Lactobacillus jensenii in Urine Culture: Management Approach
Lactobacillus jensenii isolated from urine culture typically does not require antibiotic treatment, as it is a commensal organism of the female urogenital tract and not considered a clinically relevant uropathogen in otherwise healthy individuals.
Understanding Lactobacillus jensenii as a Urinary Isolate
Lactobacilli, including L. jensenii, are explicitly classified as non-pathogenic urinary isolates that should not be treated in routine clinical practice. 1 The 2011 AAP guidelines specifically state that "organisms such as Lactobacillus spp, coagulase-negative staphylococci, and Corynebacterium spp are not considered clinically relevant urine isolates for otherwise healthy" patients. 1
Key Clinical Context
- L. jensenii is a normal inhabitant of the female vaginal and urinary microbiota, where it serves a protective role against uropathogenic bacteria. 2, 3
- The organism is known for its low pathogenicity and beneficial properties in preventing recurrent UTIs through competitive inhibition of pathogenic bacteria. 4, 2
- Isolation in urine culture most commonly represents contamination from periurethral/vaginal flora rather than true infection. 1
When Treatment May Be Considered
Treatment should only be considered in highly specific, exceptional circumstances:
Immunocompromised or High-Risk Patients
- Severe immunosuppression (diabetes mellitus with poor control, chronic renal failure, or other significant immunodeficiency). 4
- Recent invasive urological procedures (ureteral stent placement, lithotripsy, or other instrumentation). 5
- Presence of systemic signs of infection including bacteremia, sepsis, or abscess formation with positive blood cultures for Lactobacillus species. 4, 5
Treatment Regimen When Indicated
If treatment is deemed necessary based on the above criteria:
- Amoxicillin-clavulanic acid is the documented effective agent for L. jensenii bacteremia/sepsis. 4
- Ceftriaxone plus metronidazole has been used successfully for polymicrobial infections involving L. jensenii with anaerobes. 5
- All vaginal Lactobacillus species are susceptible to nitrofurantoin but resistant to fluoroquinolones, gentamicin, and cotrimoxazole. 6
Critical Management Pitfalls to Avoid
Do not treat asymptomatic bacteriuria with Lactobacillus species. 1 The EAU 2024 guidelines strongly recommend against screening or treating asymptomatic bacteriuria in women without risk factors, as treatment may eliminate protective commensal flora and paradoxically increase UTI risk. 1
Avoid classifying patients with Lactobacillus isolation as having "complicated UTI." 1 This leads to inappropriate use of broad-spectrum antibiotics with prolonged treatment courses, which can disrupt the protective vaginal microbiota and increase recurrent UTI episodes. 1
Do not use prophylactic antibiotics that eliminate Lactobacillus species. 6 Fluoroquinolones, gentamicin, and cotrimoxazole are uniformly ineffective against vaginal lactobacilli and will eliminate this protective flora, potentially increasing UTI susceptibility. 6
Recommended Clinical Approach
For asymptomatic patients with L. jensenii in urine culture:
- No treatment is indicated. 1
- Reassure the patient that this represents normal flora, not infection.
- Consider the culture result as likely contamination from vaginal flora.
For symptomatic patients with only L. jensenii isolated:
- Investigate alternative causes of symptoms (interstitial cystitis, pelvic floor dysfunction, other non-infectious etiologies).
- Repeat urine culture with careful midstream collection technique to rule out contamination. 1
- Consider that symptoms may be unrelated to the Lactobacillus isolation.
For patients with systemic illness and L. jensenii bacteremia: