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PubMed1980

Monitoring health care: children with bacteriuria.

A program which used a nurse clinician to monitor the health care received by children with bacteriuria is described. We identified 152 patients with significant bacteriuria (greater than or equal to 10(5) organisms/ml) by urine culture from 351 patients who either had symptoms suggestive of urinary tract infections or routine urinalysis during health care visits. Adequate health care was provided to 116 (76%) of the 152 patients and inadequate health care to 31 (24%) of these patients. A significant number of patients who received inadequate therapy (12 of 36, or 37%) compared to 8 (7%) of 116 patients who received adequate therapy failed to clear their bacteriuria (Chi-square = 17, p less than 0.001). Eight patients with recurrent bacteriuria despite adequate therapy were shown to have no urinary tract anomaly by radiography. The use of recurrence of UTI as a criterion for measuring adequacy of therapy and the uniqueness of the program are discussed.

Bacteriuria↗
PubMed1989

Fever, bacteriuria and concomitant disease in children with urinary tract infection.

A total of 124 children aged 0.2 to 6 years were enrolled in a study of first time febrile urinary tract infection. The patient population was stratified in groups according to the stringency of criteria for fever and bacteriuria and the presence of concomitant disease. The major group of 88 patients consisted of children with fever greater than or equal to 38.5 degrees C measured at the hospital within 24 hours of diagnosis, bacteriuria verified by suprapubic bladder aspiration or repeated cultures of voided urine, but without concomitant disease. These children were mainly infected with attaching Escherichia coli specific for galactose alpha (1----4) beta galactose containing receptors and had laboratory evidence of inflammation. Another group of 11 children were distinguished with strictly defined bacteriuria and concomitant disease. These children were infected with nonattaching bacteria and had lower concentrations of C-reactive protein in serum and lower microsedimentation rates than the major group. Five of these children had a reduction in renal concentrating capacity. The study emphasizes the heterogeneity among patients with fever and bacteriuria but does not rule out the possibility of renal involvement in any subgroup.

Acute Disease↗
PubMed1990

Screening for bacteriuria in Japanese school children.

Bacteriuria was screened among 28,202 healthy school children, 14,575 boys and 13,627 girls, by dipstick and dipslide methods and also by pour plate culture. The prevalence of bacteriuria was 0.06% in boys and 0.52% in girls after the third screening. A high rate of false negative results with the dipstick test and a high rate of false positive results with the dipslide culture method using Microstix-3 were observed. About 60% of screened children continued to have bacteriuria persistently for 9 months after the third screening, which was followed by monthly urine cultures. Anomalies of the urinary tract were detected in 9 of 26 children with persistent bacteriuria.

Adolescent↗
PubMed1994

Bacteriuria in patients with a continent ileal reservoir for urinary diversion does not regularly require antibiotic treatment.

OBJECTIVE: To elucidate the importance of bacteriuria in patients with a continent urinary diversion. PATIENTS AND METHODS: Eighteen asymptomatic patients (16 women and two men, with a mean age of 53 years [range 22-73]) with ileal reservoirs coupled to the skin for urinary diversion were studied. Consecutive urine cultures were performed over 5 months. Concomitant measurements of antibody titres against Escherichia coli and Proteus, and C-reactive protein (CRP) values were made. RESULTS: The results of the urine cultures varied considerably between samples. Increased titres of antibodies against E. coli were seen in several patients but the correlation with bacteriuria caused by E. coli was weak (sensitivity 33%, specificity 56%). Increased titres of antibodies against Proteus were rarely seen and in no patient correlated with bacteriuria caused by Proteus. Increased levels of CRP were seen in three patients. CONCLUSION: The present results indicate that asymptomatic bacteriuria in patients with a continent ileal reservoir for urinary diversion is generally of no clinical importance and should not be treated with antibiotics. This conclusion is based on the observations that the bacterial strains growing in the reservoir changed spontaneously indicating colonization rather than infection. Raised titres of antibodies against E. coli correlated weakly with bacterial growth. The observed elevations in antibody titres were usually just above the normal upper limit.

