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PubMed1981

Bacteriuria and survival in old age.

We studied the effect of asymptomatic bacteriuria on survival in 342 healthy residents of a home for the aged. At entry into the study 76 subjects (22 per cent) had bacteriuria on two consecutive urine cultures. There were no differences in age distribution, blood pressure, hematocrit, smoking habits, cholesterol, or myocardial changes between bacteriuric and nonbacteriuric subjects. Median survival was 53 and 75 months in nonbacteriuric men and women 70 to 79 years old, and 45 months in all nonbacteriuric subjects over 79; median survival of bacteriuric men and women aged 70 to 79 was 33 and 34 months, and that of those older was 31 and 29.5 months; the shorter survival of bacteriuric subjects was significant (P less than 0.003). These differences in mortality among subjects living under identical conditions and with equal prevalence of risk factors indicate that bacteriuria in old age is associated with a reduction in survival of 30 to 50 per cent.

Age Factors↗
PubMed1979

Malumfashi Endemic Diseases Research Project, X. Schistosoma haematobium and bacteriuria in the Malumfashi area.

No association was found between bacteriuria and Schistosoma haematobium infection in the Malumfashi area, and no male had a confirmed significant bacteriuria. The overall bacteriuria prevalence rate in a separate group of schoolgirls was 0.96%, while in females over the age of 20 it was 1.37%; there was an estimated prevalence of 3.2% in women over the age of 30. These figures for females agree with those from populations which have no experience of bilharzia. No urinary S. typhi carriers were found. The lack of association between urinary bacterial infection and schistosomiasis probably reflects the low intensity of S. haematobium infection in the Malumfashi area of northern Nigeria.

Adolescent↗
PubMed2002

Asymptomatic bacteriuria in a population of elderly in municipal institutional care.

OBJECTIVE: To study the prevalence of asymptomatic bacteriuria (ABU) among patients in municipal institutional care for the elderly. DESIGN: A cross-sectional study. SETTING: Three different municipalities in southern Sweden. SUBJECTS: 237 elderly people in municipal institutional care. MAIN OUTCOME MEASURES: Positive urine cultures. RESULTS: In the first culture, the prevalence of bacteriuria was 42%; 47% for women and 30% for men. ABU occurred in 23% of the patients; in 26% of women and in 16% of men. Urinary incontinence was more common among patients with ABU. CONCLUSION: Bacteriuria is common among elderly people living in institutions. This should be borne in mind when patents in institutional care for the elderly have fever. Other differential diagnoses than urinary tract infection should be considered before antibiotic treatment is given.

Aged↗
PubMed1991

Single preoperative bladder instillation of povidone-iodine for the prevention of postprostatectomy bacteriuria and wound infection.

OBJECTIVE: To study the effectiveness of preoperative bladder washing with povidone-iodine to prevent postprostatectomy wound infection. DESIGN: Patients with an indwelling catheter and scheduled for prostatectomy were divided into two groups. In patients in group 1 (n = 76) the indwelling catheter was simply removed without bladder irrigation. Patients in group 2 (n = 80) had their bladder washed with a nondiluted solution of povidone-iodine before surgery. PATIENTS: One hundred fifty-six consecutive patients with an indwelling catheter and bacteriuria. Mean age was 64 years. All patients had an open prostatectomy during the 12-month study period. Patients undergoing open prostatectomy during the first 6 months of the study had no bladder irrigation and served as the control group. Patients undergoing open prostatectomy during the following 6 months had a bladder instillation with povidone-iodine. RESULTS: Wound infection appeared in 17 of 76 patients (22.4%) without bladder washing and in 4 of 80 patients (5%) when 50 to 60 ml of the solution was retained in the bladder for 10 to 13 minutes (p = .001). The incidence of postoperative bacteriuria remained unchanged in the control group (100%) but was reduced to 22.5% in the treated group (p = .001). Statistical comparisons of incidence were done using the chi square test. CONCLUSIONS: It has been demonstrated that the use of preoperative bladder instillation of povidone-iodine may be highly effective in the prevention of postprostatectomy wound infection and in reducing the incidence of bacteriuria in patients with an indwelling catheter and urine colonization.

Administration, Intravesical↗
PubMed1994

Catheter-associated bacteriuria in long-term care facilities.

