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PubMed1986

Epidemiology of bacteriuria in an elderly ambulatory population.

This study of bacteriuria in elderly (mean age 85 years, range 68 to 103) Jewish subjects of mostly middle and upper class attempted to determine disease prevalence, define the turnover in infected subjects, and assess the relation between functional status and infection. The prevalence of bacteriuria (midstream clean-catch method) was assessed in 373 women and 150 men. It was higher in women (18.2 percent) than in men (6.0 percent) (p less than 0.001) and was more common in functionally impaired nursing home residents (23.5 percent) than in apartment house dwellers (12.1 percent) (p less than 0.01). In longitudinal studies, 260 subjects (184 women and 76 men) had three urine culture surveys at six-month intervals. The cumulative percent infected on at least one survey was high (women 30.4 percent, men 10.5 percent). However, persistence of the same organism on all three surveys was surprisingly infrequent (women 6.0 percent, men 1.3 percent), and the turnover of infected and noninfected subjects was considerable. Persistence of bacteriuria on all three surveys was significantly more common in nursing home residents (13.9 percent) than in apartment house dwellers (3.1 percent) (p less than 0.01). Thus, bacteriuria is common in the elderly and appears related to functional status. However, the turnover of infected and noninfected subjects was high, and surprisingly, persistence was not found in most. The transient nature of bacteriuria in most provides support against the treatment of asymptomatic bacteriuria in the elderly.

Activities of Daily Living↗
PubMed2006

Asymptomatic bacteriuria: review and discussion of the IDSA guidelines.

Asymptomatic bacteriuria is a common finding, but is usually benign. Screening and treatment of asymptomatic bacteriuria is only recommended for pregnant women, or for patients prior to selected invasive genitourinary procedures. Healthy women identified with asymptomatic bacteriuria on population screening subsequently experience more frequent episodes of symptomatic infection, but antimicrobial treatment of asymptomatic bacteriuria does not decrease the occurrence of these episodes. Clinical trials in spinal-cord injury patients, diabetic women, patients with indwelling urethral catheters, and elderly nursing home residents have consistently found no benefits with treatment of asymptomatic bacteriuria. Negative outcomes with antimicrobial treatment do occur, including adverse drug effects and re-infection with organisms of increasing resistance. Optimal management of asymptomatic bacteriuria requires appropriate implementation of screening strategies to promote timely identification of the selected patients for whom treatment is beneficial, and avoidance of antimicrobial therapy where no benefit has been shown.

Bacteriuria↗
PubMed1995

Bacteriuria in children with neurogenic bladder treated with intermittent catheterization: natural history.

OBJECTIVE: To determine whether bacteriuria unassociated with symptoms in patients with neurogenic bladder will lead to symptomatic infection and/or deterioration of the upper urinary tract if left untreated, we examined whether bacteriuria persisted in bladder urine of children with neurogenic bladder treated with clean intermittent catheterization (CIC) and whether persistence of bacteria led to symptomatic infection or deterioration of the upper urinary tract. DESIGN: Weekly home visits were made during 6 months of surveillance of 14 children on the CIC regimen with a normal upper urinary tract and no reflux (as determined by renal ultrasonography, voiding cystourethrography, and serum creatinine measurement). During visits a sample of bladder urine was obtained by CIC, and signs and symptoms of urinary tract infection and all medications were recorded. RESULTS: Fourteen children were observed for 323 weeks. Cultures of 70% (172/244) of the urine samples collected were positive for organisms (> or = 10(4) colony-forming units per milliliter), 152 (88%) for the usual pathogens and 20 (12%) for commensal organisms. Bacteriuria was associated with pyuria two thirds of the time, regardless of bacterial species. Carriage of the same pathogen for 4 weeks or longer, with associated pyuria, was common during surveillance. Despite frequent episodes of bacteriuria with associated pyuria, there were only five symptomatic infections during the 323 patient-weeks. Children remained clinically well during the study period, and their upper urinary tract did not deteriorate. CONCLUSION: Bacteriuria persists for weeks in symptom-free children being treated with CIC for neurogenic bladder associated with a normal upper urinary tract. Before attempts are made to eradicate bacteriuria, treatment should be proved to be beneficial to this population.

