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PubMed2002

Evaluation of the Coral UTI Screen system for rapid automated screening of significant bacteriuria in a regional centralized laboratory.

An evaluation of the Coral UTI screen system (Coral Biotechnology, San Diego, CA) compared to urinalysis/urine culture was done to assess its performance for rapidly screening a high volume of urine samples for significant bacteriuria in a regional central microbiology laboratory. A total of 1094 urine samples from ambulatory patients were evaluated. 670 (61.2%) urine samples were negative or positive [178 (16.3%)] by both methods. 217 (19.8%) other samples were UTI screen positive but had either no growth or no uropathogens on culture; 9 of these samples were possibly false negative by culture because of the presence of pyuria, indicating the presence of either a urinary tract infection or another inflammatory process. Another 29 (2.7%) samples had false negative screens because the urine culture was positive, but only 5 of these patients were treated with antibiotics after urine specimen collection. Overall, the Coral UTI screen has a sensitivity of 86.0%, a specificity of 75.5% and a positive and negative predictive value of 45.0% and 95.9% respectively. Routine use of the UTI screen would allow same day reporting of 65% of all urine culture results without having to proceed to culture.

Automation↗
PubMed1997

The natural history of bacteriuria in childhood.

Urinary tract infections are common during infancy and childhood but are easily overlooked because of the unspecific symptoms. Prevention of renal scarring and its potential long-term consequences is possible but requires an increased awareness of the diagnosis, the imaging revealing anomalies within the urinary tract, and the long-term supervision. This should include any possibility of the child having pyelonephritic recurrences, which should be treated without delay; however, asymptomatic bacteriuria in infants and children is an innocent condition and screening is not recommended.

Adolescent↗
PubMed2001

Staphylococcus aureus bacteriuria and surgical site infections by methicillin-resistant Staphylococcus aureus.

Surgical site infection (SSI) remains an important cause of morbidity among hospitalized patients. We reviewed 421 patients who underwent open urological operations between January 1993 and December 1997 in our institute. Group I consisted of 259 patients who received uncontrolled antimicrobial prophylaxis (AMP) between 1993 and 1995. Group II consisted of 162 patients who received controlled AMP between 1996 and 1997. In group II, penicillins or first to second-generation cephalosporins was used and the duration of use for these agents regulated according to the wound class of each operation. The operations with clean wounds showed the lowest rate of SSI in both groups; the operations with contaminated wounds showed the highest rate of SSI (32.0% in group I and 33.3% in group II). There was no significant difference in the total rates of SSI between the two groups (P=0.216). The most frequently isolated bacterial species was methicillin-resistant Staphylococcus aureus (MRSA), isolated in 73.3% of the cases in group I and in 93.3% in group II. There was no significant difference in the incidence of MRSA isolation between the two groups (P=0.114). The controlled AMP could not lower the incidence of MRSA-induced SSIs. In SSI patients, 22.7% of group I and 35.7% in group II, had MRSA bacteriuria before operation. The prohibition of third-generation cephalosporins and shorter duration of AMP did not reduce the incidence of SSI induced by MRSA because MRSA was not the emerging microorganism but rather a resident in the urological ward. On the other hand, the total incidence of SSI did not increase after regulation of AMP. This finding suggests that older antibacterial agents can prevent infection, except those caused by resistant microorganisms such as MRSA. The effective counter-measure for the prevention of MRSA-induced SSI is needed.

Anti-Infective Agents, Urinary↗
PubMed2003

Asymptomatic bacteriuria. Clinical significance and management.

The clinical significance and management of asymptomatic bacteriuria (ASB) differs according to different groups of patients. ASB requires antibiotic treatment in pregnant women, children aged 5-6 years and prior to invasive genitourinary procedures. However, there is a consensus that ASB in the elderly, healthy school girls and young women, diabetic women and patients with indwelling catheters or intermittent catheterization has no clinical significance and antibiotic prescription is not indicated.

Adult↗
PubMed2005

Screening for asymptomatic bacteriuria in pregnancy.

