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PubMed1985

Comparison of the antibacterial effect of uroepithelial cells from healthy donors and children with asymptomatic bacteriuria.

Bacterial attachment to uroepithelial cells (UEC) and the effect of UEC on bacterial growth was investigated in 15 healthy persons and 12 patients suffering from asymptomatic bacteriuria (ABU) with recurrent urinary tract infections (UTI). Desquamated UEC and mannose-resistant Escherichia coli were co-cultivated for up to 90 min. While no difference in bacterial adherence was observed between healthy controls and patients, 33.4% of the bacteria attached to normal UEC were found to be dead under microscopic evaluation (acridine orange staining), whereas no killing effect could be observed in patients' UEC 5 min after the onset of incubation. This phenomenon was confirmed by investigating the E. coli growth rate in the presence of UEC, measured by counting bacterial colony forming units (CFU) on agar plates. While E. coli showed exponential growth in RPMI medium, the addition of normal UEC suppressed bacterial growth (P less than 0.01). UEC from patients with ABU, however, did not show this effect. It has been concluded that bacterial adhesion may initiate an epithelial defence function, present in healthy controls and lacking in ABU patients.

Adolescent↗
PubMed1975

Diagnosis and importance of asymptomatic bacteriuria in adults.

There are now laboratory means of screening and identifying people who, although they are free from the signs of urinary tract infection, fit into abnormal groups owing to the high numbers of bacteria and leukocytes in their urine. Chronic bacteriuria and pathologic pyuria, with or without symptoms, have important physiologic and pathologic consequences. It is the physicians opportunity to recognize and treat these asymptomatic as well as symtomatic urinary tract infections. If untreated and uncorrected the result, with progressive frequency over a period of 10-15 years, is increased morbidity, especially with pregnancies, structural damage to the kidneys, kidney stones, uremia, hypertension, and premature death.

Adult↗
PubMed1979

A comparative trial of pivmecillinam and ampicillin in bacteriuria of pregnancy.

A comparative trial of pivmecillinam and ampicillin was performed on 100 women with bacteriuria of pregnancy. They received either 400 mg pivmecillinam four times daily or 500 mg ampicillin four times daily for seven days. Cure rates at two weeks were 88% in the pivmecillinam group and 85% in the ampicillin group. At six weeks the respective rates were 76% and 64%. Failure of therapy was not associated with the appearance of bacterial resistance in either treatment group. Side-effects, particularly vomiting and premature cessation of therapy, were significantly more frequent in the pivmecillinam group. No significant effects on liver function were found. In subsequent patients treated in a non-comparative manner with 200 mg pivmecillinam three times daily, the incidence of side effects was markedly reduced with no loss of efficacy.

Amdinocillin Pivoxil↗
PubMed1990

The epidemiology of urinary tract infection and the concept of significant bacteriuria.

Urinary tract infections (UTI) are among the most common infections afflicting man. Urinary tract infections in young adult women are usually uncomplicated, but are often recurrent and cause considerable morbidity. Urinary tract infections in pregnant women, elderly patients, and catheterized patients warrant special attention because of their association with increased morbidity and possibly with increased mortality. Diagnosis of UTI is usually based on quantitation of uropathogens in voided urine. The traditional criteria for significant bacteriuria, greater than or equal to 10(5) uropathogens per ml of voided urine, is insensitive for detecting acute symptomatic cystitis in men and women and should be replaced with a lower colony count threshold.

Bacteriuria↗
PubMed1992

Treatment of bacteriuria in pregnancy with single dose fosfomycin trometamol: a review.

Bacteriuria in pregnancy occurs in about one in 20 pregnant women and is usually initially asymptomatic. It is an important marker for acute symptomatic infection (often pyelonephritis) later in pregnancy, which occurs in about one in four bacteriurics. Several considerations surround the antibiotic treatment of the asymptomatic infection; these include a low frequency of in vitro resistance to the agent used, lack of toxicity to the foetus, a low incidence of gastrointestinal side effects, good compliance and proven efficacy. Fosfomycin trometamol seems to fit these requirements. In three controlled studies (two multicentric) 250 patients were treated with fosfomycin trometamol in a 3 g (as fosfomycin) single dose; 197 patients were given one of three other agents. Cure rates for fosfomycin trometamol were 77-94% (68-94% for other agents), which was satisfactory in an infection which is sometimes difficult to eradicate. Further studies are needed in this important but accessible group of patients. Opportunities should be taken to study more foetal outcomes and provide more data on gastro-intestinal tolerability.

