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PubMed1996

[Postoperative bacteriuria and urinary tract infections in gynecological patients].

This prospective study was carried out to establish the risk of postoperative asymptomatic bacteriuria developing into a symptomatic urinary tract infection if left untreated. Among 454 women who underwent routine gynaecological surgery using transurethral catheters for a mean of 1.4 days, 243 (53.5%) had postoperative bacteriuria and 74 (16.3%) developed urinary tract infection. Positive urine cultures showed a low predictive value for infection, even when combined with the presence of pyuria. Among 174 women discharged with asymptomatic bacteriuria, 36 (20.7%) developed urinary tract infection, of which all but two were caused by Gram-negative organisms or enterococci. A set of recommendations for handling postoperative bacteriuria is proposed.

Bacteriuria↗
PubMed1997

[Clinical evaluation of nitrite test for the detection of bacteriuria].

A nitrite test for bacteriuria was compared with routine microscopic examination in 1,318 clinical urine specimens and with bacterial culture in 132. Sensitivity, specificity, positive predictive value and accuracy rate are as follows; for diagnosis of bacteriuria more than 10(4) CFU/ml, 53.4%, 88.6%, 90.4 and 65.2%, respectively; for more than 10(5) CFU/ml, 55.4%, 87.8%, 88.4% and 67.2%, respectively. The positive rate for the nitrite test was 21.4% for bacteriuria of > or = 10(4) CFU/ml in gram positive cocci and 56.9% in gram negative rods. False negative results were obtained from gram positive cocci without nitrate reductive activity or from patients with acute uncomplicated cystitis because of insufficient incubation time in urinary tract. However, this simple test is valuable in the detection of bacteriuria in clinical practice with high specificity.

Bacteria↗
PubMed1997

Pyuria as predictor of bacteriuria in catheterized patients.

Six hundred and nine urine samples were analyzed for pyuria to assess its efficacy as a predictor of bacteriuria, in catheterized patients, using different techniques of pus cells estimation. In 235 and 323 urine samples, pus cells were counted per high power field in centrifuged and uncentrifuged urine respectively, while in 51 urine samples pus cells were counted per cubic millimeter in uncentrifuged urine. All the urine samples were simultaneously cultured. Pyuria (pus cells > 10/HPF or CMM) was correlated with bacteriuria (colony count > 10(5) per ml). The overall efficacy of pyuria as a predictor of bacteriuria was low (52.01-60.78%) and there was no significant difference among the different techniques. It was concluded that pyuria as predictor of bacteriuria is the least reliable technique to be recommended in routine clinical practice.

Bacteriuria↗
PubMed2006

Asymptomatic bacteriuria in type 2 Iranian diabetic women: a cross sectional study.

BACKGROUND: The risk of developing infection in diabetic patients is higher and urinary tract is the most common site for infection. Serious complications of urinary infection occur more commonly in diabetic patients. To study the prevalence and associates of asymptomatic bacteriuria (ASB) in women with type 2 diabetes mellitus in the Iranian population, this study was conducted. METHODS: Between February 10, 2004 and October 15, 2004; 202 nonpregnant diabetic (type 2) women (range: 31 to 78 years old) with no abnormalities of the urinary tract system were included in this clinic based study. We defined ASB as the presence of at least 105 colony-forming units/ml of 1 or 2 bacterial species, in two separated cultures of clean-voided midstream urine. All the participants were free from any symptoms of urinary tract infection (UTI). Associates for developing bacteriuria was assessed and compared in participants with and without bacteriuria. RESULTS: In this study, the prevalence of ASB was 10.9% among diabetic women. E. coli was the most prevalent microorganism responsible for positive urine culture. Most of the isolated microorganisms were resistant to Co-trimoxazole, Nalidixic acid and Ciprofloxacin. Pyuria (P < 0.001) and glucosuria (P < 0.05) had a meaningful relationship with bacteriuria but no association was evident between age (P < 0.45), duration of diabetes (P < 0.09), macroalbuminuria (P < 0.10) and HbA1c level (P < 0.75), and the presence of ASB. CONCLUSION: The prevalence of ASB is higher in women with type 2 diabetes, for which pyuria and glucosuria can be considered as associates. Routine urine culture can be recommended for diabetic women even when there is no urinary symptom.

