Treatment of Lactobacillus jensenii in Urine Culture
Do Not Treat in Most Cases
Lactobacillus jensenii isolated from urine cultures should not be treated in the vast majority of cases, as these organisms are not considered clinically relevant urine isolates and typically represent colonization or contamination rather than true infection. 1
Clinical Approach
When to Withhold Treatment
Asymptomatic bacteriuria with Lactobacillus should never be treated, regardless of colony count, as this leads to unnecessary antibiotic exposure, antimicrobial resistance, and does not improve outcomes 1, 2
Lactobacillus species (including L. jensenii) are explicitly listed as organisms that are not considered clinically relevant urine isolates for otherwise healthy children and adults 1
These bacteria are normal commensals of the female genital tract and urinary microbiota, where they actually provide protective antimicrobial properties 3, 4
Treatment of asymptomatic bacteriuria has been shown to foster antimicrobial resistance and increase recurrent UTI episodes 2
When to Consider Treatment (Rare Circumstances)
Treatment should only be considered in the exceptional situation where all of the following criteria are met:
Clear urinary symptoms are present (dysuria, frequency, urgency, or fever with no other source) 1, 2
Lactobacillus is the only organism isolated on properly collected urine culture (catheterized or suprapubic aspiration specimen, not voided/bag collection) 1
Significant colony count (≥50,000 CFU/mL) is documented 1
Immunocompromised state or structural urinary tract abnormalities are present that increase susceptibility to opportunistic infection 2, 5, 6
No evidence of contamination (specimen properly collected and processed) 1
Treatment Regimen (If Truly Indicated)
If the rare decision is made to treat symptomatic Lactobacillus UTI:
First-line: Nitrofurantoin 100 mg twice daily for 7 days (due to low resistance rates) 2
Alternative: Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 5-7 days 2
Duration should be 7 days for prompt symptom resolution, or 10-14 days for delayed response 2
Critical Pitfalls to Avoid
Do not treat positive urine cultures in confused or febrile patients without urinary symptoms - confusion and fever are common reasons urine cultures are inappropriately obtained and treated, leading to massive overuse of antibiotics 7
Do not treat catheter-associated asymptomatic bacteriuria with Lactobacillus, as this represents colonization 1
Avoid broad-spectrum antibiotics if treatment is deemed necessary - use targeted narrow-spectrum agents 2
Recognize that voided/bag specimens have high contamination rates - if Lactobacillus is isolated from such specimens, obtain a catheterized specimen before considering treatment 1
Special Populations
Pregnancy: Even in pregnant women where asymptomatic bacteriuria with typical uropathogens should be treated, Lactobacillus is not a pathogen requiring treatment 1
Pre-urologic procedures: Lactobacillus does not require treatment before endoscopic urologic procedures, unlike typical uropathogens 1
Immunocompromised patients: While rare cases of Lactobacillus bacteremia and endocarditis have been reported, these are exceptional and typically involve sources other than the urinary tract 5, 6