Bacteriuria↗
PubMed1987

Automated bacteriuria screening using the Berthold LB 950 luminescence analyser.

The Berthold LB950 Automatic Luminescence Analyser was used to estimate bacterial adenosine triphosphate in urine. The system provided a rapid (15 min) and fully automated screening test for bacteriuria at the 10(5) CFU/ml level. Bioluminescence results for 1040 urines were compared with viable counts using two reference culture methods and frequency distributions of bacterial counts and adenosine triphosphate levels were calculated. With a specificity of 79% the automated method showed a sensitivity of 84% using a pour plate reference count and 91% using a standard loop reference count. When contaminated urines were excluded the sensitivity improved to 98%. The automated bioluminescence test, though expensive, was shown to work well with good quality specimens.

Adenosine Triphosphate↗
PubMed1979

Acute glomerulonephritis with bacteriuria: a probable etiologic relationship.

Twenty-one cases of acute glomerulonephritis in children with no previous history of renal disease were studied. Urinary infection with a rising titre of serum agglutinins against the organisms isolated from urine was found in 5 cases. No evidence of previous streptococcal infection was found in these cases. In the meantime all 8 cases with post-streptococcal glomerulonephritis remained without bacteriuria. In one case acute glomerulonephritis followed virus hepatitis, and in the remaining 7 cases the cause of glomerulonephritis was unknown. It is suggested that in predisposed patients the bacteria present in urinary infections might act as antigens starting immunologic reactions in the glomeruli, leading to glomerulonephritis. The final proof of this theory awaits immunofluorescence identification of these antigens in the glomeruli.

Bacteriuria↗
PubMed2004

Quantitative detection of Escherichia coli from urine of patients with bacteriuria by real-time PCR.

INTRODUCTION: Compared with the classical urine culture method, PCR is more rapid, and can detect smaller numbers of bacteria, however it is inferior for quantification. Because of the lack of quantification in routine PCR, the meaning of a positive PCR test result has not been validated for all infections. We report on the development of a novel quantitative detection system for the urinary tract infection (UTI) Escherichia coli using real-time PCR. PATIENTS: We enrolled 200 patients with suspected bacteriuria. METHODS: The gene encoding the universal stress protein (uspA) was found to be highly specific for E. coli. We quantified the copy numbers of E. coli in the urine of patients with UTI by using a real-time PCR assay (the TaqMan system) targeting uspA genes in genomic DNAs isolated from urine samples (n=200). To evaluate the feasibility of this method, the results were compared with those of a standard urine culture. RESULTS: The incidence of positive urine cultures was 75% (150 of 200), and various doses of E. coli were detected in 84 of 150 specimens. The real-time PCR method also detected 84 cases of urinary infections of E. coli in the same specimens. Furthermore, the result of the quantification of E. coli using real-time PCR strongly correlated (r2=0.925) with the result of urine culture. CONCLUSION: Our results suggest that using quantitative-PCR means a faster and simpler diagnosis of E. coli urinary infection can be made compared with the traditional urine culture method.

Bacteriuria↗
PubMed2005

Asymptomatic bacteriuria as a predictor of subsequent hospitalisation with urinary tract infection in diabetic adults: The Fremantle Diabetes Study.

AIMS/HYPOTHESIS: We examined the prognosis of well-characterised community-based diabetic patients with asymptomatic bacteriuria (ASB). METHODS: We studied 496 adults with type 1 or 2 diabetes participating in a prospective observational study. In addition to detailed clinical and laboratory data, a single mid-stream urine sample was taken for aerobic culture and antibiotic-sensitivity testing. ASB was defined as >/=10(5) colony-forming units/ml of one or two organisms without symptoms of urinary infection. Patients were followed for 2.9+/-0.6 years for hospital admission for/with urosepsis or death. RESULTS: Thirty-six patients (7.3%) had ASB, comprising 33 females (14.4% of all females) and three males (1.1% of all males). Only female sex predicted ASB amongst a range of variables including indices of metabolic control. Twenty-nine patients (5.8%) were subsequently hospitalised with urosepsis. Of these, urosepsis was the principal diagnosis in 12 (41%). In a Cox proportional hazards model, ASB was associated with an increased risk of hospitalisation for urosepsis as principal diagnosis (hazard ratio [95% CI] 4.4 [1.2-16.5]; p=0.004). ASB did not predict the combined endpoint of hospitalisation with urosepsis as principal or secondary diagnosis (2.3 [0.8-6.7]; p=0.12), or of non-urinary sepsis as principal (n=12) or principal/secondary (n=28) diagnosis (p>0.3). CONCLUSIONS/INTERPRETATION: ASB identifies diabetic patients who are at significantly increased risk of subsequent urosepsis requiring hospitalisation. Further large-scale studies are needed to establish the cost-effectiveness of screening for, and pre-emptive treatment of ASB, especially in females.

