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PubMed1987

Long-term catheter-associated bacteriuria: species at low concentration.

Polymicrobial bacteriuria in patients with long-term (greater than or equal to 30 days) indwelling urethral catheters is common and is associated with potentially serious acute and long-term complications. The dynamics of organisms at low concentration (less than 10(5) cfu/mL) in this setting has not been well-characterized; however, in patients with short-term catheters organisms initially present at low concentration (less than 10(5) cfu/mL) usually grow to high concentration (greater than or equal to 10(5) cfu/mL). At the time of catheter replacement for 7 long-term catheterized patients who were not receiving antibiotics, we identified all species at greater than or equal to 10(2) cfu/mL in fresh urine aspirated from the old indwelling catheter and the new sterile replacement catheter and then determined which of these species were present at high concentration two weeks later. A total of thirty-seven species, nineteen at high and eighteen at low concentration were detected in either the old or the new catheters. Eighteen of the nineteen initially detected at high concentration but only one of the eighteen initially detected at low concentration (p less than 0.001) were present at high concentration two weeks later. In patients with long-term indwelling urethral catheters, the number and multiplicity of species causing bacteriuria at low concentration rival that of species at high concentration; however, species at low concentration usually do not grow to high concentration in the presence of other species at high concentration.

Bacteriuria↗
PubMed1990

A comparison of the effect of chlorhexidine antisepsis, soap and antibiotics on bacteriuria, perineal colonization and environmental contamination in spinally injured patients.

The effect of chlorhexidine antisepsis on bacteriuria, perineal colonization by coliforms and environmental contamination by these organisms was investigated in spinally injured patients treated by intermittent catheterization. Patients were body washed daily in chlorhexidine and chlorhexidine cream was applied to the glans penis after each catheterization. Urine cultures were obtained each day. A statistically significant reduction in bacteriuria was achieved by antisepsis in male patients not receiving antibiotics, from 74% of urine cultures in patients receiving soap to 60% with antisepsis (P less than 0.01). No effect of antisepsis was found on perineal coliform colonization, nor on contamination of bed sheets or the environment by these organisms. There was a significant reduction in perineal coliforms by antibiotics.

Anti-Bacterial Agents↗
PubMed1993

Nosocomial catheter-associated bacteriuria: a clinical trial comparing two closed urinary drainage systems.

We compared the time of onset and incidence of nosocomial bacteriuria between two different closed urinary drainage systems: a simple closed drainage system containing an antireflux valve ('Urias A-4') and a complex closed drainage system ('Curity Infection Control System') incorporating: (1) a preconnected, coated catheter, (2) a tamper discouraging seal at the catheter-drainage tubing junction, (3) a drip chamber, (4) an antireflux valve, (5) a hydrophobic drainage bag vent and (6) a povidone-iodine releasing cartridge in line with the outlet tube of the urine collection bag. 181 non-bacteriuric patients, requiring catheter drainage for more than 48 h, were assigned by chance to either of the two systems. Bacteriological monitoring of bladder urines of the enrolled patients was performed every 24 h by establishing viable counts and identification of all microorganisms. No differences in the onset and incidence of nosocomial bacteriuria between the two urine drainage system groups were noted. We conclude that additional complex features aimed at preventing intraluminal spread of bacteria did not reduce the risk of urinary tract infection, compared to a simple closed urinary drainage system.

Adult↗
PubMed1995

Analysis of bacteriuria in patients with burns.

A detailed analysis of bacteriuria in 148 aged patients with burns was made for a period of 2 years (1991-92), in order to determine the incidence of the urine infections they sustained, the sources and mechanisms of the infections and the impact on the course and outcome of the primary disease. Urine infection was found in 7.6 per cent (46 patients) of all patients treated for burns during the study period; 39.1 per cent were community acquired uroinfection (CAU) and 60.9 per cent were hospital acquired (HAU). In addition there were eight patients with bacteriuria, secondary to a generalized bacterial infection (GBI), and 11 with candiduria associated with massive antibacterial therapy. Leading causes of CAU were the common uropathogens: E. coli, Citrobacter and Proteus sp.; those of HAU were multiresistant hospital strains, characteristic of the Burns Clinic: Pseud. aeruginosa, Klebsiella sp., Acinetobacter sp. and Serratia sp. This study confirmed the role of transurethral catheterizations as factors associated with the development or exacerbation of chronic uroinfections, which increased the chances of non-survival, especially in aged people with concomitant chronic urological, nephrological or other underlying diseases. The causes of death in 20 patients with HAU, CAU, GBI and candiduria were analysed. The need for strict monitoring of burned patients at risk for uroinfection development and the need to take urgent preventive measures is emphasized.

