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PubMed1981

Bacteremia and bacteriuria after transrectal prostatic biopsy.

To determine the efficacy of parenteral gentamicin versus povidone-iodine enema (P.I.E.) in preventing infectious complications, a randomized study was undertaken in 40 patients undergoing transrectal needle prostatic biopsy. In 69 per cent of patients not receiving P.I.E. bacteremia developed, and 32 per cent acquired bacteriuria; whereas only 19 per cent of patients given P.I.E. alone or in combination with gentamicin because bacteremic, and 9.5 per cent had postbiopsy bacteriuria. Thus, P.I.E. provided a safe and effective means for preventing most bacteremia and bacteriuria associated with transrectal biopsy of the prostate.

Adult↗
PubMed1984

Significance of asymptomatic bacteriuria in neurogenic bladder disease.

Whether or not to treat bacteriuria (greater than or equal to 100,000 col/cc) in the asymptomatic patient has long been controversial. Fifty-two patients with uncomplicated neurogenic bladder disease secondary to spinal cord injury and bacteriuria were followed throughout their hospitalization. Antibiotics were reserved only for symptomatic patients. Our results indicate the value of no treatment for chronic bacteriuria as an alternative to chronic suppressive therapy.

Adolescent↗
PubMed1985

Catheter-associated bacteriuria. An experimental study.

A bacteriologically-stressed catheterized animal model was developed to evaluate the comparative importance of the intraluminal versus the extraluminal route of catheter-acquired urinary tract infections. This study indicated that in short-term catheterization (less than 7 days), contamination of the drainage spout or accidental disconnection of the drainage tube resulted in bacteriuria within a short time (32-48 hours). If a strict sterile closed drainage system was maintained, the extraluminal route assumed more importance in the development of bacteriuria, however this pathway was considerably slower (72-168 hours). It appeared that catheter-associated bacteriuria results from ascending bacterial colonization within glycocalyx-enclosed biofilm on the inside and/or outside surfaces of the catheter and drainage systems. Development of a biomaterial that inhibits bacterial adherence and does not allow upstream colonization of bacteria on the catheter drainage system would significantly influence the rate of catheter-acquired urinary tract infection.

Adhesiveness↗
PubMed1988

Bacteriuria during indwelling urethral catheterization.

The incidence of bacteriuria and the risk factors related to its acquisition were determined in a prospective study of 220 hospitalized patients. Bacteriuria was recorded in 97/220 (44%) of patients, in 42 cases within 48 h (Group A) and in 55 cases more than 48 h (Group B) after catheterization. The results of a multivariate analysis of Group A demonstrated that the reason for catheterization, the use of antimicrobial chemotherapy and the medical specialty of care were the only variables of those assessed associated with the acquisition of bacteriuria. In a similar analysis of Group B the number of days the catheter was in situ and the use of antimicrobial chemotherapy were the only factors which achieved statistical significance.

Adolescent↗
PubMed1990

The relation of colonization of the perineum to bacteriuria and environmental contamination in spinally injured patients.

We have examined the relation of perineal colonization by coliforms to bacteriuria and to contamination of bedclothes and other environmental sites with these organisms in spinally injured patients. Perineal colonization was significantly associated with bacteriuria and with contamination of bedclothes, but not with contamination of other sites. There was no association between bacteriuria and contamination of bedclothes or the environment. The perinea of these and other patients may be an important source of contamination of the environment and indirectly of the hands of the patients and staff.

Bacteriuria↗
PubMed1985

An evaluation of a leukocyte esterase/nitrite test strip and a bioluminescence assay for detection of bacteriuria.

A leukocyte esterase/nitrite (Chemstrip LNTM) and a bioluminescence assay (LumacTM) were evaluated for detection of bacteriuria in 1,000 urine specimens. Both devices provided high predictive negative values (95.4-97.8%); however, false-negative values at levels of bacteriuria greater than or equal to 10(4) CFU/ml were 22.6% and 12.3%, respectively, for the leukocyte esterase/nitrate and the bioluminescence assay tests. The corresponding false-negative values at levels of bacteriuria of greater than or equal to 10(5) CFU/ml were 16.5% and 3.9%, respectively.

Bacteriuria↗
PubMed2005

Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital: a clinical, epidemiologic, and laboratory perspective.

