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PubMed1986

Screening for bacteriuria with the LN strip test.

Recently, the LN strip test was introduced for purposes of rapid screening of urine specimens for bacteriuria. The LN strip test permits detection of urinary leukocyte esterase and nitrite. A total of 2,481 unselected urine specimens from three tertiary care hospitals were examined using the LN strip test and the results were compared with those obtained with a conventional quantitative culture technique. When the results of the leukocyte esterase and nitrite tests were combined, the sensitivity and specificity of the LN strip test were 88.8% and 71.3%, respectively, based on culture results of greater than or equal to 10(5) CFU/ml. Test sensitivity decreased at greater than or equal to 10(4) CFU/ml, whereas test specificity increased.

Bacteriuria↗
PubMedDate not supplied

Evaluation of the FiltraCheck-UTI for detection of bacteriuria.

The FiltraCheck-UT1 (FC) is a disposable colorimetric urine screen for bacteriuria that requires less than 1 min to perform. The results of the FC and two other urine screens, the Bac-T-Screen (BTS) and the Chemstrip LN test strip (LN), were compared with quantitative culture method. A total of 551 urine specimens were tested. The sensitivity of FC, BTS, and LN for probable pathogens at greater than or equal to 10(5) CFU/ml was 94.8%, 97.4%, and 77.9% respectively. These values for specimens with probable pathogens at greater than or equal to 10(4) CFU/ml were 91.1%, 92.1%, and 74.3%, respectively. When the LN was combined with the FC or BTS as a urine screen, the sensitivity for probable pathogens was improved.

Bacteria↗
PubMed1986

Office diagnosis of asymptomatic bacteriuria in pregnant women.

Diagnosis and treatment of asymptomatic bacteriuria in pregnant patients can virtually eliminate pyelonephritis, the most common medical cause for antepartum hospitalization. However, the ever-increasing cost of the urine culture has led most clinicians away from routine urine screening. Uricult dip-slide paddles provide an inexpensive, efficient way to screen urine. Clean-catch urine specimens were obtained from 544 consecutive asymptomatic pregnant patients seen in the outpatient obstetric clinic at the Medical University of South Carolina. Specimens were analyzed by both traditional culture techniques and the Uricult dip-slide paddles. By comparison, the Uricult test detected 55 of the 56 significant gram-negative urinary pathogens found by culture. Detection of potential gram-positive pathogens is more difficult. A scheme is proposed that allows reliable, inexpensive surveillance in all pregnant patients. Hopefully, this algorithm will rekindle the obstetrician's interest in urine screening.

Ambulatory Care↗
PubMed1988

Bacteriuria in appendicitis.

The value of bacteriologic findings in patients with acute appendicitis was studied. Routine urinary culture specimens were taken preoperatively from 194 children (mean age 11 +/- 3 years) undergoing emergency appendectomy. Bacteria were found in culture specimens of urine from 26 of 156 patients with acute appendicitis. The bacteriuria was correlated to the position of the appendix, the duration of disease, and the degree of inflammatory changes in the appendix. The results suggest direct spread of bacteria from the inflamed appendix to the urinary tract due to close anatomic relationship and to the severity of the inflammatory changes. That this spread of bacteria can have clinical significance cannot be excluded. Urinary sedimentation study is of no use in the diagnosis of acute appendicitis.

Appendectomy↗
PubMed1997

Relapsing significant bacteriuria: effect on urinary tract infection in patients with spinal cord injury.

