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PubMed1983

Association of bacteriuria and pyuria during intermittent catheterization after spinal cord injury.

Because patients on intermittent catheterization often suffer asymptomatic bacteriuria it is important to know how serious such a colonization may be. We followed 156 hospitalized spinal cord injury subjects on intermittent catheterization. Daily bacterial cultures were performed. When bacteriuria was detected bacterial cultures and uncentrifuged urinary leukocytes were quantified. Gram-positive bacteria, such as Staphylococcus epidermidis and Streptococcus faecalis, produced minimal white cell response, even in high colony counts. However, gram-negative and fungal organisms elicited significant pyuria. Analysis of pyuria in conjunction with urine cultures may serve as a clinical guide to treatment of significant bacteriuria.

Bacteriuria↗
PubMed1982

Catheter-associated bacteriuria in patients in reverse isolation.

We determined the incidence and source of bacterial colonization of the bladder in 18 consecutive renal transplant recipients who required postoperative indwelling urethral catheterization and who were in reverse isolation. The patients were catheterized for an average of 6 days. Bladder bacteriuria occurred in 5 patients (27 per cent): 2 owing to urethral organisms, 2 after breaks in the drainage system and 1 owing to an unidentified source. The drainage bag urine was contaminated rarely and never was a source of bladder bacteriuria. The data suggest that bacterial contamination of the drainage bag may be an infrequent source of bladder bacteriuria in patients with limited contact with a hospital environment.

Adult↗
PubMed1980

Decreased incidence of bacteriuria associated with periodic instillations of hydrogen peroxide into the urethral catheter drainage bag.

We determined the incidence and source of bacterial colonization of the bladder in 31 consecutive patients with acute spinal cord injury who required indwelling urethral catheterization. Patients were randomized to conventional drainage or to conventional drainage with a secondary sterile bag for periodic administration of saline or 3 per cent hydrogen peroxide. The hydrogen peroxide group maintained sterile bladder urine significantly longer than the conventional drainage group (p less than 0.05). Cultures suggested that the reservoir for bladder colonization was the bag in 5 of 12 patients (42 per cent) on conventional drainage. Instillation of hydrogen peroxide prevented bacterial contamination of the drainage bag before bladder bacteriuria (p less than 0.01) and also reduced drainage bag bacteriuria in patients with urinary infections (p less than 0.0005). The data indicate that bacterial contamination of the drainage bag is a frequent source of bladder bacteriuria that can be eliminated effectively by periodic instillation of hydrogen peroxide.

Adolescent↗
PubMed1979

Bacteriuria during closed urinary drainage: an evaluation of top-vented versus bag-vented systems.

For a 10-month period a top-vented closed urinary drainage system was evaluted and compared to a conventional bag-vented drainage system. The study involved random assignment of either system to all adult patients who required urinary catheterization. Criteria for exclusion included acute or chronic genitourinary tract infection and surgical interference with bladder function. The end point of the study was removal of any part of the system after at least 24 hours or a positive urine culture (greater than 10,000 colonies per ml. urine). The series included 236 patients. Distributions of patient age, sex and hospital service assignment (medical or surgical), antibiotic usage and duration of catheterization were similar in both study groups. Of 113 patients with the top-vented system 16 (14.2 per cent) acquired bacteriuria, whereas 13 of 123 (10.6 per cent) with the bag-drainage system acquired bacteriuria. No significant difference was noted. Antibiotics were used in 202 of 236 patients (86 per cent). Although usage delayed the appearance of bacteriuria in both groups isolates were more frequently yeasts and gram-negative organisms other than Escherichia coli.

Adolescent↗
PubMed1979

Adhesiveness to urinary tract epithelial cells of fecal and urinary Escherichia coli isolates from patients with symptomatic urinary tract infections or asymptomatic bacteriuria of varying duration.

Adhesiveness to human urinary tract epithelial cells was high for Escherichia coli strains isolated from patients with acute pyelonephritis and acute cystitis, and low for asymptomatic bacteriuria strains detected at screening. Escherichia coli bacteria causing asymptomatic reinfections, detected near the onset of bacteriuria, adhered more than those detected at screening. No difference in the adhesive ability was found between fecal isolates of the strain causing urinary tract infection, isolated at or before onset of bacteriuria, and the urinary strain in symptomatic or asymptomatic patients. Normal fecal Escherichia coli from non-bacteriuric patients adhered less than all other strains tested.

Adhesiveness↗
PubMed1978

Prevention of bacteriuria after transurethral prostatectomy with nitrofurantoin macrocrystals.

