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PubMed1977

Bacteriuria in geriatric hospital patients its correlates and management.

Significant bacteriuria is associated with dementia, incontinence of faeces and of urine in long-stay hospital patients. Bacteriuria in these patients is a fluctuating condition: it occurred in 47% of an initially sterile control group during the course of a year. Management with urinary antiseptics and an initial course of antibiotics is more successful than antibiotics on demand. However, since the condition is so fluctuating, it is doubtful if any treatment is usually needed other than the prevention of faecal incontinence.

Aged↗
PubMed1984

Rapid detection of insignificant bacteriuria by concomitant use of Lumac system and Gram's stain.

The Lumac system, which assays bacterial ATP by bioluminescence, is a rapid method (less than 1 hour) for detection of bacteriuria. Conventional culture by calibrated loop technic and the Lumac system were compared using 2,000 urine specimens. Interpretation of Gram's stains of uncentrifuged specimens in addition to results of the Lumac system provided a second comparison with culture. Using a criterion of greater than or equal to 10(4) CFU/mL, conventional culture yielded 17% of the 2,000 specimens positive for bacteriuria. By Lumac + smear 27% were positive opposed to 41% positive by the Lumac system alone. The Lumac + smear method produced sensitivity (97%), specificity (88%), positive predictive value (62%), and negative predictive value (99.3%). False negative rates by the Lumac alone and Lumac + smear were 0.65% and 0.5%, respectively.

Adenosine Triphosphate↗
PubMed1984

Pathogenesis of bacteriuria in elderly women: the role of Escherichia coli adherence to vaginal epithelial cells.

In vitro Escherichia coli adherence to exfoliated epithelial cells obtained from a group of elderly women was compared with adherence values in young healthy women in an attempt to define the role of adherence as an independent host risk factor for the acquisition of bacteriuria. Utilizing four uropathogenic strains of E. coli possessing differing fimbrial adherence mechanisms, no evidence was found of increased adherence receptivity of vaginal epithelial cells for bacteria in elderly women. In contrast, there was evidence of significantly reduced attachment of two of four strains in the elderly women (p less than .02). Based upon preliminary studies using four E. coli strains, susceptibility to bacterial adherence does not appear to be a mechanism responsible for the increased frequency of E. coli bacteriuria in elderly women.

Adult↗
PubMed1981

Anaerobic and other fastidious microorganisms in asymptomatic bacteriuria in pregnant women.

Urine from 44 pregnant women with known or suspected renal disease (group 1) and from 50 healthy pregnant women (group 2) with negative routine cultures of midstream urine was obtained by suprapubic aspiration. Aerobic and anaerobic cultures showed bacteriuria in 70% of the women in group 1 and in 26% of those in group 2. Gardnerella vaginalis was the most frequently isolated organism. Ureaplasma urealyticum was isolated from 14(48%) of 29 women in group 1 and from two (12.5%) of 16 women in group 2. Radiologic studies showed a high incidence of underlying renal disease in asymptomatic women with bacteriuria. Localization testing indicated kidney infection in six of 14 women in group 1 and in one of four women in group 2. These findings suggest that there is an increased susceptibility to colonization of the bladder with these microorganisms during pregnancy and that persistence of infection and renal involvement are associated with underlying renal disease.

Anaerobiosis↗
PubMed1988

Localization of urinary tract infection in elderly, institutionalized women with asymptomatic bacteriuria.

We determined the site of urinary tract infection in 51 elderly, institutionalized women (mean age, 80.5 years) with asymptomatic bacteriuria by using the Fairley bladder washout technique. Thirty-four (67%) infections were localized in the kidney and 17 (33%) in the bladder. Women with renal infection were older than those with bladder infection (81.9 vs. 77.6 years of age; P = .04). The antibody-coated bacteria test had a sensitivity of 58%, specificity of 71%, positive predictive value of 82%, and negative predictive value of 43% for upper-urinary-tract infection. A quantitative urinary leukocyte count of greater than or equal to 20 leukocytes/mm3 had a positive predictive value of 80% and a negative predictive value of 88% for upper-urinary-tract infection. This study suggests that the majority of elderly, institutionalized women with asymptomatic bacteriuria have upper-urinary-tract infection. Both the antibody-coated bacteria test and the quantitative urinary leukocyte count may be useful as noninvasive tests for localization of urinary tract infection in this population.

Age Factors↗
PubMed1989

Detection of bladder bacteriuria in patients with acute urinary symptoms.