OBJECTIVE: To evaluate whether there is a relation between relapsing significant asymptomatic bacteriuria (ASB) and symptomatic urinary tract infection (UTI), and to determine the frequency rate of UTI in patients with spinal cord injury (SCI) using indwelling catheters (IC). DESIGN: Cohort study. Patients were followed up for 24 to 270 days (mean, 66.3 +/- 42.2). SETTING: A department of physical therapy and rehabilitation in a research hospital of a university referral center. PATIENTS: Fifty patients with SCI using IC. Patients with severe concurrent illness, known vesicouretheral reflux, urinary calculi, and severely disturbed renal function were excluded. MAIN OUTCOME MEASURE: Symptomatic UTI, relapsing ASB, and recurrent significant ASB. RESULTS: There was significant difference between relapsing ASB and recurrent ASB with regard to occurring symptomatic UTI (chi 2, 4.92; p < .03). Symptomatic UTI was observed at a rate of 9.35, relapsing ASB 35.59, and recurrent ASB 55.80 per 1,000 patient-days. CONCLUSION: Relapsing ASB is an important factor in the development of symptomatic UTI.

Adolescent↗
PubMed1990

Significance of asymptomatic bacteriuria in spinal cord injury patients on condom catheter.

A total of 56 male spinal cord injury patients on condom catheter drainage was studied prospectively within 6 months of the injuries for 5 years. Low bladder pressures (filling maximum 35 cm. water and voiding maximum 70 cm. water) were ascertained with video-urodynamics. External sphincterotomy was performed when necessary for detrusor-sphincter dyssynergia. Yearly upper tract imaging, serum creatinine levels and urine cultures were obtained. All patients had colonized urine (asymptomatic) during the entire study period. No patient sustained deterioration of the urinary tract on imaging or by serum creatinine determinations during the 5-year interval. We conclude that asymptomatic bacteriuria is of no consequence to the integrity of the upper urinary tract when low pressures are operant.

Bacteriuria↗
PubMed1983

Comparison of mid catheter collection and suprapubic aspiration of urine for diagnosing bacteriuria due to fastidious micro-organisms.

We examined 40 female patients for the presence of fastidious bacteria in the bladder by culture of mid catheter and suprapubic aspiration urine specimens. Gardnerella vaginalis and Ureaplasma urealyticum were the most frequently isolated fastidious species. The suprapubic aspirate was positive in 3 patients with more than 10(5) colony-forming units per ml. Gardnerella vaginalis and 7 with more than 10(2) colony-forming units per ml. Ureaplasma urealyticum in the mid catheter urine specimen, while it was negative for bacteria in 6 patients with less than 10(4) colony-forming units per ml. coryneform bacilli or lactobacilli in the mid catheter urine specimen. The results show that culture of mid catheter urine samples provides a reasonable guide to the presence of bacteriuria owing to fastidious micro-organisms and can be used when a suprapubic aspiration specimen cannot be obtained easily.

Bacteriological Techniques↗
PubMed1980

Prophylaxis of bacteriuria during intermittent catheterization of the acute neurogenic bladder.

A randomized prospective study of bacteriuria control during early intermittent bladder catheterization was performed on a spinal cord injury service. The 64 male subjects underwent 16,620 catheterizations and had 83 significant episodes of infection. The infection rates among various groups were compared: 1) control patients, 2) patients treated with intravesical neomycin/polymyxin-B, 3) patients given low dose daily macrocrystals of nitrofurantoin and 4) patients given intravesical treatment and oral nitrofurantoin. There was significant reduction in infection rates when oral and intravesical antibiotics were used.

Acute Disease↗
PubMed1994

Cerebrospinal fluid shunt infection secondary to Escherichia coli bacteriuria.

A 10-year-old girl with a lumbosacral myelomeningocele, managed with clean intermittent catheterization, presented with headache, vomiting, and lethargy. The cerebrospinal fluid (CSF) and urine cultures revealed Escherichia coli, documented to be the same subtype. The organisms were subtyped and the E. coli from both the urine and CSF were noted to be of the same strain. Management consisted of intravenous antibiotics and ultimate replacement of the ventriculoperitoneal shunt. Children with myelodysplasia and CSF shunts should be carefully monitored in a multidisciplinary fashion to anticipate, correctly diagnose, and treat CSF shunt infections associated with bacteriuria.

Bacteriuria↗
PubMed1999

Asymptomatic bacteriuria in spinal cord patients and the elderly.

