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PubMed1982

Evaluation of leukocyte esterase activity as a rapid screening technique for bacteriuria.

Microscopy and leukocyte esterase activity, both employed as screening techniques for urine cultures, were evaluated with respect to two distinct populations, male and female. When 424 urine specimens from males were examined, 95% of the Gram-stained smears and 91% of the leukocyte esterase tests correctly correlated with culture results, indicating significant bacteriuria. There were no significant differences between the Gram stain and leukocyte esterase activity in predicting a negative culture: 99% and 98%, respectively. Neither microscopy nor esterase activity proved as sensitive or as efficient in predicting a negative culture with the female population.

Bacteriuria↗
PubMed1982

Evaluation of the MS-2 urine screening method for detection of bacteriuria.

A collaborative evaluation of the MS-2 urine screening system indicated that the automated method could successfully identify at least 84% of urine specimens that contained greater than or equal to 10(5) colony-forming units per ml. Most specimens not detected as positive by the system contained primarily diphtheroids and yeasts. Excluding those specimens which contained diphtheroids and yeasts, the MS-2 system correctly identified as positive 94.8% of specimens that contained greater than or equal to 10(5) colony-forming units per ml and as negative 96.1% of specimens that contained less than 10(4) colony-forming units per ml. The automated system is an attractive method for the screening of urine specimens for significant bacteriuria.

Bacteriuria↗
PubMed1982

Rapid detection of significant bacteriuria by use of an automated Limulus amoebocyte lysate assay.

Previous studies have demonstrated that significant gram-negative bacteriuria can be detected by using the Limulus amoebocyte lysate test. A series of 580 urine specimens were tested in parallel with the automated MS-2 (Abbott Laboratories) assay and with quantitative urine bacterial cultures. The overall ability of the MS-2 Limulus amoebocyte lysate test to correctly classify urine specimens as containing either greater than or equal to 10(5) organisms or less than 10(5) organisms per ml during a 20-min test period was 92.6%.

Bacteria↗
PubMed1983

Firefly luciferase ATP assay as a screening method for bacteriuria.

A rapid (15 min) test for bacteriuria based on firefly luciferase analysis of bacterial ATP has been evaluated in 2,018 clinical urine specimens. The test procedure involves removal of nonbacterial ATP by treatment of urine with Triton X-100 and apyrase, extraction of bacterial ATP by boiling, and bioluminescent analysis of bacterial ATP by firefly luciferase, using a luminometer. For comparison, the widely used nitrite test was included in the study as an example of an alternative rapid chemical test. The test was set up to distinguish between specimens yielding greater than 10(5) CFU/ml and specimens yielding less than 10(5) CFU/ml. A level of 13.5 nM ATP was chosen to define the limit between negative and positive results. At this discriminatory level, 92% of specimens yielding greater than 10(5) CFU/ml and 88% of specimens yielding less than 10(5) CFU/ml were correctly classified with the luciferase method, whereas corresponding figures for the nitrite test were 55 and 99%, respectively. Of the 12% false luciferase positives, 20% were shown to contain greater than 10(5) CFU/ml on prolonged incubation, thus reducing the false-positive rate to 10%. Of the 8% false luciferase negatives, 65% had low levels of CFU in the range of 10(5) to 10(6).

Adenosine Triphosphate↗
PubMed1983

Use of leukocyte esterase-nitrate activity as predictive assays of significant bacteriuria.

The present study evaluated the usefulness of the 1-min leukocyte esterase-nitrite tests in a tertiary-care hospital as a screening procedure to detect significant bacteriuria and correlated the findings with culture results. A total of 531 urine samples were reviewed, of which 484 were evaluated. Of the evaluated samples, 113 positive cultures (23.4%) were found, of which 93 (82.3%) were detected by leukocyte esterase-nitrite tests. In addition, 365 of 371 (98.4%) urine samples with negative bacterial cultures were negative in leukocyte esterase and nitrite tests.