BACKGROUND: Serratia marcescens is an aerobic gram-negative bacillus belonging to the family Enterobacteriacea. Infections caused by S marcescens may be difficult to treat because of their resistance to a variety of antibiotics, including beta-lactams and aminoglycosides. METHODS: This study aimed to (1) identify the risk factors associated with the development of Serratia marcescens bacteriuria in neurosurgical intensive care units (NSICU); (2) genotype the pathogens to determine the source of infection; (3) compare these results with antibiograms; and (4) determine and implement appropriate control measures. A retrospective case-control study of the epidemiologic data, the surveillance of environmental cultures, and the genotyping of strains using arbitrarily primed polymerase chain reaction (AP-PCR) were performed at a 750-bed, tertiary care teaching hospital. Seventy-four bacteriuria patients were compared with 74 age/sex-matched control patients in the NSICU between March 2002 and March 2004. The factors assessed were patient demographics; duration of hospital stay; duration of indwelling catheter use before and during stay in the NSICU; chronic underlying illnesses (diabetes mellitus, cardiovascular disease, malignancy); other sites of infection; history of trauma; exposure to a nasogastric tube; mechanical ventilation; urinary catheterization; central venous catheterization; surgical drainage; tracheostomy; brain or spine surgery; and receipt of total parenteral nutrition (TPN), antimicrobials (beta-lactams, aminoglycosides, quinolones, carbapenems, vancomycins), or steroids. RESULTS: Patients with S marcescens bacteriuria were more likely to have a longer NSICU stay and other sites of infection. Environmental surveillance showed the handling of urine jugs to be the point source of contamination. Genotyping and antibiograms of 14 patients were the same except for those of 2 patients. CONCLUSION: The patient-related risk factors were identified, and a rapid identification of the organism was made. Heightened surveillance, infection control measures, and empiric therapy led to improved methods for handling urine jugs, which terminated the outbreak.

Anti-Bacterial Agents↗
PubMed2006

Bacteriuria in pregnant women with sickle cell trait.

OBJECTIVE: The purpose of this study was to compare the following outcome variables in pregnant patients with sickle cell trait and matched pregnant control patients: asymptomatic bacteriuria, acute cystitis, urinary pathogens that were present, and pyelonephritis. STUDY DESIGN: This was a retrospective cohort study that was conducted at a university clinic. Pregnant patients with sickle cell trait (n = 455) were matched with control patients (n = 448) for race, age, gestational age at entry into prenatal care, and number of prenatal visits. RESULTS: Women with sickle cell trait received urine testing significantly more often. There was no difference in the incidence of positive urine cultures, urinary pathogens, or asymptomatic bacteriuria among the comparison groups. Sickle cell trait carriers had significantly higher rates of pyelonephritis, but many affected patients had risk factors, such as previous pyelonephritis or noncompliance with therapy. CONCLUSION: Sickle cell trait carriers were no more susceptible to acute cystitis and asymptomatic bacteriuria than were the control patients. On the basis of these data, we outline recommendations for urinary screening and pyelonephritis prevention in pregnant patients with sickle cell trait.

Acute Disease↗
PubMed2006

Comparison of three automated urinalysis systems--Bayer Clinitek Atlas, Roche Urisys 2400 and Arkray Aution Max for testing urine chemistry and detection of bacteriuria.

BACKGROUND: Our study is aimed to determine the performance of 3 automated urinalysis systems-Clinitek Atlas, Urisys 2400 and Aution Max. METHODS: One thousand urine specimens were analyzed with the 3 automated systems. The results of the 3 assays were compared for testing urine chemistry and evaluating the capacity of leukocyte esterase and nitrite to detect bacteriuria. RESULTS: The correlation between the 3 instruments represented as within 1 grading difference was better between the Atlas and Aution Max systems for pH, blood, glucose, urobilinogen, ketone and specific gravity. For protein and nitrite, better correlation was observed between the Atlas and Urisys 2400, while the Aution Max and Urisys 2400 conveyed better correlation for bilirubin and white blood cells. The sensitivity and specificity of both the leukocyte esterase and nitrite in screening for significant bacteriuria were 71.7, 58.9, 70.8% and 99.1, 99.1 and 97.2%, for the Clinitek Atlas, Aution Max and Urisys 2400, respectively. CONCLUSIONS: The automated urinalysis systems demonstrate acceptable correlations with each other in urine chemistries, especially between the Clinitek Atlas and Aution Max systems on the majority of items. The specificity and negative predictive value of leukocyte esterase and nitrite of the 3 instruments for screening of significant bacteriuria were sufficient to avoid unnecessary urine culture.

Bacteriuria↗
PubMed2006

Effectiveness of ciprofloxacin prophylaxis in preventing bacteriuria caused by urodynamic study: a blind, randomized study of 192 patients.

