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PubMed1995

Fever after extracorporeal shock wave lithotripsy for patients with upper urinary tract calculi associated with bacteriuria before treatment.

The present study was carried out to determine the relationship between fever (> or = 38 degrees C) after extracorporeal shock wave lithotripsy (ESWL) and the history of bacteriuria before ESWL. The subjects of this study comprised 958 patients. Significant bacteriuria before ESWL was found in 75 patients. These patients were treated with antibiotics and underwent ESWL after bacteriuria disappeared. Despite treatment with antibiotics, the patients with bacteriuria before ESWL had a significantly higher incidence of fever after ESWL than those without bacteriuria. Among the 14 patients whose high fever persisted after ESWL, the patients with bacteriuria included 7 (50%) with stones > 20 mm in size. The patients with stones > 20 mm and bacteriuria before ESWL had a high risk of persistent high fever after ESWL.

Adolescent↗
PubMed1995

Does eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residents?

OBJECTIVE: To determine the effects of eradicating otherwise asymptomatic bacteriuria on the severity of chronic urinary incontinence among nursing home residents. DESIGN: Residents were categorized as nonbacteriuric or bacteriuric on the basis of urine cultures. Bacteriuric residents were then randomly assigned to immediate and delayed treatment groups. The delayed treatment group was included to control for spontaneous changes in the severity of incontinence. The immediate treatment group received antimicrobial therapy for 7 days; after outcome measures had been repeated, the delayed treatment group was treated. SETTING: 6 community-based nursing homes. PATIENTS: Nursing home residents with chronic urinary incontinence. MEASUREMENTS: The frequency and volume of urinary incontinence were determined by physical checks for wetness by trained research aides hourly between 7 a.m. and 7 p.m. for 3 days in all patient groups (non-bacteriuric, bacteriuric with immediate treatment, and bacteriuric with delayed treatment) at baseline, after the immediate treatment group was treated, and again after the delayed treatment group was treated. RESULTS: 191 residents were enrolled, and 176 completed the study. Bacteriuria was eradicated by antimicrobial therapy in 71 residents (40%), and 17 residents (10%) had bacteriuria before and after therapy. The percentage of hourly checks at which the residents were found wet and other measures of incontinence severity remained essentially the same after bacteriuria was eradicated. In the nonbacteriuric group, the percentage of checks that were wet increased from 29% (95% CI, 26% to 32%) at baseline to 30% (CI, 27% to 34%) on repeated measurement. In the bacteriuric groups, the percentage increased from 34% (CI, 30% to 38%) before treatment to 35% (CI, 31% to 39%) after bacteriuria was eradicated. The presence of pyuria did not affect the results. CONCLUSION: Eradicating bacteriuria has no short-term effects on the severity of chronic urinary incontinence among nursing home residents. Our data support the practice of not treating asymptomatic bacteriuria in this population and validate the recommendations in the Health Care Financing Administration's Resident Assessment Protocol for urinary incontinence.

Aged↗
PubMed2000

Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people? A qualitative study of physicians' and nurses' perceptions.

BACKGROUND: Antibiotic therapy for asymptomatic bacteriuria in institutionalized elderly people has not been shown to be of benefit and may in fact be harmful; however, antibiotics are still frequently used to treat asymptomatic bacteriuria in this population. The aim of this study was to explore the perceptions, attitudes and opinions of physicians and nurses involved in the process of prescribing antibiotics for asymptomatic bacteriuria in institutionalized elderly people. METHODS: Focus groups were conducted among physicians and nurses who provide care to residents of long-term care facilities in Hamilton, Ont. A total of 22 physicians and 16 nurses participated. The focus group discussions were tape-recorded, and the transcripts of each session were analysed for issues and themes emerging from the text. Content analysis using an open analytic approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent themes and issues. RESULTS: We observed that the ordering of urine cultures and the prescribing of antibiotics for residents with asymptomatic bacteriuria were influenced by a wide range of nonspecific symptoms or signs in residents. The physicians felt that the presence of these signs justified a decision to order antibiotics. Nurses played a central role in both the ordering of urine cultures and the decision to prescribe antibiotics through their awareness of changes in residents' status and communication of this to physicians. Education about asymptomatic bacteriuria was viewed as an important priority for both physicians and nurses. INTERPRETATION: The presence of non-urinary symptoms and signs is an important factor in the prescription of antibiotics for asymptomatic bacteriuria in institutionalized elderly people. However, no evidence exists to support this reason for antibiotic treatment. Health care providers at long-term care facilities need more education about antibiotic use and asymptomatic bacteriuria.