Adolescent↗
PubMed1993

Risk factors for bacteriuria and clinical urinary tract infection in patients treated with clean intermittent catheterization.

To study factors that may predict the occurrence of bacteriuria and clinical urinary tract infection, a total of 302 patients using clean intermittent catheterization was followed. Bacteriuria was found equally in men and women, while clinical urinary tract infection was significantly higher among women. Predictive factors of clinical urinary tract infection were low age and high mean catheterization volume in women. In men low age, neurogenic bladder dysfunction and nonself-catheterization were predictors in addition to urine leakage in patients with neurogenic dysfunction. Bacteriuria was a risk factor of future clinical infection and bacteriuria. No other risk factor of bacteriuria could be identified in the female population, while low frequency of catheterization, high age and nonself-catheterization were predictive in men. Patients using anti-infective agents had fewer episodes of bacteriuria but significantly more clinical urinary tract infections compared to nonusers.

Adolescent↗
PubMed2004

Low colony counts of asymptomatic group B streptococcus bacteriuria: a survey of practice patterns.

The purpose of this study was to survey expert opinion on the management of low colony counts (< 100,000 colony forming units/mL) of asymptomatic group B streptococcus (GBS) bacteriuria discovered in the first trimester. A survey was sent to the 241 senior obstetricians affiliated with each of the Obstetrics and Gynecology training programs in the United States on July 10, 2002. Surveys received by the deadline (September 1, 2002) were included in the dataset. Eighty-five completed surveys were returned for a response rate of 35%. Seventy-seven percent reported treating low colony counts of asymptomatic GBS bacteriuria in the first trimester at the time of diagnosis, whereas 23% stated they did not treat prior to labor (margin of error 7.5% with 95% confidence). Nine percent stated that their institution had a written protocol for the treatment of low colony counts of asymptomatic GBS bacteriuria. Two physicians indicated that they screened for asymptomatic GBS bacteriuria at 28 weeks. Currently, no generally accepted protocol for the management of low colony counts of asymptomatic GBS bacteriuria exists. This survey indicates that most of the responding senior obstetricians at United States training programs treat low colony counts of asymptomatic GBS bacteriuria in the first trimester.

Bacteriuria↗
PubMed2000

Epidemiology of bacteriuria caused by vancomycin-resistant enterococci--a retrospective study.

BACKGROUND: The epidemiology of vancomycin-resistant enterococcal (VRE) bacteriuria has not been previously described. Our objectives are to describe the frequency of VRE bacteriuria, to use strict definitions to distinguish symptomatic urinary tract infection (UTI) versus urine colonization without pyuria versus asymptomatic bacteriuria with pyuria, and to describe the outcomes of each group. METHODS: We used a retrospective analysis of patients with VRE bacteriuria in an academic medical center. RESULTS: During the 18-month study period, 98 of the 107 patients (92%) with urine cultures positive for VRE (23/10,000 admissions), had charts that were available for review. In 94 of 98 patients, the organism was Enterococcus faecium, and in only 4 was Enterococcus faecalis recovered. Thirty-seven patients were colonized with VRE; 21 patients had asymptomatic bacteriuria, and the status of 27 patients was not ascertainable. Thirteen patients had VRE UTIs with two associated bacteremias and one death. Patients with UTI versus patients without UTI were more likely to have an underlying malignancy (39% vs 9%, P =.014). CONCLUSION: The majority of urine cultures yielding VRE do not represent true infection, rather colonization or asymptomatic bacteriuria.

Adolescent↗
PubMed1998

Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden.

The aims of the study were to estimate the prevalence of bacteriuria in a female urban population, to follow up the same population over the years, and to relate bacteriuria to long-term prognosis with respect to mortality and kidney disease. The study was based on a randomly selected population sample comprising 1462 women aged 38-60 years at entrance to the study in 1968-69 with an initial participation rate of 90.1%. Bacteriuria was observed in 3-5%, increasing with age, and most often asymptomatic. Bacteriuria on one occasion meant increased risk of having bacteriuria 6 and 12 years later. The percentages of different types of bacteria and the resistance pattern were similar initially and at follow-up studies after 6 and 12 years. There were no differences in mortality or incidence of severe kidney disease during a 24-year follow-up between those with and those without bacteriuria in the baseline study.

Adult↗
PubMed2004

Asymptomatic bacteriuria in women with diabetes: influence of metabolic control.