OBJECTIVES: To determine the efficacy of prophylactic ciprofloxacin in preventing urinary tract infections caused by urodynamic study (UDS). METHODS: A total of 210 patients presenting for UDS during a 16-month period were offered enrollment in the study. A clean-catch midstream urine sample was taken 24 hours before and 48 to 72 hours after the procedure and after microscopic examination and culture were done. All patients underwent a standard UDS. The 192 patients who had sterile urine before intervention were included in the study. Randomly, 98 of the 192 patients were orally given 500 mg of ciprofloxacin 1 hour before the urodynamic intervention and 94 were not given anything. The patients who were found to have significant bacteriuria after UDS were followed up and treated properly. RESULTS: Eighteen patients (8.6%) who had significant bacteriuria in the urine culture before UDS were excluded from the study. The rate of significant bacteriuria in the urine culture after UDS was 7.3% overall, 1% in the prophylaxis group, and 14% in the controls, a significant difference (P = 0.002). The most common uropathogen was Escherichia coli (57%). Three independent risk factors were identified: not giving antibiotic prophylaxis before UDS; antibiotic use in the preceding month; and the presence of pyuria before UDS. CONCLUSIONS: Urinary tract infections after UDS decreased from 14% to 1% with a single dose of ciprofloxacin 500 mg orally before UDS. We recommend antibiotic prophylaxis for patients undergoing a UDS.

Anti-Infective Agents↗
PubMed2002

Pathogenesis of bacteriuria and infection in the spinal cord injured patient.

Spinal cord injury (SCI) produces profound alterations in lower urinary tract function. Incontinence, elevated intravesical pressure, reflux, stones, and neurological obstruction, commonly found in the spinal cord-injured population, increase the risk of urinary infection. The overall rate of urinary infection in SCI patient is about 2.5 episodes per patient per year. Despite improved methods of treatment, urinary tract morbidity still ranks as the second leading cause of death in the SCI patient.SCI removes the ability of the pontine micturition center and higher centers in the brain to inhibit, control, or coordinate the activity of the vesicourethral unit. As a result, a patient with complete quadriplegia is typically unaware of bladder activity. Bladder contraction is accompanied by vesicosphincter dyssynergia instead of sphincter relaxation. It is widely accepted that intermittent catheterization, when compared with indwelling catheters, reduces the risk of urinary tract infection (UTI) in SCI patients and is the preferred method of bladder drainage in this patient population. Attempts at eliminating bacteriuria associated with indwelling or intermittent catheters have generally been unsuccessful. There is now appreciation of the fact that a creeping adherent biofilm of bacteria frequently ascends through the luminal and external surfaces of an indwelling catheter, often within 8 to 24 hours, leading to bacterial adherence to the bladder surface and correlating with symptomatic infection. The use of antimicrobial agents to clear or prevent bacteriuria in patients on indwelling or intermittent catheterization has had mixed success. Treatment for asymptomatic bacteriuria in SCI patients remains controversial. SCI patients with symptomatic urinary infections should be treated with the most specific, narrowest spectrum antibiotics available for the shortest possible time. Guidelines for selecting antimicrobial agents in SCI patients are similar to guidelines for the treatment of complicated urinary infections in the general population. Characteristics of the quinolones make them well suited to treating UTI in the SCI patient.

Anti-Infective Agents, Urinary↗
PubMed1978

Asymptomatic bacteriuria in schoolgirls. VIII. Clinical course during a 3-year follow-up.

A 3-year follow-up of 116 schoolgirls with asymptomatic bacteriuria, treated or untreated is reported. It is concluded that bacteria isolated from girls with asymptomatic bacteriuria do not commonly cause symptomatic pyelonephritis and that the risk of developing renal damage as a result of asymptomatic bacteriuria in a schoolgirl with a roentgenographically normal urinary tract seems to be small. It is also suggested that for the majority of these patients therapy is not necessary.

Adolescent↗
PubMed1990

Follicular cystitis in girls with untreated asymptomatic or covert bacteriuria.

Nodular changes of the bladder mucosa, that is cystitis follicularis or cystitis cystica, are found in 2 to 9% of all children with urinary tract infections. The nodules are composed of lymphoid aggregates, resembling Peyer's patches in the intestine. Children with this finding are considered to have a poor short-term prognosis with a marked tendency for recurrent infections. Screening programs for bacteriuria have revealed that a few per cent of the female population are bacteriuric without symptoms of overt disease. Of 59 girls followed with untreated asymptomatic bacteriuria 52 had nodular changes of the bladder mucosa at cystoscopy. Biopsy was performed in 22 girls, and revealed lymphocytic infiltration in 19 and follicular formation in 11. The nodular changes persisted when bacteriuria continued but disappeared in patients who became abacteriuric. This finding demonstrates the reversibility of the changes, and supports the assumption that they are secondary to the presence of bacteria and not a primary lesion.

Bacteriuria↗
PubMed1990

Lower urinary tract dysfunction in girls with untreated asymptomatic or covert bacteriuria.

