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PubMed1990

Spontaneous clearance of asymptomatic bacteriuria in infants.

In an unselected population of 3,581 infants, 14 girls and 36 boys were found to have bacteriuria verified by suprapubic aspiration. Among the bacteriuric infants, one girl and one boy developed symptoms of pyelonephritis close to the time of detection; the others remained asymptomatic. Eleven girls and 34 boys were left untreated. One of these girls and 7 of the boys became abacteriuric after treatment for respiratory tract infections. Ten girls and 26 boys became spontaneously abacteriuric, with a median persistence of bacteriuria of 2 months in girls and 1.5 months in boys. Recurrences were observed among boys only in those who had been treated with antibiotics.

Bacteriuria↗
PubMed1999

Direct antimicrobial susceptibility testing in bacteriuria.

A method for diagnosis of bacteriuria using semiquantitative culture in combination with direct susceptibility testing is described. Susceptibility testing with the breakpoint method was performed by means of a multiple inoculation technique. A simple biochemical typing on solid media of lactose-fermenting Enterobacteriaceae strains and aesculin testing of Enterococcus strains were performed simultaneously. Staphylococcus and Streptococcus strains were tested for susceptibility using the conventional disc diffusion technique. The results of the direct susceptibility test and the disc diffusion test were compared in a study of 983 consecutively positive urine cultures: 6624 susceptibility tests from 882 specimens with one microorganism revealed complete agreement in 6343 cases (95.8%); the discrepant results were 15 very major errors (0.2%), 84 major errors (1.3%) and 182 minor errors (2.7%). The direct susceptibility test revealed 42 more cases of bacteriuria with enterococci in combination with Enterobacteriaceae strains compared to the conventional method. 59% of all positive urine cultures were completed, including the susceptibility test report, within 24 h after arriving at the laboratory. The diagnostic costs were approximately the same as for the conventional method.

Anti-Bacterial Agents↗
PubMed1994

New support for a folk remedy: cranberry juice reduces bacteriuria and pyuria in elderly women.

Cranberry juice has developed a following as a simple, nonpharmacologic means to reduce or treat urinary tract infections, yet the scientific basis for such a claim has been lacking. A new study suggests that bacterial infections (bacteriuria) and associated influx of white blood cells into the urine (pyuria) can be reduced by nearly 50% in elderly women who drink 300 mL of cranberry juice cocktail each day over the course of a 6-month study. The results of this study suggest that consumption of cranberry juice is more effective in treating than preventing bacteriuria and pyuria. Along with earlier reports on the ability of cranberry juice to inhibit bacterial adherence to urinary epithelial cells in cell culture, this new work suggests that drinking cranberry juice each day may be clinically useful. Additional work must be conducted, however, to more completely define the efficacy of cranberry juice.

Aged↗
PubMed1981

Chronic Salmonella bacteriuria with intermittent bacteremia treated with low doses of amoxicillin or ampicillin.

Amoxicillin and ampicillin were compared at a dose of 250 mg twice daily for 4 weeks to treat Salmonella typhi or Salmonella paratyphi A chronic bacteriuria with intermittent bacteremia. Eleven patients received amoxicillin, and 15 received ampicillin. Concentrations of the two drugs were measured in the urine and serum on treatment days 1, 2, and 7. The urine levels of both antibiotics were maximal 2 h after administration, and minimal levels were 80-fold higher than the S. typhi minimal inhibitory concentration and 20-fold higher than the S. paratyphi A minimal inhibitory concentration. The serum level of amoxicillin was below the minimal inhibitory concentration of S. paratyphi A 6 h after administration on each of the testing days. The serum antibiotic levels of the two drugs showed no cumulative effect at day 2 or day 7. Of the 11 patients treated with amoxicillin, 1 had positive urine cultures during treatment, and 1 treated with ampicillin continued to be symptomatic.. Recurrence of bacteriuria occurred in three of seven patients with persistent bladder calcification. None of the 26 patients in this study had positive blood culture during or after treatment. Amoxicillin and ampicillin at a dose of 250 mg twice daily were equally successful in treating chronic salmonelluria.

