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PubMed1984

Detection of bacteriuria by leukocyte esterase, nitrite, and the automicrobic system.

The predictive value for detection of significant bacteriuria was determined for use of the Chemstrip leukocyte esterase-nitrite dipstick (LN) and the Vitek Automicrobic System (AMS) using a conventional culture method (CM) as the reference procedure. The predictive values for positive and negative tests for detection of greater than or equal to 10(5) bacteria/mL for LN testing alone (2,782 specimens), AMS testing alone (729 specimens), and AMS testing of only LN positive specimens (253 specimens) were 29% and 97%, 67% and 99.5%, and 74.7% and 99.4%. The low predictive values for positive AMS tests were the result of discrepancies in enumeration in which counts of 10(4)/mL by CM often were classified as 10(5)/mL by AMS. Screening of specimens by LN reduces the cost of subsequent processing of LN positive specimens. Processing of LN positives by CM yielded the lowest total cost. Processing of LN positives by AMS resulted in the lowest labor cost.

Autoanalysis↗
PubMed2005

Pregnancy outcomes following hospitalization for motor vehicle crashes in Washington State from 1989 to 2001.

This retrospective cohort study evaluated the risk of adverse pregnancy outcomes following motor vehicle crashes during pregnancy. The authors assessed outcomes of pregnant women hospitalized for motor vehicle crashes in Washington State from 1989 to 2001 (n = 582). They used the Injury Severity Score (ISS) to classify 84 severely injured (ISS > or =9), 309 non-severely injured (ISS 1-8), and 189 uninjured (ISS 0) pregnant women and compared them with pregnant women who had not been hospitalized for a motor vehicle crash (n = 17,274). Of pregnant women in motor vehicle crashes, 82.9% were hospitalized and discharged without delivering, and 17.1% delivered at hospitalization. Compared with women not in motor vehicle crashes, severely and non-severely injured women were at increased risk of placental abruption and cesarean delivery, and their infants were at increased risk of respiratory distress syndrome and fetal death. Uninjured women were also at increased risk of preterm labor (relative risk = 7.9, 95% confidence interval: 6.4, 9.8) and placental abruption (relative risk = 6.6, 95% confidence interval: 3.9, 11.2) compared with women not in motor vehicle crashes. Pregnant women hospitalized following motor vehicle crashes are at increased risk of adverse pregnancy outcomes, regardless of the presence or severity of injuries.

Accidents, Traffic↗
PubMedDate not supplied

Providencia stuartii: a common cause of antibiotic-resistant bacteriuria in patients with long-term indwelling catheters.

The long-term-catheterized urinary tract may offer a particular niche to Providencia stuartii, which is otherwise an uncommon clinical isolate. Published accounts of bacteriuria in patients catheterized for long periods indicate that P. stuartii has often been found as frequently as familiar uropathogens such as Escherichia coli, Proteus mirabilis, enterococcus, and Pseudomonas aeruginosa. As in most nosocomial infections, the frequency of isolation of a given species has commonly differed among institutions. In the future P. stuartii may be more frequently encountered as a nosocomial pathogen in nursing homes and in acute care hospitals to which bacteriuric patients are transferred. This trend appears likely because of the increasingly large nursing-home population, the predilection of the bacterium for the long-term-catheterized urinary tract, the opportunity for nosocomial transmission from this reservoir, the resistance of the organism to multiple antibiotics, and the occasional systemic illness and bacteremia caused by P. stuartii.

Adult↗
PubMed1983

Bacteriuria due to Ureaplasma urealyticum and Gardnerella vaginalis in women with preeclampsia.

Certain fastidious organisms such as U urealyticum and G vaginalis can be isolated from the aspirated bladder urine of pregnant women more frequently than conventional urinary pathogens such as Escherichia coli [1]. They can be isolated even more often from the aspirated bladder urine of patients with renal disease, but rarely from that of healthy men or nonpregnant women [2]. We investigated the incidence of bacteriuria due to these two organisms--particularly U urealyticum--in patients with preeclampsia. U urealyticum was isolated more frequently (rate, 20%), and usually in higher colony counts, from the urine of patients with preeclampsia than from that of healthy pregnant women (rate, 7%). G vaginalis was isolated with approximately the same frequency as U urealyticum from specimens of bladder urine; both organisms were isolated from the urine of 11 patients (eight healthy women and three with preeclampsia). High colony counts of G vaginalis were also found more frequently in patients with preeclampsia. In both groups other fastidious organisms were isolated in a total of only five patients, and in four of these five cases U urealyticum and/or G vaginalis were also isolated from the same specimen. Urine cultures were more frequently positive in patients with moderately severe hypertension (blood pressure, greater than 160/100 mm Hg) than in those with mild hypertension (blood pressure, 140/90-160/100 mm Hg, occurring in nine (53%) of 17 patients and in nine (26.5%) of 34 patients, respectively. This difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteriuria↗
PubMed1987

Fever, bacteremia, and death as complications of bacteriuria in women with long-term urethral catheters.