Adult↗
PubMed1984

Evaluation of a rapid bacteriuria screening instrument.

A newly modified, semiautomated instrument (Bacteriuria detection device (BDD] designed to detect the presence of bacteriuria in less than 3 min was compared to quantitative urine culture plating techniques. The instrument consists of a self-enclosed vacuum-filtration-staining system in which a 1-ml urine filtrate is stained on a filter. The resulting color determines the quantitation. Of the total of 525 clinical urine specimens tested, 66 (12.6%) were uninterpretable due to pigment deposition or inability to complete the filtering process (clogging of the filter). Of the remaining 459 specimens, 93 (20.3%) had a plate quantitation colony count of 10(5) colony-forming units (CFU)/ml or more. The BDD detected 94.2% of these positive specimens if only significant pathogens were included (85% if specimens that were probably contaminated were also included). For specimens containing significant pathogens at 10(4)-10(5) CFU/ml, the BDD detection rate was 41%. The device detected most (94.3%) gram-negative bacilli and enterococci at colony counts of 10(5) CFU/ml or more. In addition, the BDD accurately detected 95.6% of specimens with no growth or fewer than 10(4) CFU/ml. With several proposed modifications, these results suggest that this instrument is potentially useful as a urine screening device in a select population.

Bacteriological Techniques↗
PubMed1984

Rapid screening of urine for significant bacteriuria by Gram stain, acridine orange stain, and the Autobac MTS system.

Urine specimens submitted for microbiologic examination were screened for evidence of bacteriuria by three rapid methods: Gram staining, acridine orange staining, and the Autobac MTS system. The screening results were compared with those obtained by semiquantitative colony counts on agar plates. In this comparative study 1055 urine specimens were examined, of which 146 (13.8%) had colony counts of greater than or equal to 1 X 10(5)/ml. All three urine screening methods detected this level of bacteriuria at a sensitivity of 98% and a specificity of 55.2% (acridine orange), 66.0% (Gram stain), and 83.2% (Autobac), respectively. Of the 1055 urine specimens examined, 185 (17.5%) had colony counts of greater than or equal to 1 X 10(4)/ml, at which level the sensitivity of the three methods was 93% and the specificity was 56.7% (acridine orange), 68.0% (Gram stain), and 86.0% (Autobac), respectively. For any level of sensitivity, the Autobac urine screen was shown to be more specific than either the Gram stain or the acridine orange method. The acridine orange stain was the least specific urine screen, especially at the upper limits of sensitivity.

Acridine Orange↗
PubMed1993

A comparison of the API Uriscreen with the Vitek Urine Identification-3 and the leukocyte esterase or nitrite strip as a screening test for bacteriuria.

The API Uriscreen is a rapid urine-screening test based on the detection of catalase activity present in somatic cells and in many of the bacteria commonly causing urinary tract infections. Of 487 routine, outpatient urine specimens processed by conventional quantitative culture, API Uriscreen, Vitek UID-3 panel, and a leukocyte esterase-nitrite strip, 142 had no growth. Of 336 urine specimens with > or = 10(3) colony-forming units (CFU)/ml, 79 were considered to be indicative of possible or probable urinary tract infection (Cumitech 2A). The sensitivity and specificity of the API Uriscreen for the detection of bacteriuria at > or = 10(5) CFU/ml were 62% and 85%, those of the leukocyte esterase-nitrite strip was 61% and 82%, those of the Vitek UID-3 panel were 91% and 66%. When bacteriurias were classified into possibly or probably indicative of urinary tract infection, the sensitivity and specificity of the API Uriscreen at > or = 10(5) CFU/ml were 87% and 78%, those of the leukocyte esterase-nitrite were 84% and 76%, those of the Vitek UID-3 were 93% and 55%. In this study, we consider the API Uriscreen did not have significant advantages over the leukocyte esterase-nitrite strip.

Bacteria↗
PubMed2006

The microbiology of bacteriuria in men: a 5-year study at a Veterans' Affairs hospital.

