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PubMed1975

Controlled trial of therapy in covert bacteriuria of childhood.

Sixty-three girls with covert bacteriuria were included in a controlled trial of therapy. Recurrent infection in the treated group was common and was not significantly different from the rate of persistent infection in the untreated control group. Two children in each group developed clinical pyelonephritis; the others have remained healthy and all of them have a normal rate of growth. 2 years after diagnosis three of the thirty-four children in the control group and one of twenty-six children in the treated group have radiological evidence of new scars of pyelonephritis. These changes were relatively minor and in both groups of children renal growth was similar to that in normal children. It is suggested that for most of these children therapy is not essential, and that when renal changes occur they are of little or no significance. Prescriptive screening for cobert bacteriuria of childhood cannot be recommended at present.

Ampicillin↗

PubMed1982

Bacteriuria and subsequent mortality in women.

The relation of bacteriuria to subsequent mortality was investigated in population-based cohort data from women living in Jamaica and Wales. Three surveys were done in each location over a 13-year period. Women with 10(5) or more gram-negative bacilli per millilitre of urine in three consecutive cultures over a 3-week span were considered bacteriuric for that survey. Mortality was determined at the second and third surveys. Bacteriuria was associated with increased mortality both in the crude data and in life-table analyses adjusted for the confounding effects of age and weight. The adjusted risk ratio for death between the first and third surveys was 1.5 for women bacteriuric at the first survey compared with non-bacteriuric women. For deaths between the second and third surveys, the adjusted risk ratio was highest (2.0) in women who were bacteriuric at both of the first two surveys. The adjusted risk ratio for death between the second and third surveys for women who were bacteriuric at one of the first two surveys but not at the other was 1.6.

Adolescent↗

PubMed1987

Effect of symptomless bacteriuria in childhood on subsequent pregnancy.

The outcome of 52 pregnancies in 34 women who had had bacteriuria in childhood was compared with that of normal control pregnancies. The prevalence of bacteriuria at the first antenatal visit was significantly higher (p less than 0.001) in previously bacteriuric women (35%) than in controls (5%), and acute pyelonephritis developed in 10% compared with 4% of controls. Pre-eclampsia (arterial pressure above 140/90 mm Hg with proteinuria above ++) developed in 4 of 12 previously bacteriuric women known to have renal scarring (5 of 16 pregnancies), in only 1 of 22 previously bacteriuric women without scars (1 of 36 pregnancies), and in 1 of 52 controls (p less than 0.001). Women with renal scars were also more likely to undergo induction of labour (44% of pregnancies) and operative delivery (57% of pregnancies) than previously bacteriuric mothers without scars (17%, 22%) or control mothers (16%, 20%). The infants of previously bacteriuric mothers were not significantly smaller than those of healthy control mothers, but Apgar scores were lower among offspring of previously bacteriuric mothers with scarred or normal kidneys (p less than 0.001). Fetal outcome was, however, satisfactory in all cases.

Adult↗

PubMed1993

M2 mitochondrial antibodies and urinary rough mutant bacteria in patients with primary biliary cirrhosis and in patients with recurrent bacteriuria.

Primary biliary cirrhosis (PBC) patients have a higher incidence of recurrent urinary tract infection and an increased prevalence of rough forms (mutants) of E. coli in their stool samples than other chronic liver disease patients. PBC patients exhibit autoantibody reactivity against mitochondria, the most common antigen (M2) being a family of antigens with the major components having approximate molecular weights of 74, 56, 52 and 48 kD. Cross-reactivity between M2 antigen components and corresponding antigenic bands of bacteria has been demonstrated with PBC sera. Patients with recurrent urinary tract infections, all of whom had normal liver function and were taking prophylactic antibiotic treatment, had weak anti-mitochondrial antibody (AMA) reactivity (69%), with reactivity against the 74-kD antigen alone being the most common. When antibody to the 74-kD band was eluted, it was found to cross-react with bacterial membrane fractions. In the controls, 12/77 chronic liver disease patients and 2/24 normals possessed AMA. Rough forms of bacteria were found in the urine of patients with significant bacteriuria: 39% PBC, 5.3% chronic liver disease and 41% of the recurrent urinary tract infection group. M2 antibodies may be induced by urinary organisms in 'normal' women with recurrent bacteriuria and in females with PBC.