Adolescent↗
PubMed1985

Comparative study of amoxicillin-clavulanic acid and cephalexin in the treatment of bacteriuria during pregnancy.

A comparative clinical trial of amoxicillin-clavulanic acid and cephalexin was carried out in 80 women with bacteriuria of pregnancy. Treatment was randomly allocated and consisted of either one tablet of amoxicillin plus clavulanic acid (250 and 125 mg, respectively) three times daily or cephalexin (250 mg) three times daily for 7 days. Overall bacteriological cure rates at 2 weeks were 77% in the amoxicillin-clavulanic acid group and 74% in the cephalexin group. At 6 weeks the respective rates were 76 and 60%. Twenty-five episodes of infection were with ampicillin-resistant strains; cure rates were 82% (2 weeks) and 80% (6 weeks) in the amoxicillin-clavulanic acid group and 85 and 64%, respectively, in the cephalexin group. Differences in cure rates were not statistically significant. No significant difference in the rate of side effects was found. In particular, no toxicity to the fetus was seen which could be ascribed to either drug. Amoxicillin-clavulanic acid would appear to be a safe and effective treatment for bacteriuria of pregnancy.

Amoxicillin↗
PubMed1986

Single-dose cephalexin therapy for acute bacterial urinary tract infections and acute urethral syndrome with bladder bacteriuria.

The efficacy of single-dose therapy with 3 g of cephalexin was evaluated in 129 women with symptoms of acute uncomplicated lower urinary tract infections. Of 91 patients with significant bacteriuria, 61 (67%) were cured of their original infection; this was similar to the 54 to 79% cure rates reported in unselected populations of women of a wide age range treated for acute uncomplicated urinary tract infections with a single dose of amoxicillin or trimethoprim-sulfamethoxazole (J. Rosenstock, L. P. Smith, M. Gurney, K. Lee, W. G. Weinberg, J. N. Longfield, W. B. Tauber, and W. W. Karney, Antimicrob. Agents Chemother. 27:652-654, 1985; N. E. Tolkoff-Rubin, M. E. Wilson, P. Zuromskis, I. Jacoby, A. R. Martin, and R. H. Rubin, Antimicrob. Agents Chemother. 25:626-629, 1984). The cure rates of (87%) for our younger patients, those less than 25 years of age, was better than that (46%) for our patients over 40 years of age (P less than 0.001). Patients with infections that were negative in an antibody-coated bacteria test were cured at a significantly higher rate than those with infections that were positive in an antibody-coated bacteria test (71 versus 19%; P = 0.003). Those patients with infections caused by cephalexin-susceptible organisms were cured at a rate similar to that for patients with infections caused by cephalexin-resistant organisms (68 versus 50%; P = 0.62). The cure rate for suburban patients was 90%, versus 45% for inner-city patients (P = 0.008). Of the 28 women with acute urethral syndrome due to low-level bacteriuria, 27 were cured.

Acute Disease↗
PubMed1974

Evaluation of miniature test for bacteriuria using dehydrated media and nitrite pads.

A new dip-inoculum method for detecting bacteriuria which utilizes dehydrated media pads and a nitrite pad attached to a small plastic strip was evaluated in hospitalized patients. Discrepant interpretations were made by independent observers in 9.3% of the specimens with > 10(5) colonies per ml. The media pads failed to support growth of yeast and gave variable results with Staphylococcus epidermidis and non-group D streptococci. False-negative culture results commonly occurred if the patients were receiving antibiotics. The nitrite test occasionally remained positive for brief periods after the elimination of bacteriuria by antibiotics. Conditions and drugs (especially phenazopyridine) which discolor urine interfered with reading both the culture and nitrite tests. Although not suitable for hospital use, or for monitoring therapy, the test strip is probably as reliable as the calibrated loop-streak plate culture for office screening.

