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PubMed1991

Screening for asymptomatic bacteriuria in pregnancy: urinalysis vs urine culture.

BACKGROUND: Asymptomatic bacteriuria is common during pregnancy. Its average prevalence is 6%. It is an important risk factor for acute pyelonephritis, hypertension, preeclampsia, fetal wastage, low birthweight, and prematurity. This study was performed to determine the usefulness of urine microscopy as a substitute for doing a screening urine culture. METHODS: The medical records of all first trimester obstetric visits from 1984 to 1990 were reviewed at a major university. The results of 888 screening urinalyses were recorded and compared with those of subsequent urine cultures. RESULTS: Fifty-four cultures had growth of a single organism with a bacteria level of at least 1000 organisms per milliliter. In the prediction of a positive culture, the microscopic findings of five or more leukocytes per high-power field (HPF) showed a sensitivity of 94.4% and a specificity of 95.0%. CONCLUSION: Physicians should test the urine of all prenatal patients at their first visit and send to the laboratory only those specimens with 5 or more leukocytes per HPF. Using this method, unnecessary screening urine cultures will be substantially reduced.

Adolescent↗
PubMed1989

[Phase contrast microscopy in the detection of bacteriuria].

Despite the recognized superiority of traditional culture methods to investigate bacteriuria their routine use in population studies is costly. We proposed to use Phase contrast microscopy (PCM) which allows clear visualization of bacteria with no centrifugation or staining. Urine samples from 214 patients were studied by PCM and results compared to those obtained by quantitative culture. MCF had 95% sensitivity and 96% specificity. Therefore, PCM may be used to screen urine samples for further bacteriologic study with the highest chance of obtaining positive cultures.

Bacteriological Techniques↗
PubMedDate not supplied

[Evaluation of a new method (Filtrachek-UTI) for the detection of bacteriuria].

The diagnostic effectiveness of a new test for the detection of bacteriuria (Filtrachek-UTI) was compared with Gram stain and semiquantitative culture in 955 urine samples. 276 of these were from inpatients (108 males and 168 females), and 677 from outpatients (206 males and 471 females). Overall 229 positive cultures were obtained. Taking the sample culture as the standard, the statistical parameters obtained were very low, particularly the sensitivity and the negative predictive value (75-89% sensitivity and 80-91% NPV in inpatients, and 67-92% sensitivity and 79-98% NPV in outpatients). Other problems of the method are the subjective interpretation, choluria or filter obliteration by the urine, high cost and an approximate false negative rate of 16%.

Adult↗
PubMed1989

Single-dose versus six-day therapy with sulfamethizole for asymptomatic bacteriuria during pregnancy. A prospective randomised study.

Single-dose versus conventional six-day therapy with sulfamethizole for asymptomatic urinary tract infection in pregnant women was investigated in a prospective, randomised open study. During a nine-month period 4,274 pregnant women were screened for significant bacteriuria, which was found in 123 (2.9%), of whom only five had symptoms of urinary tract infection. Seventy-nine of the patients had a second urine culture performed, revealing significant counts of the same bacteria in only 41. These 41 patients were randomly allocated to one of the two treatment groups. Control urine cultures one week and 4-6 weeks after start of treatment revealed the same cure rates of approximately 50% in both groups. Single-dose treatment is not inferior to conventional therapy; future study is needed to find the best single-dose regimen.

Bacteriuria↗
PubMed1989

[Differentiation of coagulase negative staphylococci from significant bacteriuria].

According to our experience in identifying coagulase negative staphylococci (CNS) a modified Kloos-Schleifer-scheme proved useful in species identification. Of 595 urine isolates from cases with significant bacteriuria tested 89.5% could be identified. For routine identification on the one hand the Kloos-Schleifer-scheme is only practical by using commercial identification systems, on the other hand applying an abbreviated scheme species identification is unsatisfactory. As an alternative for identification of CNS in clinical microbiology the Phosphatase-Novobiocin-Mannose-Inhibition-Test (PNMI-Test) is presented. This test in combination with a coagulase test proved suitable to identify the three most important staphylococcal species S. aureus, S epidermidis, and S. saprophyticus and seems to be an acceptable compromise in the bacteriological routine laboratory. For extended species identification of CNS the Kloos-Schleifer-scheme should not be reduced but this identification should be reserved to special laboratories.