Aged↗
PubMed2006

Colonization of internal ureteral stent and bacteriuria.

To demonstrate the infection rates, colonization rates following the internal ureteral stent placement; the correlation of indwelling time with the infection, bacterial colonization and the value of urine culture to identify colonizing bacteria One hundred and forty-eight stents of 146 patients were evaluated for the bacteriuria and colonization after internal ureteral placement average 8.6 weeks according to the indication. All patients were ambulatory and were examined in an outpatient clinic. Urine culture and 1 cm of proximal and distal ends was taken for culture for bacterial evaluation. The rate of colonization is 33, 50 and 54% when indwelling time is less than 4 weeks, 4-6 weeks and more than 6 weeks, respectively. Urine culture can detect colonization in 69%. Colonization was not found if the indwelling time was less than 2 weeks. Escherichia coli, Enterobacter and Pseudomonas spp. were the most common colonized organisms. Colonization is common if the indwelling time is more than 2 weeks, urine culture can detect colonization in about two to three of the patients. Even if the culture is negative, prophylactic antibiotic that cover gram-negative and gram-positive organisms should be administrated when the patients require further procedures.

Adolescent↗
PubMed2006

Incidence and risk factors associated with urinary tract infection in diabetic patients with and without asymptomatic bacteriuria.

In order to compare the incidence of symptomatic urinary tract infection (UTI) in diabetic patients with and without asymptomatic bacteriuria (ASB), and to identify other risk factors for these infections, 289 females and 168 males were studied over a 12-month period. Symptomatic UTI occurred in 69.2% of patients with ASB (67.6% female and 76.5% male) versus 9.8% without ASB (14.9% female and 2.6% male). ASB and urinary incontinence were associated with symptomatic UTI in both women and men. Other risk factors included previous antimicrobial treatment and macrovascular complications in women and obesity and prostatic syndrome in men. The presence of ASB was found to be the major risk factor for developing symptomatic urinary tract infection. Further prospective randomized clinical trials of diabetic patients with risk factors for UTI who are receiving or not receiving treatment may be considered.

Aged↗
PubMed2004

History taking and leukocyturia predict the presence of asymptomatic bacteriuria in women with diabetes mellitus.

OBJECTIVE: To investigate the accuracy of history taking to diagnose asymptomatic bacteriuria (ASB) in diabetic women, and the added value of leukocyturia. METHODS: Data were obtained from a multicenter study including 465 women with diabetes. Many patient characteristics were considered as potential diagnostic determinants. A urinary leukocyte count and a urine culture (the criterion standard) were performed. Logistic regression analyses were performed and areas under the receiver operating characteristic curves (AUC) were calculated. RESULTS: For women with type 1 diabetes (n = 236; ASB 11%), duration of diabetes and glycosylated hemoglobin (GHb) were powerful predictors of ASB. The AUC of the model including these two variables was 0.66 (95% confidence interval (CI) 0.53-0.78). After addition of leukocyturia, the AUC increased considerably to 0.78 (95% CI 0.68-0.88; p = 0.018). For women with type 2 diabetes (n = 229; ASB 19%), age and the number of symptomatic urinary tract infections (UTIs) in the previous year were the strongest predictors of ASB. The AUC of the model including these variables was 0.70 (95% CI 0.61-0.80). After addition of leukocyturia, the AUC increased to 0.79 (95% CI 0.71-0.86; p = 0.023). CONCLUSION: In diabetic women, ASB can be diagnosed using two easily obtainable variables (duration of diabetes and GHb for women with type 1 diabetes, and age and the number of UTIs in the previous year for women with type 2 diabetes) in combination with a urinary leukocyte count. This results in a model with sufficient accuracy (AUC > 0.75).

Adult↗
PubMed2003

Virulence characteristics of Escherichia coli strains causing asymptomatic bacteriuria.

