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PubMed1991

Prognostic factors in the conservative treatment of ureteric stones.

A prospective study was made of 125 ureteric stones in order to detect factors which would predict the successful outcome of conservative treatment. The factors studied were the duration of pain prior to presentation, pyuria, haematuria, surface regularity of the stone and the degree of obstruction as seen radiologically. In stones less than or equal to 10 mm in size, conservative treatment was successful when the duration of pain was less than 30 days (39/45), when there was no significant pyuria (53/82), when the stones had an irregular surface (44/65) and when obstruction was only partial (55/88). Since most of these factors were interactive, further statistical analysis showed that duration of pain was the only significant factor in predicting the outcome of conservative treatment. In stones greater than 10 mm in size these factors had no predictive value and only 2/23 were passed spontaneously on conservative treatment.

Hematuria↗
PubMed1988

Detection of urinary tract infections by rapid methods.

A review of rapid urine screens for detection of bacteriuria and pyuria demonstrates a number of available alternatives to the culture method. Selection of one or more of these systems for routine use is dependent upon the laboratory and the patient population being tested. The laboratory approach to the diagnosis of urinary tract infection should consider the clinical diagnosis of the patient whenever possible. Keeping in mind that quantitative urine cultures alone cannot be used to detect infection in some patient populations unless lower colony counts are considered, a rapid screen may be a more practical approach. It has become accepted that 10(5) CFU/ml can no longer be used as the standard for all patient groups, that pyuria often is important in making the diagnosis of a urinary tract infection, and that most of the rapid screens are more sensitive than the culture method at 10(5) CFU/ml. Presently, no one approach can be recommended for all laboratories and all patient groups. However, each diagnostic laboratory should select one approach which is best for its situation. It is not practical, efficient, or cost effective to define a protocol for each possible clinical condition; however, all should be considered when developing a protocol. This protocol should be compatible with the patient population and communicated to the physicians. Use of a rapid screen should be beneficial to the patient, the physician, and the laboratory.

Bacterial Infections↗
PubMed1986

Aetiology of urinary symptoms in sexually active women.

Two hundred and fifty six unselected women, 50 of whom had urinary symptoms (frequency of urination or dysuria, or both), and who were attending a department of genitourinary medicine, were investigated. The urinary symptoms were associated both with pyuria and the isolation of undoubted pathogens from midstream urine (MSU) specimens. No associations were found between urinary symptoms and the isolation of Neisseria gonorrhoeae or Chlamydia trachomatis from the urethra or cervix; the recovery of Mycoplasma hominis from the urethra, cervix, or MSU; the recovery of Trichomonas vaginalis or Candida albicans from the vagina; or the presence of bacterial vaginosis. Urethral leucocytosis was associated with the isolation of T vaginalis but not with the recovery of N gonorrhoeae, C trachomatis, C albicans, or urinary pathogens. Pyuria was associated with the isolation of urinary pathogens and with the presence of trichomoniasis; it was not associated with the recovery of C trachomatis or M hominis.

Adolescent↗
PubMed1977

Urinary tract infections in childhood: the place of the nitrite test.

The effectiveness of the nitrite test available on the N-Multistix (Ames Co.) was compared with that of the microscopic examination of urine as a screening test for the detection of urinary tract infections in children presenting to a general paediatric clinic. The nitrite test gave a positive result in 59% of children with urinary infections, while microscopic pyuria (more than 50 white blood cells per cubic millimetre of uncentrifuged urine) was found in 72% of the same group. Of children who did not have a urinary tract infection, 2.8% had microscopic pyuria compared with only 0.2% who showed a false-positive nitrite test result. The ease and rapidity of the nitrite test make it a useful screening test for the presumptive diagnosis of urinary tract infections, and in certain circumstances it is preferable to the conventional microscopic examination of urine. However, as in the case of microscopic examination, urine culture must always be performed to avoid missing the urinary infections that are not detected by the screening test.

Bacteriuria↗
PubMed1986

Urinalysis and urine culture in women with dysuria.

