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PubMed1997

A simple and efficient urine sampling method for bacteriological examination in elderly women.

AIM: to determine how collecting urine voided directly into a container compares with urine obtained by suprapubic aspiration. METHOD: urine samples were collected in a sterile recipient placed in the toilet or in the bed-pan during voiding, after the vulval region had been cleaned by water. These samples were compared with samples of the same urine obtained by suprapubic aspiration. The samples were examined for pyuria and bacteriuria. Applying the Kass criteria on the voided urine specimen and assessing the presence of leucocyturia, it was possible to differentiate urinary tract infection, asymptomatic bacteriuria and contamination. RESULTS: all 13 cases of infection found on suprapubic aspiration were also identified by this sampling technique. The technique produced four false-positive results. CONCLUSION: this simple sampling method may not only obviate the need for suprapubic aspiration but also for bladder catheterization in the diagnosis of urinary tract infection in many elderly women.

Aged↗
PubMed1987

Diagnosis of bacteriuria in men: specimen collection and culture interpretation.

Bacteriologic criteria for diagnosing urinary tract infections in men have not been well defined. For determination of the bacterial colony count in voided specimens that most accurately reflects bladder bacteriuria, culture results were compared for voided urine and bladder urine (obtained by suprapubic aspiration and urethral catheterization) from men with various genitourinary problems. Bladder bacteriuria was found in 36 (47.3%) of 76 sets of specimens from 66 individuals. Culture results of bladder specimens showed excellent agreement with those of clean-catch midstream-void and uncleansed first-void specimens (weighted kappa = 0.924 and 0.906, respectively). The criterion for clean-catch midstream-void specimens that best differentiated sterile from infected bladder urine was growth of greater than or equal to 10(3) cfu of one predominant species/ml; this definition had a sensitivity of 0.97 and a specificity of 0.97. Uncleansed first-void specimens were equally sensitive (0.97) but less specific (0.91-0.92) in detection of bacteriuria. Pyuria (greater than or equal to leukocytes/mm3) and irritative genitourinary symptoms showed modest correlations with bladder bacteriuria.

Bacteria↗
PubMedDate not supplied

Urinary tract infection among women attending a clinic for sexually transmitted diseases.

The symptoms, signs, and laboratory findings for 69 women who were seen at a sexually transmitted disease (STD) clinic and who had acute urinary tract infection (UTI) were compared with those for women who had vaginitis, gonorrhea, or chlamydial infection. Escherichia coli and Staphylococcus saprophyticus were the two most common causes of acute cystitis in this population and accounted for 62 (90%) of 69 infections. Forty-three percent of the women had positive tests for antibody-coated bacteria (ACB), an observation implying renal infection although symptoms of upper tract infection were infrequent. Frequency, urgency, dysuria, and suprapubic tenderness were significantly associated with cystitis, whereas vaginal discharge and vulvar itching were associated with vaginitis. There was, however, considerable overlap in symptoms among the four groups of women, and their accurate differentiation required objective information based upon pelvic examination, examination of vaginal fluid, and urinalysis. In the absence of vaginitis on wet mount and mucopurulent cervicitis on examination, pyuria, as determined by examination of centrifuged urine, had an 88% sensitivity, 76% specificity, 61% positive predictive value, and 93% negative predictive value for acute UTI. Because of the high prevalence of positive ACB tests and the possibility that infection with Chlamydia trachomatis and/or Neisseria gonorrhoeae may be mistaken for cystitis, we prefer a five- to seven-day course of antibiotics over single-dose therapy for treatment of patients with possible UTI in the setting of an STD clinic.

Acute Disease↗
PubMed1979

Faecal and introital bacteria and urinary tract infection.

The faecal, introital, and urinary bacterial flora have been studied in 3 normal women and 5 women with recurrent urinary infection. In the normal women urinary abnormalities were uncommon, but the patients regularly had episodes of bacteriuria and pyuria, only a quarter of which were symptomatic. Symptoms tended to be associated with high white cell excretion rates and with the longer episodes. Introital colonisation was heavier and more frequent in the patients than in the control subjects. Organisms recovered from the urine had previously colonised the introitus in most cases. It appears that symptomatic episodes constitute only a small part of the disease process in patients with recurrent urinary tract infection.

Adult↗
PubMed1986

Bacterial study of clean intermittent catheterisation in children.