Autoantibodies↗

PubMed2004

[Antimicrobial susceptibility of Escherichia coli isolated from bacteriurias in Bierzo health area during 2003].

OBJECTIVE: Sensitivity to antibiotics of Escherichia coli isolated from intrahospital and extrahospital bacteriurias is analyzed. MATERIAL AND METHODS: Sensitivity to nineteen antibiotics used in the clinical practice was determined in strains of Escherichia coli isolated from intrahospital and extrahospital bacteriurias. RESULTS: The prevalence of in-vitro susceptibilities to antibiotics were (hospital, state health service clinic, health center-primary-care): imipenem (100%-100%-100%; p=NS), amikacin (100%-100%-99.7%; p=NS), fosfomicyn (98.6%-98.4%-99.6%; p=NS), cefepime (96%-96.9%-98.3%; p=NS), piperacillin-tazobactam (96%-95.3%-96.6%; p=NS), aztreonam (93.5%-94.7%-97.7%; p<0.001), ceftazidime (93.5%-94.3%-97.8%; p<0.001), cefotaxime (93.1%-95%-97.7%; p<0.001), cefixime (92.7%-94.6%-96.7%; p<0.05), nitrofurantoin (92%-94.7%-94.7%; p=NS), cefuroxime (88.4%-93.1%-95%; p<0.001), amoxicillin-clavulanic (87.7%-88.7%-93.8%; p<0.001), tobramicyn (87%-93.7%-93.8%; p<0.001), gentamcin (85.9%-92.8%-93%; p<0.001), cefazolin (84.4%-88.7%-91.6%; p<0.01), ciprofloxacin (63.8%-71.4%-78.4%; p<0.001), norfloxacin (63%-70.8%-78.2%; p<0.001), cotrimoxazole (65.2%-68.6%-74.9%; p<0.01) and ampicillin (35.5%-42.5%-47.8%; p<0.01). (*NS= No significant differences). CONCLUSIONS: The knowledge of the sensitivity of uropathogens to antimicrobians can allow us to initiate empirical therapy of urinary tract infections.

Anti-Bacterial Agents↗

PubMed2003

C-reactive protein in early detection of bacteriemia and bacteriuria after extracorporeal shock wave lithotripsy.

OBJECTIVES: To evaluate the value of plasma C-reactive protein (CRP) levels in early detection of bacteriuria and bacteriemia after extracorporeal shock wave lithotripsy (ESWL) of calcium and infection stones. METHODS: A total of 75 patients who had infection stones (n = 27) and calcium stones (n = 48) were included in the study. All patients had sterile urine before ESWL. The mean age was 41.6 +/- 4.85 and male/female ratio was 2.12. Blood cultures were obtained within 1 hour post-ESWL period. Urine cultures were obtained 3 times just after and on the first and seventh day of ESWL. RESULTS: Post-ESWL evaluations showed 3 positive blood cultures with 2 (2.66%) patients in infection stone and 1 (1.33%) patient in calcium stone groups, whereas urine cultures revealed 6 (8%) positive results in infection stones and 4 (5.33%) in calcium stones. The patients who had positive cultures also had elevated plasma CRP levels when compared to the levels in patients with negative cultures (p = 0.000). CONCLUSIONS: Bacteriuria and bacteriemia after ESWL have been well-identified entities and may be responsible from some of the post-ESWL complications. CRP can be useful for early detection of such complications.

Adult↗

PubMed2002

Pathogenesis of bacteriuria in women with diabetes mellitus.