Bacteriological Techniques↗
PubMed1984

Rapid detection of bacteriuria by laser nephelometry.

A total of 1,002 urine specimens were evaluated by laser nephelometry. This technique was compared with both colony counts, done with a calibrated loop, and serial dilutions. For urine specimens containing between 10(4) and 10(5) bacteria per ml, laser nephelometry detected 75.4% of those detected by colony count and 65.6% of those detected by serial dilution. For specimens where the concentration of bacteria was greater than 10(5) per ml, laser nephelometry detected 95.8 and 92.4% of those detected by colony count and serial dilution, respectively. The mean detection time for bacteriuria varied from 1.57 h for more than 10(5) bacteria per ml to 4.47 h for more than 10(4) bacteria per ml. To determine the number of bacteria according to the voltage growth curve, the passage time at 3 V was used as an index. The mean passage time at 3 V decreased from 5.18 h for fewer than 10(4) bacteria per ml to 1.42 h for more than 10(6) bacteria per ml. The mean passage time at 3 V differed significantly for different concentrations of bacteria. Thus, this index allowed us to predict the number of bacteria in the urine specimens. Laser nephelometry has been used for many years for the immunological determination of proteins; it can now also be considered a tool for rapid screening in bacteriology.

Bacteriological Techniques↗
PubMed1985

Bacteriuria screening by use of acridine orange-stained smears.

Acridine orange (AO)-stained smears of 1,042 urine specimens were examined for the presence of bacteria and compared with quantitative culture results. The detection of one or more organisms per three AO fields at X200 magnification was noted in 161 of 162 and 193 of 195 urine specimens that grew greater than 10(5) and 10(4) CFU/ml, respectively, of a clinically relevant organism. However, a high number of false-positive AO smears (356 and 324, respectively) was observed among urines that failed to grow organisms at 10(5) and 10(4) CFU/ml. Sensitivity, specificity, and positive and negative predictive values of AO smears were 99, 58, 26, and 99%, respectively, for cultures of greater than or equal to 10(5) CFU/ml and 98, 59, 32, and 99%, respectively for cultures of greater than or equal to 10(4) CFU/ml. Despite the poor specificity of the AO smear, the very high negative predictive value would allow for the ruling out of bacteriuria defined at 10(4) CFU/ml and would eliminate the need for culture of ca. 50% of the urine specimens in this study. Employment of the rapid, inexpensive AO procedure only as a means to eliminate specimens for culture would allow significant cost savings and permit the laboratory to send out a large number of potentially negative or low-count urine results within a short time of specimen receipt.

Acridine Orange↗
PubMed1985

Clinical evaluation of three rapid methods for the detection of significant bacteriuria.

Random urine specimens (848) were screened for significant bacteriuria by using the 30-min Lumac (3M, St. Paul, Minn.), the 2-min Bac-T-Screen (Marion Laboratories, Inc., Kansas City, Mo.), and the 13-h AutoMicrobic system (AMS) urine identification card (Vitek Systems, Inc., Hazelwood, Mo.). MacConkey and 5% sheep blood agar plates were inoculated with a 10(-4) dilution of urine and used for the reference method. Bac-T-Screen results were uninterpretable for 9.1% of the specimens owing to either urine sample pigmentation (5.3%) or clogging of the filter (3.8%). Screen-negative urine specimens made up 49.6, 57.2, and 48.5% of the total number of specimens evaluated with AMS, Lumac, and Bac-T-Screen, respectively. False-positive results with Lumac and Bac-T-Screen were 20.6 and 22.3%, respectively. False-negative results for cultures with greater than or equal to 10(4) CFU/ml were 22.0% with AMS, 29.4% with Lumac, and 25.5% with Bac-T-Screen, and false-negative results for cultures with greater than or equal to 10(5) CFU/ml were 29.6% with AMS, 9.9% with Lumac, and 7.0% with Bac-T-Screen. For each system, greater than 70% of false-negatives at greater than or equal to 10(5) CFU/ml consisted of mixed or pure cultures of common contaminants. With any of these screening methods, a clinically significant isolate at greater than or equal to 10(5) CFU/ml would rarely be missed (less than or equal to 1.7% for all systems). A cost-effective and rapid approach to urine microbiology could consist of screening out negative specimens by either Lumac or Bac-T-Screen and processing only screen-positive specimens by the AMS.

