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PubMed2000

Which antibiotics are appropriate for treating bacteriuria in pregnancy?

Bacteriuria in pregnancy, with or without clinical symptoms, is frequent. If left untreated, it can in 20-30% of cases lead to acute pyelonephritis, which is a serious threat to the mother and fetus, increasing the risk of preterm labour and low birthweight infants. This paper is a review of the literature concerning antibacterial treatment of bacteriuria in pregnancy. It is crucial to ensure that drugs to be used in pregnancy are safe and effective. Established first-line drugs such as ampicillin (pivampicillin) and amoxycillin, and other commonly used treatments such as trimethoprim-sulphamethoxazole, are associated with a high degree of resistance in Escherichia coli, the most common pathogen in the urinary tract. A recent survey of physicians in Denmark, Finland, Norway and Sweden confirms that beta-lactam antibiotics (particularly pivmecillinam) and nitrofurantoin are the drugs of first choice in the treatment of bacteriuria in pregnancy in the Nordic countries. No teratogenic effects have been associated with these agents. In contrast to nitrofurantoin, pivmecillinam is also efficient against pyelonephritis. In spite of resistance in E. coli and possible adverse effects on the fetus, many physicians still prescribe sulphonamides during the first two trimesters of pregnancy.

Journal Article↗
PubMed1965

THE DETECTION OF SIGNIFICANT BACTERIURIA: AN ASSESSMENT OF THE TRIPHENYLTETRAZOLIUM CHLORIDE REDUCTION TEST.

The degree to which quantitative urine cultures and the triphenyltetrazolium chloride (TTC) reduction test can be correlated can be directly related to the species of organism involved, the actual level of bacterial population in the urine and the presence of antibiotics. The influence of these various factors is discussed and it is concluded that, depending upon the group of patients involved, the TTC test will detect 70-90% of cases of significant bacteriuria. The TTC test would appear to be a useful screening procedure in the surveillance of large outpatient populations and in the detection of bacteriuria during pregnancy, considering the difficulty of applying the technique of complete quantitative culture to these groups.

Anti-Bacterial Agents↗
PubMed1976

Home culturing program for children with recurrent bacteriuria.

One hundred forty-one children were selected from a clinic for children with recurrent bacteriuria to participate in a home culturing program. The parent was taught to employ a semiquantitative method to test the child's urine for bacteria. The degree and persistence of bacteriuria as detected by the parent strongly correlated with results obtained in the clinic, although there was a significant incidence of false-positive results as detected by the parent. Home culturing proved to be an inexpensive, reliable technique for following up children with recurrent urinary tract infections.

Bacteria↗
PubMed1978

Home-testing for recurrent bacteriuria, using nitrite strips.

Follow-up of children with recurrent urinary infections would be simplified by an accurate home-testing program for detection of infection. We provided nitrite test strips to the parents of 30 girls with recurrent urinary infection to determine if twice weekly home testing of first-voided urine could reliably detect infection. Infections were documented by dip slides or colony counts indicating more than 10(5) bacteria per milliliter of urine. Twenty-four families (80%) complied over a mean study period of 11 months, detecting 28 of 30 episodes of bacteriuria (93%). No false-positive tests occurred. Urinary nitrate, the substrate for nitrite production by bacteria, was universally present (greater than 100 microgram/ml) in 80 children. The nitrite test is useful for home follow-up observation of children at high risk of bacteriuria if applied repeatedly by motivated parents.

Adolescent↗
PubMed1989

Bacteriuria testing by the ATP method as an integral part in the diagnosis and therapy of urinary tract infection (UTI).