Women with diabetes mellitus (DM) have asymptomatic bacteriuria (ASB) and symptomatic urinary tract infections (UTIs) more often than women without DM. The increased prevalence of bacteriuria in diabetic patients can be the result of differences in the host responses between diabetic and nondiabetic patients, or a difference in the infecting bacterium itself. We have shown that the increased prevalence of ASB in diabetic women is not the result of a difference in bacteria, because the same number of virulence factors was found in the infecting Escherichia coli (most common causative microorganism of ASB) in our diabetic women with ASB, as listed in the literature for nondiabetic patients with ASB. We found that bacterial growth in vitro was increased after the addition of different glucose concentrations, as found in urine of poorly controlled patients. However, we could not confirm that glucosuria was a risk factor for ASB in vivo. In addition, we demonstrated that women with both DM and ASB have lower urinary cytokine and leukocyte concentrations than women without DM but with ASB. Finally, we found that E. coli expressing type 1 fimbriae (the virulence factor that plays an important role in the pathogenesis of UTIs) adhere better to uroepithelial cells of women with DM compared with the cells of women without DM.

Bacteriuria↗

PubMed1979

[Routine diagnosis of bacteriuria: estimation of urinary sediment or counting blood cells? (author's transl)].

Testing of a method of bacteriuria diagnosis which would be feasible for outpatient routine work and highly reliable while requiring little cost and effort, revealed the clear superiority of examining the uncentrifuged urine in the counting chamber over the sedimentation method. Whereas the accuracy of the sedimentation method in bacteriuria diagnosis is about 50%, the counting chamber method gave correct results in more than 90% of the cases. This entails saving in terms of manhours. The only drawback of the counting chamber method is its higher rate of false-positive findings caused by the fact that the microscopic identification of bacteria enters into the final count. This drawback, however, is more than made up by the reduced amount of material and time involved in this procedure.

Bacteriuria↗

PubMed1975

[The value of suprapubic bladder aspiration in the diagnosis of bacteriuria (author's transl)].

Urine obtained simultaneously by midstream voiding and supra-public bladder aspiration from 500 patients were compared by bacteriological and, in some, microscopic examination. In a second series a similar examination was undertaken on 1000 samples each, obtained by midstream voiding, catheterisation or suprapublic bladder aspiration from different patients. There was no significant difference in sediments or Stansfeld count between midstream and aspirated samples. Qualitative false-positive results for protein were obtained in 20% of midstream samples from women. The Kass count for significant bacteriuria was false-positive in 3.4% of midstream compared with bladder-aspiration samples, in 7.6% for "questionable bacteriuria". Positive counts of under 10(5)/ml were obtained in 41.3%, of under 10(4)/ml in 26.7% of aspirated samples. Counts under 10(4)/ml in midstream-voided samples are usually considered the result of contamination, at times falsely so. "Mixed infections" were 7.8 times more common in catheter and 11.4 to 11.8 times more common in midstream than in aspirated samples. The presence of microorganisms in suprapublic bladder aspiration is always abnormal. Chemotherapy is indicated only on results from bladder aspiration.

Bacteriuria↗

PubMed1984

Urinary tract infection during pregnancy. Asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis.

Urinary tract infection is one of the most common medical complications of pregnancy, occurring in roughly 10% of all pregnancies. The clinical entities most commonly seen are bacteriuria, acute cystitis, and acute pyelonephritis. Relative stasis of urine due to pregnancy-induced changes in the urinary tract is a significant causative factor. Escherichia coli is the most common responsible organism. Patients with untreated or inadequately treated asymptomatic bacteriuria are at high risk for development of acute pyelonephritis, a serious febrile illness that can lead to major maternal and fetal complications. Patients with acute pyelonephritis should be hospitalized and treated aggressively.

Acute Disease↗

PubMed2004

Effect of cranberry extract on bacteriuria and pyuria in persons with neurogenic bladder secondary to spinal cord injury.