Of 40 patients who underwent transurethral prostatectomy without receiving antimicrobial chemoprophylaxis 13 had significant bacteriuria at some time in the postoperative course. Of 47 patients given nitrofurantoin none of the 42 for whom culture results were available had bacteriuria. This difference between the 2 groups is statistically significant (p less than 0.01). Nitrofurantoin prevents post-prostatectomy bacteriuria and has a theoretical advantage over agents such as the cephalosporins in that its action is limited to the urinary tract.

Bacteriuria↗
PubMed2000

Rapid enzymatic urine screening test to detect bacteriuria in pregnancy.

OBJECTIVE: To determine the sensitivity, specificity, and positive and negative predictive values of an enzymatic urine screening test for diagnosing bacteriuria in pregnancy. METHODS: Clean-catch midstream urine samples were collected from 383 women who had routine prenatal screening for bacteriuria. Sensitivity, specificity, and positive and negative predictive values for each screening test (enzyme activity, nitrites or leukocytes on dipstick, and bacteria or pyuria on microscopic examination) were estimated using urine culture as the criterion standard. Urine cultures were considered positive if they grew 10(4) colony-forming units of a single uropathogen. Standard deviations used to calculate 95% confidence intervals were based on binomial distribution. A sample of 30 urine specimens was selected to evaluate interrater agreement using Cohen's kappa statistic. RESULTS: Five of 383 samples were contaminated, leaving 378 samples for evaluation. Thirty of 43 specimens with positive urine culture had positive enzyme activity. Of 335 samples with no growth, 150 had negative enzyme activity. Sensitivity, specificity, and positive and negative predictive values for the Uriscreen enzymatic screening test (Bard Patient Care Division, Murray Hill, NJ) were 70%, 45%, 14%, and 92%, respectively. Sensitivity of the Uriscreen was lower than that of bacteria alone. Interrater agreement for Uriscreen testing was high among the three testers (kappa =.86). CONCLUSION: The Uriscreen enzymatic screening test had inadequate sensitivity for rapid screening for bacteriuria in pregnancy.

Bacteriuria↗
PubMed1996

Bacteriuria and urinary infections in the elderly.

Aging is associated with a decreased physiological functioning, reflecting the body's progressive inability to maintain homeostasis as age increases. The physiologic dysfunctions experienced in response to the aging process increase the individual's susceptibility to infection. Many elderly subjects are hospitalized for the care and treatment of functional disabilities; thus, an increased exposure to possible uropathogens (many with antimicrobial resistance) often results in infection. Additionally, indwelling catheters and other attending procedures may provide a microenvironment conducive to infection. In catheterized patients, the drainage bag often is infected with polymicrobes, which enhances the transference of antimicrobial genetic information. Postmenopause reflects a decrease in circulating estrogen, and a relational decrease in lactobacilli colonization with a lower vaginal pH. Consequently, vaginal colonization with possible uropathogenic and gastrointestinal bacteria increases, which partially may account for the generally higher incidence of bacteriuria in elderly women as opposed to elderly men. Urinary infections in the elderly more commonly are asymptomatic. Treatment for asymptomatic bacteriuria is not justified and will often present opportunities for the infecting organism to acquire antimicrobial resistance. Only symptomatic bacteriuria presenting adverse conditions in the host should be treated. Antimicrobial selection for the treatment of complicating symptomatic urinary infections in elderly subjects is complicated by the many physiological and environmental conditions associated with older age patients. Unfortunately, data confirming the efficacy and safety of antimicrobial agents for the treatment of symptomatic infections in the elderly presently are insufficient.

Aged↗
PubMed1984

Bacteriuria screening and antimicrobial susceptibility testing of aerobic bacteria by an electrochemical method.

A method is described for detecting significant bacteriuria and determination of minimal inhibition concentrations (MIC's) of aerobically growing bacteria by using electrochemical electrodes to measure changes of oxygen tensions in liquid nutrient media resulting from bacterial growth. Urine specimens (n = 577) were screened electrochemically, parallel investigations were performed by standard culture methods and by photometrical measurements. All the specimens showing significant bacteriuria in standard culture were selected within 3.5 h by the electrochemical technique. An oxygen index OI was introduced which quantitatively reflects changes in oxygen tension of nutrient media during growth. OI shows good agreement with extinction and light scattering indices, respectively. On the basis of OI as a parameter of inhibited and uninhibited growth a correlation between OI and MIC's of aerobically growing bacteria was found. The electrochemical method provides an useful aid for rapid, preliminary antimicrobial susceptibility testing and definite bacteriuria screening. The application of this method in bacteriological urine diagnostics significantly reduces laboratory work and costs, and can be recommended for the screening of urine specimens to exclude negative specimens from further processing.

Anti-Bacterial Agents↗
PubMed1993

Occurrence of pyuria and bacteriuria in asymptomatic hemodialysis patients.