Deterioration of the upper urinary tract is exceptional in children on clean intermittent catheterisation for neuropathic incontinence and is found only in those with pre-existing renal damage. This report describes a bacteriological study of 24 children, of whom 10 had renal damage and 14 did not have renal damage before clean intermittent catheterisation began. Boric acid was added as a preservative to samples of urine in preference to the use of dip-slides because it preserves pus cells as well as bacteria. The incidence of bacteriuria in the two groups was similar (78% of samples from those with, and 72% of samples from those without, pre-existing renal damage). The groups differed in that the urine of children in the group with pre-existing renal damage yielded organisms other than Escherichia coli more than twice as often as did the urine of those children without renal damage. Moreover, the children with pre-existing renal damage were more likely to have fever with urinary tract infection and some of them showed frequent changes of organisms in the urine. Whatever organism was present, however, children in the group with renal damage more often had heavy pyuria.

Adolescent↗
PubMed1975

Asymptomatic bacteriuria in schoolgirls. I. Clinical and laboratory findings.

Among 116 schoolgirls with asymptomatic bacteriuria detected at urinary screening, renal parenchymal reduction was found in 10.3%, while reflux was found in 20.7%. Only 30% of the 116 patients had a history referable to earlier urinary tract infection and there were remarkably few girls with an increased sedimentation rate (4.4%), C-reactive protein (9.5%), pyuria (25.8%) or lowered concentrating capacity (3.4%) at the time of detection of their bacteriuria. No method was found efficient in predicting lesions on the pyelogram and urethrocystogram, but determination of renal concentrating capacity and C-reactive protein was of some value in predicting parenchymal reduction. The girls with pyelonephritic changes on the pyelogram had a mean renal concentrating capacity significantly lower than the girls without changes. The concentrating capacity of the girls with reflux but without renal scarring and those bacteriuric patients without radiologically demonstrated defects did not differ significantly from the age-related normal values.

Adolescent↗
PubMed1986

Inability of the Chemstrip LN compared with quantitative urine culture to predict significant bacteriuria.

The Chemstrip LN (Boehringer Mannheim Biochemicals, Indianapolis, Ind.), designed to detect pyuria and bacteriuria, was compared with culture of 1,020 unselected, consecutive midstream urine specimens and evaluated on its ability to predict colony counts at three levels. At the level of greater than or equal to 10(5) CFU/ml, the combined test (detection of leukocyte esterase and nitrite) had sensitivity of 82.3%, specificity of 67.9%, positive predictive value of 41.3%, and negative predictive value of 93.3% at prevalence rate of 21.6%. The test would have rejected 9.4% of the specimens with significant bacteriuria if the Chemstrip alone had been used.

Bacteria↗
PubMed1969

Analgesic nephropathy. Clinical course after withdrawal of phenacetin.

Of 14 patients with analgesic nephropathy 11 were followed up for 9 to 88 (mean 36) months after withdrawal of analgesics containing phenacetin. Ten of these 11 are still alive and have improving, static, or very slowly declining renal function. Analgesic withdrawal is therefore worth achieving even in the presence of advanced renal failure. Careful prolonged follow-up is required to prevent or detect relapse and to deal with the complications of prolonged renal failure, particularly bone disease and acidosis.Early diagnosis is life-saving in this condition. Attention is drawn to the diagnostic value of sterile pyuria, but the best screening test for the condition is careful interrogation of all patients with chronic renal disease of unknown aetiology; analgesic intake is rarely denied if asked for specifically.

Acidosis, Renal Tubular↗
PubMed1985

Leucocyte esterase determination as a secondary procedure for urine screening.

The use of a dipstick to detect leucocyte esteraseuria (Chemstrip L) was compared with the visualisation of leucocytes in a Gram stained smear for the detection of pyuria. The sensitivity and specificity of the two systems using the predictive value theory were similar. The use of a dual screening procedure (automation plus dipstick) allowed reliable 4 h screening of urine specimens for the detection of urinary tract infections.

Esterases↗
PubMed1980

Tetracycline in nongonococcal urethritis. Comparison of 2 g and 1 g daily for seven days.