Journal Article↗
PubMed1999

Preventing catheter-related bacteriuria: should we? Can we? How?

Up to 25% of hospitalized patients undergo urinary catheterization, and about 5% develop bacteriuria each day of catheterization. Catheter-related bacteriuria is associated with increased morbidity and mortality. We performed an evidence-based synthesis of the literature on preventing catheter-associated urinary tract infections (UTIs) to develop recommendations for clinicians. Catheterization should be avoided when not required and when needed, should be terminated as soon as possible. Use of suprapubic and condom catheters may be associated with a lower risk of UTI than use of urethral catheters. Aseptic catheter insertion and a properly maintained closed drainage system are crucial to reducing the risk of bacteriuria. Instillation of antimicrobial agents into the bladder or urinary drainage bag and rigorous meatal cleansing seem to be of little benefit. Use of urinary catheters coated with silver alloy may reduce the risk of UTI. Systemic antimicrobial drug therapy seems to prevent UTIs, but primarily for patients catheterized for 3 to 14 days. Antibiotic drug prophylaxis is especially valuable in patients undergoing transurethral resection of the prostate or renal transplantation. Using these methods, urinary catheter-associated UTI can often be prevented for weeks, but not longer terms.

Anti-Infective Agents, Urinary↗
PubMed1996

Virulence factors and O groups of Escherichia coli isolates from patients with acute pyelonephritis, cystitis and asymptomatic bacteriuria.

The relationship between the presence of bacterial virulence factors and the severity of urinary tract infection (UTI) was analized in this study. The production of alpha-hemolysin (Hly), the expression of P-fimbriae and the mannose-resistant hemagglutination (MRHA) type IVa (associated with the presence of P-fimbriae), were all detected more frequently in Escherichia coli strains from acute pyelonephritis than in strains isolated from cystitis and asymptomatic bacteriuria. In contrast, the production of cytotoxic necrotizing factor type 1 (CNF1) and the expression of MRHA types III and IVb were distributed uniformly between strains causing different clinical categories of UTI. Thus 88% of the E. coli strains from acute pyelonephritis showed some of the virulence factors investigated in this study, whereas only 60% (p < 0.01) and 56% (p < 0.01) repectively of the strains isolated from cystitis and asymptomatic bacteriuria possessed virulence factors. There were no significant differences in the prevalence of virulence properties between strains isolated from patients with or without complicating factors. Only 16% (p < 0.001) of the fecal isolates from healthy individuals showed virulence factors. The virulence factors were concentrated in strains belonging to 10 (O1, O2, O4, O6, O7, O14, O18, O22, O75 and O83) of the 12 serogroups most frequently detected in uropathogenic E. coli strains. The majority of uropathogenic O4, O6, O14, O22, O75 and O83 E.coli strains were Hly+CNF1+ and expressed P-fimbriae or MRHA type III, whereas the strains of serogroup O18 were Hly+CNF1- and P-fimbriated. Among O1 and O7 strains we found Hly-CNF1-strains that expressed P-fimbriae. Among O2 strains we found Hly+CNF1+ strains that expressed P-fimbriae or MRHA type III and other Hly-CNF1-strains that possessed P-fimbriae. We conclude that E.coli strains isolated from pyelonephritis show virulence factors more frequently than those from cystitis and asymptomatic bacteriuria, and that strains that cause urinary tract infections in Spain belong to the same serogroups as uropathogenic E.coli isolated in other areas of the world. Our results support the special pathogenicity theory and suggest that many cases of serious urogenital disease may be caused by a limited number of P-fimbriated E.coli strains that usually produce alpha-hemolysin.