Catheter-associated bacteriuria is the most common infection acquired in long-term care facilities. Complications include fever, acute pyelonephritis, bacteremia, catheter obstruction, urinary stones, chronic interstitial nephritis, renal failure, and death. The closed-catheter system has been the only innovation in this traditional method of care that has led to prevention of bacteriuria. Antimicrobial agents rarely are indicated to prevent or treat bacteriuria in long-term catheterized patients, except for those with symptomatic infection. Alternative devices are available and often may be preferable to the indwelling urethral catheter. These patients and their reservoirs of bacteriuric organisms are sources of nosocomial outbreaks. Such outbreaks can be prevented and controlled with attention to catheter hygiene, prevention of patient-to-patient transmission on the hands of caregivers, and possibly use of antimicrobials to diminish bacterial concentrations in the urine.

Anti-Bacterial Agents↗
PubMed1995

Bacteriuria and colonization of double-pigtail ureteral stents: long-term experience with 237 patients.

We prospectively studied 266 patients with indwelling double-pigtail ureteral stents to determine the incidence of stent colonization and associated bacteriuria. A urine culture was obtained just prior to stent insertion and was repeated at the time of its removal. The stent itself was also cultured. Of the 237 evaluable patients, 71 (29.9%) developed bacteriuria. Of the 237 stents, 161 (67.9%) became colonized with microorganisms. Pseudomonas aeruginosa was the most common pathogen isolated from the urine and the stents. Stents in female patients had a higher rate of colonization than those used in males (74.4% v 66.5%). The longer the duration of stenting, the higher was the rate of colonization (58.6% for stents left for < 1 month v 75.1% for those left for > 3 months). The rate of colonization according to catheter type was as follows: C-flex 55.5%, silicone 62.6%, urethane 100%, and Urosoft 56%. Long-term ureteric stenting is associated with a high rate of bacteriuria and stent colonization. The duration of stenting and the type of stent influence the results. We recommend that patients with double-J ureteral stents who could be at risk from bacteremia be covered by appropriate antibiotics, and the stents should be kept indwelling for the shortest possible time. If a patient with a stent develops symptomatic infection, an antibiotic should be started that covers the Pseudomonas species.

Adolescent↗
PubMed1995

Bacteriuria following extracorporeal shock-wave lithotripsy in patients whose urine was sterile before the procedure.

During 10 months at our hospital, 413 patients underwent extracorporeal shock-wave lithotripsy (ESWL). The occurrence of complications was examined in the 126 (30.5%) of these patients who had sterile urine before the procedure and who had neither indwelling catheters nor stents. No patient received prophylactic antibiotics. After ESWL, nine patients (7%) developed bacteriuria, which was usually transient and required no therapy. Seven of the nine cases developed within 2 weeks of ESWL. In no case did other complications follow bacteriuria. Patients in whom bacteriuria was suspected because of fever all proved to have sterile urine. Our results indicate that patients whose urine is sterile before ESWL do not need antimicrobial prophylaxis.

Adolescent↗
PubMed2006

Asymptomatic bacteriuria in a population of elderly residents living in a community setting: prevalence, characteristics and associated factors.

BACKGROUND: Asymptomatic bacteriuria (ASB) is common among the elderly in institutional care, but less is known about its prevalence among the elderly living in community settings. Knowledge of the prevalence of ASB in this population could contribute to a reduction in unnecessary use of antibiotics. OBJECTIVE: To study the prevalence of ASB and associated health and social factors in a population of elderly people, aged 80 and over, in a community setting. DESIGN: A cross-sectional study. SETTING: The catchment area of a primary health care centre in a Swedish middle-sized town. METHOD: All residents, aged 80 and over, except for those in institutional living, were invited. A structured interview was carried out and urinary culture obtained. RESULTS: ASB was found in 14.8% of the participants, in 19.0% of the women and 5.8% of the men. In women independent associations with ASB were found for urinary incontinence (OR: 2.99, CI: 1.60-5.60), reduced mobility (OR: 2.68, CI: 1.42-5.03) and oestrogen treatment (OR: 2.20, CI: 1.09-4.45). CONCLUSION: Bacteriuria is common among the elderly living in non-institutional community settings, especially among women, although not as common as among the elderly in institutional settings. A woman over 80, with urinary incontinence, and needing support to walk has a risk of nearly 50% of presenting with ASB, a condition about which there is consensus not to treat with antibiotics. This should be borne in mind when examining patients with diffuse symptomatology and an accidental finding of bacteriuria.