Aged↗
PubMed2001

[Occurrence of bacteriuria in malignant hematologic diseases].

BACKGROUND: Infection risk with patients suffering from hematological malignant diseases is a result of an interaction between a patient and a host and of a dysfunction of organs. During the evolution, human beings have developed an effective defense mechanism. It was defined with functioning of: 1) skin and mucus membranes, 2) phagocyte cells and 3) humoral and cellular immunity. The patients with malignant hematological diseases are exposed to complex pathogenic processes that disturb their balance, which leads to the occurrence of an infective syndrome. METHODS: In the retrospective study of 422 patients with malign hematological disease, epidemiological-clinical analysis of the infectious syndrome has been carried out. Patients were hospitalized at the Clinic for Hematology--Clinical Center of Sarajevo University, in the period from January 1, 1993 to January 1, 2000. diagnostic protocol included the following procedures: anamnesis, clinical picture, biochemical, cytomorphological, pathohistological, microbiological and radiological test. The goal of work was to determine bacteriuria in case of malign hematological diseases as an accompanying, combined complication during the treatment of these patients. RESULTS: In case of patients that were hospitalized in 1994, bacteriuria was present in the percentage of 56, which is over expected trend line whereas in 2000 it was registered in 20.65% of patients had bacteriuria while 17% of patients had have infection, 28% of patients had bacteriuria while 17% of patients had other infections. In case of patients up to 65 age, bacteriuria was more frequent in female population while in the age of over 65 it was more frequent in male population. Through microbiological analysis of urinary flora, monomicrobial bacteriuria was found in case of 58% patients, and patients were mainly in the initial phase of disease. In case of patients with long treatment with antineoplastic drugs or in the phase of advanced basic process, bacteriurias with polymicrobial character were dominant, which is characteristic of recurrent infections of urinary tract. CONCLUSIONS: The authors came to the conclusion that it is necessary to monitor urine flora with malignant hematological disease patients and by using an adequate treatment to minimize initial infection, relapse and reinfection of urinary tract. Still, it is not clear which is the basic factor initiating the infection of urinary tract--whether it is the prevailing intensity and pathogenic aggressiveness of an agent, or the exposure intensity or a supportive condition of the patient.

Aged↗
PubMed1992

[Prevalence and treatment of bacteriuria in the geriatric population].

The aim of this study was to evaluate the prevalence of asymptomatic bacteriuria and its prognostic factors in a geriatric population living in a nursing home. Seventy-eight patients (68 females, 10 males) with a mean age of 82 +/- 6 years (range: 60-94) were studied. Once symptomatic infection is ruled out and the risk factors had been analyzed, a urine culture was performed in all cases. We then identified two different population groups: asymptomatic bacteriuria without risk factors (group A), and asymptomatic bacteriuria with risk factors (group B). Overall prevalence of asymptomatic bacteriuria was 38.5% (Group A: 23%, group B: 63%; p < 0.001). Considering all patients with bacteriuria, 50% of cases (15 out of 30 patients) had urine incontinence, 40% suffer from severe limitation of movements and 70% had a past history of pregnancy. The same figures for the population with negative urine culture were 12.5%, 14.5%, and 46% respectively (p < 0.01). In group B, 79% of cases had more than one RF, including all patients with the association of urine incontinence, movement limitation and diabetes. In group A, 93% of asymptomatic bacteriuria were due to E. coli with low adhesin expression (27%) whereas in group B, E. coli was isolated in 44% asymptomatic bacteriuria cases, with high adhesin expression (71.5%), other enteric gram-negative bacilli (31%), non-fermentative gram-negative bacilli (19%) and gram-positive cocci (6%). Group A patients were treated with a single dose of ciprofloxacin (500 mg) with elimination of bacteria in urine in 91% of cases (at one week) and 73% of cases (at one month).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Clinical trial of junction seals for the prevention of urinary catheter-associated bacteriuria.