Acute Disease↗
PubMed1990

Single dose fosfomycin trometamol versus multiple dose nitrofurantoin in pregnant women with bacteriuria: preliminary results.

Pregnancy induces anatomical and physiological changes in the urinary tract. In this condition a bacteriuria, even asymptomatic, may lead more frequently to pyelonephritis. Asymptomatic bacteriuria in pregnant women has therefore got to be treated. According to recent studies, long course antibiotherapy did not prove to be more effective than a single-dose one in the case of non-complicated bacteriuria. Moreover, the maternal and foetal toxicity should be reduced in the latter regimen. In this paper we present the preliminary results of our study comparing a single-dose treatment by fosfomycin trometamol (3 g) and nitrofurantoin (200 mg per day during a week).

Administration, Oral↗
PubMed1978

Screening for bacteriuria of schoolchildren by the nitrite reaction.

The author is conducting systematic screening surveys for bacteriuria among the pupils in the primary schools (6-14 years) of a provincial town and environments. He applies the nitrite reaction for the detection of bacteriuria. Over the past 5 years 16,621 children, 7982 girls and 8639 boys, were screened, part of them repeatedly. Four bacteriuric cases were diagnosed among the boys and 130 among the girls. In a single screening the prevalence rate of bacteriuria proved to be 1.23% among the girls. In repeated screenings the incidence rate was 0.44% on the average per annum. Fifty-six of the 130 bacteriuric girls were subjected to general examination; radiological abnormalities were found in 26 of them. The author considers the systematic screening of schoolchildren as reasonable. The nitrite reaction is the most appropriate for mass screening, since it is simple, immediate, inexpensive, specific and sufficiently sensitive.

Adolescent↗
PubMedDate not supplied

Asymptomatic bacteriuria in school children.

We studied 2447 asymptomatic school children by microscopic examination of urine and culture of a clear voided midstream specimen of urine. Only three children had bacteriuria (0.12%). Urographic abnormalities were detected in both the cases, which could be investigated. This study has shown that asymptomatic bacteriuria is comparatively rare in our community; however where there is bacteriuria, renal damage is common.

Adolescent↗
PubMed2001

Does the menopause influence the risk of bacteriuria?

The objective of this study was to test the hypothesis that the risk of bacteriuria is increased as a result of estrogen deprivation following the menopause. All midstream urine samples (MSU) sent to the King's College Hospital department of microbiology by general practitioners in 1997 were assessed. Bacteriuria was diagnosed when the bacterial count was >10(5) organisms/ml. Logistic regression analysis was performed to investigate the effects of age and sex on the likelihood of having a positive result. Non-linear effects of age were investigated, with interest focusing in particlar on the time around the menopause. There were 15,392 MSU samples analyzed; 11,811 (77%) were from women and 3581 (23%) from men. In both sexes the proportion of positive results increased with increasing age (P<0.0001). The specimens taken from women were significantly more likely to be positive than those taken from a man of the same age (P<0.0001). In women there was no evidence of any non-linear relationship between age and the log odds of a positive result. A plot of the proportion of positive results versus age did not suggest any departure from a linear relationship at or following the menopause. In conclusion, the increased risk of bacteriuria which occurs as women get older appears to happen gradually as a result of the aging process, rather than as the result of pathophysiological changes in the urogenital tract that take place at or following the menopause.

Adolescent↗
PubMed2001

Circumcision for the prevention of significant bacteriuria in boys.