Anti-Bacterial Agents↗
PubMed1998

Genomic analysis of a pathogenicity island in uropathogenic Escherichia coli CFT073: distribution of homologous sequences among isolates from patients with pyelonephritis, cystitis, and Catheter-associated bacteriuria and from fecal samples.

Urinary tract infection is the most frequently diagnosed kidney and urologic disease and Escherichia coli is by far the most common etiologic agent. Uropathogenic strains have been shown to contain blocks of DNA termed pathogenicity islands (PAIs) which contribute to their virulence. We have defined one of these regions of DNA within the chromosome of a highly virulent E. coli strain, CFT073, isolated from the blood and urine of a woman with acute pyelonephritis. The 57,988-bp stretch of DNA has characteristics which define PAIs, including a size greater than 30 kb, the presence of insertion sequences, distinct segmentation of K-12 and J96 origin, GC content (42.9%) different from that of total genomic DNA (50.8%), and the presence of virulence genes (hly and pap). Within this region, we have identified 44 open reading frames; of these 44, 10 are homologous to entries in the complete K-12 genome sequence, 4 are nearly identical to the sequences of E. coli J96 encoding the HlyA hemolysin, 11 encode P fimbriae, and 19 show no homology to J96 or K-12 entries. To determine whether sequences found within the junctions of the PAI of CFT073 were common to other uropathogenic strains of E. coli, 11 probes were isolated along the length of the PAI and were hybridized to dot blots of genomic DNA isolated from clinical isolates (67 from patients with acute pyelonephritis, 38 from patients with cystitis, 49 from patients with catheter-associated bacteriuria, and 27 from fecal samples). These sequences were found significantly more often in strains associated with the clinical syndromes of acute pyelonephritis (79%) and cystitis (82%) than in those associated with catheter-associated bacteriuria (58%) and in fecal strains (22%) (P < 0.001). From these regions, we have identified a putative iron transport system and genes other than hly and pap that may contribute to the virulent phenotype of uropathogenic E. coli strains.

Bacteriuria↗
PubMed1985

Detection of bacteriuria and pyuria within two minutes.

A study was performed to evaluate two rapid urine screening methods, Bac-T-Screen (Marion Laboratories, Inc., Kansas City, Mo.) and Chemstrip LN (Boehringer Mannheim Diagnostics, BioDynamics, Indianapolis, Ind.), for their ability to screen for bacteriuria and pyuria within 2 min. A total of 1,000 urine specimens were tested with the Bac-T-Screen and the Chemstrip LN and compared with a semiquantitative plate culture method. Of the 1,000 specimens tested, 249 had colony counts of greater than or equal to 10(5) CFU/ml by the culture method. Of these, the Bac-T-Screen detected 94.8% (236 of 249) and the Chemstrip LN detected 84.7% (210 of 249). There were 120 pure cultures of probable pathogens of which the Bac-T-Screen detected 97.5% (117 of 120) and the Chemstrip LN detected 91.7% (110 of 120). Leukocyte counts were performed on all specimens, and both methods have the ability to detect greater than 10 leukocytes per mm3 in a majority (greater than 93%) of the specimens. The cost per test for a negative screen is approximately $1.30 for the Bac-T-Screen and $0.40 for the Chemstrip LN. Overall there is a similar negative predictive value with both methods for bacteriuria and pyuria.

Bacteriological Techniques↗
PubMed1985

Chromogenic Limulus amoebocyte lysate assay for rapid detection of gram-negative bacteriuria.