We screened 228 women with diabetes for bacteriuria during the period of January 1997 through December 2000 at Pisa General Hospital (Pisa, Italy). A control group of 146 women without diabetes was also evaluated. The frequency of significant bacteriuria was 17.5% (40 of 228) among women with diabetes and 18.5% (27 of 146) among women in the control group. Seven (13.5%) of 52 and 33 (18.8%) of 176 women with type 1 and in type 2 diabetes, respectively, had significant bacteriuria. The presence of higher glycated hemoglobin levels was the only significant risk factor for significant bacteriuria in women with type 2 diabetes. A similar frequency of bacteriuria in women with and women without diabetes was found. Severe impairment of metabolic control of type 2 diabetes increases the risk of acquiring asymptomatic bacteriuria.

Adolescent↗
PubMed1991

Daily meatal care for prevention of catheter-associated bacteriuria: results using frequent applications of polyantibiotic cream.

OBJECTIVE: To determine the efficacy of meatal treatment with a polyantibiotic cream in the prevention of bacteriuria during transurethral bladder catheterization. DESIGN: Randomized controlled trial. SETTING: Community teaching hospital. PATIENTS: Adult patients who underwent closed urinary catheter drainage for short and intermediate durations (two to 30 days). INTERVENTION: Polyantibiotic cream containing polymyxin B sulfate, neomycin sulfate, and gramicidin was applied to the urethral meatus-catheter interface three times daily from the first day of catheterization until bacteriuria was found. The onset of bacteriuria was defined as the day the colonizing species first achieved a colony count of greater than or equal to 1000 colonies/ml. Patients randomized to the control group received routine meatal care with cleansing of the meatal surface during daily bathing. RESULTS: Among 2,923 patients who were randomly allocated to receive either the protocol meatal care or routine care, the evaluable study population consisted of 747 patients who were nonbacteriuric and who remained catheterized for more than two days. Overall, 26 (6.8%) of 383 patients given the polyantibiotic treatment acquired bacteriuria, as compared to 37 (10.1%) of 364 patients not given this treatment (p = .167). A Cox proportional hazards regression analysis showed that, among putative risk factors including lack of meatal care, only female gender, a meatal swab culture yielding gram-negative rods or enterococci, and lack of antibiotic use during catheterization were independently associated with the development of bacteriuria. CONCLUSIONS: The adverse effect of meatal care noted in earlier studies of a disinfectant ointment applied twice daily was not found in this study of an antimicrobial preparation in a cream vehicle applied three times daily. However, the results do not support meatal care as an efficacious method to prevent catheter-associated bacteriuria in all patients.

Aged↗
PubMedDate not supplied

Bacteriuria and excess mortality: what should the next steps be?

Population studies have been reviewed that demonstrate that bacteriuria confers an increased risk of earlier death and that this risk is greater in older-age groups. Whether this relationship is due to the capacity of bacteria to infect selectively those who are already seriously ill or is a direct consequence of the presence of bacteria remains to be decided. However, studies have already demonstrated that the excess mortality associated with bacteriuria in hospitalized patients with indwelling catheters can be greatly reduced by simple devices that prevent bacteriuria and that this reduction in rates of bacteriuria is accompanied by a corresponding significant decline in associated mortality. The time is therefore right for a large-scale, controlled clinical trial of the effect on mortality of treatment of bacteriuria in older-age populations. However, such a trial cannot be conducted in the manner in which such studies have been conducted in the past--i.e., with a single course of treatment given over a brief time as the only method of therapy. Instead, more individualized treatment will be necessary if the effect of bacteriuria on mortality in the general population is to be investigated in a scientifically sound manner.

Aged↗
PubMed1978

Bacteriuria in a population-based cohort of women.

A survey for bacteriuria was conducted in a community-wide, unselected population of women 16--69 years old. The overall prevalence of bacteriuria was 3.5%. The prevalence of bacteriuria increased with age with a linear trend, but with a significant nonlinear component as well. Bacteriuria was associated with parity after correction for the effects of age. Current symptoms of dysuria and a history of previous urinary tract infection were slightly but significantly more common in women with bacteriuria. The population described should serve as an adequate base for continuing studies of the possible consequences of bacteriuria.