Bacteriological Techniques↗
PubMedDate not supplied

[The effect of treatment of bacteriuria on pregnancy outcome].

In the period from 1972 to 1979, 3497 pregnant women were tested at the two Zagreb Health Centers. Urine cultures were taken from all women by Arneil's "dip slide" method, modified by Babić. Significant asymptomatic bacteriuria (SAB) was found at the onset of pregnancy in 10.7% cases. Pregnant women with SAB at the end of pregnancy, in comparison to those whose urine was sterile, had significantly more children weighing under 1000 g at birth (1.3% v. 0.2%; x2 = 8.44, p less than 0.01) and under 2500 g (6.5% v. 3.8%; x2 = 3.95, p less than 0.05), more deliveries by vacuum extraction (3.0% v. 1.3%; x2 = 4.62, p less than 0.05), and a significantly higher perinatal mortality (64.9 v. 15.6; x2 = 24.73, p less than 0.001). The treatment of SAB at the very beginning of pregnancy significantly decreased, by a fourth (25.5%), its frequency at the end of pregnancy. This figure is almost twice as high in those not treated (46.1%, x2 = 16.64, p less than 0.001). SAB treatment contributed to a significantly lower frequency of hypertension at the end of pregnancy (8.9%) in comparison to non-treated cases (31.4%, x2 = 29.45, p less than 0.001).

Bacteriuria↗
PubMed1988

Protocol for diagnosis of urinary tract infection: reconsidering the criterion for significant bacteriuria.

The traditional criterion of 10(5) colony-forming units (CFU) per milliliter of urine to diagnose urinary tract infection was based on studies of pregnant and nonpregnant women with asymptomatic bacteriuria or acute pyelonephritis. Recent studies of symptomatic women revealed that urine cultures in approximately one third of those with confirmed urinary tract infections grew only 10(2) to 10(4) CFU/mL. The major causes of acute dysuria among such women are urinary tract infection, sexually transmitted disease, and vaginitis. In most instances, it is possible to make the diagnosis based on clinical features. The major features of urinary tract infection are internal dysuria; frequency, urgency, and voiding of small volumes; abrupt onset; suprapubic pain; presence of pyuria. Presence of hematuria which occurs in about 50 percent of patients strongly suggests bacterial cystitis. Three to seven days of empiric antimicrobial therapy is indicated for these patients, with selection of a first-line antimicrobial agent that offers efficacy against Escherichia coli or Staphylococcus saprophyticus; reasonable cost; few side effects. Ampicillin is not recommended. Indications for culture include uncertain clinical features; history of previous infection within the past three weeks; duration of symptoms of more than seven days; recent hospitalization or catheterization; pregnancy; diabetes. To maximize the sensitivity and specificity of the urine culture in acutely symptomatic women, it is necessary to request the laboratory to report 10(2) to 10(4) CFU/mL.

Bacterial Infections↗
PubMed1977

Reliability of the Bacturcult system in the clinical evaluation of postpartum bacteriuria.

The reliability of the Bacturcult system versus the standard calibrated loop-direct streak technic for screening bacteriuria was determined for 182 postpartum patients. Both false negative and false positive results were obtained by the Bacturcult system, therefore precluding its usefulness as a screening method. Based on these findings, therapy should not be instituted prior to performance of the standard culture technic.

Bacteriological Techniques↗
PubMed1988

[Bacteriuria].

Bacteriuria remains the most important sign of urinary tract infection. A standardization of the diagnosis and treatment of urinary tract infection requires a standard period of urine collection (4 hours), the correct collection of specimens, the determination of the number of bacteria by appropriate media (dipslide) and of urinary leucocytes. Test strips cannot replace the microscopy of the sediment. The therapeutic consequences result from the localization of the infection, the duration of treatment of cystitis is 1 to 4 days, of pyelonephritis 10 to 14 days.