BACKGROUND: The objective of this study was to examine the expression of Escherichia coli virulence-associated factors among the strains isolated from a group of women with a history of recurrent urinary tract infections (UTIs), in whom asymptomatic bacteriuria (ABU) was detected at follow-up, and from a group of children without a history of previous UTI, in whom ABU was detected during the screening. Possible differences between the virulence potential of these strains were investigated. MATERIALS AND METHODS: Hemolysin production, the ability to adhere to Buffalo green monkey cell line and hemagglutination (HA) ability of the ABU-associated E. coli strains were tested. E. coli strains isolated from patients with acute recurrent UTIs served as a comparison. RESULTS: The well-known low virulence of strains isolated from patients with ABU was demonstrated. In contrast to strains isolated from recurrent uncomplicated UTIs, the ABU-associated strains were mostly nonhemolytic (75%), nonadherent (70%) and lacked HA ability (61%). HA ability was significantly more common among the strains isolated from children without a history of UTI than among the strains isolated from women with recurrent UTIs (chi2 = 9.97, p < 0.01), whereas the adherence and hemolytic abilities did not differ between the two ABU groups. CONCLUSION: A further prospective study is needed to determine whether the HA ability is the predictor of subsequent symptomatic UTI.

Adhesins, Bacterial↗
PubMed1983

Quantitative definition of bacteriuria.

Quantitative criteria distinguish bacterial infection (or colonization) of the urine from contamination. These criteria depend on the fact that the density of bacteria in infected urine is usually several orders of magnitude higher than the density of bacteria in contaminated urine. Most research on quantitative definitions of infection has concerned Gram-negative rod infections in women. For asymptomatic bacteriuria, the most prevalent urinary tract infection, and for pyelonephritis, a criterion of 1 X 10(5) cfu/ml provides optimal separation of infection from contamination of voided urine. For acute dysuria and frequency, recent evidence supports the use of a colony count of 1 X 10(2) cfu/ml bacteria as the most useful criterion. For the diagnosis of catheter-associated urinary tract infection, the criterion of 1 X 10(5) cfu/ml has been used most commonly, although a lower threshold may be appropriate. Additional investigation is required to determine the most appropriate quantitative definition of infection in this and several other circumstances.

Bacteria↗
PubMed1985

Detection of asymptomatic bacteriuria in obstetric patients with a semiautomated urine screen.

Urine specimens (1215) from obstetric patients were evaluated for the presence of significant bacteriuria by the Bac-T-Screen (Marion Scientific Division, Marion Laboratories, Inc., Kansas City, Missouri) and a conventional semiquantitative culture method. Seventy (5.8%) specimens were not processed successfully by the Bac-T-Screen because pigments interfered with interpretation or the test filters clogged. The remaining 1145 specimens screened by the Bac-T-Screen were compared with a conventional culture method. The sensitivity, specificity, positive predictive value, and negative predictive value for specimens containing greater than or equal to 10(5) colony-forming units per milliliter were 97.4%, 70.4%, 19.0%, and 99.7%, respectively. These values for specimens containing greater than or equal to 10(4) colony-forming units per milliliter were 92.2%, 71.6%, 24.1%, and 98.9%, respectively.

Bacteriological Techniques↗
PubMed1976

Simple screening test for significant bacteriuria in urine. Catalase determination by disk flotation method.

Colony count cultures and catalase determinations were done on 294 urine samples in two series of patients at Royal Victoria Hospital. Thirty-six specimens were reported to be positive by colony count and by catalase determination. A total of 135 specimens found to be negative by colony count were also negative by the disk flotation test. Catalase activity in 4 urines reported as false negative were found to contain 6,000 or less colonies per ml. More than 50 per cent of the false positive results could be attributed to the presence of red blood cells. Data were insufficient to explain the remaining false positive catalase determinations. However, catalase determinations by the disk flotation method proved to be a successful screening test for significant bacteriuria.

Bacteriuria↗
PubMed1976

Unilateral medullary sponge kidney: cause of persistent bacteriuria.

A patient with twenty years of persistent bacteriuria secondary to unilateral medullary sponge kidney, and in whom no antibiotic would sterilize the urine, was cured of her infection by nephrectomy in the presence of contralateral hydronephrosis. A review of the literature shows 23 cases of unilateral medullary sponge kidney in which nephrectomy or partial nephrectomy was apparently equally successful, although no bacteriologic follow-up data are given.

Bacteriuria↗
PubMed1979

Monitoring for bacteriuria in spinal cord-injured patients on intermittent catheterization. Dip-slide culture technique.

Spinal cord-injured patients on intermittent catheterization underwent careful scrutiny of daily bacteriuria using the dip-slide culture technique. Comparison with conventional bacteriologic streaked plates revealed good correlation for quantitating low-density bacteria as well as 10(5) organisms. The technique serves as a useful tool in screening for urinary tract infection among patients with neurogenic bladder.

Bacteriological Techniques↗