BACKGROUND: Preconnected catheter systems with sealed junctions have been associated with reduced rates of bacteriuria and mortality. A clinical trial was undertaken to evaluate the effectiveness of a junction seal applied after catheter insertion for preventing bacteriuria and reducing mortality. METHODS: Patients undergoing transurethral catheterization at a community hospital were randomized within 24 hours of catheter insertion to receive either a tape seal applied to the catheter-drainage tubing junction or no tape seal. Catheter urine cultures and catheter care violations were monitored daily until catheter removal or patient discharge. RESULTS: Overall, 124 (13.7%) of 903 patients in the group receiving a junction seal acquired bacteriuria, compared with 125 (14.9%) of 837 patients in the control group (P = .52, odds ratio = 0.91, 95% confidence interval, 0.69 to 1.20). Multivariate analysis revealed that only female gender and lack of systemic antibiotic use independently correlated with the development of bacteriuria; neither junction treatment randomization nor disconnection of the junction was associated with bacteriuria. Survival curve analysis of patients stratified by gender and antibiotic use revealed no significant differences in the rate of bacteriuria between treatment groups. The overall mortality in the tape seal group was less than that in the control group (6.6% vs. 8.0%, respectively), but not to a statistically significant extent despite stratification by antibiotic use. CONCLUSIONS: The use of a tape seal applied to the catheter-drainage tubing junction within 24 hours of catheter insertion was not associated with significantly lower rates of bacteriuria and mortality in patients undergoing short-term catheterization.

Bacteriuria↗
PubMed2005

[Prevalence and risk factors for bacteriuria in patients with cirrhosis].

Bacterial infections occur frequently in patients with cirrhosis and may worsen the disease outcome. We investigated the prevalence of bacteriuria in 500 consecutive patients with cirrhosis, in different Child-Pugh stages (41.4% A; 40.8% B; 17% C) and analysed the associated risk factors. Most of the cirrhosis cases were virus related; alcohol abuse was recorded in 6.2% of the patients. Bacteriuria was detected in 139 (27.8%) cases: 32.4% were more than 100,000 cfu/ml; 7.9% between 100,000 and 1.000,000 cfu/ml and the remaining cases more than 1000,000 cfu/ml. Escherichia coli was the most frequent isolated agent (84.5%); Proteus spp. strains were detected only in bacteriuria with more than 100,000 cfu/ml. At univariate analysis, female gender, age and presence of diabetes were significantly associated to bacteriuria, while Child-Pugh stage and the presence of hepatocellular carcinoma were not. In a multivariate model, only female gender and diabetes were significantly associated to bacteriuria. These results indicate that advanced cirrhosis was not a risk for bacteriuria, that was associated rather to gender and diabetes, which are common risk factors for bacteriuria in non-cirrhotic patients.

Adult↗
PubMedDate not supplied

[Trial evaluation of familial asymptomatic bacteriuria].

Between September 1, 1987 and December 1, 1988, 57 cases of asymptomatic bacteriuria were distinguished in the group of 2,898 schoolgirls, aged between 15 and 20 years (mean 16.7 years). For screening purposes Griess'test modified by Sleigh was used. Bacteriologic tests have shown, that 12 out 57 mothers (21.05%) and 5 out of 39 sisters (12.82%) suffered from asymptomatic bacteriuria, while this pathology was diagnosed in 61 (2.10%) out of all control population, i.e. 66 girls. Incidence of the asymptomatic bacteriuria was 4.55% in the 66 mothers. The differences in the incidence of the infection between the whole population and mothers of the control group, and between sisters and mothers of girls with asymptomatic bacteriuria were statistically significant (p < .001 and p < .01, respectively). History of the urinary tract infections was significantly more frequent in girls with asymptomatic bacteriuria, their mothers and sisters than in the control group. Type of bacterial strains isolated from the urine, similar sanitary conditions in these families as well as the lack of ultrasonographically and renographically diagnosed urinary pathologies in 11 out of 13 girls whose mothers and sisters suffered from asymptomatic bacteriuria suggest that familial asymptomatic bacteriuria may have a genetic background.

Adolescent↗
PubMed1980

Significant bacteriuria in the puerperium: a prospective study of the risk factors.

The rate of significant bacteriuria in the puerperium was studied prospectively in 3554 women who were delivered at the State Maternity Hospital. The influence of catheterisation during labour and before Caesarean section, urinary tract infection during pregnancy, puerperal endometritis and impaired glucose metabolism on the rate of significant postpartum bacteriuria was studied. Catheterisation significantly increased the rate of significant bacteriuria in patients who were delivered vaginally. A single catheterisation before Caesarean section did not increase the incidence of significant bacteriuria in comparison with the incidence of patients not catheterised before surgery. Patients with urinary tract infection diagnosed during pregnancy are at risk of developing significant postpartum bacteriuria. Patients with postpartum endometritis had twice the rate of significant bacteriuria than patients not developing postpartum endometritis, but the difference was not statistically significant. The presence of impaired glucose metabolism did not affect the rate of significant postpartum bacteriuria.