Bacteriuria and urinary tract infection occur relatively frequently in older men, but data regarding the causative microorganisms are limited. We retrospectively identified all positive cultures of urine specimens (n = 4943) obtained over a 5-year period at our institution. We determined the frequency of causative microorganisms and grouped these by Gram type, setting of patient care, and method of urine specimen collection. We also assessed the performance characteristics of the Gram-stained smear of uncentrifuged urine. Among our patients, Gram-positive cocci (GPC) were isolated as often as Gram-negative rods (GNR). Escherichia coli was the single or predominant isolate in only 14% of cases, and Enterococcus was the single most commonly identified genus (22.5%). The Gram stain was accurate in predicting the culture results (positive likelihood ratio, 7.0 for GPC and 8.1 for GNR). We conclude that the microorganisms causing bacteriuria in older male veterans are substantially different from those found in women, and the Gram-stained smear provides useful information on the causative organisms.

Aged↗
PubMed2006

Mucosal host responses to bacteriuria in colonic and ileal neobladders.

OBJECTIVE: To study the local host response in patients with colonic and ileal neobladders, with or without bacteriuria. METHODS: Twenty-three patients with colonic neobladders and 19 with ileal neobladders were included. Eleven radical prostatectomy patients and seven healthy male volunteers were used as controls. Six urine samples were obtained from all patients and controls over a six-month period. The samples were cultured semiquantitatively, and the number of neutrophils and concentrations of the inflammatory mediators interleukin 6 and 8 (IL-6, IL-8) in the urine were determined. RESULTS: The prostatectomy patients and healthy volunteers had sterile urine, and concentrations of IL-6 and IL-8 were below the detection limit. Most (>70%) of the urine samples from patients with colonic and ileal neobladders showed anaerobic or aerobic bacterial growth, and uropathogens were identified in about 45% of the samples. The local host response was minimal or undetectable in the sterile urine samples. However, the host response was markedly induced by uropathogenic strains in the urine, but not by urinary carriage of nonpathogenic or anaerobic strains. IL-8, but not IL-6, was increased in colonic neobladders, which corresponds to the mucosal host responses in patients with intact lower urinary tracts and asymptomatic bacteriuria. In ileal neobladders, the IL-8 responses were higher, and levels of IL-6 were significantly increased. CONCLUSION: Neobladders exhibit a significant local host response to colonization with bacterial uropathogens. This reaction is more pronounced and includes IL-6 activation in ileal neobladders than in colonic neobladders.

Aged↗
PubMed2004

The role of meatal disinfection in preventing catheter-related bacteriuria in an intensive care unit: a pilot study in Turkey.

The purpose of this study was to investigate the efficacy of antiseptics meatal care in preventing catheter-related urinary tract infections (UTIs) in patients with an indwelling urinary catheter in the intensive care unit of Osmangazi University Medical School. One hundred patients were divided into four groups (25 per group) and treated with once or twice daily application of chlorhexidine gluconate or povidone-iodine. A control group was also studied (N=30). Urine samples were taken weekly and cultures were evaluated quantitatively. Meatal swabs were obtained on the first, fifth, and 10th day and determinated semiquantitatively. UTI was defined as bacteriuria with 10(5)cfu/L. Cultures showing no growth or mixed growths were stated as negative for UTI. UTI developed in 16 patients on days two, three, four, five and seven (including control group). Dominant micro-organisms in the meatal area were found to be Candida species. In nine cases the causative agents of UTI were Candida species. It was therefore decided that the use of antiseptics to clean the periurethral area provides no benefit in decreasing the rate of bacteriuria.

Administration, Topical↗
PubMed1987

Significance of immediate preoperative bacteriuria with pyuria in renal transplant recipients.

The presence of bacteriuria and pyuria on urinalysis immediately before renal transplantation has resulted in cancellation of surgery because of concern about post-transplant wound infection. Of 113 renal transplant recipients reviewed 41 (36 per cent) had 5 or more white blood cells per high power field with bacteria in either a voided urine or bladder washout specimen obtained just before grafting. Of those 41 patients 2 suffered postoperative wound infections. Of 72 patients (64 per cent) with less than 5 white blood cells or no bacteria on a preoperative specimen 1 suffered a wound infection (p not significant by Fisher's exact test). Preoperative urine cultures and operative bladder cultures of all 3 patients failed to yield the organisms found later in the wound infections. The factors of sex, insulin-dependent diabetes, delayed graft function, living related versus cadaver donor and pre-transplant splenectomy had no significant relationship to wound infection rates. Renal transplantation can be performed safely in patients who have pyuria and bacteriuria but no signs or symptoms of infection.

Adult↗
PubMed1986

Rapid bacteriuria screening in a urological setting: clinical use.