OBJECTIVE: To compare the following 4 screening strategies for detecting asymptomatic bacteriuria (ABU) in pregnancy: urine testing with leukocyte-esterase-nitrite (LEN) strips at each prenatal visit followed by a urine culture if positive; a single urine culture at fewer than 20 weeks' gestation; 2 urine cultures, at fewer than 20 weeks' gestation and at 28 weeks' gestation; or 3 urine cultures, at fewer than 20 weeks', at 28 weeks', and at 36 weeks' gestation. METHODS: Participants were pregnant women presenting to 2 obstetricians and 6 family physicians at outpatient family medicine and obstetrical clinics in a large Canadian urban teaching hospital. LEN dipstick urine testing was conducted at each prenatal visit. A midstream urine culture was obtained from all women before 20 weeks' gestation and at 28 weeks' and 36 weeks' gestation, as well as for positive LEN tests. Any positive urine culture in an asymptomatic woman was designated a case of ABU. The total number of ABU cases that would be detected by each of the 4 strategies (LEN dipstick testing only, a single urine culture, 2 cultures, and 3 cultures) was determined and compared. RESULTS: There were 49 cases of ABU among 1050 women (4.7%). LEN testing at each prenatal visit identified 7 cases (14.3%), compared with 20 cases (40.8%) with 1 urine culture, 31 (63.3%) with 2 urine cultures, and 43 (87.8%) with 3 urine cultures. CONCLUSION: A single urine culture before 20 weeks' gestation missed more than one-half the ABU cases. A culture in each trimester identified most ABU cases.

Adult↗
PubMed2001

Virulence factors of Escherichia coli isolated from urine of diabetic women with asymptomatic bacteriuria: correlation with clinical characteristics.

Since Escherichia coli isolated from compromised patients with symptomatic urinary tract infections (UTIs) express fewer virulence factors than those isolated from healthy controls, the question arises whether this is also the case for diabetic patients with asymptomatic bacteriuria (ASB). Polymerase chain reaction (PCR) assays were conducted on 111E. coli strains, isolated from the urine of diabetic women with ASB, using primers for the major subunit A and the G-adhesin (I, II, and III) of P fimbriae, type 1 fimbriae, S fimbriae, afimbrial adhesin, cytotoxic necrotizing factor (CNF), and aerobactin. Phenotypically, hemolysis, mannose-sensitive hemagglutination, mannose-resistant hemagglutination and O:K:H-serotypes were determined. Furthermore, we investigated the associations between virulence factors and patient characteristics (including deterioration of renal function). Type 1 fimbriae were the most prevalent virulence factor (86% by genotyping and 59% phenotypically). Except for a lower prevalence of known uropathogenic O-serotypes, we found the same number of virulence factors in our compromised patient group as listed in the literature in noncompromised patients with ASB. Certain virulence factors (type 1 and S fimbriae and CNF) of the causative E. coli correlated with the risk of a decline in renal function. In conclusion, the number of virulence factors in E. coli isolated from the urine of diabetic women with ASB are comparable with the results found in other (noncompromised) patients with ASB. Furthermore, certain virulence factors of E. coli might contribute to a decline in renal function.

Adult↗
PubMed2002

Bacterial colonization of double J stents and bacteriuria frequency.

AIM: Stents and catheters are widely used in urology. In our study the frequency of double J stent (DJS) colonization and stent associated bacteriuria is investigated. MATERIALS AND METHODS: Between June 2000-April 2001, 61 patients (17-72 years old) to whom DJ stenting was done (5 of them bilateral) were included in this study. Stone extraction/lithotripsy, extracorporeal shockwave lithotripsy (ESWL), open urolithiazis surgery and hydronephrosis were the indications. Sterile urine samples were obtained prior to stenting. Patients were clinically followed and after the treatment DJ stents were removed after having urinary cultures via the cystoscope. DJS cultures were also made. RESULTS: DJS indwelling times were between 15-90 days (52.5 +/- 8.6). In 3 female, 8 male totally 11 patients bacterial colonizations were observed. In 10 of them both stent and urinary cultures were positive, and showed identical microorganisms; 80% E. Coli, 10% E. Coli+ Candida, 10% Klebsiella. CONCLUSIONS: Our infection rate of DJS and urine is 18% which is not very high. Routine DJS cultures are not needed as the same microorganisms grow in urine cultures. No age or sex relation to the infections is found. Antibiotic prophylaxis is effective in preventing clinically ouvert infectious diseases.