A chromogenic Limulus amoebocyte lysate assay was evaluated as a rapid screening test for the detection of clinically significant gram-negative bacteriuria. The development of a distinctive yellow color after the addition of chromogenic substrate to the Limulus amoebocyte lysate-urine reaction mixture was used to measure greater than or equal to 10(5) gram-negative bacteria per ml. A total of 324 urine specimens were assayed, with 68 gram-negative urinary tract infections identified as defined by quantitative urine colony counts of greater than or equal to 10(5) bacteria per ml. Of these, 68 and 67 of 68 were detected by the chromogenic Limulus amoebocyte lysate assay at urine dilutions of 1:10 and 1:20, respectively. Nine false-positive chromogenic Limulus amoebocyte lysate assay results were observed at both urine dilutions and in the same specimens. At a urine dilution of 1:10, sensitivity and specificity were 100 and 96.6%, respectively, with predictive values of 100% for a negative test and 88.3% for a positive test. At a urine dilution of 1:20, sensitivity and specificity were 98.6 and 96.6%, respectively; predictive values were 99.6% for a negative test and 88.3% for a positive test. These data suggest that chromogenic Limulus amoebocyte lysate assay of urine has potential usefulness as a rapid, reliable, and easily performed and interpreted screening test for the diagnosis of clinically significant gram-negative bacteriuria.

Bacteriuria↗
PubMed1985

Evaluation of three bacteriuria screening methods in a clinical research hospital.

In a study conducted to compare three screening methods for their ability to detect significant bacteriuria, 2,815 urine specimens were screened by Chemstrip LN (BioDynamics, Division of Boehringer Mannheim Chemicals, Indianapolis, Ind.), 1,000 were screened by Bac-T-Screen (Marion Scientific Laboratory, Kansas City, Mo.), and 289 were screened by ATP assay (Turner Designs, Mountain View, Calif.). Results were compared with those obtained by quantitative culture plate method. The ATP assay showed the highest sensitivity (91%) compared with the Bac-T-Screen (67%) and Chemstrip LN (50%) tests but had the lowest specificity (64%) compared with the Bac-T-Screen (83%) and Chemstrip LN (91%). In 101 leukopenic patients with significant bacteriuria, the Bac-T-Screen test showed a higher sensitivity (33% at 10(4) to 10(5) CFU/ml and 80% at greater than or equal to 10(5) CFU/ml). It is concluded from this study that none of the three methods are sufficiently sensitive for the clinical research patients in this institution.

Adenosine Triphosphate↗
PubMed1985

Laboratory evaluation of leukocyte esterase and nitrite tests for the detection of bacteriuria.

We compared the sensitivity, specificity, and predictive values of the 1-min leukocyte esterase test and the test for urinary nitrite alone and in combination as screening tests for bacteriuria in over 5,000 clinical urine specimens. The leukocyte esterase-nitrite combination had a sensitivity of 79.2%, a specificity of 81%, and a negative predictive value of a negative test of 94.5% for specimens with greater than or equal to 10(5) CFU/ml. Although the sensitivity of this test was too low to allow its use as the only screening test for bacteriuria, it may serve as a useful adjunct to culturing and other urine-processing systems in the microbiology laboratory.

Bacteriuria↗
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↗
PubMed1986

Use of the Bac-T-Screen to predict bacteriuria from urine specimens held at room temperature.

Results from the Bac-T-Screen (BTS) of fresh urine specimens were compared with the BTS results obtained when the same urine specimens had been held at room temperature for 24 h. Of the 246 specimens studied, 43 were initially BTS positive, 11 were false-negative, and 39 had greater than or equal to 10(5) CFU/ml. After 24 h at room temperature an additional 60 specimens had greater than or equal to 10(5) CFU/ml, of which only 16 were BTS positive; 10 specimens still gave false-negative results, and the number of false-positive specimens increased by only 6.5% of all specimens. For significant specimens (containing greater than or equal to 10(5) CFU of probable pathogens per ml), the predictive value of a negative test changed by only 0.1% (99.5 to 99.4%), whereas the sensitivity of the test remained at 96.4% for incubated specimens. Of those specimens that developed greater than or equal to 10(5) CFU/ml in vitro, 85% contained gram-negative bacilli. Neither bacteria grown in vitro nor urine specimens from normal females containing greater than or equal to 10(5) CFU/ml were positive with the BTS. For reasons not entirely understood, the BTS system may be unique in its ability to discriminate between bacteria which represent true bacteriuria and those which are present because of contamination, possibly due to other cellular elements present in infection-related bacteriuria, namely leukocytes and sloughed bladder epithelial cells.

