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PubMed2002

Covert bacteriuria in nephrotic syndrome.

Prevalence of covert bacteriuria in patients of nephrotic syndrome admitted for kidney biopsy was studied in 205 patients. Age ranged from 10 years to 65 years. 148 patients were male and 57 were female. Prevalence of covert bacteriuria was found in 38 patients (18.53%). In bacteriuric patients 30 were male, 8 were female. Escherichia coli was the commonest organism grown in bacteriuric patients (30 or 78.9%). Serum albumin was low and 24-hour urinary protein excretion was high in bacteriuric patients in comparison to abacteriuric patients. In bacteriuric patients membranous nephropathy was the commonest histopathological finding present in 15 patients (39.47%).

Adolescent↗
PubMedDate not supplied

[Catalase test (Uriscreen) in the detection of bacteriuria-candiduria in hospitalized adults with Foley catheter].

BACKGROUND: Most urinary pathogens have the catalase enzyme, which has been used recently for detection of bacteriuria-candiduria, by an economic reaction in a tube containing 10% hydrogen peroxide and a catalyzer (Uriscreen). It has not been studied in patients with indwelling urinary catheter. OBJECTIVE: To determine the accuracy of the catalase test (CT) in hospitalized patients with indwelling urinary catheters and to compare it against other rapid tests (nitrites and pyuria detection). METHODS: The gold standard was the culture of urine, with 10(3) colony-forming units/mL as the threshold for significant growth. The nitrite test was determined by dipstick. The pyuria was determined by dipstick and microscopic examination. RESULTS: Of 108 cultures from 57 patients, 62 were positives (57.4%). The values of accuracy of the CT were (%): sensitivity 88.5, specificity 42.6, predictive positive value 66.7, and predictive negative value 74.1. Compared against nitrites detection the CT showed higher sensitivity and specificity. Against pyuria detection, it showed higher sensitivity, but lower specificity. CONCLUSIONS: Our study complements medical literature as it is the first focused in patients with indwelling catheter. The clinical use of the CT is limited and not superior to pyuria detection in this setting. However, because of its high sensitivity and low cost, it could be recommended for ruling out bacteriuria-candiduria in selected patients. A negative CT may prevent the need for expensive cultures.

Bacteriuria↗
PubMed2004

[Asymptomatic bacteriuria in women. Epidemiological, pathologic and therapeutic study].

OBJECTIVES: To perform an epidemiological, pathologic and therapeutic study of asymptomatic bacteriuria (AB) in a population of outpatient women. METHODS: Transversal study for detection of AB in 1718 outpatient women 14-year-old or older. All patients complied with the inclusion/exclusion criteria for the study. Two groups of patients, with AB (n = 113) and controls without AB (n = 200), underwent: 1) urine analysis: urine sediment, biochemical analysis, and culture; 2) blood tests: hemoglobin, red blood cell count, urea, creatinine, sedimentation rate velocity, C reactive protein, immunoglobulins (IgA, IgM, and IgG), HLA-A3, blood group and Rh. The therapeutic management for AB was analyzed. Comparative statistical analyses of data were performed. RESULTS: AB prevalence was 6.34%. The most frequently isolated germ was E. coli (77.87%). Diabetes mellitus was detected in 27.43% of patients with AB and 7.01% without AB (27.43% vs. 7.01%); coronary arterial disease and other heart disorders (9.73% vs. 4%, p = 0.0206); general cardiovascular disorders excluding hypertension (46.9% vs. 31%, p = 0.0025). Urine analysis showed leukocyturia in 81.41% of the patients with AB and 17.5% without AB (p = 0.0002); positive nitrites (77.87% vs. 0%, p < 0.001); urine sediment showed bacteriuria in 86.72% of patients with AB and 0% of non-AB patients (p < 0.0001), leukocytes (93.80% vs. 6%, p < 0.0001), and pyuria (19.46% vs. 2.5%). Low water intake (50.44% vs. 9.5%, p < 0.0001) was the most significant urinary tract infection hygienic-dietetic predisposing factor. Higher levels of IgA (15% vs. 2%, p = 0.004). Positive HLA-A 3 (5% vs. 0%, p = 0.039), Rh negative (16.66% vs. 13.33%), and increased C reactive protein (15% vs. 10%). Renal abnormalities detected by radiological tests (10.29% vs. 1.47%, p = 0.014). AB disappeared after treatment with cefuroxime, ceftibuten, trimetropin/sulfametoxazole and amoxicillin in 100% of the patients receiving treatment. Topical vaginal estrogen therapy was effective in 38.09% of the patients. CONCLUSIONS: The prevalence of AB increases with age. The most frequent germ is Escherichia coli. A statistically significant greater number of coronary artery disease, other heart diseases, and cardiovascular disorders were found among patients with AB in comparison with non-AB controls. Immunoglobulins levels disturbances, and HLA-A3 positivity suggest an immune systemic imbalance in certain patients with recurrent AB. Other therapeutic alternatives such as vaginal topical estrogens, fruit juices intake, vaccinations, etc. should be pursued in addition to antimicrobial therapy.