The aim of this study was to determine whether circumcision affects significant bacteriuria in boys. During a 60-month prospective study, 100 boys with microbiologically confirmed symptomatic urinary tract infection (UTI) were evaluated. Twelve patients with abnormal ultrasonography findings were excluded from the study. Eighteen of the boys had not been circumcised due to parental choice. The remaining 70 boys with normal renal ultrasonography were randomly allocated into two groups. In the first group 35 boys ranging in age from 6 months to 10 years (mean 33.2+/-30.9 months) were observed for 6 months and urinary cultures were taken monthly. When they had a positive urine culture (with or without any symptoms), they received antibiotic treatment. After 6 months they were circumcised and then observed for another 6-month period. Group 2 comprised 35 boys aged from 3 months to 9 years (mean 29.1+/-36.7 months). They were circumcised immediately after the first UTI and were followed for 6 months. Urine samples were obtained by the bag technique in infants and by the mid-stream technique in older patients. In the uncircumcised group, the rate of significant bacteriuria per patient did not change in two 6-month follow-up periods (3.46+/-0.91 and 3.33+/-0.97 episodes). In group 1, the rate of positive urine cultures dropped from 3.57+/-1.11 to 0.14+/-0.35 episodes after circumcision (P<0.001). In the second group, the rate of significant bacteriuria was 0.17+/-0.38 episodes after circumcision. Among the uncircumcised patients, symptomatic UTI was observed in 6 cases (3 cases in the first period of group 1, 1 case in the first and 2 cases in the second period of the uncircumcised group), whereas after circumcision no patient had symptomatic UTI. The mean age at circumcision was 42.7+/-28.4 months. No complication due to circumcision occurred in any patient. UTI may also occur in boys after the 1st year of life. The present study indicated that circumcision in boys decreases the rate of positive urine cultures. Therefore circumcision could be considered as a part of UTI therapy.

Bacteriuria↗
PubMed2006

Risk factors for bacteriuria due to Pseudomonas aeruginosa or Enterococcus spp in patients hospitalized via the emergency department.

To determine the incidence and risk factors related to isolation of Pseudomonas aeruginosa or Enterococcus spp from urine cultures obtained from patients in the emergency department (ED), a 1-year prospective study was conducted of all urine specimens collected in the ED of a general hospital. Specimens from which one of these organisms was isolated at a concentration of >or=10(5) cfu/ml were included. Of 744 positive urine cultures, 39 (5%) were P. aeruginosa and 28 (4%) Enterococcus spp. Comparison with a control cohort of 80 patients with Escherichia coli bacteriuria revealed several univariate indicators for P. aeruginosa bacteriuria, including male sex, indwelling catheter, past prostatectomy, hospitalization in the previous 2 months and pregnancy; multivariate indicators were indwelling catheter (p<0.001) and male sex (p<0.001). Enterococcus and P. aeruginosa were significantly more often associated with asymptomatic bacteriuria. These data will help clinicians select appropriate antibiotic treatment for patients with urinary tract infections.

Bacteriuria↗
PubMed2001

Risk factors for catheter-associated bacteriuria in a medical intensive care unit.

In a prospective study including 137 consecutive catheterised patients in a medical intensive care unit, the following variables were analysed as possible risk factors for catheter-associated bacteriuria, defined as a quantitative culture with > or = 10(5) organisms/ml: age, sex, simplified acute and physiologic score at admission, duration of catheterisation, diabetes mellitus, immunosuppression, neurologic disorders and prior systemic antibiotic exposure during hospitalisation. The frequency of catheter-associated bacteriuria was 30.7%. By multivariate analysis, female sex (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.9-13.5; P=0.001) and a duration of catheterisation >11 days (OR, 19.4; 95% CI, 5.5-68.7; P=0.0001) were risk factors for catheter-associated bacteriuria, and prior antibiotic exposure was a protective factor (OR, 0.06; 95% CI, 0.019-0.21; P=0.0001).

Adult↗
PubMed2003

Effect of Hochu-ekki-to on asymptomatic MRSA bacteriuria.