Bacteriological Techniques↗
PubMed1988

Evaluation of the modified Bac-T-Screen and FiltraCheck-UTI urine screening systems for detection of clinically significant bacteriuria.

Previous evaluations of the Bac-T-Screen system (Vitek Systems, Inc., Hazelwood, Mo.) demonstrated excellent sensitivity with specimens from patients with clinically significant bacteriuria (including infections with small numbers of uropathogens) but poor specificity with specimens from noninfected patients. In the study reported here, the sensitivity and specificity of the Bac-T-Screen system with a modified decolorizing reagent were evaluated. A manual filtration system, FiltraCheck-UTI (Vitek Systems), for screening urine specimens, Gram stains of mixed urine specimens, and quantitative cultures were also evaluated. The test sensitivity for clinically significant bacteriuria was greater than 96% with the original Bac-T-Screen system as well as the modified system and the manual system. In comparison, the sensitivities of the Gram stains and quantitative cultures (greater than or equal to 10(5) CFU/ml) were 82 and 77%, respectively. Of the 375 patients classified as noninfected by clinical parameters, 34% had positive screening tests with the original Bac-T-Screen system, as compared with 13 and 11% with the modified Bac-T-Screen and FiltraCheck-UTI systems, respectively. Thus, the modified Bac-T-Screen system and the manual FiltraCheck-UTI system have sensitives comparable to that of the original Bac-T-Screen system and markedly improved test specificities.

Bacteria↗
PubMed1988

Urine specimen collection with external devices for diagnosis of bacteriuria in elderly incontinent men.

We determined the validity of using external devices for urine specimen collection from 24 elderly incontinent men residing in a nursing home by collecting three sequential specimens, two with external devices and then one by catheterization. The positive predictive value of organisms isolated in quantitative counts of greater than or equal to 10(5) CFU/ml in external devices for bladder bacteriuria was 86% for either sterile or clean collecting devices and 93% for the same organism in two consecutive specimens. The negative predictive value for organisms present in quantitative counts of less than 10(5) CFU/ml was 90% for both sterile and clean devices and 86% when the organism was present in both specimens. Contamination in external collection devices was not influenced by whether the device was clean or sterile, circumcision of the resident, or duration of time between device application and specimen collection. These data suggest that urine specimens collected by ward nursing staff with external devices are reliable for the diagnosis of bacteriuria in this patient population.

Aged↗
PubMed1989

Rapid bioluminescence method for bacteriuria screening.

A study was performed to evaluate the UTIscreen (Los Alamos Diagnostics, Los Alamos, N. Mex.), a rapid bioluminescence bacteriuria screen. The UTIscreen was compared with three other rapid bacteriuria screens: the Bac-T-Screen (Vitek Systems, Hazelwood, Mo.), an automated filtration device; the Chemstrip LN (Boehringer Mannheim Diagnostics, BioDynamics, Indianapolis, Ind.), an enzyme dipstick; and the Gram stain. A semiquantitative plate culture was used as the reference method. Of the 1,000 specimens tested, 276 had colony counts of greater than 10(5) CFU/ml by the culture method. Of these, the UTIscreen detected 96% (265 of 276) using greater than or equal to 5% of the integrated light output of the standard reading as a positive interpretive breakpoint, the Bac-T-Screen detected 96% (266 of 276), the Chemstrip LN detected 90% (249 of 276), and the Gram stain detected 96% (264 of 276). Of the 214 probable pathogens isolated at greater than 10(5) CFU/ml, the UTIscreen detected 95% (204 of 214), the Bac-T-Screen detected 98% (210 of 214), the Chemstrip LN detected 92% (198 of 214), and the Gram stain detected 98% (209 of 214). The predictive values of negative test results at greater than 10(5) CFU/ml for the UTIscreen, the Bac-T-Screen, the Chemstrip LN, and the Gram stain were 98, 97, 93, and 98%, respectively. The overall specificities at greater than 10(5) CFU/ml for the UTIscreen, the Bac-T-Screen, the Chemstrip LN, and the Gram stain were 70, 48, 51, and 69%, respectively. There were 532 specimens with colony counts of >10(3) CFU/ml, and of these, the UTIscreen, the Bac-T-Screen, the Chemstrip LN, and the Gram stain detected 72, 81, 76, and 73%, respectively. Of the 249 probable pathogens isolated at >10(3) CFU/ml, the UTIscreen, the Bac-T-Screen, the Chemstrip LN, and the Gram stain detected 91, 95, 89, and 93%, respectively. The overall specificities at > 10(3) CFU/ml for these methods were 79, 55, 57, and 78%, respectively. The cost per test for detection was approximately $0.50 for the Chemstrip LN. Overall, the UTIscreen is rapid and easy to perform; its sensitivity compared favorably with those of the other screening methods; it had higher specificity than the Bac-T-Screen and Chemstrip LN; and it allowed for bathing of specimen.