Adult↗
PubMed1993

Bacteriuria, bacterial virulence and host factors in diabetic patients.

The prevalence of bacteriuria as well as bacterial virulence and host factors were studied in 514 diabetic outpatients and 405 nondiabetic controls. The prevalence of bacteriuria was not significantly higher in diabetic women (15/239, 6.3%) than in age-matched nondiabetic women (8/236, 3.4%). In diabetic and nondiabetic men, the prevalence was also similar but lower than in women. E. coli was found in 55% of urine cultures with significant growth from diabetic patients, while in 91% of positive cultures from nondiabetic controls. Most E. coli strains lacked ability of P-fimbriae-mediated adhesion and aerobactin-mediated iron uptake, indicating low bacterial virulence. Long-term metabolic control (HbA1c), prevalence of retinopathy, neuropathy and previous foot ulcers were similar in bacteriuric and nonbacteriuric diabetic patients, matched according to gender, age, and duration of diabetes. Renal function was also similar, though the frequency of proteinuria and elevated blood pressure tended to be higher in the bacteriuric than in the noninfected group. Eight-three percent of the bacteriuric patients reported previous urinary tract infections but only 61% of nonbacteriuric patients (p = 0.07). As compared to non-diabetic women, diabetic women reported significantly more previous urinary tract infections (p < 0.01). In conclusion, the prevalence of bacteriuria in diabetic outpatients was not significantly higher than in non-diabetic outpatients or healthy volunteers. No studied host factor was clearly associated with bacteriuria in diabetic patients, although proteinuria and hypertension tended to be more common. The infecting E. coli strains were of low virulence.

Adult↗
PubMed1983

Bacteriuria in pregnancy treated with a single dose of cephalexin.

Of 87 women in whom bacteriuria was diagnosed on dip slides at between 9 and 22 weeks gestation only 51 (59%) had true bacteriuria in urine obtained by suprapubic aspiration. A single oral dose of cephalexin (3 g) was given to 37 of these patients, 10 were Indian and none of them had recurrence of infection after treatment, whereas 11 of the 27 (41%) 'indigenous' women again had bacteriuria within 2 weeks of treatment. None of the other 26 patients had recurrent bacteriuria in the pregnancy studied. Success of treatment was not related to renal concentrating ability nor, apart from ethnic group, were there other significant differences between successes and failures. Although single-dose treatment seems to be less effective in pregnancy than in the non-pregnant patients, it is an acceptable method of treatment provided that all treated patients are followed closely to detect those who do not respond and require further therapy.

Bacteriuria↗
PubMed1990

Lack of association between medication use and the presence or absence of bacteriuria in elderly women.

This study was undertaken to determine if there is an association between medication use and the presence or absence of bacteriuria in elderly ambulatory women. Of 198 women who participated in three urine culture surveys (every 6 months) during the 18-month study period, 66 (34.4%) had bacteriuria on at least one survey. Both univariate and multivariate analyses for the demographics, age, place of residence, and medication use (by drug class) revealed that only place of residence had a significant association with the presence or absence of bacteriuria. In this regard, bacteriuric subjects more commonly resided in the nursing home and less commonly lived in the apartment-house complex compared with nonbacteriuric subjects (P less than .05). Therefore, this study demonstrates that in elderly ambulatory women, medication use does not appear to be associated with the presence or absence of bacteriuria.

Aged↗
PubMed1990

Clinically inapparent (asymptomatic) bacteriuria in ambulatory elderly men: epidemiological, clinical, and microbiological findings.