Rapid tests for bacteriuria have the highest value, if the test result is available while the patient is with the doctor. At the bacteriological laboratory rapid testing of samples obtained by mail may be cost-effective but is of little clinical value. In a previous study performed at a health care centre using conventional urine culture as a reference the ATP test came out as the most reliable one among several rapid bacteriuria tests. The present study was performed to see how the ATP test could be fitted into the routine of the health care centre. Female patients with UTI symptoms were asked to deliver a urine sample to the health care centre laboratory and to wait for the result before seeing the doctor. After having the symptoms confirmed the doctor based the diagnosis on the ATP value. A low ATP value ruled out UTI and a high ATP value confirmed UTI. In patients with an intermediary ATP value (10-50 nmol/l) a positive nitrite test was used to confirm UTI. Only those patients with intermediary ATP values and negative nitrite test had to wait for conventional urine culture. Thus in most patients the decision on antibiotic therapy or not was based on clinical symptoms and ATP results only. Antibiotics (trimethoprim) were given as single dose or as a conventional 7-day regime in a double-blind comparison. The correlation between the ATP method and conventional culture was good.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1985

Prevalence of asymptomatic bacteriuria and comparison between different screening methods for its detection in infants.

Urine was cultured from 441 healthy children, aged 3 to 36 months, simultaneously by standard pour plating and by dip-slide. Significant bacteriuria (greater than or equal to 10(5) colony-forming units/ml in two successive specimens) was found in 13 children (2.9%): 11 boys, 2 girls. Proteus mirabilis was the most frequently isolated organism. Of the 13 infants, 2 had malformations on intravenous pyelography. All 13 had a negative antibody-coated bacteria test. Nitrite test (N-Multistix) and microscopic examination were also performed. The results suggest that asymptomatic bacteriuria cannot be accurately predicted either by microscopic examination or by the nitrite test, and that the quantitative urine culture by dip-slide is the easiest and most reliable way of diagnosing urinary tract infections. However the criteria of Kass were found to be too strict.

Antibody-Coated Bacteria Test, Urinary↗
PubMed1992

Periurethral colonization and urinary leukocytes as markers for bacteriuria in children with neurogenic bladder.

Bacteriuria and associated renal damage is common in children with a neurogenic bladder, but the pathogenesis of urinary tract infection (UTI) is undefined. We examined the association between periurethral bacterial colonization and the presence of urinary leukocytes in 76 catheter urine specimens from children with neurogenic bladders. Although all the children were asymptomatic, 38/76 (50%) of the urine cultures were positive. Periurethral colonization was significantly more common with positive than with negative urine cultures, suggesting a pathogenetic role for periurethral bacteria in infection of the neurogenic bladder. Urinary leukocytes were present in 24/38 (63%) with positive cultures, as against none (0/38) of those with negative urine cultures, and their presence represents a host response to bladder bacteriuria.

Bacteriuria↗
PubMed1993

Two rapid urine screens for detection of bacteriuria: an evaluation.

Five hundred twenty-five random clean catch urine specimens, collected from 339 adult females, 137 adult males, and 49 pediatric patients, were screened for the presence of bacteriuria with the Uriscreen catalase test and with the Chemstrip 2 LN dipstick. Quantitative cultures were performed on all specimens. The sensitivity, specificity, positive predictive value, and negative predictive value for the catalase test, with 10(5) CFU/ml as the threshold for significant bacteriuria, were 91.3%, 72.3%, 33.7%, and 98.0%, respectively. Values for the dipstick were 83.9%, 77.9%, 43.7%, and 96.0%. When 10(4) CFU/ml was used as the threshold, the catalase test had a sensitivity of 89.2%, specificity of 70.4%, positive predictive value of 37.3%, and a negative predictive value of 97.0%. Values for the dipstick at that level were 82.3%, 77.5%, 48.6%, and 94.8%. While the catalase test was more sensitive than the dipstick, it was our opinion that high rates of false-negatives associated with these methods negated the convenience of these fast and simple urine screens.

Bacteriuria↗
PubMedDate not supplied

Rapid screening for bacteriuria in pregnancy.

We evaluated a bioluminescence assay as a screening test for the detection of bacteriuria in pregnancy. A total of 1,000 urine specimens from a randomly selected group of pregnant women undergoing prenatal surveillance was investigated. Sequential dilution of urine specimens on CLED agar plates served as a reference method. Set against the reference group, bioluminescence screening scored a 93% sensitivity, a 78% specificity and a 99% predictive accuracy for negative results. All urine specimens were also analysed chemically for the presence of nitrite and leucocyte esterase by dip sticks. Dip sticks proved to be insufficient because of poor sensitivities of 54% and 59%, respectively. The bioluminescence assay is an effective, time- as well as labor-saving but questionably cost-effective method for the detection of bacteriuria in pregnancy.