Aged, 80 and over↗
PubMed1979

The presence of antibody-coated anaerobic bacteria in asymptomatic bacteriuria during pregnancy.

Quantitative anaerobic culture of urine samples obtained from 593 pregnant women by suprapubic bladder aspiration was performed to establish the involvement of anaerobic bacteria in asymptomatic urinary tract infections. The fluorescent antibody (FA) test was applied to the sediments of bladder aspirates to determine the site of infection. Anaerobic bacteriuria (greater than or equal to 10(4) microorganisms/ml of urine) was found in 34 patients, of whom five were FA-positive. These anaerobes were identified as Lactobacillus minutus, Veillonella parvula (two patients). Clostridium putrefaciens, and Peptostreptococcus anaerobius. Aerobic bacteriuria (greater than 10(4) microorganisms/ml of urine) was detected in 27 patients, of whom 13 were FA-positive. In 10 women with mixed aerobic/anaerobic bacteriuria, no FA-positive bacteria were found. The finding of FA-positive anaerobes may indicate that these organisms are involved in silent renal infection.

Adolescent↗
PubMed2005

Bacteriuria management and urological evaluation of patients with spina bifida and neurogenic bladder: a multicenter survey.

PURPOSE: We assessed how groups at spina bifida clinics evaluate and manage the urinary tract in patients with spina bifida, neurogenic bladder and bacteriuria. MATERIALS AND METHODS: A survey was mailed to all 169 clinics listed by the Spina Bifida Association of America. Survey items addressed baseline and surveillance evaluation, criteria used to assess urinary tract health and approaches to treatment in patients with spina bifida and neurogenic bladder. RESULTS: Of the 169 clinics personnel at 59 (35%) responded to the survey. Almost half of the respondents had an established protocol or standard of care. At most clinics the use of ultrasound (93%), voiding cystourethrograms (85%) and urodynamic testing (76%) was supported but not renal isotopic studies (14%) or excretory urograms (2%) for baseline evaluation. At all clinics ultrasound was supported for routine surveillance but there was no consensus for other imaging modalities. Assessment of clinic approaches to the evaluation and management of bacteriuria demonstrated variable results, although at most clinics fever, flank pain, dysuria, and changes in urinary pattern were identified as being consistent with true infection. Groups at clinics following their protocol or standard of care showed no significant differences in their approach compared to those at clinics lacking a protocol or standard of care. CONCLUSIONS: No consensus exists for the evaluation and management of bacteriuria in patients with spina bifida and neurogenic bladder at clinics specializing in the care of such patients, even at those with established standards of care. A clear need exists for an established, national set of evidence based guidelines to assist medical decision making in this high risk population and, thus, improve care.

Bacteriuria↗
PubMed1975

Urinary and faecal Escherichia coli O-sero-groups in symptomatic urinary-tract infection and asymptomatic bacteriuria.

The degree of correspondence between urinary and faecal Escherichia coli O-groups has been assessed in non-pregnant women with symptomatic urinary-tract infection or asymptomatic bacteriuria. In 20 of 26 patients with symptomatic urinary tract infection E. coli of the same O-groups as that of the urinary infecting strain was also present in the patient's faecal flora of only five of 25 patients with asymptomatic bacteriuria. This finding indicates that the majority of episodes of symptomatic urinary tract infection in non-pregnant women are not preceded by a significant period of asymptomatic bacteriuria. E. coli O6 showed correspondence between urinary and faecal isolates more frequently than did other O-groups, but it had a relatively low prevalence in the faecal flora of patients with urinary-tract infection caused by E. coli of other O-groups. This finding lends support to previous suggestions that E. coli O6 may be especially pathogenic for the urinary tract.

Bacteriuria↗
PubMed1982

Urine microscopy as screening method for bacteriuria.

Fresh urine samples from 90 ambulatory patients with urological disorders were examined for leucocytes by counting the number of WBC/mm3 and per high power field (HPF) in sediment. Bacteria could be cultured in 20 samples, 18 of which contained greater than 8 WBC/mm3. Two (3%) of the 63 samples with less than or equal to 8 WBC/mm3 contained bacteria. Bacteriuria was found in two (3%) of 65 samples containing 0--1 WBC/HPF. Microscopic examination of the sediment might be used for the screening of patients with a high frequency and urgency of micturition for bacteriuria. A normal number of urinary leucocytes (less than or equal to 8/mm3) indicates that no bacteria will be found in culture. Leucocyturia indicates a high probability of bacteriuria.