In a prospective longitudinal study, ambulatory elderly men were followed from 1 to 4.5 years to gain insight into the prevalence rates, clinical characteristics, and patterns of clinically inapparent (asymptomatic) bacteriuria (CIB). The prevalence of CIB was 12% (29/238) and increases with age. Unlike the gram-negative organisms that cause overt urinary tract infection in this age group, gram-positive organisms dominated the CIB group. Both the CIB and abacteriuric patients have multiple chronic medical conditions and are indistinguishable on that basis. Twenty-nine elderly men with bacteriuria and 105 abacteriuric subjects were followed with serial urine cultures. During the study period the bacteriuric subjects exhibited spontaneous temporary or permanent resolution (76%, 22/29), intermittency (21%, 6/29), and probable bacterial persistence (38%, 11/29). No consistent pattern of bacteriuria was evident. Therefore, antimicrobial therapy is not warranted in the treatment of asymptomatic or clinically inapparent bacteriuria in ambulatory elderly men.

Age Factors↗
PubMed1995

Accuracy of rapid urine screening tests among incontinent nursing home residents with asymptomatic bacteriuria.

OBJECTIVE: To determine the accuracy of rapid urine screening tests in detecting bacteriuria among incontinent nursing home residents. SETTING: Six nursing homes. PARTICIPANTS: 214 chronically incontinent, but otherwise asymptomatic, nursing home residents who were enrolled in a clinical intervention trial for urinary incontinence. MEASUREMENTS: 684 urine specimens were collected, the majority (76%) by a clean catch technique and the remainder by in-and-out catheterization. Each specimen underwent dipstick testing for nitrite and leukocyte esterase, a rapid, enzyme-based screening test for bacteriuria, and a quantitative urine culture using standard laboratory techniques. RESULTS: No one screening test or combination of tests had adequate sensitivity and specificity for clinical purposes. However, using all three tests, the sensitivity increases to 97% in females and 92% in males when any one of the tests is positive, and the specificity increases to 95% in females and 97% in males when all three tests are negative. Among nursing home residents suspected of having a symptomatic urinary tract infection, the prevalence of bacteriuria is probably higher than in our study population (e.g., 60-70%, compared with 32%). At these prevalence rates, the positive predictive value of any of the three tests being positive is 93% and higher, and the negative predictive value of all three tests being negative is 80 to 90%. CONCLUSIONS: Our data must be interpreted cautiously because of the specimen collection methods, the definitions we used, and the fact that we studied a population who did not have symptoms of an acute urinary tract infection. In addition, we did not examine the absolute accuracy of the screening tests, but their accuracy as a clinician might use them in a nursing home. Despite these caveats, our data suggest that a combination of these screening tests could be useful in the initial assessment of nursing home residents for bacteriuria, and result in considerable cost savings. Studies are needed to replicate our findings among nursing home residents with symptomatic urinary tract infections.

Aged↗
PubMed1996

Does treatment of asymptomatic bacteriuria in older ambulatory women reduce subsequent symptoms of urinary tract infection?

OBJECTIVE: To determine whether treatment of symptomatic bacteriuria in older ambulatory women affects the subsequent development of symptoms of urinary tract infection. DESIGN: A controlled clinical trial. PARTICIPANTS: Older women not having urinary catheters. MEASUREMENTS: Urine cultures every 6 months (the same organism at 10(5) colony-forming units or more per mL on two midstream urine specimens defined asymptomatic bacteriuria) and questionnaire surveys for the new development of symptoms of urinary tract infection (dysuria, frequency, urgency, low back pain with fever) 1, 3, and 6 months after the initial survey. RESULTS: Of the 23 initially culture-positive participants receiving antibiotic treatment for symptomatic bacteriuria, nine were culture positive at 6 months, which contrasts with 18 of 27 who received no treatment or placebo, P = .05. However, symptoms of urinary tract infection were more common in the antibiotic-treated group. CONCLUSION: Antibiotic therapy effectively reduced the subsequent occurrence of positive urine cultures, but symptoms were not reduced. Based on this study of morbidity, previous studies failing to show any relation to mortality, and the cost and complications of antibiotic therapy in the older population, treatment of asymptomatic bacteriuria in older women is contraindicated.