Numbers of nursing home beds now exceed hospital beds in the United States and are usually occupied by women. Urinary incontinence is very common and may be managed with long-term urethral catheters. Bacteriuria invariably results, yet its clinical consequences are not well known. We studied 47 catheterized and bacteriuric women for almost 25 patient-years. The incidence of febrile episodes of possible urinary origin was 1.1 episodes/100 patient-days. Because these were diagnoses of exclusion, even this low incidence may be an overestimate. Most of these episodes were of less than or equal to 38.3 C (101.0 F), lasted for less than one day, and resolved without antibiotic therapy. Six deaths, half the total from all causes, occurred during these episodes, an incidence 60 times that during afebrile periods. Deaths and bacteremias were significantly associated with episodes of greater than or equal to 38.8 C (102.0 F). In the individual patient, these risks should be weighed against benefits of patient comfort, family satisfaction, and prevention and management of decubitus ulcers.

Aged↗
PubMed1987

Bacteriuria with a multiply resistant species of Corynebacterium (Corynebacterium group D2): an unnoticed cause of urinary tract infection.

We studied the records of 43 patients with significant bacteriuria caused by Corynebacterium group D2. All suffered from underlying diseases, and 54% were immunosuppressed. The predisposing factors were urologic procedures (100%), previous use of antibiotics (90%), age greater than 65 years (65%), and previous urinary tract infections (UTI;60%). Two-thirds of the patients had urinary tract symptoms, and these symptoms were more common in men than in women. The existence of previous lesions in the bladder favored the development of serious urinary symptoms (encrusted cystitis). Alkaline urine had abnormal sediment that yielded Corynebacterium group D2 in the absence of other microorganisms, a result suggesting that this organism could be an etiologic agent of UTI. Because cultures of urine may appear to be sterile, prolonged incubation must be used to detect Corynebacterium group D2. Correct treatment improved the outcome and probably prevented the development of encrusted cystitis in most of our patients.

Adolescent↗
PubMed1988

Acute pyelonephritis associated with bacteriuria during long-term catheterization: a prospective clinicopathological study.

Bacteriuria is virtually universal in long-term catheterized patients. This blinded autopsy study of 75 aged nursing home patients demonstrated that acute inflammation of the renal parenchyma was present in 38% of patients with a urinary catheter in place at death versus 5% of noncatheterized patients (P = .004). Of a number of clinical and demographic variables studied, only catheterization was significantly related to acute renal inflammation. Acute cystitis was uncommon, but each case was associated with inflammation of at least one kidney. The majority of kidneys showing acute inflammation (21 [68%] of 31) were not accompanied by acute pyelitis. Acute renal inflammation with or without pelvic inflammation is a common finding in nursing home patients dying with urethral catheters in place. This finding provides additional support for the development of alternatives to the indwelling urethral catheter.

Acute Disease↗
PubMed1996

Interleukin (IL)-6 and IL-8 in children with febrile urinary tract infection and asymptomatic bacteriuria.

Urine and serum interleukin (IL)-6 and IL-8 responses were higher in children with febrile urinary tract infection (n = 61) than in those with asymptomatic bacteriuria (n = 39). By univariate analysis, cytokine levels were related to age, sex, reflux, renal scarring, urine leukocytes, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and bacterial properties (P fimbriae but not hemolysin). Multivariate modeling showed that urine IL-6 responses were higher in girls than boys, increased with age, and were positively associated with CRP, ESR, serum IL-6, and urine leukocyte counts. The urine IL-8 response was not influenced by age, but it was influenced by P fimbriae and was associated with ESR, CRP, urine leukocytes, and female sex. The results show that cytokine responses to urinary tract infection vary with the severity of infection and that cytokine activation is influenced by a variety of host and bacterial variables.

Bacteriuria↗
PubMed1983

Bactericidal activity of norfloxacin and nine other urinary tract antibiotics against Gram-negative bacilli causing bacteriuria in chronically catheterized patients.

We compared the bactericidal activities of norfloxacin and nine other oral urinary tract antibiotics against 344 Gram-negative bacilli causing bacteriuria in chronically catheterized patients. Norfloxacin killed all organisms at 32 mg/l, 91% of isolates at 2 mg/l, and was the most active antibiotic tested.