Bacteriuria↗
PubMed1976

Clinical evaluation of commercial reagent strips for detection of significant bacteriuria in dogs and cats.

The reagent strip technique of quantitative urine culture was a satisfactory screening test for the detection of significant bacteriuria in dogs and cats. The reagent strip technique was found to be of almost equal sensitivity as the calibrated loop technique in identifying significant bacteriuria. Significant bacteriuria was detected in 38 of 148 urine samples evaluated by the calibrated loop technique. Of these 38 urine samples, significant bacteriuria was detected in 35 by the commercial test. False-negative results were obtained with reagent strips in 1 urine sample which had significant bacteriuria by the calibrated loop technique. The other 2 samples had bacterial counts of suspicious significance (10,000/ml of urine) by the reagent strip technique. False-positive results were obtained with the reagent strip technique in 3 urine samples; however, all 3 urine samples had bacterial counts (10,000/ml of urine) of suspicious significance when evaluated by the calibrated loop technique. The reagent strip technique was not satisfactory for the examination of patients with gross hematuria. The nitrite test portion of the commercial test did not detect significant bacteriuria in all samples and, therefore, was not suitable as a screening test for significant bacteriuria in dogs and cats. The nitrite test may have been inhibited by ascorbic acid, a metabolite which normally may exist in the urine of these animals.

Animals↗
PubMedDate not supplied

[Urinary incontinence and bacteriuria in women].

We analyzed the urodynamic data and their relationship with significant bacteriuria in 103 consecutive female patients (mean age = 55.7 yrs) with urinary incontinence. Significant bacteriuria was observed in 25.2% of the cases. E. coli was the pathogen most frequently isolated (70.3%). Significant bacteriuria was demonstrated in 29.3% of the patients with urge-incontinence. The most frequent type of incontinence in patients with bacteriuria was no urodynamic reproduction of urinary incontinence (42.8%). Bladder instability was not associated with significant bacteriuria (27.2%). Significant bacteriuria was observed in 75% of the patients with lower urinary tract obstruction, 66.6% of the patients who voided by abdominal straining and 26.3% of those with postvoiding residual urine. These findings indicate that urine culture should be done in patients with no urodynamic reproduction of urinary incontinence. There was no statistically significant correlation between urge-incontinence/bladder instability and significant bacteriuria. Consequently, antibiotics should not be used routinely in female urinary incontinence.

Adolescent↗
PubMed1998

Asymptomatic bacteriuria in human immunodeficiency (HIV)-infected women.

Objective: To determine the prevalence of bacteriuria in HIV- infected women versus healthy non-HIV-infected controls.Methods: A prospective cohort study was undertaken between January 1996 and March 1997. One hundred nineteen ambulatory, premenopausal women from the Women's HIV Clinic and 191 similar non-infected Gynecology Clinic controls were recruited. Information recorded from the medical record and patient questionnaire included: age, prior history of UTI, antibiotic usage, sexual frequency, diaphragm/spermicide use, and CD4 count. A clean catch urine culture was collected on all patients. Statistical analysis was via SPSSPC.Results: The mean age of HIV-infected women was 33 vs 26 for non-infected. The mean CD4 count was 341. A prior history of UTI (mean # per lifetime) was significantly higher for HIV women (2.8) vs controls (1.8) [P =.01]. The mean weekly sexual frequency was significantly higher in HIV-negative (2.1) vs HIV-infected (1.2) [P <.001]. Diaphragm/spermicidal use was uncommon but equal in both groups. The prevalence of any growth of uropathogens (>10(2) cfu/mL) was 30% in the HIV-infected vs 47% in controls. The percentage of asymptomatic bacteriuria for each range of uropathogen titer (cfu/mL) in urine was:Chronic antibiotic usage (39% of HIV-infected vs 4% of controls) was associated with a decreased prevalence of bacteriuria, but there was not a significant difference in prevalence of bacteriuria between groups. Regardless of titer ranges of uropathogens evaluated, the prevalence of bacteriuria was not different between CD4 counts of <200 and >/=200. As compared to controls, HIV-infected individuals demonstrated shifts toward nosocomial pathogens: Enterococcus, S. aureus and non-E. coli gram-negative rods.Conclusion: The prevalence of bacteriuria was not greater in HIV-infected women versus non-HIV-infected women versus HIV non-infected controls and was not significantly affected by antibiotic usage or CD4 count. Uropathogens responsible for asymptomatic bacteriuria in HIV-infected women are different from "healthy" controls and are more representative of nosocomial flora.