Bacteria↗
PubMed1987

[ABACTO-SCREEN: a new system for the rapid screening of bacteriuria. Evaluation of the precision versus the traditional methods and compared with the Abbott MS-2].

ABACTO-SCREEN is an automated turbidimetric system for rapid screening of bacteriuria composed by a multichannel photometric instrument and an original disposable. In this study the system has shown good sensitivity (6.9% of false negative results on the true positives) and specificity (22.4% of false positive results on the true negatives) when on assuming 100,000 colony forming units (CFU)/ml as a threshold of positivity. Comparison with Abbott MS-2 has revealed better performances for sensitivity and comparable specificity. False negatives analysis has revealed probable influence of anaerobic bacteria in the plate counting or slowing in culture broth growth cause by antimicrobial substances in urine samples.

Bacteria↗
PubMed1987

Urinary tract infections in urology: a urologist's view of chronic bacteriuria.

Urine culture performed during and after antimicrobial therapy will differentiate unresolved urinary tract infections from recurrent infections. Recurrent infections with the same organism and at close intervals are frequently caused by a focus of bacterial persistence within the urinary tract, and infections with different organisms and/or at longer intervals are characteristic of reinfections with bacteria from outside the urinary tract. Unresolved infections are usually due to resistant bacteria and are treated by modification of therapy based on antimicrobial sensitivity testing. When unresolved bacteriuria is caused by organisms sensitive to the initial antimicrobial therapy, azotemia or a large bacterial mass density should be suspected. Recurrent infections at close intervals and/or with the same organism are usually caused by a bacterial focus in an acquired or congenital abnormality of the urinary tract such as infection stones, which must be removed to cure the recurrent infections. If the bacterial focus within the urinary tract cannot be removed, long-term low-dose antimicrobial prophylaxis can prevent the morbidity of recurrent infections. Reinfection requires careful bacteriologic monitoring and low-dose prophylactic, intermittent, or post-intercourse antimicrobial therapy.

Adult↗
PubMed1977

Comparison of nitrite and dipslide methods for bacteriuria screening.

The results of screening for bacteriuria by the nitrite reaction and the dipslide method were compared. The nitrite reaction was specific in 99.8%, its sensitivity was 93.1% and its reproducibility, 100%. Specificity of the dipslide method was 94.5%. The nitrite reactions is considered most suited for screening, owing to its specificity, satisfactory sensitivity, short time requirement and low cost. The dipslide method is not suited for screening, as apart from being expensive it yielded 5.5% false positive reactions, but proved excellent for estimating the bacterial count in nitrite positive samples.

Adolescent↗
PubMed1978

The relationship of antibody-coated bacteria to clinical syndromes as found in unselected populations with bacteriuria.

In selected patients, detection of antibody-coated bacteria (ACB) in voided urine has correlated with upper urinary tract infection. From unselected patients, we studied 350 consecutive urine specimens submitted to the diagnostic laboratory with colony counts greater than or equal to 10(5)/ml. In 19% (55) among 288 specimens selected for final analysis ACB occurred. There were no substantial differences in the occurrence of ACB by age or sex of patients or by species of bacteria. The relationship of ACB to clinical syndromes was: asymptomatic bacteriuria, 15% (27/178); cystitis, 8% (6/75); acute hemorrhagic cystitis, 67% (4/6); prostatitis, 67% (2/3); and acute pyelonephritis, 62% (16/26). Among seven clinical findings, only structural abnormalities of the upper urinary tract correlated with the presence of ACB. Failure of fever and leukocytosis to correlate with ACB probably reflected the presence of other associated primary medical or surgical conditions.

Acute Disease↗
PubMed1986

Catheter-associated bacteriuria.