Anti-Infective Agents, Urinary↗
PubMed1984

Pivmecillinam for bacteriuria in pregnancy.

Pivmecillinam was given to 44 women with bacteriuria in pregnancy. Treatment was successful in 33 (87%) out of the 38 patients assessed. Thirty women subsequently received at random either a low-dose of pivmecillinam for up to three months or acted as a control group. Further bacteriuric episodes during pregnancy were recorded only in three patients in the control group. Thirty-nine out of the 41 women followed to term delivered healthy babies. One infant was stillborn and another child had a cleft palate. Neither was considered to be related to treatment with pivmecillinam.

Adolescent↗
PubMed1990

Three-day antibiotic therapy in bacteriuria of old age.

A three day oral antibiotic course was given to 71 elderly bacteriuric subjects with no or only moderate mobility problems. Seven of 17 men (41%) and 34 of 54 women (63%) had strongly positive antibody coated bacteria (ACB) in the urine. Following sensitivity tests and randomization one of the following agents was given: cefadroxil 1 g tid (13 subjects): co-trimoxazole 160/800 mg bd (23 subjects); or norfloxacin 400 mg bd (35 subjects). One week after therapy urines were negative in 13 men (76.5%) and 37 women (68.5%). Patients who were fully mobile and/or were ACB(-) responded better than those with moderate mobility problems or who were ACB(+). At six months, urines were negative in six (40%) of 15 men and 15 (33.3%) of 45 women. Two men and six women of these 21 subjects had a positive urine at one month. Of the three agents tested cefadroxil was less effective in women. The study indicates that a three day course will clear bacteriuria in about 70% of patients at one week, but only about 25% will remain free of infection at six months; these are usually patients with adequate mobility and normal renal function.

Aged↗
PubMed2003

Asymptomatic bacteriuria rates in schoolchildren: results from a rural city in Turkey.

Although the treatment of asymptomatic bacteriuria (ABU) is recommended in certain conditions, and screening for ABU is generally not recommended in healthy children, high prevalence of ABU in infants in a former study from eastern Turkey, led us to conduct a study to discover ABU rates in schoolchildren in the province of Isparta, Turkey. Children (n = 10289) from 14 schools and aged 6-14 years participated voluntarily. Two clean-catch midstream urine samples were collected, and screened by microscope and culture for infection. Bacterial agents were identified by Gram's stain. Urological and radiological examinations were suggested to the parents of the children identified with ABU. Five thousand and seventy three participants (49.3 per cent) were girls and 5216 (50.7 per cent) were boys. The median age was 10 (6-14) years. The prevalence of ABU in the total population was 0.37 per cent. The prevalence for ABU was higher in female students 134 (0.67 per cent) vs. 4 (0.08 per cent)], [x 2 (df = 1) = 24.44, p < 0.01]. A decline of ABU from the first to the second screening was observed. In 30 (79 per cent) children with ABU, Escherichia coli was isolated. One year later 27 (71.1 per cent) of the 38 children with ABU were found to be culture negative. The prevalence of ABU in our sample population was consistent with the literature. Lower prevalence of ABU in boys may be linked to the high circumcision frequency in Turkey.

Adolescent↗
PubMed1981

Screening for asymptomatic bacteriuria in pregnant patients: three office screening systems versus quantitative culture.

We screened 691 asymptomatic prenatal patients by quantitative culture of clean voided urine specimens and one of three office screening devices to detect bacteriuria. The ability of each screening system to detect a single pathogenic organism in concentration equal to or greater than 100,000/ml was analyzed. Microstix-3 reagent strips had 87.5% accuracy, with the smallest number of false-positive results (6.7%). The Bacturcult system was correct in 75% of cases, but yielded 30% false-positive results. The Testuria system was least accurate (62.5%) and had the highest incidence of false-positive tests (71%).

Bacteriological Techniques↗
PubMed1988

Bacteriuria and bacteraemia in patients with long-term indwelling catheters--a domiciliary study.

Men with indwelling catheters and men and women with suprapubic catheters were studied in their homes. Urine and blood were cultured and body temperature recorded after every catheter change. Nearly all patients had infected urine after 4 weeks of catheterisation, and all had bacteriuria after longer periods, usually with a mixture of organisms. Culture on selective media revealed a wider range of organisms than was detected on routine C.L.E.D. and blood agar with antibiotic sensitivity disks, but routine culture gave adequate information for clinical purposes. Bacteraemia was demonstrated after 20 of 197 changes of urethral catheter and after one of 19 changes of suprapubic catheter; but no patient had pyrexia or other symptoms. However, two had rigors on other occasions. When assessing "risk factors" for blood-stream infection in catheterised patients, it is important to record the total incidence of bacteraemia, asymptomatic as well as symptomatic.