Adolescent↗
PubMedDate not supplied

Evaluation of calibrated 1 and 10 microl loops and dipslide as compared to pipettes for detection of low count bacteriuria in vitro.

Criteria for defining urinary tract infection have changed as the importance of low count bacteriuria in patients with symptoms of infection has been recognized. Little has been published, however, regarding the ability of routine laboratory methods to meet this new challenge. We compared 1 microl and 10 microl calibrated plastic loops (Nunc, Denmark), to a commonly used dipslide method (Uricult, Orion, Finland) using a 0.1 ml pipette as the gold standard. Four typical uropathogens, E. coli, P. aeruginosa, S. saprophyticus and E. faecalis, were mixed in pooled human urine in numbers representing low counts, i.e. 10(2), 10(3), and 10(4), together with 10(5) colony-forming units (cfu)/ml, and sampling with the four methods was performed 20 times for each with each bacterium and each dilution. Colony counts showed that in many cases the 1 microl loop did not deposit any bacteria on the agar plate when colony counts were lower than 10(4) cfu/ml. The 10 microl loop constantly deposited 1.5 times higher numbers of bacteria than predicted, which correlated with the results of weighing the amount of water sampled, i.e. 15.24 (1.55) microg (mean (SD)). The dipslide counts correlated with the 10 microl loop although the agar mounts on the slides absorbed water equal to about 200 microl. There were no significant differences in the counts of the four different bacteria. Variation coefficients increased with decreasing volumes sampled, but the 10 microl loop was found sufficiently exact to detect counts from 10(3) to 10(4), since only 10-fold multiples are usually reported for urine cultures.

Bacteriological Techniques↗
PubMed1990

Peroral treatment with ciprofloxacin of patients with spinal cord lesion and bacteriuria caused by multiply resistant bacteria.

Eleven patients, median age 38 years, with spinal cord lesion (SCL) and urinary tract infection (UTI) caused by multiply resistant bacteria entered an open clinical trial of peroral ciprofloxacin 250 mg b.i.d. for 6 days. P. aeruginosa was the most prevalent bacteria. Ciprofloxacin was clinically effective in all patients who had symptoms of UTI at entry. Bacterial eradication was achieved in 9 out of 11 patients immediately after treatment. At 4 weeks post-treatment 5 patients had relapse of bacteriuria with the initial micro-organism and only 2 had long term eradication. One patient had transient elevation of transaminases, but no other adverse reactions were noted. Pharmacokinetic analysis showed that ciprofloxacin was readily absorbed with a terminal half life of 2.5 hours and considerable nonrenal elimination. The urinary concentration of ciprofloxacin was high during the whole dosing interval. Oral treatment with ciprofloxacin is an alternative to parenteral antibiotics in SCL-patients with urinary tract infection caused by resistant bacteria.

Adult↗
PubMed1988

Asymptomatic bacteriuria--a long-term study.

Four percent of the women in a population study 1969-1970 had asymptomatic bacteriuria (ABU). 15 years later a reinvestigation was carried out, in women-born 1913-1948. 40 women with ABU and 40 age-matched healthy controls from the population study participated. The frequency of symptomatic urinary tract infections (UTI) had been significantly higher in the ABU group than in the control group during follow-up, but nobody had developed progressive renal disease. Three women in the ABU group and one in the control group had low urine concentrating capacity. All other osmolality values were within normal limits, although there was a significant difference between the two groups. The age-dependent decrease after 15 years was the same in both groups. The number of new hypertensives was the same in both groups. A total of 37.5% were hypertensive in the ABU group and only 12.5% in the control group, but as hypertension had been excluded in the control group at the first investigation the groups could not be compared in this respect.

Adult↗
PubMed1995

A prospective study of bacteriuria and pyuria in catheter specimens from hospitalized children, Durban, South Africa.