In a previous study treatment with minocycline 100 mg orally every day for seven days was as effective for nongonococcal urethritis (NGU) as 200 mg for seven days or 100 or 200 mg for 21 days. In this prospective, randomised study men with NGU received tetracycline either 500 mg or 250 mg four times daily for seven days. of 200 men initially enrolled, Chlamydia trachomatis was isolated from 40% and Ureaplasma urealyticum from 48%. Eight of 10 homosexual men compared with 39 (21%) of 190 bisexual or heterosexual men had negative culture results for both C trachomatis and U urealyticum (x2 = 15.5, P < 0.0005). U urealyticum was isolated more frequently from chlamydia-negative men and from men with 10 or fewer sex partners during their lifetime. Both regimens were equally effective in their in-vivo activity against C trachomatis and U urealyticum. Failure rates were similar with the two regimens. More obvious failure with purulent or profuse mucoid discharge and pyuria occurred more frequently with the 250-mg regimen (20% of 76 men on the 250-mg regimen compared with 7% of 67 men on the 500-mg regimen; x2 = 4.45, P < 0.05). Failure occurred more frequently in men who were initially chlamydia-negative and in men in whom U urealyticum persisted after medication. Thus, the 250-mg regimen appeared to be as effective as the 500-mg regimen in the initial treatment of NGU. However, one-third of men had persistent or recurrent urethritis with these regimens, and there is a need for antimicrobial agents with greater in-vivo activity, especially against chlamydia-negative NGU.

Chlamydia trachomatis↗
PubMed1989

Antibiotics and nephrostomy tube care: preliminary observations. Part I. Bacteriuria.

The authors sought to establish whether bacteriuria or candiduria would develop in patients with a noninfected, obstructed renal collecting system after placement of a percutaneous nephrostomy tube. Tubes were placed in 27 sterile systems in 25 patients. Urine was cultured at 7-10-day intervals, and urinalysis was performed. Bacteriuria and pyuria were defined on the basis of laboratory values of greater than or equal to 10(4) colony-forming units per milliliter and greater than or equal to five white blood cells per high-powered field, respectively. Twenty-two systems were followed until all demonstrated multiple organisms. No clinical symptoms were related to bacteriuria.

Adult↗
PubMed2000

Outcome of augmentation sigmoidocystoplasty in children with neurogenic bladder.

PURPOSE: The role of augmentation cystoplasty in the neuropathic bladder has been well determined since clean intermittent self-catheterization (CISC) has been accepted as a treatment modality in voiding dysfunction. We present our clinical experience with sigmoid augmentation cystoplasty in children with neurogenic bladder disorder. MATERIAL AND METHODS: From 1991 to 1997 sigmoid augmentation cystoplasty with modified clam technique was performed in 18 cases with neuropathic bladder pathologies. In 4 cases, ureteroneocystostomy was performed, 2 of whom were bilateral. Age range of these patients was 5-17 years (mean 10.3 years) and follow-up period was from 16 to 70 months (mean 41 months). RESULTS: Pyuria was detected in 10 cases and 2 of them were symptomatic. Clinical acidosis was detected in only 1 case. Fifteen cases (83%) were continent by using CISC with 4-6 hourly and detrusor pressure lower than 30 cm water at maximal bladder capacity. CONCLUSION: In children with neurogenic bladder pathologies refractory to conservative management, augmentation cystoplasty with CISC is an effective treatment modality in protecting the upper urinary tract and preventing incontinence.

Adolescent↗
PubMed1986

Mortality in relation to urinary characteristics in the very aged.

The value of urinary characteristics observed in a health survey of people aged 85 years or more was studied in a 5-year follow-up. Of the 561 aged people participating in the initial survey, 167 (30%) were alive after 5 years. Hematuria, pyuria, and albuminuria were associated with high mortality; urinary acidity was associated with low mortality. Positive bacterial staining, glucosuria, and specific gravity of urine were not related to the survival rate. Contrary to earlier observations, bacteriuria found in the urinary bacterial culture did not have any prognostic significance in respect of survival during the follow-up period. Judging from the results, the medical treatment of asymptomatic bacteriuria, with the aim of reducing the mortality of the very aged, appears to be unwarranted.

Aged↗
PubMed1984

Hypercalciuria in clinical pediatrics. A review.

Idiopathic hypercalciuria is a cause of a variety of urinary tract complaints in clinical pediatrics. These include gross or microscopic hematuria, enuresis, urinary frequency or urgency, dysuria, sterile pyuria, and proteinuria in addition to renal calculi. A random urine calcium-creatinine concentration ratio can be used to initially screen for hypercalciuria. Patients with indeterminate results should have the test repeated, while those with abnormal values should receive a complete metabolic workup to determine the cause of hypercalciuria. Identifiable causes of hypercalciuria should be treated specifically, and thiazide diuretics are the preferred treatment for uncomplicated renal calculi. Pharmacotherapy in children with idiopathic hypercalciuria and symptomatology other than renal stones is controversial and should be limited to patients with severe clinical manifestations.

Adolescent↗
PubMed1980

Acute abdominal pain in children.