Adenosine Triphosphate↗
PubMed1982

Evaluation of a commercially available semi-automated bioluminescence system for bacteriuria screening.

A commercially available semi-automated bioluminescence adenosine triphosphate assay system for rapid detection of significant bacteriuria was evaluated. Excellent reproducibility of results using the bioluminescence apparatus was noted, and there was no bacterial carry-over using a pre-diluter. The results obtained with 2,000 urine specimens tested by bioluminescence and a routine cultural technique were compared. The bioluminescence system gave no false negative results and a bioluminescence positive/culture negative finding of 13.6% in general specimens and 45.0% in ante-natal and maternity specimens. In the latter group, the majority of urines yielded growth of lactobacilli and/or diphtheroids (less than 10(4) organisms/ml) when subcultured on enriched media. Results indicated that bioluminescence may identify urinary tract infections in patients receiving antimicrobial therapy. The advantages of this 45 minute technique for bacteriuria screening are presented.

Adenosine Triphosphate↗
PubMedDate not supplied

Detection of pyuria and bacteriuria in symptomatic ambulatory women.

OBJECTIVE: To compare the abilities of two methods for rapid detection of pyuria and three methods of urinalysis to predict significant bacteriuria in symptomatic ambulatory women. DESIGN: Prospective simultaneous comparison of the results of dipstick urinalysis, standard microscopic urinalysis, and hemocytometric cell counting and Gram staining with the results of a standard urine culture. SETTING: Two outpatient ambulatory care facilities serving predominantly minority and uninsured individuals. SELECTION CRITERIA: Nonpregnant women presenting with symptoms of urinary tract infection without symptoms of vaginal infection. MEASUREMENTS AND MAIN RESULTS: 105 women with symptoms were evaluated. The sensitivities of the dipstick urinalysis and the microscopic urinalysis in predicting pyuria as defined by hemocytometry were 0.76 and 0.77, respectively, and their specificities were 0.94 and 0.97, respectively. The sensitivities and specificities of the three methods of urinalysis in predicting greater than or equal to 10(4) colony-forming units (CFU)/mm3 in a urine culture were 0.88 and 0.70 for the leukocyte esterase-nitrite dipstick urinalysis, 0.98 and 0.68 for the standard microscopic urinalysis, and 1.00 and 0.49 for the Gram staining and hemocytometric cell counting. CONCLUSIONS: The standard urinalysis was the most accurate single method to predict significant bacteriuria in symptomatic ambulatory women. Sequencing the dipstick urinalysis with the standard urinalysis may be a cost-effective approach to evaluating these patients in clinical practice.

Adolescent↗
PubMed2006

There is a low incidence of recurrent bacteriuria in painful bladder syndrome/interstitial cystitis patients followed longitudinally.