In a prospective study of 180 children admitted consecutively to King Edward VIII Hospital, bacteriuria (BU) was detected in 47 (26%), associated with pyuria in 35. BU occurred in association with other common childhood diseases in all but one child: acute lower respiratory tract infection (LRTI) in 43%, gastro-enteritis (GE) in 34% and protein energy malnutrition (PEM) in 26%. Conversely, BU was detected in 24% of children with LRTI, 33% with GE and 38% with PEM. Children with or without BU thus presented with similar symptoms and signs, except for vomiting and dehydration which were more frequent in those with BU. The male:female ratio was higher in BU under 2 years of age. Localizing urinary tract symptoms and signs were infrequent. Only one of the 35 children in whom ultrasonography was performed showed structural defects. The organisms detected (mainly Escherichia coli) were resistant to commonly used antibacterial drugs. There was a high specificity for dipstix testing, but low sensitivity, possibly because of sampling by catheter. There were seven deaths, three with and four without BU. Other illnesses contributed to death in all cases. Our findings have implications for the management of children who are hospitalized for common diseases in developing countries. It is not clear whether pyuria and BU were transient or indicative of serious disease of the kidney and urinary tract.

Anti-Bacterial Agents↗
PubMed1996

Bacteriuria in children attending a primary health care clinic: a prospective study of catheter stream urine samples.

Urinary tract infection (UTI) in infancy and childhood has received scant attention at primary health care (PHC) level, rarely featuring as one of the common diseases. In a prospective study conducted at a PHC clinic, 16 of 94 children (17%) from whom urine was collected by strict aseptic catheterization had bacteriuria (BU). Twelve of these had associated leucocyturia (> 5 WBC/HPF). The median age of those with BU was 9 months (range 1-30 months). BU rarely occurred in isolation (6%), but was most often detected in association with acute respiratory infection (43%) and acute diarrhoea (19%). No association of BU with mild malnutrition was detected in the 50% of children who were underweight for age. Gram-negative pathogens accounted for 14 cases (87.5%). These pathogens were resistant to commonly recommended antibiotics for UTI. Only five cases of BU returned for follow-up at 3 months; no abnormalities were detected on repeat catheter urine samples, urinary tract ultrasonography, voiding cystourethrogram and DMSA studies in them. From these and other findings we conclude that BU is probably often present in young children with common diseases attending PHC centres in developing countries. Further studies are required to establish exactly the role these pathogens play in the pathogenesis of UTI.

Ambulatory Care Facilities↗
PubMed1992

Short vs. long cotrimoxazole courses in eradicating bacteriuria in the elderly.

To test whether longer duration of treatment of asymptomatic bacteriuria in old age could improve the efficacy of cotrimoxazole therapy, three regimens were given to 75 ambulant bacteriuric residents of a retirement home, aged greater than or equal to 68 years. The groups and regimens were: A:23 subjects (160/800 mg b.i.d. orally x 3 days). B: 24 subjects (160/800 mg i.m. x 10 days); C: 28 subjects (160/800 mg b.i.d. orally x 20 days). One week, one month and five months post-therapy urines were negative in 78.3% vs 52.9% vs 42.9% of group A, in 54.2% vs 56.5% vs 50% of group B and in 57.1% vs 60.7% vs 68% of group C subjects respectively. The data indicate that: 1) the efficacy of any schedule is only moderate irrespective of the presence of antibody-coated bacteria in urine; 2) a 3-day course appears more effective at one week post-therapy; 3) at one and five months greater than or equal to 50% of the subjects were infection-free, the 20 day treatment resulting in fewer failures; 4) subjects with long-term eradication had no mobility problem, low serum creatinine and a normal urinary tract as seen by ultrasound.

Administration, Oral↗
PubMed1994

Asymptomatic bacteriuria of pregnancy: do obstetricians bother?