During a twelve-month period, 416 children with acute abdominal pain required emergency admission to Southampton General Hospital; 46% had operations. Appendicitis was the commonest organic cause of acute abdominal pain identified (31%). Constipation (9%) can present as acute abdominal pain simulating appendicitis. All children should have a urine sample examined microscopically and the finding of significant pyuria is suggestive, but not diagnostic, of a urinary tract infection (7%). Mesenteric adenitis, which can only be diagnosed with certainty at laparotomy, was less common (4%). Despite careful clinical assessment and follow up, 45% of children in this series remained undiagnosed. Sedation but not analgesia may assist in the diagnosis of the acute abdomen in children.

Abdomen, Acute↗
PubMed1999

The validity of the uriscreen test for early detection of urinary tract infection in children.

OBJECTIVE: To determine the validity of the Uriscreen, a rapid diagnostic test based on the detection of urine catalase for the early detection of urinary tract infection (UTI) in children, compared with standard urinalysis and dipstick tests. STUDY DESIGN. Cross-sectional study. STUDY POPULATION: Children 1 month to 17 years of age who presented to the emergency department of a pediatric tertiary care center between March and November of 1996 with symptoms suggestive of UTI. METHODS: Urine specimens obtained from a random sample of 121 patients were evaluated simultaneously for possible UTI by Uriscreen (catalase test), urinalysis (microscopic pyuria), dipstick (leukocyte esterase and nitrite), and quantitative urine culture. All specimens were collected by one of three sterile techniques (midstream void technique, bladder catheterization, or suprapubic aspiration), as appropriate for age, and tested immediately. Using the quantitative urine culture as the gold standard (reference test), the sensitivity, specificity, and positive and negative predictive values of all the screening tests were determined and compared. Age, sex, temperature, presenting symptoms, and method of urine collection were recorded for each participant. RESULTS: Of the 121 patients, 35 (28.9%) had positive culture results: 30 girls (85.7%) and 5 boys (14.3%). Compared with urinalysis and dipstick tests, Uriscreen had the highest sensitivity (100% vs 88.6% and 97.1%, respectively) and the highest negative predictive value (100% vs 95% and 98.6%, respectively), but the poorest specificity (68.6% vs 88.4% and 82.5%, respectively) and positive predictive value (56.4% vs 75.6% and 69.4%, respectively). CONCLUSIONS: The clinical use of Uriscreen for the presumptive diagnosis of UTI in children is limited and not significantly superior to urinalysis or the dipstick test. However, because of its 100% sensitivity and negative predictive value and its ease of use, rapidity, and low cost, it is recommended highly for ruling out the diagnosis of UTI. In laboratories, a negative Uriscreen result may prevent the need for performing expensive urine cultures.

Bacteriuria↗
PubMed1996

[A boy highly suspected of hypersensitivity pneumonitis characterized by generalized mucosal lesions].

The case is a boy who developed progressive dyspnea and had since been followed over a long period time as a case of unknown fever without respiratory symptoms. He showed mucosal symptoms such as intraoral aphtha, eosinophilic pyuria and diarrhea and was clinically diagnosed as hypersensitivity pneumonitis. The affected child showed high levels of circulating immune complex, a decline in DLco on the respiratory function test and a decrease in CD 4/8 in bronchoalveolar lavage lymphocytes; furthermore, an antibody specific to Aureobasidium pullulans was positive in the precipitated antibody test. As for the immune function of the affected child during the follow-up, hypergammaglobulinemia and various immune abnormalities were observed. We thought the clinical feature of the affected child to be of pathophysiological value in dealing with unknown fever in childhood, so we reported our findings in this paper.

Alveolitis, Extrinsic Allergic↗
PubMed1985

Management of acute dysuria. A decision-analysis model of alternative strategies.

A decision-analysis model was developed to estimate the effects and costs of alternative initial management strategies for women presenting with dysuria and pyuria. We compared days of morbidity and direct medical costs associated with single-dose and multiple-dose regimens of amoxicillin and trimethoprim-sulfamethoxazole and examined the cost-effectiveness of doing an initial urine culture. We used varying assumptions for prevalence of etiologic agents, treatment efficacy, frequency of side effects, and duration of symptoms. Single-dose regimens were preferable to multiple-dose regimens of either drug, and trimethoprim-sulfamethoxazole was preferable to amoxicillin. Single-dose trimethoprim-sulfamethoxazole therapy resulted in the fewest expected symptom-days (2.7) and the lowest expected cost (+54). The advantage of single-dose strategies in minimizing expected symptom-days resulted largely from the threefold to fourfold increase in the incidence of side effects reported with multiple-dose therapy. Obtaining an initial urine culture in all patients reduced expected symptom-days by about 10% but increased expected cost by about 40%.

Adult↗