OBJECTIVE: To determine whether antibacterial effects of cranberry extract will reduce or eliminate bacteriuria and pyuria in persons with spinal cord injury (SCI). DESIGN: Randomized, double-blind, placebo-controlled study. PARTICIPANTS: Participants were people with SCI residing in the community who were 1 year or longer postinjury with neurogenic bladder managed by intermittent catheterization or external collection device and a baseline urine culture demonstrating at least 10(5) colonies per milliliter of bacteria. METHODS: Each participant ingested 2 g of concentrated cranberry juice or placebo in capsule form daily for 6 months. Baseline urinalysis and cultures were performed at the time of the initial clinic visit and monthly for 6 months. Microbiologic data were evaluated using analysis of variance with repeated measures. RESULTS: Twenty-six persons received cranberry extract and 22 persons received placebo. There were no differences or trends detected between participants and controls with respect to number of urine specimens with bacterial counts of at least 10(4) colonies per milliliter, types and numbers of different bacterial species, numbers of urinary leukocytes, urinary pH, or episodes of symptomatic urinary tract infection. CONCLUSION: Cranberry extract taken in capsule form did not reduce bacteriuria and pyuria in persons with SCI and cannot be recommended as a means to treat these conditions.

Adult↗

PubMed2000

Is a second urine specimen necessary for the diagnosis of asymptomatic bacteriuria?

By use of pulse-field gel electrophoresis, we evaluated the molecular identity of 32 Escherichia coli isolates obtained in 2 consecutive urine cultures from 16 patients as part of a large study of asymptomatic bacteriuria in diabetic women and found different E. coli isolates in 7 of 16 patients, meaning that nearly half (44%) of the patients who had been previously classified as having asymptomatic bacteriuria were reinfected with a different strain.

Bacteriuria↗

PubMed2006

The postoperative bacteriuria score: a new way to predict nosocomial infection after prostate surgery.

OBJECTIVE: Urinary tract infections are the leading nosocomial urologic infections and may be a cause of added morbidity and costs, and sometimes sepsis. The aim of this study was to design a predictive score for these complications after prostate surgery. DESIGN: Multicenter prospective survey. SETTING: Eleven French urology centers. PATIENTS: All patients undergoing transurethral resection of prostate (TURP) during a 3-month period. RESULTS: The overall incidence of postoperative bacteriuria was 25.0% (95% confidence interval, 17.7%-29.5%). Almost all patients (95.7%) received antibiotic prophylaxis. A predictive postoperative bacteriuria score (POBS), with a 6-point scale of 0 to 5, was constructed on the basis of independent risk factors identified in multivariate analysis of a test sample of patients (n=135) and tested in a validation sample (n=73). Significantly more infections occurred in patients with a POBS of 2 or higher (87 [8%] vs 48 [50%]; P<.0001). With the test sample, this yielded a sensitivity of 77%, a specificity of 77%, a positive predictive value of 50%, a negative predictive value of 92%, and a global accuracy of 77%. CONCLUSIONS: POBS could be used to distinguish patients at risk of developing infection after TURP. This information might be useful for implementing selective prevention measures or for adjustment for differences in nosocomial infection rates when comparing data between urology centers.

Aged↗

PubMed1993

Incidence of bacteremia and bacteriuria in patients with non-infection-related urinary stones undergoing extracorporeal shock wave lithotripsy.

In a prospective pilot study, 26 patients with non-infection-related renal or ureteric stones and sterile urine were examined for evidence of bacteriuria and bacteremia following extracorporeal shock wave lithotripsy (SWL). Blood samples were obtained for aerobic and anaerobic bacterial culture at the end of, and 1 hour after, the SWL procedure. Urine cultures were performed 24 hours before and after treatment. Bacteremia was recorded in 7.7% of the patients immediately after SWL but in no patient at 1 hour after treatment. None of the patients manifested significant bacteriuria or post-SWL fever. These findings support the contention that, provided the urine is sterile and a negative history of urosepsis is available, antibiotic prophylaxis is unnecessary in patients with non-infected renal stones submitted to SWL treatment.