Patients with end-stage renal disease on hemodialysis have documented defects in their immune responses, and infections contribute significantly to their morbidity and mortality. This study prospectively detected and quantitated leukocyturia and bacteriuria in asymptomatic hemodialysis patients. Thirty-one percent of asymptomatic hemodialysis patients had significant pyuria (> 10 white blood cells per high-power field) and 25% had bacteriuria of pathologic dimensions, (> 1 x 10(5)/mL of a single microorganism). Pyuria was a good marker for significant bacteriuria in these patients. These results demonstrate that the urinary tract, even in ESRD patients on hemodialysis, may represent a significant reservoir for infection.

Bacteriuria↗
PubMed1996

The influence of PCP prophylaxis on bacteriuria incidence and resistance development to trimethoprim/sulfamethoxazole in HIV-infected patients.

BACKGROUND: Earlier studies have shown that men infected with HIV-1 and a CD4+ cell count below 200 mm3 are at increased risk for bacteriuria. We studied the effect of 3 Pneumocystis carinii (PCP) prophylaxis regimens (low-dose TMP/SMZ, high-dose TMP/SMZ and pentamidine aerosol) on the incidence of bacteriuria and resistance development to TMP/SMZ. METHODS: Retrospective analysis of 103 HIV-positive patients. RESULTS: Nine patients using pentamidine had a positive culture (32%), compared to 9 patients using low-dose TMP/SMZ (17%) and 5 patients using high-dose TMP/SMZ (22%). These differences were not significant (P = 0.207). However, almost all episodes in patients using TMP/SMZ were due to infection with a resistant strain. CONCLUSION: PCP prophylaxis with trimethoprim/sulfamethoxazole does not significantly influence the rate of bacteriuria, probably due to the development of resistance.

Bacteriuria↗
PubMed2002

Asymptomatic bacteriuria in elderly humans is associated with increased levels of circulating TNF receptors and elevated numbers of neutrophils.

Low-grade inflammatory activity is strongly associated with age-associated diseases such as atherosclerosis, dementia, type-2 diabetes, sarcopenia, and osteoporosis and predicts mortality risk in elderly populations. The aim of the current study was to investigate if asymptomatic bacteriuria in elderly humans was associated with inflammation. Midstream clean-catch urine culture was collected from consecutive, elderly patients at admission to a department of internal medicine due to functional disability. Forty patients (age 70-91 years) were selected and included in the current study; 20 subjects had positive urine culture and 20 sex- and age-matched subjects had negative urine culture. Inclusion criteria were temperature below 37.8 degrees C, no clinical signs of infection and no current antibiotic treatment. Patients with asymptomatic bacteriuria had significantly increased levels of circulating tumor necrosis factor receptors (sTNFR-I) and a higher number of neutrophils in the blood compared to the group without bacteriuria. Thus, the present study provides some support for the hypothesis that asymptomatic urinary infections are associated with low-grade immune activity in frail, elderly humans.

Aged↗
PubMed1984

A multivariate analysis of risk factors for acquiring bacteriuria in patients with indwelling urinary catheters for longer than 24 hours.

Data related to risk factors for catheter-acquired bacteriuria were collected prospectively on 112 patients consecutively catheterized for greater than 24 hours at the Hadassah University Hospital. Logistic regression analysis indicated that factors independently associated (p less than or equal to 0.05) with a higher risk of catheter-acquired bacteriuria were as follows: hospitalization in orthopedics or urology, ethnic origin (Arabs greater than Jews), insertion of a catheter after the sixth day of hospitalization, catheterization outside the operating theatres, lack of administration of systemic antibiotics, unsatisfactory catheter care, and prolonged duration (greater than or equal to 7 days) of catheterization before infection occurred. The risk associated with catheterization outside the operating theater could be explained by its correlate, that is, catheterization for incontinence/obstruction as opposed to output measurement. Life-table analyses demonstrated that the daily risk for acquiring bacteriuria during the first six days of catheterization was higher among patients ultimately catheterized for greater than or equal to 7 days than among those ultimately catheterized for less than 7 days (P less than 0.05).

Aged↗
PubMed1985

Evaluation of H2O2 prophylaxis of bacteriuria in patients with long-term indwelling Foley catheters: a randomized controlled study.

Since the long-term catheterized patient is at significant risk of urinary tract infection, and the catheter drainage bags of these patients are at significant risk of becoming reservoirs for nosocomial pathogens, we carried out a randomized, controlled study to determine the efficacy of intermittent drainage bag instillation of hydrogen peroxide (H2O2) in patients requiring indwelling Foley catheters for 5 days or more. Herein we report the effects of this technique on the rates of catheter and bag bacteriuria, the duration to positive culture, the temporal relationships observed, and the spectrum of organisms recovered. Bag source bacteriuria was found with the same frequency in both control and H2O2 groups. H2O2 did reduce contamination of the drainage bag but did not reduce catheter-associated bacteriuria or frequency of symptomatic urinary tract infection. Furthermore, H2O2 did not reduce the frequency of bag contamination with most of the common nosocomial urinary pathogens.