The prevalence and incidence of symptomatic and asymptomatic bacteriuria will remain high for many years to come. Antimicrobial agents are necessary to treat symptomatic UTI because no natural methods have been shown to be effective. Treatment of ABU is not appropriate. There is growing resistance to antibiotics, biocides, and antiseptics and, simultaneously, a decreasing rate of introduction of new antibacterial agents; thus the problem of resistance is magnified and potentially complicates the management of patients with SCI and elderly persons. New options of managing health and of preventing ABU and UTI and the complications arising from these diseases must be investigated vigorously and urgently. In particular, further study of the role of bacterial biofilms, the normal microflora, the influence of diet and hygiene, and the importance of the host immune response in the process of urinary tract colonization and infection is relevant and necessary.

Aged↗
PubMed1975

Relevance of "significant bacteriuria" to aetiology and diagnosis of urinary-tract infection.

28 of 74 female domiciliary patients who presented with urinary-tract symptoms did not fulfil the usually accepted laboratory criterion required for confirmation of urinary-tract infection (i.e., a urinary bacterial viable count in excess of 100 000/ml). The progress of the disease was similar in non-bacteriuric and bacteriuric patients. In addition, a significant proportion of the bacteriuric group did not show the response to therapy expected from the results of in-vitro tests of antibiotic sensitivity and urinary antibacterial activity. To explain these findings, it is postulated that bacteria may not be primary pathogens in uncomplicated urinary-tract infection even where "significant bacteriuria" is demonstrated.

Adolescent↗
PubMed1975

Urine microscopy as an aid to detection of bacteriuria.

Fresh, uncentrifuged urine specimens obtained from children attending a renal clinic were examined microscopically for leucocytes and bacteria, and the results were compared with quantitative bacterial cultures. Of the 51 specimens giving colony-counts larger than or equal to 10-5 per ml., 6 (12 per cent) showed no microscopical bacteriuria and 22 (43 per cent) contained smaller than 10 leucocytes per c.mm.; only 3 specimens (6 per cent) showed neither bacteria nor excess cells. Of the 186 uninfected specimens, bacteria were seen microscopically in 32 (17 per cent) and an excess of leucocytes in 27 (15 per cent); in only 9 (5 per cent) were both observed. Leucocyte-counting alone is therefore an unreliable technique, but microscopy for both bacteria and leucocytes affords a simple and rapid method of preselecting urine specimens for culture, with a high probability of predicting the correct result. While not suitable for population screening, it is ideal for use in hospital clinics and wards, as well as in general practice.

Adolescent↗
PubMed1976

An automated test for the detection of significant bacteriuria.

A fully automated technique for the rapid detection of significant bacteriuria is described. The method, which depends on the detection of bacterial adenosine triphosphate (A.T.P.) by bioluminescence, was found to have better sensitivity than a conventional cultural technique which uses a standardised loop. Results were available in 30 minutes. In the 957 urine samples tested, specificity was 84.5% relative to a pour-plate technique; results were not affected by the presence of non-bacterial elements.

Adenosine Triphosphate↗
PubMed1984

The effect of covert bacteriuria in schoolgirls on renal function at 18 years and during pregnancy.

Schoolgirls shown to have covert bacteriuria (CB) by a screening programme and followed up for 5 years to assess whether chemotherapy had any beneficial effect, underwent a further assessment of renal function at the age of 18 years and during subsequent pregnancies. At age 18, glomerular filtration rate (GFR) and urine concentrating ability were the same as in controls, but fractional reabsorption of glucose was significantly reduced in those who had previously been prescribed chemotherapy because of renal scarring or who had been randomly allocated not to receive prophylactic chemotherapy. Those who had had CB as schoolgirls had a higher frequency of CB in pregnancy than did controls, whether or not prophylactic chemotherapy had been given to the subjects when they were schoolgirls. Furthermore, compared with girls who had had such treatment, untreated patients had smaller increments in GFR, reduced fractional reabsorption of glucose, and more than usual degree of glycosuria during pregnancy. This suggests that subclinical renal damage may be prevented by prophylactic chemotherapy but this advantage is unmasked only by the physiological demands of pregnancy.