Adult↗
PubMed2006

Urinary cytokine response to asymptomatic bacteriuria in type 1 diabetic children and young adults.

It has been reported that urinary interleukin-6 (IL-6) and IL-8 levels are decreased in adult diabetic women with asymptomatic bacteriuria (ASB) when compared with non-diabetic women with ASB. Such impaired cytokine excretion might play a role in the higher prevalence of ASB among diabetic subjects. The aim of this study was to examine the urinary IL profile in children and young adults with type 1 diabetes mellitus (T1DM) with and without ASB. Midstream clean voiding urine samples were collected and cultured from 133 patients with T1DM (age: 15.6 +/- 5.7 yr) and 178 controls (14.1 +/- 4.7 yr) for two consecutive days. ASB was diagnosed in the case of >or=10(5) bacteria/mL. The urinary IL-6 and IL-8 concentrations were determined, and the presence of leukocyturia was also recorded. The prevalence of ASB was 16.5% in diabetic subjects and 2.8% in controls (p = 0.001). There was no difference between the diabetic and the control groups in the prevalence of 'IL-6-uria' (21.9 vs. 18.0%; p = 0.41), but IL-8 was more frequently detectable in the diabetic group (47.4 vs. 27.5%; p = 0.001). In individuals with ASB, the IL-8 level was similar in the diabetic (median: 70.0 pg/mg creatinine) and control group (42.3 pg/mg creatinine; p = 0.8). Indeed, the IL-8 levels were higher in diabetic subjects with ASB as compared with those without it (70.0 vs. <3.1 pg/mg creatinine; p = 0.001), and there was a significant association between the urinary IL-8 concentration and the bacterial count (p = 0.001). Diabetic patients with leukocyturia had higher IL-8 concentration than those without it (20.9 vs. <3.1 pg/mg creatinine; p = 0.003). Weak significant correlation was found between urinary IL-8 and hemoglobin A1c (HbA1c) (r = 0.4; p = 0.002). The sensitivity and specificity of leukocyturia were 50 and 89.9% in the whole population and those of IL-8 were 74.1 and 67.5%, respectively. In diabetic patients, 36.4% of the bacteriuria were gram-negative and 63.6% gram-positive. Our results suggest that diabetic children with ASB mount an IL-8 response to pathogens, which is comparable to non-diabetic children with bacteriuria. Thus, early in the natural history of diabetes, there are no significant changes in the IL response of children with ASB, as previously reported in adults.

Adolescent↗
PubMed1978

Diagnostic catheterization and bacteriuria in women with urinary incontinence.

The risk of single catheterisation in females with urinary incontinence and/or genital prolapse was studied in patients referred for urodynamic examination. Two hundred and eighty-six catheterisations were performed followed by a mid-streem specimen 1 week later, and in 31 of these the initial specimen contained more than 10(5) bacteria. Following catheterisation bacteriuria occurred in 5 (2%) of the patients with initially sterile urine. The phenomenon of "asymptomatic bacteriuria", "transient significant bacteriuria" and "bladder defence mechanism" is discussed. The risk of introducing urinary tract infection in urodynamic studies is low.

Adult↗
PubMed1991

Bladder instillations of trisdine compared with catheter introducer for reduction of bacteriuria during intermittent catheterisation of patients with acute spinal cord trauma.

An open, prospective, randomised trial was conducted to compare the incidence of significant bacteriuria following 2 methods of intermittent urethral catheterisation in patients with acute spinal cord trauma. Twenty-two patients were catheterised with a Nelaton catheter and 50 ml of Trisdine were instilled into the bladder and left there immediately prior to withdrawal of the catheter. Fifteen patients were catheterised with a Nelaton catheter with a special introducer to improve asepsis (O'Neil catheter). The mean incidence of significant bacteriuria in males and females who received Trisdine bladder instillations was 0.58 and 0.48% per catheterisation respectively; in males and females catheterised with the O'Neil catheter it was 1.16 and 2.93% per catheterisation respectively. The instillation of Trisdine into the bladder after each passage of a catheter resulted in a significantly lower incidence of bacteriuria compared with that which resulted from the use of the O'Neil catheter. The former method is therefore to be preferred for aseptic intermittent urethral catheterisation in patients with acute spinal cord trauma.