Adult↗
PubMed1987

Urease-positive bacteriuria and obstruction of long-term urinary catheters.

Long-term urethral catheterization (greater than or equal to 30 days), a management technique for urinary incontinence, results in polymicrobial bacteriuria. We frequently found urease-producing bacteria: of 1,135 weekly urine specimens from 32 long-term-catheterized patients, 86% had urease-positive bacterial species at greater than or equal to 10(5) CFU/ml. The most common species were Proteus mirabilis and Morganella morganii, each found in over half the specimens. P. mirabilis, but not other urease-positive species, was significantly associated with the 67 obstructions observed in 23 patients. M. morganii had a more complex association and in some way may protect the catheter from obstruction.

Aged↗
PubMed1987

FiltraCheck-UTI, a rapid, disposable system for detection of bacteriuria.

The initial evaluation of the FiltraCheck-UTI bacteriuria detection system is described. The colorimetric test, which utilizes a disposable filter disk and a stable reagent system, does not require instrumentation. The test procedure is simple and may be performed in less than 1 min. Results obtained with the FiltraCheck-UTI system were compared with those obtained by conventional semiquantitative culturing. Of 1,198 urine specimens evaluated, 202 (16.9%) were determined to be significant positives at greater than or equal to 10(5) CFU/ml by the culture method. The sensitivity and specificity of the FiltraCheck-UTI system were 96.5 and 79.7%, respectively, and the negative predictive value was 99.1%. The high sensitivity, rapidity, simplicity, and unique disposable format of the FiltraCheck-UTI system offer significant advantages over other commonly used screening methods.

Bacteria↗
PubMed1992

Analyses of the FlashTrack DNA probe and UTIscreen bioluminescence tests for bacteriuria.

Five hundred urine specimens were selected at random and screened for bacteriuria by a DNA probe method, FlashTrack (Gen-Probe, San Diego, Calif.), and an automated bioluminescence method, UTIscreen (Los Alamos Diagnostics, Los Alamos, N.M.), and the results were compared with those of the semiquantitative plate culture method. The performance of each test versus culturing was evaluated at colony counts of greater than or equal to 10(4), greater than or equal to 5 x 10(4), and greater than or equal to 10(5) CFU/ml. Since the interpretive breakpoint of each test was user selectable, the results were reported as receiver operator characteristic curves. Optimum interpretive breakpoints were determined for each test at each colony count by calculating a performance index that emphasized sensitivity over specificity in a 70:30 ratio. Although both tests had less-than-optimal sensitivities and specificities, the performance of FlashTrack was significantly better than that of UTIscreen at two of the three colony counts (10(4) and 10(5) CFU/ml); however, FlashTrack costs more and is a labor-intensive procedure. Neither method was evaluated for the detection of colony counts of less than 10(4) CFU/ml.

Bacteriological Techniques↗
PubMed1994

Molecular epidemiology of catheter-associated bacteriuria in nursing home patients.

Urine samples from 19 nursing home patients with long-term urinary catheters were cultured every 3 months for 18 months. Providencia stuartii, present in 74% of the elderly and in 59% of urine specimens, was the most frequently isolated bacteria. The persistence of P. stuartii was significantly higher among females than among males. In order to study the epidemiology of bacteriuria in this nursing home, bacteria were characterized by biochemical tests, antibiotic susceptibility pattern, and restriction fragment length polymorphism (RFLP) analysis. The antibiotic susceptibility pattern indicated that each patient had two to three different strains of P. stuartii during the 18 months of follow-up. In contrast, the RFLP analysis revealed that a specific strain had persisted in the urinary tract of the patient during the entire follow-up period. According to the biochemical profile, 74% of the patients had the same bacteria in urine cultures, pointing to a common source of transmission. RFLP analysis, however, demonstrated different patterns of RFLP, suggesting concomitant multiple sources of infection.