Adolescent↗

PubMed1982

Turnover of bacteriuria in old age.

Among 352 residents of a home for the elderly, who were fully mobile and devoid of most predisposing factors for bacteriuria, 19% of men and 27% of women had two positive cultures within two months. Positive conversion at one year among men and women negative at entry was 11% and 23% respectively, negative conversion of bacteriurics 22% and 27%. Subjects bacteriuric at entry but sterile at six months had a 77% (men) and 44% (women) reinfection rate at 12 months. The data indicate firstly that a significant proneness to infection does exist in old age, coupled with a lesser trend toward spontaneous cure; the latter is equal to that of younger ages. Thus, prevalence rises steadily in old age. Secondly a previous history of bacteriuria in a subject with currently sterile urine increases his chances of reinfection or recurrence two to seven times compared to those of subjects without past infection.

Aged↗

PubMed1987

Diuresis bacteriuria in physically dependent elderly women.

Among 34 women aged 74-96 years, residents of a Home for the Aged, with reduced mobility and repeatedly negative urine cultures, 16 (47%) responded to a rapid hydration and 20 mg frusemide administered intravenously with a transient bacterial excretion usually trailing the diuresis. Antibody-coated bacteria were detected in 11 of the 13 Gram-negative isolates tested. Women with urine turning positive had significantly lower glomerular filtration rates and more advanced renal tubular defects than the steadily nonbacteriuric subjects of the same age. Progress to renal insufficiency was somewhat faster and all-causes mortality at 1 year was higher in subjects with urine turning positive. Diuresis bacteriuria originating from the upper urinary tract along with frank bacteriuria may be detected in up to 70% of women in their mid-80s and represents a likely source of the most common infection in man's last period of life.

Activities of Daily Living↗

PubMed1988

Outcome following antimicrobial therapy for asymptomatic bacteriuria in elderly women resident in an institution.

Twenty-six elderly (mean age 83.3 +/- 8.7 years) institutionalized women with asymptomatic bacteriuria were treated with antibiotic therapy, including initial single-dose and subsequent 2 weeks' therapy, then 6 weeks' therapy if relapse occurred. Forty-seven courses of single-dose, 30 of 2 weeks', and 10 of 6 weeks' therapy were given during a 1-year period. At 8 weeks of follow-up, 57% of single-dose courses, 52% of 2-week, and 29% of 6-week had been followed by relapse, and 32%, 24%, and 29%, respectively, by reinfection. Outcome with single-dose therapy did not correlate with infecting organism, antimicrobial therapy, or presence of pyuria with the infection. However, residents who persistently relapsed following single-dose therapy appeared to be a less-well population, as evidenced by a significantly greater age, number of chronic disease diagnoses and medications, as compared to those who were cured by single-dose therapy. Thus, recurrent infection, including both relapse and reinfection is the usual short-term outcome following therapy for asymptomatic bacteriuria in this population. Differences in patient characteristics may prove useful in predicting which individuals may respond to minimal therapy.

Age Factors↗

PubMed1991

A comparison of single-dose versus conventional-dose antibiotic treatment of bacteriuria in elderly women.

The efficacy of single-dose antibiotic therapy for the treatment of bacteriuria in a group of non-catheterized elderly women was compared with that of conventional 7-10 day courses of antibiotic therapy. Thirty-one women received single-dose treatment and 22 conventional-dose treatment. The cure rates at 1 and 6 weeks for the single-dose treatments were 52% and 38%, respectively, and the cure rates for the conventional-dose treatments at 1 and 6 weeks were 59% and 52%, respectively. It is concluded that there may be a place for the use of single-dose antibiotic therapy for the treatment of selected elderly women with bacteriuria, but larger studies are needed.

Age Factors↗