Quantitative culture of midstream urine fails to yield a significant microorganism in many patients with acute urinary symptoms. We cultured bladder urine, obtained by aspiration, from symptomatic adults with equivocal findings on standard testing of midstream urine for low numbers of conventional uropathogens and fastidious bacteria. We found 561 (31%) of 1817 women and 36 (12%) of 300 men to be culture positive. Five hundred eighty-one (70%) of 830 isolates were fastidious bacteria; 191 (34%) of 561 culture positive women and 0 of 36 culture-positive men had polymicrobic bacteriuria. Bacterial counts were less than 10(5) colony-forming units/mL in 67% of samples; 204 of 406 patients with single-species infections had increased leukocyte counts in urine. Patients with symptoms of urinary tract infection who are culture negative on standard testing may harbor fastidious bacteria or low numbers of conventional uropathogens in the bladder. In these patients, culture of bladder aspiration urine for low counts and fastidious species is necessary to diagnose bacteriuria.

Acute Disease↗
PubMed1994

Bacteriuria of pregnancy--an update on significance, diagnosis and management.

Bacteriuria of pregnancy is a common condition which is thought to be associated with serious sequelae in mother and fetus. A programme of screening, treatment and follow-up is likely to be cost-effective, but will depend on local prevalences of bacteriuria and pyelonephritis. If treatment is undertaken, nitrofurantoin and cephalexin are both safe and effective and have resistance rates of below 10%. Amoxycillin is also safe, but resistance rates in Escherichia coli are about 40%. A 7 day course of treatment remains advisable.

Bacteriuria↗
PubMed1986

Bacteriuria in the catheterized surgical intensive care patient.

A prospective microbiologic evaluation of the urine was conducted on 100 catheterized ICU patients. Eight subjects had positive initial bladder urine cultures and were eliminated from further study. The remaining 92 patients were catheterized for up to 22 days, mean 4.8 +/- 4.3 (SD). During the first 5 days, 57 (62%) patients completed the surveillance protocol; seven (12.3%) of these had bladder bacteriuria. Of 20 patients with positive urine cultures, six had microorganisms in the collection bag urine alone. The remaining 14 had organisms both in the bladder and in the bag urine. The urine collection bag was the apparent source of microorganisms in the bladder urine in only three cases. The daily incidence of new cases and the cumulative rate of bladder bacteriuria remained below 7% and 22%, respectively, during the first week of catheterization. These rates are similar to those previously reported for various other patient groups outside the ICU setting. Frequent microbiologic monitoring of the urine seems to be unnecessary for most ICU patients because of the short duration of catheterization.

Adult↗
PubMed1987

Prevalence of bacteriuria in febrile children.

To determine the risk of urinary tract infections in acutely ill febrile children younger than 5 years of age we obtained a urine culture from 664 children presenting to our walk-in clinic with an acute febrile episode. Only 11 children (1.7%) had significant bacteriuria. This figure is similar to the number of children who would be expected to have asymptomatic bacteriuria. These results suggest that pediatricians are not missing the diagnosis of urinary tract infection in febrile children.

Age Factors↗
PubMed1977

Bacteriuria after out-patient cystoscopy.

The presence of bacteriuria 48-72 hours after cystoscopy has been correlated with the sex and previous history of the patient, and with the use of chlorhexidine 1/5,000 and water as alternative irrigant solutions. The infection rate was higher in women than in men. Chlorhexidine in the irrigant solution protected against postoperative bacteriuria in patients who did not have a history of previous urinary infection, but did not do so where there was such history.

Bacteriuria↗
PubMed1979

The value of kanamycin-colistin bladder instillations in reducing bacteriuria during intermittent catheterisation of patients with acute spinal cord injury.

Two groups of patients with acute spinal cord trauma had initial bladder management by standard non-touch techniques of intermittent catheterisation. Twenty-two patients (17 males and 5 females) had kanamycin-colistin solution instilled into the bladder at the end of each catheterisation, and 25 patients (21 males and 4 females) were not given these instillations. The incidence of significant bacteriuria during intermittent catheterisation of both males and females receiving the instillations was only half the incidence of those not receiving the instillations. Also, a significantly higher proportion of males receiving the instillations did not have any episodes of significant bacteriuria compared with those not receiving the instillations, and the same trend was evident in the small number of female patients. It is recommended that patients should have kanamycin-colistin bladder instillations when they are being intermittently catheterised.

Acute Disease↗
PubMed1980

48-hour cephradine and post-prostatectomy bacteriuria.

In a randomised, controlled trial of intramuscular cephradine given in a dose of 1 g 6-hourly for 48 h, there was a significant reduction in the incidence of significant bacteriuria after transurethral resection. In contrast, the incidence of significant bacteriuria after open prostatectomy was unchanged. Post-operative complications were reduced in patients who received cephradine. The use of short-term cephradine would appear to be justified.

Aged↗
PubMed1988

Comparison of the efficacy of "Trisdine" and kanamycin-colistin bladder instillations in reducing bacteriuria during intermittent catheterisation of patients with acute spinal cord trauma.

