normal vaginal flora and prevent colonization by uropathogens
• Vaginal estrogen with lactobacillus-containing probiotics is recommended for postmenopausal women with recurrent UTIs 1

Rare Cases of Pathogenic Lactobacillus

While extremely uncommon, there have been isolated case reports of Lactobacillus species causing true UTIs:

• Lactobacillus delbrueckii has been reported as a causative agent in a female patient with chronic pyuria and urinary symptoms 3
• Lactobacillus gasseri has been reported to cause septic urinary infection in a patient with urinary stasis and diabetes 4

Key Pitfalls to Avoid

1. Overtreatment: Treating Lactobacillus in urine when it's merely a contaminant leads to unnecessary antibiotic use and potential resistance
2. Misdiagnosis: Assuming Lactobacillus is always a contaminant without considering the rare cases where it may be pathogenic
3. Ignoring underlying conditions: Failing to address predisposing factors in cases of true Lactobacillus UTI
4. Disrupting beneficial flora: Unnecessary antibiotic treatment may disrupt normal vaginal flora and predispose to true UTIs

Remember that organisms such as Lactobacillus species, coagulase-negative staphylococci, and Corynebacterium species are not considered clinically relevant urine isolates for otherwise healthy individuals 1.