The objective of this paper was to establish whether patients with confirmed painful bladder syndrome/interstitial cystitis (PBS/IC) presenting with symptoms of UTI have actual bacteriuria vs a flare of their PBS/IC symptoms. One hundred and six (n = 106) consecutive female patients (mean age 39.8 +/- 14 years) with newly diagnosed IC were identified and followed longitudinally for 24 months. At the initial visit and at all subsequent visits, urinary specimens were obtained by sterile catheterization (Bard 14Fr female) and cultured for bacteria. Eight patients had an initially positive urine culture, and repeat cultures 8 weeks after treatment were all negative. Once sterile urine was established, the diagnosis of PBS/IC was confirmed. A pelvic pain/urgency/frequency (PUF) questionnaire score was obtained from 89 patients. After the diagnosis of PBS/IC, all patients received multimodal treatment. Patients were instructed to present to the office whenever they developed symptoms of UTI, at which time a sterile catheter specimen was obtained and sent for culture. Greater than 10(3) colonies were considered positive. Patients who did not report flares were contacted to establish whether unreported treatments were given. Seventy-two patients (68%) had no UTI episodes or flares. The remaining 34 patients (32%) presented with 54 flares, of which 44 were culture-negative and 10 were culture-positive. A single flare was reported by 21 patients during the 24 months, with three positive cultures (14.3%). Recurrent UTI symptoms (two to four flares) were seen in a small group (n = 13) for a total of 33 flares. Of these, seven had two flares each (12 negative, 2 positive), five had three flares each (12 negative, 3 positive), and one patient had four flares (two negative, two positive). Therefore, within the group with recurrent symptoms, seven positive cultures were obtained for a rate of recurrent bacteriuria of 6.6% (7/106). Nine of the 10 positive bacterial cultures were due to gram-negative bacteria: Escherichia coli (n = 6), Proteus mirabilis (n = 1), Klebsiella pneumonia (n = 1), and Citrobacter sp. (n = 1). One grew Streptococcus sp. There was no difference between the flare group and nonflares in regards to age or PUF scores between groups. This study is the first to report on the low incidence of confirmed UTIs in a large group of PBS/IC patients followed longitudinally. These data suggest that only a small number of PBS/IC patients with UTI symptoms have positive urine cultures (9.4%; 10/106). Although the symptoms of recurrent UTI are prevalent in IC patients, the incidence of confirmed recurrent UTIs is only 6.6%. Because the flares of IC are usually self-limiting, treatment response to antibiotics may be misleading in light of the low incidence of positive urine cultures. These data suggest that the symptom flares of IC are not usually associated with recurrent UTI and, therefore, are likely due to a triggering of the other painful mechanisms involved in IC patients who are culture-negative.

Adult↗
PubMed2006

Is single-dose fosfomycin trometamol a good alternative for asymptomatic bacteriuria in the second trimesterof pregnancy?

Untreated asymptomatic bacteriuria has been associated with acute pyelonephritis, which may have a role in many maternal and fetal complications. Acute pyelonephritis in pregnancy is related to anemia, septicemia, transient renal dysfunction, and pulmonary insufficiency. A randomized study was conducted to assess the clinical and microbiological efficacy of a single dose of fosfomycin trometamol for the treatment of asymptomatic bacteriuria in the second trimester of pregnancy compared with a 5-day regimen of cefuroxime axetyl. Forty-four women received fosfomycin trometamol and 40 women received cefuroxime axetyl. There were no statistically significant differences between both groups regarding the mean age and mean duration of pregnancy. Therapeutic success was achieved in 93.2% of the patients treated with fosfomycin trometamol vs 95% of those treated with cefuroxime axetyl. A single dose of fosfomycin trometamol is a safe and effective alternative in the treatment of asymptomatic urinary tract infections in the second trimester of pregnancy.

Adult↗
PubMed2004

Bladder, bowel and bugs--bacteriuria in patients with intestinal urinary diversion.

The incorporation of intestinal segments into the urinary tract favors bacterial growth of the skin flora, anaerobic bacteria, and uropathogenic strains. The route of infection is ascending; bacteria enter the urethra or the abdominal stoma, which is followed by colonization of the reconstructed lower urinary tract. Bacteriuria is common in all kind of reconstructions; however, urine from neobladder patients with complete emptying is reported to carry bacteria to a lesser extent. Clean intermittent catheterization and residual urine seem to increase the bacterial burden. Patients with augmentation cystoplasties constitute a distinct subgroup in which the remaining part of the bladder tissue is an important determinant of urinary tract susceptibility to infection. The increased rate of bacteriuria in the reconstructed patients indicates a lack of "antibacterial defenses", and the symptom free state of the patients suggests that only a restricted host response is triggered. The role of the specific and inflammatory antibacterial defenses in the reconstructed lower urinary tract remains largely unknown.

Antibiotic Prophylaxis↗
PubMed1996

Uriscreen, a rapid enzymatic urine screening test: useful predictor of significant bacteriuria in pregnancy.