In caring for women with acute dysuria, clinicians traditionally have relied on clinical findings to distinguish between acute pyelonephritis and "cystitis"; they have ordered urinalysis and urine culture regularly for patients with suspected acute pyelonephritis and ordered these tests inconsistently for patients with suspected "cystitis." Recent evidence indicates that "cystitis" may actually be any of six different clinical conditions, each of which is managed differently; subclinical pyelonephritis, lower urinary tract bacterial infection, chlamydial urethritis, other forms of urethritis, vaginitis, or dysuria without any urinary tract or vaginal infection. The distinction between these entities is made primarily from clinical findings. Urinalysis is also of great value in symptomatic patients; the presence of pyuria (and possibly indirect quantitation of pyuria by the leukocyte esterase test) is a reliable indicator of treatable infection, and its absence indicates infection is not present. In contrast, urine culture is of clear value only in patients with acute pyelonephritis or subclinical pyelonephritis.

Bacteriological Techniques↗
PubMed1990

[Asymptomatic bacteriuria in patients with diabetes mellitus].

The prevalence of asymptomatic bacteriuria and the relation of bacteriuria to pyuria, glycosuria and HbA1c in patients with diabetes mellitus were investigated. The study population included 110 diabetic patients and 100 healthy persons (control group). The ratio of bacteriuria was found as 25.5% (31.3% in women, 17.4% in men) in the diabetic group and as 9% (16% in women, 0% in men) in the control group. The prevalence of asymptomatic bacteriuria was significantly higher in the diabetic patients than in the control group (p less than 0.05). There was a significant relation between bacteriuria, pyuria and HbA1c levels (p less than 0.05). But, there wasn't any important correlation between bacteriuria and glycosuria.

Bacteriuria↗
PubMed1989

[Urinary tract infection associated with urinary calculi. 1. The significance of urinary tract infection in urinary calculi].

We investigated 158 cases of urinary stones (infection stones 56, metabolic stones 102) with special reference to pyuria, bacteriuria, stone culture and urease activities of isolated bacteria. Abacterial pyuria was noted in 9 out of 49 (18%) infection stones and in 53 of 77 (69%) metabolic stones. Bacteriuria was noted in 79% of the infection stones and 26% of the metabolic stones. Sixty-seven percent of the infection stones were infected with mainly urea splitting bacteria such as Proteus mirabilis and Staphylococcus. Twenty-three percent of metabolic stones were also infected. Though E. coli, a non-urea splitting bacteria, was isolated most frequently from metabolic stones, urease positive Staphylococcus and Pseudomonas were also isolated. Bacteria within stones could be predicted on the basis of urine culture results of only 20 of 41 infection stones and 8 of 24 metabolic stones. These facts are useful for selection of some antibiotics in the treatment of urinary tract infections associated with urinary calculi. Urinary infections of urea splitting bacteria in infection stones are thought to be initial factors of stone formation and those of non-urea splitting bacteria are to be superimposed. However, urea splitting bacteria in metabolic stones may convert them into infection stones in future.

Adult↗
PubMed1986

[Recurrence of acute uncomplicated cystitis--criteria for the evaluation of recurrence after antimicrobial chemotherapy].

UNLABELLED: The recurrence of female acute uncomplicated cystitis was investigated clinically. The criteria for the evaluation of recurrences were proposed, as follows; PATIENTS: Target infection is acute uncomplicated cystitis (AUC) which had satisfied the specifications of AUC Criteria by the UTI Committee of Japan and showed the excellent effects of an antimicrobial agent after a definite period of administration. Treatment period: Seven days; after 3 days' administration to evaluate the drug efficacy, patients shall take an additional 4 days' treatment. Interval of follow up proposed was 7 days. Evaluation of recurrence: Parameters of criteria are pyuria and bacteriuria. Recurrence: Pyuria greater than or equal to 10 WBCs/hpf and bacteriuria greater than or equal to 10(4)/ml. Evaluation of the day of recurrence: Evaluation should be made 14 days after the start of treatment. Urine sampling: After 7 days of treatment, midstream urine is collected and in cases with positive findings, catheterized urine should then be collected. Using these criteria it will be possible to evaluate and compare the ability of various antimicrobial agents to cure acute uncomplicated cystitis.