Catheter-associated urinary tract infections are the most common nosocomial infection and a frequent cause of significant morbidity, sepsis, and death. The pathogenesis is multifaceted. Most frequently, bacteria from the urethral meatus ascend to the bladder between the mucosal and catheter surfaces. Alternatively, bacteria may ascend within the drainage system following contamination of the drainage bag or disruption of the catheter tubing junction. The incidence of infection is approximately 5 to 7 per cent for each day of catheterization and closely linked to unalterable host factors such as age, female sex, and debilitating disease. Efforts to reduce the incidence of infection must begin with reduction of the frequency and duration of catheterization. Aseptic insertion of the catheter and careful maintenance of the drainage system are mandatory to prevent incidental bacterial contamination. Prophylactic, systemic, or topical antimicrobial agents and modifications of the catheter drainage system that are designed to reduce contamination are expensive and have not been shown to be efficacious for the majority of patients. Furthermore, antimicrobial prophylaxis frequently leads to outgrowth of resistant bacterial strains that are difficult to eradicate. However, antimicrobial prophylaxis warrants consideration for high-risk patients who are catheterized for a short time. If bacteriuria occurs prior to removal of the catheter, the patient should be treated with appropriate antimicrobial therapy. Urinalysis or urine cultures should be obtained following removal of the catheter to assure sterility of the urinary tract. If these guidelines are followed, the incidence and sequelae of catheter-associated urinary tract infections can be reduced.

Anti-Bacterial Agents↗
PubMed1987

Asymptomatic bacteriuria in the Port Harcourt metropolis of Nigeria.

The Port Harcourt metropolis of Nigeria was screened to establish the prevalence of asymptomatic bacteriuria (ABU) over a 3 year period. An occurrence rate of 15% was detected. The females presented a higher incidence rate (9%) than the males (6%). Previous history of urinary tract infection (UTI) was seen to be contributory to ABU; so also was sexual activity. Of the isolates obtained, Escherichia coli was found to be predominant (45%). An isolation rate of 3.7% was realised for Staphylococcus epidermidis. This emphasizes its role in UTI. The advantages of screening for ABU was examined and it is suggested that individuals should be screened for ABU at least twice a year.

Adolescent↗
PubMed1987

Bacteriuria with fever after spinal cord injury.

Urinary tract infection continues to be a common problem among spinal cord injured (SCI) individuals despite the strides that have been made during the last decade in the care of the neurogenic bladder. A critical analysis of the system of drainage compared with the occurrence of bacteriuria with fever (BWF) is reported in a group of 705 SCI patients. At the first year (year 1) follow-up, patients being catheterized by someone else (ICO) were much more likely to have experienced at least one episode of BWF than those on self-intermittent catheterization (SIC) (p less than 0.025) or those using an indwelling catheter (IND) (p less than 0.005). In patients who underwent external sphincterotomy, the incidence of BWF was significantly decreased in year 1 (p less than 0.025) compared to those on ICO.

Bacteriuria↗
PubMed1987

Usefulness of LAL assay for rapid detection of gram-negative bacteriuria.

LAL assay is a rapid and reliable and easy to perform and interpret urine screen for clinically significant gram-negative bacteriuria. Chromogenic assays are rapid (5 min) and obviate problems associated with gel endpoints, such as inadvertant dissolution of the gel, either during incubation or reading. LAL urine screening is characterized by both high positive and negative predictive values. LAL urine assay identifies gram-negative urinary tract infections by measuring urine endotoxin content as an index for significant numbers of urinary tract pathogens, thus eliminating large numbers of false-positive tests characteristic of other urine screening methods. Screening urine for greater than or equal to 10(5) CFU/ml appears to be an acceptable criterion for defining a UTI in patient populations with low prevalence rates (2-10%). Thus, LAL urine assay may have potential usefulness for screening of asymptomatic populations, such as pregnant women and the elderly.

Bacteriuria↗
PubMed1979

Office analysis of bacteriuria.

Several techniques for determining significant bacteriuria are convenient, accurate, inexpensive and applicable for office use. The nitrite test, the dehydrated culture media technique, the dip-slide method and the agar tube method are all applicable for screening at-risk populations and for treatment follow-up. In addition, the accuracy, subculturing capabilities and potential for presumptive bacterial diagnosis of the dip-slide and agar tube methods qualify them as excellent office culturing systems.

Bacteriological Techniques↗