The clinical use of a commercially available semiautomated bacteriuria screening device was evaluated in a urological setting. The 1,300 consecutive urine specimens processed by the device were contrasted with results of standard semiquantitative culture. A small number (2 per cent) were screened unsuccessfully owing to a clogged filter. With greater than 10(5) colony-forming units per ml. the sensitivity of the device was 91 per cent but it was only 81 per cent with bacteriuria levels greater than 10(4) colony-forming units per ml. More importantly, the predictive value of a negative test was 99 per cent with more than 10(5) colony-forming units per ml. and 96 per cent with more than 10(4) colony-forming units per ml. This capability promotes safe urological instrumentation and timely patient care.

Bacteriuria↗
PubMed1986

Pyuria: its predictive value of asymptomatic bacteriuria in ambulatory elderly men.

A total of 664 urine samples collected from 254 asymptomatic, ambulatory, elderly men was examined for pyuria with a standardized glass slide microscopy method. The presence or absence of more than 10 polymorphonuclear leukocytes per high power field was highly predictive of the presence or absence of significant bacteriuria, respectively. The determination of pyuria in this select population may be a useful and inexpensive test to screen for bacteriuria.

Aged↗
PubMed1984

Culture of mid catheter urine collected via an open-ended catheter: a reliable guide to bladder bacteriuria.

Colony counts were compared from urine samples obtained by suprapubic aspiration and via a short, wide bore, open-ended urethral catheter. We studied 30 female patients in whom suprapubic aspiration of bladder urine was necessary to confirm the presence of bacteriuria with conventional or fastidious organisms. Catheterization was done immediately following suprapubic aspiration. Culture results of mid catheter urine specimens were similar to those from suprapubic aspiration urine specimens in 27 of 30 patients, a result considerably superior to that obtained with a conventional side-hole catheter. We conclude that a short, wide bore, open-ended catheter should be used to obtain urine specimens from female patients. Results confirm catheter specimens to be a satisfactory alternative to bladder aspiration of urine for detection of bacteriuria caused by fastidious micro-organisms or in patients with low numbers of conventional urinary tract pathogens.

Bacteriuria↗
PubMed1979

Bacteriuria with intestinal loop urinary diversion in children.

Bacteriuria and intestinal loop urinary diversion with open (refluxing) ureterointestinal anastomoses did not prevent normal renal and body growth in 44 children, who were followed for 55.2 months. A comparison of the long-term use of sulfamethoxazole and nitrofurantoin with no treatment showed no statistically significant changes in the stoma, loop residual, renal function, serum electrolytes and treatment or prevention of bacteriuria.

Adolescent↗
PubMed1977

Anaerobic bacteriuria in a male urologic outpatient population.

We screened 517 urine samples from male outpatients, many of whom had underlying urinary tract pathology, for anaerobic and aerobic bacteriuria. Of the 153 specimens containing greater than 10(5) bacteria per ml. 20% yielded anaerobes only and an additional 6% revealed mixed anaerobic and aerobic growth. Pyuria was found more frequently in samples containing anaerobic bacteriuria than in those containing no growth but not as frequently as when aerobic bacteria were present. The high counts of anaerobic bacteria in first-voided specimens compared to midstream and post-prostatic massage aliquots suggested a urethral source for most bacteria. However, suprapubic aspiration of bladder urine demonstrated the organism in 2 of 10 patients with high numbers of anaerobes and pyuria in voided samples.

Aerobiosis↗
PubMed1977

Evaluation of a vented drainage system in prevention of bacteriuria.

A vented urinary drainage system was compared to an otherwise identical non-vented system in a prospective, randomized, double-blind study. Among the 316 female patients evaluated there was a significant reduction in the rate of bacteriuria after 10 days using the vented system (66 per cent in the non-vented group versus 26 per cent in the vented group, p less than 0.05), while no significant difference could be demonstrated among the 190 male patients. We used urine hemoglobin as an indicator of mucosal trauma that might predispose to bacteriuria and no significant difference could be shown between the 2 drainage systems.

Adolescent↗
PubMed1976

The controversy of treatment of asymptomatic bacteriuria in non-pregnant women--resolved.

Data derived from longitudinal studies demonstrate that asymptomatic bacteriuria in non-pregnant women without stones or obstructive uropathy is a benign pathological condition. Evidence has accumulated that untreated asymptomatic bacteriuria in otherwise healthy women does not result in hypertension and/or a decline in renal function, and that this condition required neither detection nor antimicrobial therapy.

Bacteriuria↗