Acute Disease↗
PubMed1979

Urine microscopy and infection in general practice.

To test the value of urine microscopy 100 consecutive specimens were examined in the surgery and the results correlated with the subsequent laboratory culture reports.An assessment of the degree of pyuria was made by low power microscopy of a thick drop of fresh urine. A second specimen was examined under high power for the presence or absence of motile bacilli. The techniques used are described and quantified.The laboratory report was definitive in 88 of the 100 cultures. All the 33 specimens with 10(5) bacteriuria had some degree of pyuria and in 27 (82 per cent) motile bacilli had been found. In the 50 with no significant bacteriuria no motile bacilli had been seen in 38 (76 per cent).In these 88 specimens a diagnosis made in the surgery based entirely on bacterial microscopy would have been correct in 80 per cent, combined with cytological microscopy in 87 per cent, and with the addition of clinical features in 92 per cent.In the remaining 12 cases the laboratory report was inconclusive and would have made no difference to my conclusions.

Bacteriuria↗
PubMed1995

Interrater agreement in the interpretation of microscopic urinalysis.

To determine the reliability of specimen interpretation by outpatient laboratories, 150 consecutive specimens from three family practice centers were analyzed by either two laboratory technicians (n = 99) or two family physicians (n = 51). The results showed good to excellent agreement for contamination (defined as five or more epithelial cells per high-power field) or significant pyuria (five or more white blood cells per high-power field) or hematuria (five or more red blood cells per high-power field). Agreement between laboratory technicians did not differ significantly from agreement between physicians for the interpretation of contamination or pyuria, but for hematuria, agreement was higher between technicians (P = .02). These results suggest that outpatient interpretation of microscopic urine specimens shows levels of interrater agreement similar to or better than other tests that have been evaluated.

Humans↗
PubMed1984

Ticarcillin-induced cystitis. Cross-reactivity with related penicillins.

Two children had dysuria, sterile pyuria, and microscopic hematuria develop during treatment with ticarcillin disodium. With the exception of a predominance of pyuria over hematuria, the clinical course and laboratory findings in this disorder were similar to those observed in hemorrhagic cystitis, a potential complication of the use of several semisynthetic penicillins and penicillin G potassium. One patient had urinary abnormalities develop during two courses of ticarcillin therapy and subsequently after initiation of piperacillin sodium therapy. A second patient in whom hemorrhagic cystitis due to carbenicillin disodium developed experienced this related disorder four years later when first exposed to ticarcillin. Neither reduction of the dose nor substitution of one semisynthetic penicillin for another (piperacillin for ticarcillin, ticarcillin for carbenicillin) prevented recurrence of the disorder. The clinical importance of either form of cystitis induced by semisynthetic penicillins is uncertain, as is the risk for progression to interstitial nephritis.

Carbenicillin↗
PubMed1984

The nature of urogenital involvements in female uro-arthritis, with special reference to chlamydial infection.

To study the nature of urogenital involvements in female uro-arthritis 73 consecutive patients with arthritis concomitant with any type of urogenital involvement were examined. The controls were 281 females interviewed only and an additional 83 also gynaecologically examined. A history of cervicitis, salpingitis, dysuria and pyelocystitis/-nephritis occurred significantly more often in patients than in controls. Clinical gynaecological examination revealed cervicitis in 26,8% (19/71) of the patients and 15.7% (13/83) of the controls (p less than 0.05). Aseptic pyuria was definitely more frequent in patients (19/73) than in controls (0/63). The isolation of Chlamydia trachomatis was positive in 14.7% (10/68) of the patients and 3.7% (3/81) of the controls (p less than 0.025). Serological evidence (titre greater than or equal to 64) for chlamydial infection was obtained in 53.4% (39/73) of the patients and 18.2% (14/77) of the controls (p less than 0.00025). The results indicate the importance of urogenital history and findings in females with rheumatic attacks. The most prominent and persistent urogenital involvements were cervicitis, salpingitis, pyuria and dysuria. Chlamydial infection appears in any case to be responsible for part of these involvements (42/73).