Aged↗
PubMed1998

Simplified technique for detection of significant bacteriuria by microscopic examination of urine.

A comparative study of microscopic examination of 10 microl (simplified loop technique) and 50 microl (traditional drop technique) of uncentrifuged Gram-stained urine specimens for detection of significant bacteriuria was carried out. The results demonstrated that the 10-microl loop technique can be used as an alternative to the 50-microl drop technique for presumptive diagnosis of urinary-tract infection in bacteriological practice, with the advantages of greater rapidity and ease of performance.

Bacteriological Techniques↗
PubMed1978

Simplified microscopy for rapid detection of significant bacteriuria in random urine specimens.

Simplified urine microscopy, nitrite testing, and dipstick culture were compared with urine loop streak culture colony counts in 219 random voided specimens to determine the accuracy of the three rapid screening techniques. Nitrite testing resulted in 65% false negative results, which could not be significantly improved by incubation at 37 degrees C but which could be improved by adding nitrate substrate before incubation. Dipstick culture could not be quantitated until after 18 h of incubation. A new, simplified microscopy technique, using unspun, unstained urine, resulted in 4% false negative results and 4% false positive results in specimens containing over 10(5) organisms per ml and was the best method Centrifuges, Gram staining reagents, and counting chambers are not necessary for accurate microscopic screening of random urine specimens for the presence of bacteriuria by this technique, and the results are immediately available.

Adolescent↗
PubMed1975

Urinary tract in schoolgirls with covert bacteriuria.

During screening of 16,800 primary schoolgirls, aged 4-12 years, in Cardiff and Oxford, significant bacteriuria was found in 294 (1-7%). Intravenous urography and micturating cystography were performed in 246 of these girls. The urinary tract was abnormal in 47%. Pyelonephritis with or without vesicoureteric reflux was present in 26% and reflux without renal abnormality in a further 16%. The prevalence of pyelonephritis and reflux was independent of age. With few exeptions kidneys without pyelonephritic scars appeared to be normal in size, even when ureteric reflux was present.

Bacteriuria↗
PubMed1977

Psychiatric disturbance, urgency, and bacteriuria in children with day and night wetting.

Forty children with day and night wetting were compared with 46 with night wetting only to see if day wetting was then associated with particular clinical features. Interviews with mothers, questionnaries completed by teachers, physical investigations, and measurement of functional bladder capacities were used. Day wetting combined with bed wetting occurred equally in boys and girls and was associated with daytime urgency and greater frequency of psychiatric disturbance. In boys, soiling was also associated. In girls, bacteriuria, which appeared to be caused by the day wetting, occurred in about 50%. Neither daytime frequency nor small functional bladder capacity were specifically related to day wetting.

Bacteriuria↗
PubMed1969

Asymptomatic significant bacteriuria in the non-pregnant woman. I. Description of a population.

The clinical, laboratory, and radiological findings in a group of 107 non-pregnant bacteriuric women and 88 controls have been compared. A previous history of urinary tract infection was more commonly obtained from the bacteriuric women. The means of the diastolic blood pressures, serum ureas, and erythrocyte sedimentation rates were significantly higher in the bacteriuric group, and acquired renal abnormalities were demonstrated in 18% of the bacteriuric women as compared with 4% of the controls. It is concluded that screening for asymptomatic bacteriuria in the adult non-pregnant female population in many instances fails to detect urinary tract infection at an early and reversible stage.

Adult↗
PubMed1970

Transient asymptomatic bacteriuria in infancy.

Spontaneous clearing of bacteriuria occurred in three infants during the neonatal and early infancy period. In all cases, the presence of bacteria was confirmed by bladder puncture, no signs of clinical infection were present, and no treatment was given. The same host defence mechanisms as exist in adults were probably responsible for this phenomenon.

Bacteriuria↗