Journal Article↗
PubMedDate not supplied

Asymptomatic bacteriuria in institutionalized elders in Israel.

OBJECTIVES: To document the prevalence of asymptomatic bacteriuria in patients in one large long-term care facility, and describe clinical outcomes in initially bacteriuric and nonbacteriuric residents during prospective observation encompassing one year. METHODS: Patients enrolled in the study were residents of the Haim-Shoham Geriatric Center, a long-term care institute with 800 inhabitants. Twenty patients were related randomly for study enrollment on each of the ten wards. A urine culture was obtained from the enrolled patients. A second culture was obtained within one week if the initial culture grew >or= 10(5) colony-forming units per milliliter (cfu/ml) of at least one uropathogen. Demographic data and comorbidities, as well as most recent laboratory results, were recorded for all patients enrolled. Subjects were followed prospectively for one year or until death. Clinical events and usage of antibiotics were recorded. In patients with asymptomatic bacteriuria, repeated urine cultures were obtained every two months. RESULTS: Eighty-five (43.3%) of a total of 196 elder residents screened presented asymptomatic bacteriuria. There were no differences between patients with and without asymptomatic bacteriuria in age, gender, and underlying diseases. Patients with asymptomatic bacteriuria were significantly more bed-ridden (91.7% vs. 82.1%, P = 0.05); demented (78.8% vs. 59.8%, P = 0.03); and incontinent of urine (93% vs. 71.4%, P < 0.0001) and bowel (85.8% vs. 59.3%). During one year of prospective observation, bacteriuric patients had a mortality rate of 25.9%, compared to 7.1% for nonbacteriuric (P < 0.0001). Mortality in the group with bacteriuria was higher due to both urinary infection and other causes. CONCLUSIONS: In our population, asymptomatic bacteriuria was associated with increased functional impairment and increased mortality over 12 months. The increased mortality, however, was not fully attributable to urinary infection.

Journal Article↗
PubMed1990

Asymptomatic bacteriuria. Which patients should be treated?

Asymptomatic bacteriuria is common in both the community nursing home and hospital settings. Few data, however, are available about the potential complications arising from asymptomatic bacteriuria (eg, the development of symptomatic infection and renal damage) for various patient populations and for various medical conditions. On the basis of data in the literature, we believe that neonates and preschool children with asymptomatic bacteriuria should be treated. Pregnant women and "nonelderly" (less than 60 years old) men should be treated. We do not think that school-age children, nonpregnant, nonelderly women, or elderly men and women need antimicrobial treatment if their urinary tracks are normal. In addition, antimicrobial treatment is recommended for patients with asymptomatic bacteriuria and abnormal urinary tracts and those undergoing clean intermittent catheterization, genitourinary manipulation, or instrumentation. Patients with long-term indwelling catheters should not be treated. The treatment of asymptomatic bacteriuria in patients with short-term indwelling catheters and those with ileal conduits is controversial. These treatment recommendations should not necessarily be accepted as the standards of practice, since treatment is often controversial due to the lack of published data describing the natural course of asymptomatic bacteriuria in various patient populations.

Aged↗
PubMed1984

Catheter-associated bacteriuria. Failure to reduce attack rates using periodic instillations of a disinfectant into urinary drainage systems.

We assessed the efficacy of periodic instillations of hydrogen peroxide into urinary drainage systems in the prevention of catheter-associated bacteriuria in a prospective and randomized clinical study of 668 patients with indwelling urethral catheters. Bacteriuria was documented in 68 (10%) of the 668 patients after a mean duration of four days of catheterization. There was no difference between the hydrogen peroxide group and the control group in the mean duration of catheterization before the onset of bacteriuria, in the attack rate for bacteriuria, or in the spectrum of etiologic agents recovered. Bag contamination with the same organism responsible for bacteriuria preceded infection in only five (7%) of the 68 patients, three patients using hydrogen peroxide and two in the control group. We conclude that infections arising intraluminally from contamination of the drainage bag are uncommon among catheterized patients and that the periodic instillation of disinfectants into closed sterile drainage systems is not effective in reducing the incidence of catheter-associated bacteriuria.