Antisepsis↗
PubMed2004

Salmonella bacteriuria: an increasing entity in elderly women in the United States.

Salmonellosis is a major cause of gastroenteritis in the United States and can lead to septicaemia, and other extra-intestinal illness including urinary tract infections (UTIs). To examine trends in Salmonella bacteriuria in the United States, surveillance data from the National Salmonella Surveillance System from 1980 to the end of 1999 were reviewed. Overall, 17442 urinary Salmonella isolates were reported, representing 2% of all Salmonella isolates from a known source. This proportion increased from 2% during 1980--1984 to 4% during 1995--1999. The median age of persons from whom these isolates came was 51 years; 12,176 (70 %) were women. Compared to the last national survey conducted between 1968 and 1979, the rate of Salmonella bacteriuria increased among women, from 2.0 per million persons in 1980 to 3.7 in 1999; the highest rate occurring in women > or = 70 years. National reporting of Salmonella bacteriuria increased in absolute incidence and as a proportion of all Salmonella, especially in elderly women and may represent an increase in the incidence of Salmonella UTIs. Better understanding of the uropathogenicity of Salmonella serotypes may further clarify the mechanisms of Salmonella UTIs.

Adolescent↗
PubMed2000

Screening for bacteriuria in patients with spinal cord lesion: dipstick test, microscopic examination and urine culture.

AIM: To investigate the positive and negative predictive values for bacteriuria of a rapid chemical dipstick procedure for leukocytes and nitrite, and a microscopic examination for leukocytes and bacteria with a urine culture being the reference in patients with spinal cord lesion (SCL). METHODS: A prospective study. Significant bacteriuria was defined as > or = 10(5) CFU/mL. The microscopic examination for leukocytes was divided in four different cut-off limits for positive results. MATERIAL: A total of 256 consecutive early morning urine samples were collected from 143 SCL patients admitted to our in-patient facility. RESULTS: One hundred and twenty-eight urine cultures revealed significant bacteriuria. Eighty-seven were infected by only one microorganism, 41 samples contained significant growth of more than one species. A total of 186 microorganisms in significant growth were identified. CONCLUSION: Three or more leukocytes should be considered as a positive result. The dipstick and microscopy tests are equally valuable, considering the single tests as well as the combinations evaluated.

Bacteria↗
PubMed2001

Energy expenditure and nutritional adequacy of rehabilitation paraplegics with asymptomatic bacteriuria and pressure sores.

OBJECTIVE: To measure resting energy expenditure (REE) in a group of people with postacute paraplegia, quantify the impact of asymptomatic bacteriuria and pressure sore(s) on patients' metabolic rate, and estimate the adequacy of patients' nutritional intakes to preserve patients' protein levels. MATERIAL AND METHODS: Ten males with post-acute paraplegia aged 42.1+/-18.7 years. We evaluated: height, body mass index (BMI), resting energy expenditure (REE), total daily calorie requirement (E), 24-h urine creatinine excretion (Cru), creatinine index (CI), and nitrogen balance (NB). RESULTS: Subjects with paraplegia showed high erythrocyte sedimentation rates. As a group, they had normal resting calorie consumption when REE was normalized for unit of urine creatinine (REE/Cru), it was higher in patients than in controls. Six of the 10 patients had a low calorie intake: of these only three had a negative nitrogen balance. CONCLUSION: In conclusion, the resting energy expenditure of the subjects with significant bacteriuria and pressure sore(s) of 23.7 kcal/kg/day suggests that a large portion of patients may have an inadequate calorie protein intake to preserve their nutritional status. The clinical significance of this study is that 28.5 kcal/kg/day may be the lower calorie threshold to meet the metabolic demands of people with apyretic paraplegia with bacteriuria and pressure sore(s).

Adolescent↗
PubMed1981

[Is asymptomatic bacteriuria in pregnancy combined with pyuria? (author's transl)].

The midstream urine of 269 pregnant women between 10 and 36 weeks gestation were investigated bacteriologically by the semi-quantitative dip method and microscopically for leukocytes in the urinary sediment. In 20 of 269 urines (7%) an asymptomatic bacteriuria was found but only in 10% of these bacteriurias leukocytes were found in the urine. An isolated pyuria without significant bacteriuria was found in 15 of 249 urines (6%). The assumption that a physiological pyuria exists in pregnancy was not substantiated.

Bacteriuria↗