Bacteria↗
PubMed2006

Asymptomatic bacteriuria Escherichia coli strain 83972 carries mutations in the foc locus and is unable to express F1C fimbriae.

Escherichia coli is the most common organism associated with asymptomatic bacteriuria (ABU). In contrast to uropathogenic E. coli (UPEC), which causes symptomatic urinary tract infection (UTI), very little is known about the mechanisms by which these strains colonize the urinary tract. Bacterial adhesion conferred by specific surface-associated adhesins is normally considered as a prerequisite for colonization of the urinary tract. The prototype ABU E. coli strain 83972 was originally isolated from a girl who had carried it asymptomatically for 3 years. This study characterized the molecular status of one of the primary adhesion factors known to be associated with UTI, namely F1C fimbriae, encoded by the foc gene cluster. F1C fimbriae recognize receptors present in the human kidney and bladder. Expression of the foc genes was found to be up-regulated in human urine. It was also shown that although strain 83972 contains a seemingly intact foc gene cluster, F1C fimbriae are not expressed. Sequencing and genetic complementation revealed that the focD gene, encoding a component of the F1C transport and assembly system, was non-functional, explaining the inability of strain 83972 to express this adhesin. The data imply that E. coli 83972 has lost its ability to express this important colonization factor as a result of host-driven evolution. The ancestor of the strain seems to have been a pyelonephritis strain of phylogenetic group B2. Strain 83972 therefore represents an example of bacterial adaptation from pathogenicity to commensalism through virulence factor loss.

Agglutination↗
PubMed1980

Methenamine-hippurate and bacteriuria in the geriatric patient with a catheter.

Oral treatment with methenamine-hippurate (MH) in patients with an indwelling catheter has been found to reduce the need of frequent catheter exchange and the number of symptomatic infections. Bacteriuria, however, persists during MH treatment. The hypothesis that the therapeutic effect is due to a reduction in the number of bacteria, or a change in the pattern of strains was tested in a crossover study (2 x 6 weeks). MH treatment, 1 g twice daily, was compared to control periods in 52 patients. The majority of quantitative and qualitative bacterial cultures at 2-week intervals yielded 2--4 strains. Of the bacterial isolates, 50% were found on 4--6 occasions out of 6 possible. MH treatment had no significant influence on the pattern of various strains. A 30% decrease in the mean total bacterial count during MH treatment did not reach statistical significance (p approximately 0.07). It is suggested that prevention of catheter complications during MH treatment may be due to a physiochemical action on salt formation rather than a direct antibacterial effect.

Aged↗
PubMed1989

Bacteriuria and urinary incontinence in aged female nursing home residents.

Although urinary incontinence (UI) is identified as a symptom of urinary tract infection (UTI), the incontinent elderly frequently are not treated for UTI unless clinically significant manifestations are present. The purpose of this research was to identify variables that may be associated with bacteriuria in the female person who is already known to be incontinent. A sample of 65 incontinent female nursing home residents was divided into three groups: (1) those with negative urine screens; (2) those with a bacterial count of over 100,000 per ml of urine; and (3) those with a bacterial count of below 100,000 per ml urine. Variables examined were: (1) physical symptoms; (2) physical examination findings; (3) mental status; and (4) functional abilities. Significant group differences were found regarding awareness of the urge to void and ability to hold urine. A near significance finding suggested that the higher the level of cognitive function the less likely the presence of UTI. There was some evidence to suggest the higher the level of independence the less likely the presence of UTI. Recommendations for nursing practice and future nursing research are made.

Activities of Daily Living↗
PubMed1984

Detection of bacteriuria by bioluminescence: effect of pre-analysis centrifugation of specimens.

Three bioluminescence-based, rapid methods of detecting significant bacteriuria were applied in parallel to 514 urine specimens. The results were compared with those of a quantitative pour plate viable count method, defined as positive if greater than or equal to 10(5) c.f.u./ml of urine were observed. When adjusted to yield 21% falsely positive results the three rapid methods yielded 24%, 21% and 19% falsely negative results. If specimens with evidence of urethral or vaginal contamination were excluded (237 specimens remaining) the three methods yielded respectively 14%, 8% and 13% falsely negative results. A major source of disagreement between the bioluminescence-based methods and quantitative culture thus appeared to be contaminated urine specimens.

Adenosine Triphosphate↗