An open, prospective, randomised, comparative study of "Trisdine" and kanamycin-colistin bladder instillations in reducing significant bacteriuria during intermittent urethral catheterisation was conducted. Trisdine is an aqueous solution of chlorhexidine gluconate 0.01% with added ethylenediaminetetra-acetic acid disodium salt and TRIS buffer at final concentrations of 1.34 mMoles and 0.01 Molar respectively. All patients (15 males and 3 females) admitted with acute spinal cord trauma and bladder involvement requiring intermittent catheterisation for more than 5 days during a 12-month period were studied. There was no significant difference in the mean incidence of significant bacteriuria during intermittent catheterisation in the 7 males who had kanamycin-colistin bladder instillations compared with the 8 males who had Trisdine instillations. A comparison could not be made in the females because there were only 3 patients. Because Trisdine is more stable at ambient temperatures, is less likely to select antibiotic-resistant bacteria and is less expensive, it is concluded that Trisdine is preferable to kanamycin-colistin solution for bladder instillations during intermittent catheterisation.

Acute Disease↗
PubMed1990

Silver alloy coated catheters reduce catheter-associated bacteriuria.

The tendency of indwelling catheters to cause urinary tract infection was evaluated in a randomised clinical study of 223 patients. A Foley catheter coated with silver alloy on both inner and outer surfaces was used in 60 patients; 60 others received a Teflonised latex Foley's catheter and the remaining 103 patients were excluded because of antibiotic treatment, diabetes, etc. There was a statistically significant difference in the incidence of catheter-associated bacteriuria (greater than 10(5) organisms/ml) in the 2 groups after 6 days' catheterisation: 6 patients with the silver coated catheter developed bacteriuria compared with 22 who had the Teflonised latex catheter. This suggests that the silver impregnated urethral catheters reduce the incidence of catheter-associated urinary tract infection.

Bacteriuria↗
PubMed1995

Reagent strip testing urine for significant bacteriuria in a urodynamic clinic.

OBJECTIVES: To determine the effectiveness of two reagent strips in detecting significant bacteriuria amongst patients attending for urodynamic assessment. PATIENTS AND METHODS: Four hundred patients undergoing urodynamic assessment were recruited for the study. Routine diagnostic catheter specimens of urine were tested for nitrite, leucocytes and protein. RESULTS: The leucocytes and nitrite strips had a high specificity rate of 99.5%. The frequency of significant bacteriuria in our population was 7% (n = 28). CONCLUSION: Culturing samples which test negative for these strips is unnecessary. Reagent strip testing of urine provides a cheap, rapid method of screening for infection.

Ambulatory Care↗
PubMed1985

Single-dose amoxycillin in the treatment of bacteriuria in pregnancy and the puerperium--a controlled clinical trial.

Ninety obstetric patients with significant bacteriuria were treated randomly with either a single dose of 3 g amoxycillin or with a conventional course of ampicillin over 7 days. Treatment groups were comparable in terms of age, gravidity and socioeconomic status, and the outcome of pregnancy in the two groups did not differ significantly. Cure rates, assessed at 1 week and 6 weeks after treatment, were not significantly different: 88% for single-dose treatment and 84% for conventional treatment. It is concluded that a single dose of 3 g amoxycillin is a safe, effective and acceptable treatment for bacteriuria in pregnancy and the puerperium.

Adolescent↗
PubMed1991

Epidemiology of asymptomatic bacteriuria in elderly women.

We studied asymptomatic bacteriuria in elderly ambulatory women residents without indwelling catheters in self-contained apartment houses at the Philadelphia Geriatric Center (PGC), in the nursing home at PGC, and in several life-care communities (LCC). Subjects were studied every 6 months from January 1983 through January 1989, and since enrollment was continuous some participated in more surveys than others. PGC residents were middle class and lived either in a self care apartment house (CL) or nursing home (NH); LCC residents were middle or upper class. Antimicrobial therapy for asymptomatic bacteriuria was not given by the study team. The ages of the 865 women studied averaged 80.3, 82.8, and 83.3 years in LCC, CL, and NH, respectively. On each survey about 11% at LCC, 18% at CL, and 25% at NH sites had positive cultures. Turnover was high. The conversion rate from a negative to a positive culture was 5% at LCC, 11% at CL, and 8% at NH. The reversion rate from a positive to a negative culture was 33% at LCC, 34% at CL and 31% at NH (P greater than 0.05). Persistent infection with the same organism was uncommon. Infection risk was associated with residence, which was partially explained by a factor evaluating mobility, but was unrelated to age or scores evaluating activities of daily living or mental status. Besides mobility, other more complex factors play a role in the acquisition of infection.

Activities of Daily Living↗
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↗