Bacteria↗
PubMed1992

Detection of bacteriuria and pyuria by URISCREEN a rapid enzymatic screening test.

A multicenter study was performed to evaluate the ability of the URISCREEN (Analytab Products, Plainview, N.Y.), a 2-min catalase tube test, to detect bacteriuria and pyuria. This test was compared with the Chemstrip LN (BioDynamics, Division of Boehringer Mannheim Diagnostics, Indianapolis, Ind.), a 2-min enzyme dipstick test; a semiquantitative plate culture method was used as the reference test for bacteriuria, and the Gram stain or a quantitative chamber count method was used as the reference test for pyuria. Each test was evaluated for its ability to detect probable pathogens at greater than or equal to 10(2) CFU/ml and/or greater than or equal to 1 leukocyte per oil immersion field, as determined by the Gram stain method, or greater than 10 leukocytes per microliter, as determined by the quantitative count method. A total of 1,500 urine specimens were included in this evaluation. There were 298 specimens with greater than or equal 10(2) CFU/ml and 451 specimens with pyuria. Of the 298 specimens with probable pathogens isolated at various colony counts, 219 specimens had colony counts of greater than or equal to 10(5) CFU/ml, 51 specimens had between 10(4) and 10(5) CFU/ml, and 28 specimens had between 10(2) and less than 10(4) CFU/ml. Both the URISCREEN and the Chemstrip LN detected 93% (204 of 219) of the specimens with probable pathogens at greater than or equal to 10(5) CFU/ml. For the specimens with probable pathogens at greater than or equal to 10(2) CFU/ml, the sensitivities of the URISCREEN and the Chemstrip LN were 86% (256 of 298) and 81% (241 of 298), respectively. Of the 451 specimens with pyuria, the URISCREEN detected 88% (398 of 451) and Chemstrip LN detected 78% (350 if 451). There were 204 specimens with both greater than or equal to 10(2) CFU/ml and pyuria; the sensitivities of both methods were 95% (193 of 204) for these specimens. Overall, there were 545 specimens with probable pathogens at greater than or equal to 10(2) CFU/ml and/or pyuria. The URISCREEN detected 85% (461 of 545), and the Chemstrip LN detected 73% (398 of 545). A majority (76%) of the false-negative results obtained with either method were for specimens without leukocytes in the urine. There were 955 specimens with no probable pathogens or leukocytes. Of these, 28% (270 of 955) were found positive by the URISCREEN and 13% (122 of 955) were found positive by the Chemstrip LN. A majority of the false-positive results were probably due, in part, to the detection of enzymes present in both bacterial and somatic cells by each of the test systems. Overall, the URISCREEN is rapid, manual, easy-to-perform enzymatic test that yields findings similar to those yielded by the Chemstrip LN for specimens with both greater than or equal to 10(2) CFU/ml and pyuria or for specimens with greater than or equal to 10(5) CFU/ml and with or without pyuria. However, when the data were analyzed for either probable pathogens at less 10(5) CFU/ml or pyuria, the sensitivity of the URISCREEN was higher (P less than 0.05).

Bacteriological Techniques↗