Acute Disease↗
PubMed1995

Renal function up to 16 years after conduit (refluxing or anti-reflux anastomosis) or continent urinary diversion. 2. Renal scarring and location of bacteriuria.

OBJECTIVE: To evaluate the importance of refluxing versus anti-reflux ureteric implantation for the development of renal scarring in patients with a conduit or continent urinary diversion and for the incidence of bacteriuria in the upper urinary tract of patients with a conduit. PATIENTS AND METHODS: Renal scintigraphy using 99mTc-dimercaptosuccinic acid was performed on 32 of 37 evaluable patients from a prospective, randomized study at a mean of 150 months (range 102-198) after urinary diversion. In five patients with a conduit diversion and unilateral renal scarring, urine was samples for culture from the proximal end of the conduit and from both renal pelvices by direct percutaneous aspiration. RESULTS: Of 35 renal units (18 patients), studied after conduit diversion, scarring was found in 11 (two grade I, six grade II and three grade III) of 17 with refluxing anastomosis and in six (one grade I, four grade II and one grade III) of 18 with anti-reflux anastomosis (P = 0.06). Of 25 renal units (14 patients) after continent diversion, 16 showed scarring (seven grade I and nine grade II). Bacteriuria was found in four of five upper urinary tracts with a refluxing anastomosis, but in only one of five with an anti-reflux anastomosis. In these five patients scarring was present in all kidneys with refluxing anastomosis. CONCLUSION: Anti-reflux ureteric anastomosis seems to be important for preventing scarring and bacteriuria in the upper urinary tract of patients with a conduit urinary diversion. Despite the anti-reflux technique of ureteric implantation, most patients with a continent reservoir had renal scarring, though it was generally less severe than in patients with a conduit urinary diversion.

Bacteriuria↗
PubMed1986

Association between diaphragm use and asymptomatic bacteriuria.

The prevalence of asymptomatic bacteriuria was assessed in women using different contraceptive methods. Three hundred and twenty women attending a family planning centre were studied, 80 in each of the following groups: diaphragms, intrauterine contraceptive devices (IUCDs), oral contraceptives (OCs) and no contraception. The numbers with asymptomatic bacteriuria in the 4 groups were as follows: diaphragm - 12 (all E coli); IUCD - 3 (E coli; P mirabilis; S saprophyticus); OC - 5 (all E coli); no contraception - 4 (3 E coli; 1 S saprophyticus). The prevalence of Gram-negative bacteriuria in women using diaphragms was significantly higher than for women in the other groups (chi 2 = 8.98; p less than 0.05). Factors such as parity, numbers of sexual partners and frequency of sexual intercourse had no apparent effect. The use of diaphragms may contribute to the risk of Gram-negative urinary tract infections in sexually active women.

Adolescent↗
PubMed1977

Bacteriuria and renal infection in kidney-transplant recipients.

In 64 patients who had undergone renal transplantation, later on followed by bilateral nephrectomy, bacterial growth culture was performed from the original kidneys. The presence of bacteria in the nephrectomy specimens was compared with the occurrence of significant bacteriuria before transplantation and in the period between transplantation and nephrectomy. Bacteria could be cultured from the nephrectomy specimens of 18 (28.1 per cent) of the patients, almost exclusively confined to cases of obstructive chronic pyelonephritis, analgesic nephropathy and congenital renal disease. Before transplantation, bacteriuria had been recorded in 34.4 per cent of the patients, most frequently in the three groups of diseases just mentioned. Between the transplantation and nephrectomy, bacteriuria occurred in 75.0 per cent of the patients. Patients with E. coliuria before transplantation were particularly liable to have E. coliuria also after the transplantation and to E. coli in the nephrectomy specimens, whereas patients in whon E. coliuria did not occur until in the post-transplantation period were less susceptible to E. coli infection involving the kidneys. Probably the presence of bacteria in the nephrectomy specimens is related to the primary disease rather than to immunosuppressive and antiobiotic agents administered in the post-transplantation period.

Adolescent↗