Adolescent↗
PubMed2005

Aetiology of catheter-associated bacteriuria in Lagos University Teaching Hospital.

A prospective study to determine the causative agents of catheter-related bacteriuria was carried out on 99 patients with median age of 55 years, on admission in the Oncology, Paediatric Surgery and Obstetric and Gynaecology wards of the Lagos University Teaching Hospital. There was significant bacteriuria in seventy-one (72%) of the 99 urine samples. All catheter urine samples were contaminated by day 5 Gram-negative bacilli were predominant (89.3%) of which Pseudomonas aeruginosa (26.2%) was the most common, while Escherichia coli and Enterobacter aerogenes accounted for 15.5% each, closely followed by Proteus mirabilis (14.3%) and Klebsiella pneumoniae (9.5%). The Gram positive isolates Enterococcus faecalis (8.3%) and Staphylococcus saprophyticus (2.4%) made up only 10.7% of isolates. Most of the isolates from catheterised patients were resistant to the common antibiotics such as ampicillin, cotrimoxazole, gentamicin and ceftriaxone with high susceptibility to ofloxacin and ceftazidime though the isolates of Enterococcus faecalis was also resistant to ofloxacin. However, isolates of S. saprophyticus were still susceptible to the penicillins and tetracycline.

Adolescent↗
PubMed1991

[Enoxacin in the treatment of asymptomatic bacteriuria in patients with prostatic adenoma].

Fifty patients suffering from prostatic adenoma with asymptomatic bacteriuria, were admitted to an open non comparative trial. Enoxacin was administered at the daily dosage of 300 mg every 12 hours for 10 days. Three cycles of treatment were performed during three consecutive months. Treatment efficacy was established by assessing patient symptoms related to the infection such as pollakiuria , nocturia, decreased flow rate, stranguria, daily temperature. Cultural tests were also performed. All observations were collected at baseline and at the end of each cycle of therapy. Cure was obtained in 43 patients (87, 75%), 1 patient (2,04%) relapsed, 5 patients (10.2%) withdrew because of inefficacy of treatment and 1 patient died of heart failure. No side effects were observed. These results suggest that enoxacin may be successfully used in the treatment of asymptomatic bacteriuria.

Aged↗
PubMed1991

Evaluation of dipstick tests and reflectance meter for screening for bacteriuria in elderly patients.

When screening for bacteriuria in 615 elderly people was compared to standard methods of bacterial culture, the Ames Multistix 10 dipstick was more effective than the BM Test 7. Tests for nitrite and leucocyte esterase on the Multistix 10 had a higher sensitivity and specificity than tests for blood and protein only. Using a reflectance meter increased the sensitivity of the Multistix 10 to 80.6%. Of five common urinary symptoms only incontinence was significantly more frequent in patients with bacteriuria.

Aged↗
PubMed1991

Methicillin-resistant Staphylococcus aureus (MRSA) bacteriuria in nursing home-residents.

Methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly common in nursing homes in the United States. It can cause serious infections and is difficult to eradicate once it becomes established in an institution. We report three representative cases of MRSA bacteriuria occurring in residents of a skilled nursing facility that experienced an outbreak of MRSA beginning in 1988. The clinical options available in such cases are described, and the research methods that should be used to answer important clinical questions arising from the presence of MRSA bacteriuria in long-term care settings are outlined.

Adult↗
PubMed1990

[The evaluation of different methods for rapid diagnosis in the detection of asymptomatic bacteriuria in pregnant women].

We compared the effectiveness of different methods of rapid diagnosis in the detection of asymptomatic bacteriuria in 74 females during the first trimester of pregnancy. The sensitivity, specificity and negative predictive value for the visual reading of nitrites, leukocyte sterase, bacteriuria and leukocyturia in the sediment and bacteria in Gram stain were 77%, 22%, 33%, 22% and 88%, 98%, 85%, 82%, 91% and 86%, and 97%, 89%, 90% and 90%, with and accuracy of 96%, 77%, 76%, 82% and 86%, respectively. The combination of visual readings of nitrites and Gram stain showed a sensitivity and negative predictive value of 100%. We conclude that if the reading of the reactive strip is negative, the likelihood of a positive culture is very small, and it is minimal when combined with Gram stain.