A total of 50 to 80% of all girls with asymptomatic or covert bacteriuria will have recurrences after antibacterial treatment. Deficient bladder emptying is an important factor predisposing to urinary infections. We investigated lower urinary tract function in 57 girls with untreated so-called asymptomatic bacteriuria. Detailed questioning revealed a high frequency of symptoms, such as urgency and incontinence. The symptoms were not acute and no patient had dysuria. The urinary flow curve pattern indicated bladder emptying problems in 42% of the girls and residual urine of greater than 5 ml. was seen in 71%. Cystometry revealed consistent detrusor instability in 75% of the patients. Lower urinary tract dysfunction may explain the marked tendency for recurrent infection after treatment of asymptomatic bacteriuria. With a detailed history, and noninvasive determination of urinary flow and residual urine, these abnormalities are easily detected. Bladder rehabilitation may offer a new method of treatment for these patients.

Bacteriuria↗
PubMed1988

Bacteriuria following extracorporeal shock wave lithotripsy of infection stones.

Extracorporeal shock wave lithotripsy effectively pulverizes infected (struvite) renal calculi. However, after treatment minute residual fragments that may harbor bacteria and cause persistent bacteriuria remain in the renal collecting system for months. We investigated prospectively the incidence of persistent Proteus mirabilis bacteriuria after extracorporeal shock wave lithotripsy among 15 consecutive women with Proteus mirabilis urinary tract infections and struvite calculi. All patients received parenteral gentamicin for 3 to 8 days (mean 4.7 days) immediately before and after extracorporeal shock wave lithotripsy. Oral antimicrobials then were administered for 14 to 34 days (mean 25 days). Ten patients have maintained a sterile urine or experienced urinary reinfection by other organisms during 8 to 19 months (mean 13 months) of subsequent bacteriological surveillance. Of these 10 patients 9 had residual fragments. Five patients had Proteus mirabilis bacteriuria after 1 to 7 months of surveillance, including 3 with residual fragments. The mean stone size, methods and duration of renal drainage procedures, and duration of antimicrobial therapy were similar for the 2 patient groups. Proteus mirabilis was isolated from the cultures of only 3 of 11 retrievable stone fragments. In contrast to intact infected renal calculi, residual stone fragments after extracorporeal shock wave lithotripsy often are susceptible to sterilization with antimicrobials.

Adult↗
PubMed1987

Localization of bacteriuria in patients with enterocystoplasty and nonrefluxing conduits.

Urine cultures were obtained by percutaneous aspiration of renal pelvic urine in an attempt to localize the source of chronic asymptomatic bacteriuria in 10 patients with intestinal segments incorporated into the urinary tract. One child with a nonrefluxing colonic conduit and 6 of 8 patients with nonrefluxing enterocystoplasties had upper tract bacteriuria. One patient with a ureterosigmoidostomy and a history of pyelonephritis had negative cultures while on prophylactic antibacterials. The significance of upper tract bacteriuria in these patients is unknown but lifelong followup of renal function is necessary.

Bacteriuria↗
PubMed1984

The clinical significance of Staphylococcus aureus bacteriuria.

To investigate the rate of occurrence, clinical presentation, predisposing factors and frequency of secondary bacteremia 132 patients with significant Staphylococcus aureus bacteriuria were reviewed retrospectively. Staphylococcus aureus accounted for 3.3 per cent of all positive urine cultures. Most patients were elderly men. The most important predisposing factors in the urinary tract were indwelling catheters (63 per cent), obstruction (56 per cent) and instrumentation or surgery (43 per cent). Bacteremia developed secondary to bacteriuria in all 11 patients (8.3 per cent). For that reason Staphylococcus aureus bacteriuria should be regarded as a hazardous condition, especially in patients with predisposing factors in the urinary tract.

Adult↗
PubMed1984

Single-day treatment with trimethoprim for asymptomatic bacteriuria in the elderly patient.

Recent reports have demonstrated an association between bacteriuria and excess mortality. Therefore, 40 inpatients 60 or more years old with asymptomatic bacteriuria participated in a double-blind trial to assess the effect of 1-day treatment with trimethoprim. The patients were allocated randomly to receive 100 mg. trimethoprim (20 patients) or placebo (20 patients) to be taken in the morning and evening for 1 day. All patients treated with trimethoprim obtained sterile urine, whereas all patients treated with placebo remained bacteriuric (p less than 0.002). No side effects were recorded. However, many of the cured patients suffered rapid reinfection. Of the 20 initially cured patients 14 (70 per cent, 95 per cent confidence limits 46 to 88 per cent) had recurrent bacteriuria after 6 weeks, indicating that although this treatment is effective immediately it imparts no long-term effect.

Aged↗