Bacteria↗
PubMed1989

Dipstick urinalysis screening of asymptomatic adults for urinary tract disorders. II. Bacteriuria.

Using criteria adopted by the US Preventive Services Task Force, we evaluated use of the dipstick urinalysis to screen for bacteriuria. When the leukocyte esterase and nitrite dipstick tests are combined, the positive predictive value for detecting bacteriuria exceeded 12% in groups with a 5% or higher prevalence of bacteriuria: women who are pregnant, diabetic, or over 60 years of age and all institutionalized elderly. Conventional antimicrobial regimens for asymptomatic bacteriuria have proved efficacious only for pregnant women. We conclude that pregnant women should be screened for bacteriuria, but with the more sensitive urine culture, because treatment prevents serious fetal and maternal sequelae. Dipstick screening may be justified in women who are over 60 years of age or diabetic. The prevalence of bacteriuria in other groups is too low to justify screening.

Adult↗
PubMed2000

Duration of treatment for asymptomatic bacteriuria during pregnancy.

BACKGROUND: A Cochrane systematic review has shown that drug treatment of asymptomatic bacteriuria in pregnant women substantially decreases the risk of pyelonephritis and reduces the risk of preterm delivery. However, it is not clear whether single dose therapy is as effective as longer conventional antibiotic treatment. OBJECTIVES: The objective of this review was to assess the effects of different durations of treatment for asymptomatic bacteriuria in pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and the reference lists of articles. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing antimicrobial therapeutic regimens that differed in duration (particularly comparing single dose with longer duration regimens) in pregnant women diagnosed with asymptomatic bacteriuria. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by the reviewers. MAIN RESULTS: Eight studies involving over 400 women were included. All were comparisons of single dose treatment with four to seven day treatments. The trials were generally of poor quality. No difference in 'no-cure' rate was detected between single dose and short course (4-7 day) treatment for asymptomatic bacteriuria in pregnant women (relative risk 1.13, 95% confidence interval 0.82 to 1.54) as well as in the recurrent asymptomtic bacteriuria (relative risk 1.08, 95% confidence interval 0.70 to 1.66). However these results showed significant heterogeneity. No differences were detected for preterm births and pyelonephritis although sample size of trials was small. Longer duration treatment was associated with an increase in reports of adverse effects (relative risk 0.53, 95% confidence interval 0.31 to 0.91). REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate whether single dose or longer duration doses are more effective in treating asymptomatic bacteriuria in pregnant women. Because single dose has lower cost and increases compliance, this comparison should be explored in a properly sized randomized controlled trial.

Anti-Bacterial Agents↗
PubMed1983

Measurement of pyuria and its relation to bacteriuria.

Excluding specimen contamination, bacteriuria indicates either urinary colonization (replication of bacteria in urine without evidence of tissue invasion) or urinary tract infection (bacteriuria associated with clinical, histologic, or immunologic evidence of host injury). Practically speaking, measuring pyuria is the most readily available means of establishing the presence of host injury, thus differentiating colonization from infection. Careful studies have established the nonpathologic limits for pyuria (less than 10 leukocytes/mm3 in uncentrifuged urine) and have compared methods for its measurement. The most commonly used method, determination of cells per high power field in centrifuged urine, is not reproducible and does not correlate with either the actual leukocyte excretion rate or the cells per cubic millimeter as enumerated in a counting chamber. When clinical studies using the latter method of determining pyuria were reviewed, the following conclusions emerged: (1) 10 leukocytes/mm3 or greater occur in less than 1 percent of asymptomatic, nonbacteriuric patients but in greater than 96 percent of symptomatic men and women with significant bacteriuria; (2) most symptomatic women with pyuria but without significant bacteriuria have urinary infection either with bacterial uropathogens present in colony counts less than 10(5)/ml or with Chlamydia trachomatis; (3) women with asymptomatic bacteriuria probably should be divided into two subgroups: those with true asymptomatic infection (associated with pyuria) and those with transient, self-limited bladder colonization; and (4) most patients with catheter-associated bacteriuria also have pyuria and hence infection. In view of its potential value to both clinicians and microbiologists, pyuria should be accurately determined and expressed as cells per cubic millimeter in uncentrifuged urine.

Bacteria↗