OBJECTIVE: To establish the reliability of a new rapid enzymatic screening test, the Uriscreen, in the detection of significant bacteriuria in pregnancy. METHODS: During a 6-month period, from July 1 to December 30, 1993, 313 consecutive pregnant patients were evaluated. Randomly voided, midstream, clean-catch urine specimens were used. Each sample was tested by routine laboratory culture and four rapid screening tests: the nitrite and leukocyte esterase dipstick, microscopic examination for pyuria, and the Uriscreen test. Results of the four rapid tests were compared with those of the urine culture. RESULTS: Twenty-four women (7.6%) had urine culture results indicating significant bacteriuria. The sensitivity of the nitrite test, the leukocyte esterase test, and a microscopic examination for pyuria was low (37, 52, and 56%, respectively). The Uriscreen test showed very high sensitivity (100%), lower specificity (81%), a high predictive value of negative results (100%), and a low positive predictive value (30%). CONCLUSIONS: The Uriscreen test is a reliable alternative to culture screening of all pregnant patients. A policy of performing a urine culture during pregnancy only on patients with a positive Uriscreen test will save as much as 80% of unnecessary cultures.

Adult↗
PubMed1982

Association of bacteriuria and urinary nitrosamine formation with Schistosoma haematobium infection in the Qalyub area of Egypt.

In Egypt, bladder cancer incidence is high in areas where the prevalence and intensity of Schistosoma haematobium infection is also high. Experimental evidence shows bladder carcinogenesis to be a multi-stage process which can be accelerated by many factors. N-nitroso compounds, some of which are known bladder carcinogens, can be formed from amine precursors and nitrate in urine during some bacterial infections. In experimental animals the growth of nitrosamine-induced urothelial cancers is accelerated by damage to the urothelium caused by S. haematobium infections, and by analogy in man this could account for the lower peak age of incidence of this cancer in Egypt by comparison with Europe. The present study was designed to investigate whether bacterial infection of the urinary tract was common in areas of endemic schistosomiasis and whether N-nitrosamines were regularly found to be associated with bacteriuria. Urine samples from young men in the Qalyub area of Egypt and from an adjacent Delta region were analysed for S. haematobium ova, the nature and intensity of any bacterial infection, nitrate and nitrite, and total N-nitroso compounds plus volatile N-nitrosamines. A relatively high prevalence of bacteriuria was found in young men with schistosomiasis and low levels of N-nitroso compounds were present in all specimens. When the groups were sub-divided on the basis of the ability of their bacterial flora to reduce nitrate to nitrite (the latter is required for the nitrosation of amine precursors to N-nitroso compounds), significantly higher levels of N-nitroso compounds were found in S. haematobium-infected individuals also infected with nitrate-reducing bacteria by comparison either with uninfected controls (p less than 0.0005) or with those infected with non-nitrate-reducing bacteria (p less than 0.001). The results show N-nitroso compounds to be present in the urines of young men in areas of endemic S. haematobium infection in Egypt, and elevated levels of urinary N-nitroso compounds to be associated with infection of the urinary tract by various species of nitrate-reducing bacteria.

Adolescent↗
PubMed1978

Anaerobic bacteriuria in renal transplantation.

Renal allograft recipients were studied prospectively utilizing improved culture techniques to investigate anaerobic bacteriuria. The study population was compared with a population of patients with chronic renal insufficiency and end stage renal disease. The over-all incidence of anaerobic urinary tract infection was 7.5 per cent while the over-all incidence of aerobic urinary tract infection was 23.5 per cent. Patients with cadaver renal transplants during the early postoperative period had the highest incidnece of both anaerobic (42.9 per cent) and aerobic (71.4 per cent) urinary tract infection of all groups. The potential association between significant anaerobic bacteriuria during the first postoperative month and poor prognosis for cadaver renal allografts merits further investigation.

Adolescent↗
PubMed1986

Screening for urinary tract infection using Bac-T-Screen bacteriuria device.

The Bac-T-Screen was used to process 795 urine specimens. Tests for urine specimens took slightly more than two minutes. The Bac-T-Screen predicted with 99 per cent accuracy if a specimen was negative for bacteriuria or pyuria. Thus, approximately one half of all carefully collected urine specimens need no further laboratory culture. In addition, the Bac-T-Screen detected bacteriuria with a sensitivity of 96 per cent at the 10(5) CFU/ml level of probability. Pyuria (1 +) was detected with a sensitivity of 98 per cent. The Bac-T-Screen can be used in an office practice as well as in the clinical laboratory.

Bacteriuria↗