Adolescent↗
PubMed1989

Evaluation of four screening tests for bacteriuria in elderly people.

Four screening tests for bacteriuria were assessed at ward level in 418 elderly subjects and were compared with standard methods of bacterial culture. The tests were visual appearance; microscopy; dipstick for nitrite, leucocyte esterase, protein, and blood; and dipstick for nitrite and organisms. The sensitivity of the tests varied from 85.6% to 98.3%, and the specificity from 18.4% to 82.9%. A combination of visual appearance and dipstick testing for nitrite and leucocyte esterase gave a sensitivity of 96.1% with a specificity of 50.6%, and could have reduced by almost one-third the number of urine samples submitted to the laboratory for processing.

Aged↗
PubMedDate not supplied

Bacteriologic profile and drug resistance in pediatric patients with symptomatic bacteriuria.

The bacteriologic profile in 1081 pediatric patients with culture-positive symptomatic bacteriuria was studied over a 30-month period in a 500-bed acute care hospital in Riyadh, Saudi Arabia. Microbial isolates were considered significant if their numbers equaled or exceeded 10,000 colony-forming units/mL in symptomatic patients. Escherichia coli was the most common causative agent of urinary tract infections (55.1%), followed by Pseudomonas aeruginosa (11.9%), Klebsiella pneumoniae (10.0%), and Enterococcus species (6.1%). Results of antimicrobial susceptibility testing indicated that nitrofurantoin and cephradine may be used as empiric therapy pending laboratory investigation; gentamicin can be added in the treatment in severely ill inpatients, and treatment can be modified when microbiologic results become available.

Ampicillin↗
PubMed1999

Evidence that patients with rheumatoid arthritis have asymptomatic 'non-significant' Proteus mirabilis bacteriuria more frequently than healthy controls.

OBJECTIVES: patients with rheumatoid arthritis (RA) are reported to have in their sera raised levels of antibody specific to Proteus mirabilis. The aim of the study was to verify this and to determine an explanation for it by investigating the frequency of P. mirabilis urinary tract infection in RA patients and matched controls. METHODS: freshly voided urine was examined for the presence, number and identity of infecting bacteria. The levels of antibody in blood and in urine of the IgM, IgA and IgG classes to the common O serotypes of P. mirabilis and the antigens to which they reacted were determined by enzyme-linked immunosorbent assay (ELISA) and immunoblotting. RESULTS: analysis of urine from 76 patients with RA and 48 age- and gender-matched healthy controls showed that only two (4%) of the control urines but 25 (33%) of those from the RA patients were infected. The commonest infecting organism in the RA patients' urine was Proteus mirabilis which occurred twice as frequently as Escherichia coli. Proteus mirabilis was found in 52% of the infected urines of the RA patients and was always detected as a pure growth and usually in insignificant (< 10(4)/ml) numbers. It is highly improbable that this finding was the outcome of differences in age, physical ability or medication between the RA and control patient groups. Comparison of antibody levels to P. mirabilis by ELISA showed RA patients had raised (P < 0.0001, P = 0.001, P = 0.0063) levels of IgA, IgG and IgM respectively in their sera and raised (P < 0.0001, P < 0.0001, P = 0.0001) levels of IgG, IgM and IgA respectively in their urine compared with the control group. It was not possible to detect an antibody reacting to a P. mirabilis antigen that was specific to the RA patients. CONCLUSION: the results confirm that RA patients have raised levels of antibody to P. mirabilis not only in blood but also in urine and suggest that this arises because RA patients have an asymptomatic, non-significant P. mirabilis bacteriuria more frequently or more prolonged than control patients. This may be the trigger for their RA condition.

Adult↗