Activities of Daily Living↗
PubMed1975

Asymptomatic bacteriuria in school girls. V. The clinical course and response to treatment.

The short-term prognosis of 116 school girls with asymptomatic bacteriuria (ABU) treated or left untreated is reported. In untreated girls a spontaneous remission was obtained in 11% within one year. A short course of nitrofurantoin eliminated the bacteriuria in 93% of the girls in the treatment group. The recurrence rate was 30% in one year in the patients that became abacteriuric spontaneously, after a bladder washout test or after treatment with penicillin or nitrofurantoin. The first recurrence occurred withn 3 months in 79% (19/24). Nineteen of the 24 patients with recurrences (79%) had a third infection within 9 months. In patients with parenchymal reduction or reflux the renal concentrating capacity increased significantly after treatment of the bacteriuria. All the girls left untreated had normal renal concentrating capacity on detection and this remained unchanged during the year of follow-up. One of 28 untreated girls attracted a symptomatic pyelonephritis caused by a strain different from that at detection of ABU. Of 81 girls cured from the bacteriuria 24 recurred, 5 with a symptomatic pyelonephritis and 3 with cystitis. It is concluded that strains isolated from girls with ABU do not commonly cause symptomatic pyelonephritis.

Adolescent↗
PubMed1985

Epidemiology of bacteriuria during the first year of life.

Bacteriuria was studied in an unselected population of 3,581 infants. Screening was performed at three time intervals during the infants' first year of life. The public Child Health Centers cooperated in the screening and bag samples were obtained from the infants with the parents help. Bacteriuria was verified by suprapubic aspiration. 94% of the infants took part in the screening and bacteriuria was confirmed in 14 girls (0.9%) and 36 boys (2.5%). An additional 20 girls (1.1%) and 20 boys (1.2%) in the study population presented with symptomatic urinary tract infection before 12 months of age. Bacteriuria in boys was predominantly found early in infancy both with screening techniques and through symptomatic urinary tract infections.

Age Factors↗
PubMed1984

Reverse-flow apparatus for enhanced colorimetric detection of bacteriuria.

The reverse-flow apparatus is a new device for enhancing the detection of bacteria in urine. Bacteria are trapped onto a customized filter, and the pigments, crystals, and other interfering substances in the urine pass through the filter and are discarded. The bacteria are backflushed and are recovered as a concentrate, and the concentrate is then processed through the previously described colorimetric bacteriuria detection device. A total of 1,000 urine samples were obtained from randomly selected patients and were cultured on agar. Upon enumeration of the colonies, 160 urine samples were shown to contain more than 10(5) CFU/ml. In the bacteriuria detection device, 150 urine samples could not be processed (pigmenters and cloggers), and of the 850 urine samples processed, 127 were culture positive for 10(5) CFU/ml or greater, and 150 urine samples contained between 10(4) and 10(5) CFU/ml. At 10(5) CFU/ml, there were 140 false-positives and 14 false-negatives. When duplicate urine samples were processed through and concentrated by our new reverse-flow apparatus, all samples, including the above pigmenters and cloggers, could be tested in the bacteriuria detection device. The 150 unprocessable samples described above yielded 33 additional bacteria-positive urines, 23 at the 10(5)-CFU/ml cutoff and 10 at the 10(4)-to-10(5)-CFU/ml cutoff. There were 105 false-positives at 10(5) CFU/ml and only 2 false-negatives at the same level of bacteria. At 10(4) to 10(5) CFU/ml there was only 1% false-positive and 4% false-negative. The reverse-flow apparatus allows greater specificity and sensitivity in the rapid bacteriuria test. Urine containing 10(4) CFU/ml or more can now be detected with a 96% sensitivity in a total processing time of less than 2 min.

Bacteriological Techniques↗
PubMed1976

Evaluation of an adenosine 5'-triphosphate assay as a screening method to detect significant bacteriuria.