Adult↗
PubMed1990

Optimized urinary microscopy for assessment of bacteriuria in primary care.

Microscopy of wet-stained urinary sediment as an indicator of bacteriuria was evaluated in 418 consecutive primary care visits in a small community. Delivery of morning urine was encouraged and contributed to bladder incubation times of 4 or more hours in 79% of the visits; the overall culture positivity was about 80%. Bacteria or leukocytes alone or together as minimal requirements were suboptimal microscopy criteria for bacteriuria, whereas a minimum of moderate amounts of bacteria or 5 leukocytes per high-power field (x400) as a cutoff point yielded the best diagnostic accuracy. Optimization of urinary sediment microscopy in this way resulted in a desirable high sensitivity (97%) and efficacy (86%) in acutely symptomatic patients, as well as reasonably high efficacy (79%) in other patients, independent of sex or bladder incubation time. The method's simplicity and speed recommend it for use in primary care, particularly in patients with acute symptoms of urinary tract infection.

Bacteriuria↗
PubMed1986

Review of urine microscopy for bacteriuria.

Urine microscopy for bacteriuria remains a useful and valid technique for the evaluation of urinary tract infection; however, established interpretive criteria are not agreed on. Our own data and a review of the literature demonstrate that reliable data can be obtained by enumerating the organisms observed in stained or unstained centrifuged and stained uncentrifuged urine specimens. Criteria are given for the interpretation of urine microscopy for maximum sensitivity and specificity for each method reviewed. For clinicians desiring to perform urine microscopy, we recommend the use of oil-immersion microscopy of Gram-stained centrifuged urine sediment and suggest that observing at least one organism per oil-immersion field corresponds with 95% sensitivity and that observing more than five organisms corresponds with 95% specificity for bacteriuria at a level of 10(5) or more colony-forming units per milliliter. Further testing will be required on any negative specimen from a symptomatic patient.

Bacteriological Techniques↗
PubMed1989

Asymptomatic bacteriuria in pregnant Nigerian patients.

One-thousand out of a total obstetric population of 3,548 patients seen between January and December, 1985, were screened for asymptomatic bacteriuria. During the first trimester, the observed incidence was 5.3 per cent while in the second and third trimesters it was 4.1 and 2.8 per cent, respectively. The overall pick-up rate was 4.0 per cent. The significance of this observation was discussed. Escherichia coli was the predominant causative micro-organism, accounting for 45 per cent of cases. A seven-day sensitive antibiotic therapy eradicated all the positive cases. The qualitative culture method as described in this study is a simple, sensitive and reliable method of screening for bacteriuria in pregnancy, especially as it can be used for identification of the causative organism and its antibiotic sensitivity.

Bacteriuria↗
PubMed1989

Pyuria: its relationship to bacteriuria in spinal cord injured patients on intermittent catheterization.

Observations made during a study of intermittently catheterized spinal cord injured patients suggested that leukocyte counts yield higher results in aliquots of terminal-catheter urine (TCU) than in midstream-catheter urine (MCU) or suprapubic aspirate (SPA). The purpose of this study was to confirm that observation, to examine the relationship of leukocyte counts in TCU, MCU, and SPA to the leukocyte excretion rate (LER), and of pyuria to bacteriuria in this population. We collected sets of urine specimens obtained by SPA and intermittent catheterization (for leukocyte counts and quantitative culture) and timed urine collections (for LER determination). Fifty-two patients were studied for an average of five days. Leukocyte counts were performed in 241 SPA, 250 MCU, and 236 TCU specimens, and LER in 131 timed collections. The mean of the logarithm of leukocyte counts differed significantly between TCU and both MCU and SPA (p less than .0001). The difference between TCU and MCU was greater than 150 leukocytes/mm3 for 25% of paired specimens (mean 624 leukocytes/mm3, median 15 leukocytes/mm3). The statistical correlation between LER and leukocyte counts in all catheter specimens was significant; however, SPA and MCU frequently underestimated LER and TCU overestimated LER. Estimates of pyuria do not clearly separate bacteriuric from abacteriuric specimens. In spinal cord injured patients on intermittent catheterization, aliquots of catheter urine are not suitable for estimation of pyuria, and estimation of pyuria is not a feasible screening test for bacteriuria.

Bacteriuria↗
PubMed1988

Asymptomatic bacteriuria in the elderly.

Bacteriuria in the elderly is common and usually asymptomatic. In the absence of symptoms or obstructive uropathy (which is rare in women), bacteriuria in the elderly appears to be a benign disease, and therefore antimicrobial therapy is probably not warranted.