In view of the potentially serious consequences of asymptomatic bacteriuria of pregnancy (ASB), we surveyed the attitudes of Greek obstetricians towards this entity. A total of 108 obstetricians practicing in the area of Athens completed a questionnaire concerning ASB. Only 73 of the 108 stated that they screen their clients for ASB (51 of them when pyuria is present and only 22 in all pregnant women). Of special interest is the finding that a larger percentage of younger obstetricians (practicing for up to 9 years) habitually screen their patients, compared to older ones (83% vs 60%). Concerning treatment of ASB, only 45 out of 73 doctors screening for ASB give any treatment when ASB is present. Most obstetricians (87%) prefer a beta-lactam antibiotic. In almost all cases 7-10 days are considered the appropriate duration of treatment. Better education of obstetricians, especially the older ones, concerning detection and management of ASB is needed.

Attitude of Health Personnel↗
PubMed1985

The problem of bacteriuria with indwelling urethral catheterization.

Bacteriuria following long-term catheterization is more likely to occur in elderly females over the age of 50 years, in patients with some abnormality of the bladder and when traumatic catheterization has taken place. Breaks in the closed system of drainage are the most important factors leading to bladder infections which, once there, are difficult to eradicate. Antiseptics are important at the time of catheterization but have little place afterwards except to reduce cross-infection and growth in the catheter bag. Systemic antimicrobials are only of use over a short period of catheterization and should be reserved in long-term catheterized patients for those with systemic manifestations of infection.

Aged↗
PubMed1995

Clinical evaluation of the slide centrifuge (cytospin) gram's stained smear for the detection of bacteriuria and comparison with the FiltraCheck-UTI and UTIscreen.

The cytospin Gram's stained smear method for the detection of bacteriuria was compared with the FiltraCheck-UTI, the UTIscreen and culture of urine specimens from adult male and female inpatients and outpatients in a tertiary care medical institution. At a level of > or = 10(5) CFU/mL, the sensitivity of all three methods was at least 93% for organisms identified as potential pathogens. Investigation of false-negative screening tests by chart review demonstrated that only 5 of 10 combined misses in this category were clinically significant. At a level of > or = 10(4) CFU/mL, the sensitivity of the cytospin method remained essentially unchanged, whereas that of the FiltraCheck-UTI and the UTIscreen decreased to 89% and 85%, respectively. False positives were most frequent with the FiltraCheck-UTI, which was due in part to the presence of white blood cells in the urine. All three tests performed well in this population of patients.

Adult↗
PubMed1997

Evaluation of the cytocentrifuge Gram stain as a screening test for bacteriuria in specimens from specific patient populations.

To assess the usefulness of the cytocentrifuge Gram stain as a urine screening test in the clinical microbiology laboratory for the elimination of culture for screen-negative specimens, we compared the results of the cytocentrifuge Gram stain to the results of culture for 1,171 urine specimens. The data were analyzed separately for specimens from males (inpatients) and females (inpatients and outpatients), as well as for catheterized and voided specimens. Overall, the cytocentrifuge Gram stain had excellent negative predictive value (97.7%) and sensitivity (92.3%) at a culture threshold of 10(5) colony-forming units per milliliter or more. The negative predictive value and sensitivity decreased at lower culture thresholds in all populations. The negative predictive value decreased most markedly for female outpatients. Because of low positive predictive value and specificity, this test is not reliable as a sole indicator for presumptive therapy in many cases with positive results. If its limitations are recognized, the cytocentrifuge Gram stain is a useful screening test for the rapid exclusion of bacteriuria.

Adolescent↗
PubMed1975

Comparative evaluation of the Limulus assay and the direct Gram stain for detection of significant bacteriuria.

A double-blind study comparing the Limulus in-vitro endotoxin assay with the direct Gram stain of uncentrifuged urine for detection of significant bacteriuria was performed. One-thousand seventy-seven urine specimens were examined by the two methods and the results compared with results of quantitative urine cultures. Two hundred three samples produced growth of greater than 10-5 organisms per ml. urine. The Limulus assay detected 86.2% of these specimens, and 98.8% of urines that contained greater than 10-5 Gram-negative bacilli per ml. The Gram stain procedure detected only 69.5% of urines containing greater than 10-5 organisms per ml. and 74.5% of specimens with greater than 10-5 Gram-negative bacteria per ml. urine. The Limulus assay demonstrated both greater sensitivity and greater specificity than the Gram stain procedure. Moreover, the Limulus test is much less susceptible to errors of interpretation than methods involving microscopy.

Arthropods↗