Adolescent↗
PubMed1984

Clinical characteristics in male and female uro-arthritis or Reiter's syndrome.

To investigate the clinical characteristics of Reiter's syndrome (RS) or uro-arthritis in females, 73 consecutive patients were studied. The findings were compared to those in 72 consecutive males with RS. The mean ages and the clinical picture of musculoskeletal findings, including frequency of mono- or oligoarthritis (68-69%), polyarthritis (26%) and back complaints (76-71%), were similar in both sexes. Inflammation of the knee, sterno-clavicular joint and "sausage" toe occurred predominantly in males and finger involvements in females. Anamnestic gonorrhoea occurred in 17 males (24%) and in 9 females (12%) (p less than 0.05) and verified aseptic pyuria in 34 males (47%) and in 19 females (26%) (p less than 0.01). Clinical findings of urogenital abnormalities (61 and 51%) and evidence of chlamydial infection (61 and 58%) occurred equally frequently in both sexes, as did the less commonly observed gastrointestinal involvements as triggering infection. The males had high ESR (greater than or equal to 50 mm/h) and HLA-B27 antigen more often than females (p less than 0.005 and p less than 0.025 respectively). Pyuria and elevated ESR (greater than or equal to 20 mm/h) were associated with HLA-B27 in males (p less than 0.02) but not in females. The occurrence of sacroiliitis was not associated with HLA-B27 and was not sex-related. The many similarities in the clinical picture speak in favour of the same disease in both sexes. Though the "complete" form of RS with high ESR seems to be more rare in females than in males, the results of the present study emphasize that uro-arthritis is not a rare disease in females as compared to males.

Adolescent↗
PubMed1987

Quinolones in the treatment of gonorrhoea and Chlamydia trachomatis infections.

The results of two therapeutic trials in female patients with uncomplicated urogenital gonorrhoea (A) and in male patients with uncomplicated urethral gonorrhoea (B) treated with either 200 mg and 400 mg enoxacin orally, of one therapeutic trial in male patients with uncomplicated urogenital gonorrhoea treated with either 250 mg or 500 mg ciprofloxacin orally (C) and of one therapeutic trial in male patients with non-gonococcal urethritis (NGU) treated with ciprofloxacin 1 g daily during seven days (D) are presented and compared with the results of other investigators. The cure rate in study A was 100% (n = 40) in the 400 mg group and 95.7% (n = 46) in the 200 mg group. The cure rate in study B was 92% (n = 78) in the 400 mg group and 90% (n = 77) in the 200 mg group. In both studies no antichlamydial effect of enoxacin was observed. The cure rates in study C were 100% with 250 and 500 mg. An antichlamydial effect seemed to be present. In studies A, B and C side effects were minor and rare and were mainly nausea and headache. In study D (100 patients suffering from NGU) disappearance of Chlamydia trachomatis and Ureaplasma urealyticum one day after the end of treatment was observed in 29 of 32 (91%) and 28 of 32 (88%) cases, respectively. Pyuria disappeared in 44% and 74% of the patients showed clinical cure. However, two weeks after the end of treatment Chlamydia trachomatis and Ureaplasma urealyticum were observed in respectively six and eight cases. In 30% pyuria was still absent. Side effects were only minor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1981

The efficacy of the nitrite test and microscopic urinalysis in predicting urine culture results.

The efficacy of the nitrite dipstick and microscopic urinalysis in predicting culture results were evaluated for 146 urine cultures from 56 women at risk for recurrent pyelonephritis. There were 111 negative cultures, 18 positive cultures, and 17 contaminated cultures. Nitrites were not detectable in either negative or contaminated cultures. Bacilluria was present in 10% of negative cultures and in 18% of contaminated cultures. Pyuria was present in 14% of negative and in 24% of contaminated cultures. Among the 18 positive cultures, nitrite was present in only 22%, bacilluria in only 61%, and pyuria in only 67%. These results suggest that positive cultures cannot be accurately predicted by either microscopic urinalysis or the nitrite dipstick, and that routine culturing should be performed as part of the outpatient management of women at risk for recurrent pyelonephritis.