Hochu-ekki-to, a multiple herbal drug which consists of 10 medicinal plants (Astragali radix, Atractylodis lanceae rhizoma, Ginseng radix, Angelicae radix, Bupleuri radix, Zizyphi fructus, Aurantii nobilis pericarpium, Glycyrrhizae radix, Cimicifugae rhizoma, and Zingiberis rhizoma), was administered to 38 patients with asymptomatic methicillin-resistant Staphylococcus aureus (MRSA) bacteriuria, and the effect was evaluated. The patients received Hochu-ekki-to at a daily dose of 7.5 g for at least 24 weeks. As a prognostic nutritional index (PNI), albumin and lymphocytes in the peripheral blood were measured, in addition to urine culture. The results were compared with those in 12 untreated control patients with asymptomatic MRSA bacteriuria. Four of the 38 patients treated with Hochu-ekki-to received antibacterial drugs during the treatment period, and were excluded from the study. Among the 34 eligible patients treated with Hochu-ekki-to, urinary MRSA was eradicated in 12 patients, and the bacterial counts in urine culture decreased to 10(2) CFU/ml or less in 10 patients. In patients treated with Hochu-ekki-to, urinary bacteria were decreased from 10 weeks after treatment compared with the findings in control patients (P < 0.05). PNI improved in all patients compared with the baseline before treatment. It was considered that the biodefense function was recovered via nutritional improvement by the administration of Hochu-ekki-to, and, as a result, MRSA bacteriuria improved. Further investigation would be needed in future.

Adult↗
PubMed1983

Automated methods for detection of bacteriuria.

Urine specimens represent a large portion of cultures received by the clinical microbiology laboratory. Much time and effort are spent screening these specimens and approximately 80 percent show no growth. The methods employed for detection of bacteriuria include microscopic, chemical, culture, and automated. The most widely used procedure has been an agar plate culture method. However, this method requires overnight incubation and therefore results are delayed. Within the last decade many automated methods have been introduced for detecting bacteriuria, and results are available more rapidly than with the agar plate culture method. In addition to decreased detection time, these systems are accurate and cost-effective. The purpose of this report is to review these automated bacteriuria screening systems, which include bioluminescence, colorimetry, electrochemical screening, electrical impedance, microcalorimetry, photometry, and radiometry. Accuracy, detection time, and cost are also discussed in this review.

Adenosine Triphosphate↗
PubMed1977

Incidence and spontaneous resolution of postpartum bacteriuria.

On the first postpartum day, 53 patients (17.2 per cent) had asymptomatic bacteriuria. Spontaneous resolution of bacteriuria occurred in 40 (75.5 per cent) of the 53 patients by the third postpartum day--the most appropriate time to identify patients with true asymptomatic bacteriuria.

Bacteriuria↗
PubMed1987

Single-dose antimicrobial therapy in the treatment of asymptomatic bacteriuria in pregnancy.

Fifty obstetric patients with asymptomatic bacteriuria were treated by single-dose antimicrobial therapy. The immediate cure rate was 84% and the recurrence rate was 12%. Seven of the eight patients in whom single-dose treatment failed responded to subsequent 7-day therapy with the same drug, indicating renal involvement. A 50% recurrence rate in the group of patients in whom single-dose treatment failed was compared with a 5% recurrence rate in the group cured by single-dose therapy, which indicates that failure with single-dose antimicrobial therapy can serve as a therapeutic test to identify patients at high risk for recurrent bacteriuria and its sequelae during pregnancy. It is concluded that single-dose antimicrobial therapy is a safe and effective way to treat asymptomatic bacteriuria in pregnant patients without urologic problems in their history.

Amoxicillin↗
PubMed1983

Bacteriuria following vaginal delivery.

Vaginal delivery may predispose to bacteriuria, as it entails repeated vaginal examination, compression of the bladder and sometimes urethral catheterization. One hundred and forty pregnant women were studied. Three samples of urine were used for cultures; the first at start of labor, the second 24 h after labor, and the third 14 days later. Culture plates were examined for total colony count, which was multiplied by 10 to give an estimate of the number of organisms/ml. Type of organism was identified. Nine of 112 women (8%) developed bacteriuria for the first time after labor. Of these, premature rupture of membranes occurred in four, prolonged labor in two, and cervical and vaginal tears in two others. Detection and treatment of postpartum bacteriuria could decrease the incidence of urinary tract infection.

Adolescent↗