Aged↗
PubMed1988

The nitrite and leukocyte esterase tests for the evaluation of asymptomatic bacteriuria in obstetric patients.

The purpose of this investigation was to compare the reliability of a urine dipstick evaluation for nitrites and leukocyte esterase activity with that of a urine culture in diagnosing asymptomatic bacteriuria in obstetric patients. A clean-catch midstream urine specimen was obtained from 750 consecutive obstetric patients presenting for initial evaluation. One portion of the specimen was tested for nitrites and leukocyte esterase activity with Chemstrip LN dipsticks. A second aliquot of urine was plated on blood and MacConkey agar and incubated aerobically. The cost of the nitrite and leukocyte esterase test was $0.35. The per patient charge for the urine cultures would have been $28. Sixty-two women (8.3%) had urine cultures of 100,000 or more colony-forming units of a uropathogen per milliliter. The sensitivities of the nitrite and leukocyte esterase test in identifying patients with positive cultures were 43 and 77%, respectively, and the specificities were 99 and 96%, respectively. The sensitivity and specificity for the two tests combined (either test abnormal) were 92 and 95%, respectively. Five patients had negative screening tests but positive urine cultures; all five isolates were gram-positive organisms, three group B streptococci and two enterococci. We conclude that neither the nitrite test nor the leukocyte esterase test alone is a sensitive enough screening test to detect asymptomatic bacteriuria in obstetric patients. The combination of the two tests, however, may provide an acceptable cost-effective alternative to screening all asymptomatic obstetric patients with urine cultures.

Bacteriuria↗
PubMed1988

Asymptomatic bacteriuria in the elderly.

Asymptomatic bacteriuria is a condition in which a urine culture has more than 100,000 colonies per ml and in which the patient has no symptoms. There is a startling prevalence of this condition in the elderly population. Uncertainty exists about both the need and the nature of possible therapy for asymptomatic bacteriuria in the elderly. Adequate studies do not define well the associated morbidity or mortality of this condition in the patient without obstruction. When obstruction is present, therapy is necessary until the obstruction is relieved.

Aged↗
PubMedDate not supplied

[Amoxicillin in the treatment of asymptomatic bacteriuria in pregnancy--3g single dose versus 3 times 750mg 4-day therapy].

A prospective, randomized, controlled comparative clinical trial was conducted to assess the efficacy and tolerability of 2 regimens of amoxicillin. In group A a single dose of 3 g amoxicillin and in group B a 4-day course of 3 doses of 750 mg amoxicillin tablets were administered 8-hourly. Significant bacteriuria (greater than or equal to 10(5) cfu/ml midstream urine) and of urine samples obtained by bladder catheterization (greater than or equal to 10(4) cfu/ml) was diagnosed with the dip-slide method (Uricult). 91 pregnant women with a mean gestational age of 25 weeks (14-38) were randomly allocated to both treatment groups. Group A consisted of 53 patients, group B of 38. The treatment groups were comparable in terms of age, duration of pregnancy and additional therapy. Control examinations of urine cultures were taken after 1 and 4 weeks following therapy. The predominant bacterial species was E. coli isolated in 60 to 65 percent. Bacteriological cure rates at 1 and 4 weeks were in group A 77% and 74% and in group B 62% each respectively. The differences in cure rates were not significant. Side effects occurred in group A in 4% and in group B in 13%. Our results suggest that for the treatment of asymptomatic bacteriuria in pregnancy a single dose of 3 g of amoxicillin is equally effective and acceptable as a 4-day course with the advantage of a lower total-dose, lower costs and a better compliance.

Adolescent↗
PubMed1987

Asymptomatic bacteriuria in the elderly.

Bacteriuria in the elderly is common and usually asymptomatic. In the absence of symptoms and/or obstructive uropathy (which is rare in women), bacteriuria in the elderly appears to be a benign disease and therefore antimicrobial therapy is probably not warranted.

Aged↗
PubMed1986

Comparison of single dose with a five-day course of trimethoprim for asymptomatic (covert) bacteriuria of pregnancy.

Sixty consecutive pregnant women with asymptomatic (covert) bacteriuria detected between 16 and 30 weeks gestation were randomly allocated to treatment with either a single 600 mg dose or a standard five-day course of trimethoprim. Twenty-seven of 30 women were cured with a single dose. Six of these 27 women were reinfected later in the pregnancy. Twenty-four of 30 women treated with a five-day course of trimethoprim were cured, and five became reinfected later in the pregnancy. One women vomited the single dose. There were no detrimental effects on the outcome of the pregnancies. Single dose therapy should be considered as the treatment of choice for asymptomatic bacteriuria in pregnancy.

Adolescent↗