Bacteriological Techniques↗
PubMed1992

Prophylactic ciprofloxacin for catheter-associated urinary-tract infection.

Patients receiving antibiotics during bladder drainage have a lower incidence of urinary-tract infections compared with similar patients not on antibiotics. However, antibiotic prophylaxis in patients with a urinary catheter is opposed because of the fear of inducing resistant bacterial strains. We have done a double-blind, placebo-controlled trial of prophylactic ciprofloxacin in selected groups of surgical patients who had postoperative bladder drainage scheduled to last for 3 to 14 days. Patients were randomly assigned to receive placebo (n = 61), 250 mg ciprofloxacin per day (n = 59), or 500 mg ciprofloxacin twice daily (n = 64) from postoperative day 2 until catheter removal. 75% of placebo patients were bacteriuric at catheter removal compared with 16% of ciprofloxacin-treated patients (relative risk [RR] [95% CI] 4.7 [3.0-7.4]). The prevalence of pyuria among placebo patients increased from 11% to 42% while the catheter was in place; by contrast, the rate of pyuria was 11% or less in patients receiving ciprofloxacin (RR 4.0 [2.1-7.3]). 20% of placebo patients had symptomatic urinary-tract infections, including 3 with septicaemia, compared with 5% of the ciprofloxacin groups (RR 4.0 [1.6-10.2]). Bacteria isolated from urines of placebo patients at catheter removal were mostly species of enterobacteriaceae (37%), staphylococci (26%), and Enterococcus faecalis (20%), whereas species isolated from urines of ciprofloxacin patients were virtually all gram-positive. Ciprofloxacin-resistant mutants of normally sensitive gram-negative bacteria were not observed. Ciprofloxacin prophylaxis is effective and safe in the prevention of catheter-associated urinary tract infection and related morbidity in selected groups of patients requiring 3 to 14 days of bladder drainage.

Adult↗
PubMed1990

Screening asymptomatic adolescent males for chlamydia.

Ninety-seven asymptomatic 16-21-year-old sexually active adolescent males were evaluated for gonorrhea and chlamydia by culture, chlamydia enzyme immunoassay, and an analysis of a random urine sample for pyuria using centrifuged urine and urine cytometer. The incidence of gonorrhea was 5.3% and chlamydia by culture 12.3%. Immunoassay was superior in sensitivity and specificity (75% and 99%, respectively) to centrifuged urine (sensitivity 58%, specificity 92%) or urine cytometer (58% and 91%) in identifying asymptomatic chlamydia urethritis. Chlamydia enzyme immunoassay is an acceptable, more rapid, and less expensive alternative to culture. The absence of pyuria in asymptomatic males cannot be assumed to indicate the absence of a sexually transmitted disease.

Adolescent↗
PubMedDate not supplied

Absence of factors associated with significant urinary tract infections caused by coagulase-negative staphylococci.

Coagulase-negative staphylococci, excluding Staphylococcus saprophyticus, have recently been implicated as pathogens in urinary tract infections, especially in catheterized patients. In order to evaluate any laboratory markers for significant isolates of coagulase-negative staphylococci, we prospectively studied 72 patients with significant, indeterminant, or contaminant urine isolates of coagulase-negative staphylococci. Patients in the three categories did not differ by age, sex, presence of a urinary catheter, or other instrumentation or likelihood of nosocomial acquisition. The isolates from these three groups of patients were similar in antibiotic susceptibility and ability to produce slime. Overall, slime-producing coagulase-negative staphylococci were more likely to be S. epidermidis than any other species, but slime production was not associated with presence of pyuria, symptomatic urinary tract infection, instrumentation, nosocomial acquisition, or multiple antibiotic resistance. In this prospective study, no demographic characteristics or laboratory markers of coagulase-negative staphylococci were associated with clinical significance, as defined by symptoms or the presence of pyuria.

Bacteriuria↗