The bioluminescent reaction of adenosine 5'-triphosphate (ATP) with luciferin and luciferase has been used in conjunction with a sensitive photometer (Lab-Line's ATP photometer) to detect significant bacteriuria in urine. This rapid method of screening urine specimens for bacteriuria was evaluated by using 348 urine specimens submitted to the clinical microbiology laboratory at the University of Minnesota Hospitals for routine culture using the calibrated loop-streak plate method. There was 89.4% agreement between the culture method and the ATP assay, with 7.0% false positive and 27.0% false negative results from the ATP assay using 10(5) organisms/ml of urine or greater as positive for significant bacteriuria and less than 10(5) organisms/ml as negative for significant bacteriuria.

Adenosine Triphosphate↗
PubMed1972

Neonatal bacteriuria: a prospective study in 1,460 infants.

In a prospective study of 1,460 virtually consecutive neonates 14 (1%) were found to have bacteriuria, established by bladder puncture. Eleven were boys and three girls. Five of the infants with bacteriuria had symptoms suggestive of infection and were treated with antibiotics. The remaining nine were asymptomatic and remained so during a period of observation-five cleared their urine of bacteria without treatment, and four received antibiotics. Only one infant with bacteriuria had bacteraemia. Six infants had more than 10 white blood cells per mm(3) in the bladder puncture urine and three had proteinuria. The blood urea was slightly raised in only two of the infants. The intravenous pyelogram was normal in all infants with bacteriuria but eight had slight or moderate vesicoureteric reflux when examined by micturating cystourethrography.

Bacteriuria↗
PubMed1989

Untreated asymptomatic bacteriuria in girls: I--Stability of urinary isolates.

OBJECTIVE: To assess the frequency of spontaneous changes of bacterial strains in patients with untreated asymptomatic bacteriuria. DESIGN: Retrospective analysis of samples from all patients with renal scarring and random sample of patients with normal kidneys. SETTING: Outpatient clinic for children with urinary tract infections. PATIENTS: 54 Girls aged 3.3-15.5 years with untreated asymptomatic bacteriuria caused by Escherichia coli. INTERVENTION: None. END POINT: Change in bacterial strain. MEASUREMENTS AND RESULTS: Serotyping and electrophoretic analysis of sequential bacterial isolates, representing 151 patient years of untreated asymptomatic bacteriuria. A total of 24 changes of strain were identified. Eleven were related to medical interference such as treatment of other infections with antibiotics. CONCLUSIONS: Spontaneous changes of strain were uncommon, one change in 11.6 patient years, and thus are not a characteristic feature of the course of asymptomatic bacteriuria.

Adolescent↗
PubMed1969

Asymptomatic bacteriuria in girl entrants to Dundee primary schools.

During the statutory medical examination on entrance to primary school 943 5-year-old girls were screened for asymptomatic bacteriuria. A prevalence of 2.1% was found. None of the 20 children with asymptomatic bacteriuria was recognized by the parents as having a urinary infection, though 14 of them had symptoms of lower urinary tract infection. In 16 of the children with bacteriuria either the intravenous pyelogram or the micturating cystogram was abnormal. In 12 the height and weight were below the 25th percentile, and in this group the most severe radiological changes were found.Though the significance of asymptomatic bacteriuria is unknown, these results confirm that in this age group it is often associated with a urinary tract abnormality.

Bacteriological Techniques↗
PubMed1968

Evaluation of a nitrite test kit (Stat-test) for the detection of significant bacteriuria.

A commercially marketed nitrite test kit (Stat-test) for the rapid detection of significant bacteriuria has been evaluated and found to have failed to detect 50% of all cases of significant bacteriuria and 46% of significant bacteriuria associated with nitrate-reducing organisms. The number of false positive results are negligible. The Stat-test, used in its present form, cannot be recommended as a satisfactory screening test for significant bacteriuria.

Bacteriuria↗