Adolescent↗
PubMed1982

A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters.

Bacteriuria is common in chronically catheterized patients and is associated with both acute and chronic complications. Of 605 consecutive weekly urine specimens from 20 chronically catheterized patients, 98% contained bacteria at high concentrations and 77% were polymicrobial. The mean interval between new episodes of bacteriuria was 1.8 weeks. Most species of bacteria caused five to seven new episodes of bacteriuria per 100 weeks of catheterization. Even though access to the catheter lumen was similar, the duration of bacteriuric episodes varied greatly by species. Of the episodes of bacteriuria caused by nonenterococcal gram-positive cocci, greater than 75% lasted less than one week. Mean durations of episodes of bacteriuria due to Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa were four to six weeks, whereas those due to Providencia stuartii averaged 10 weeks and ranged up to 36 weeks. Thus, the very high prevalence of bacteriuria--virtually 100%--was a result of a high incidence caused by many different species combined with the prolonged residence of some gram-negative bacilli in the catheter and urinary tract.

Adult↗
PubMed1989

Bacteriuria in representative population samples of persons aged 72-79 years.

Screening for bacteriuria was performed between 1984 and 1988 in persons aged 72-79 years representative of the general population in Göteborg, Sweden. The frequency of bacteriuria (greater than or equal to 10(5)/ml) at a single screening was 6% and 16% at age 72 years and 6% and 14% at age 79 years for the screened men (n = 235 and 259) and women (n = 259 and 297), respectively. By repeated screening after one month and 30 months of those previously negative at age 72 years, an additional 4% and 3% of men and 3% and 7% of women with bacteriuria were detected. Bacteriuric persons were excluded from further screening and controlled by frequent cultures during several years, with careful monitoring of clinical interventions. The persistence of untreated bacteriuria was analyzed in relation to bacterial species and number in the untreated subgroup of bacteriuric individuals. Nine of 10 Escherichia coli (E. coli) with less than 10(6)/ml and 22/22 non-E. coli strains disappeared spontaneously. In contrast, 20/26 (77%, p less than 0.01) with greater than or equal to 10(6) E. coli/ml persisted. Of 17 persons with bacteriuria persisting at least 12 months, 16 were women and 16 had E. coli. Of 201 E. coli cultures obtained from this group, 94% had greater than or equal to 10(6)/ml, and 99% had greater than or equal to 5 x 10(5)/ml. The results indicate that screening for high counts (greater than 10(6)/ml) of E. coli most effectively detects persisting bacteriuria in the general elderly population.

Aged↗
PubMedDate not supplied

Methicillin-resistant Staphylococcus aureus bacteriuria.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteriuria was detected in 11 of 41 patients colonized or infected with MRSA. The patients with bacteriuria generally were older than 40 years of age, five were diabetic, seven had prior indwelling uretheral catheters, two had undergone other urologic manipulations, and only one was clinically symptomatic. Eight patients received variable combinations of antibiotic therapy prior to the diagnosis of MRSA bacteriuria, and seven were still on antibiotic therapy at the time the bacteriuria was detected. Bacteriuria lasted four days to 14 weeks, and was eradicated promptly with cephalosporin therapy in five six patients. Bacteriuria in the untreated patients cleared spontaneously in one month. A single MRSA serotype (83A) predominated. The MRSA isolates were resistant in vitro to most antibiotics except vancomycin. Resistant colonies were observed within cephalothin disc zones of inhibition at 30C (resistance was confirmed by microtube-dilution sensitivity testing). MRSA disc sensitivity testing for cephalothin may be unreliable when performed at 35C.

Adult↗
PubMedDate not supplied

Bacteriuria due to ureaplasmas and other fastidious organisms during pregnancy: prevalence and significance.

When urine, which has been collected by suprapubic bladder aspiration, is appropriately cultured, asymptomatic bacteriuria due to fastidious organisms can be detected quite commonly in apparently healthy pregnant women; Ureaplasma urealyticum and Gardnerella vaginalis can each be isolated from the bladder urine of 10 to 15% of subjects, other bacteria less frequently. Both organisms are often present together, sometimes in addition to "conventional" urinary pathogens. Overall bacteriuria occurs in about 25% of healthy pregnant women, including 6% with "conventional" asymptomatic bacteriuria. Pyuria occurs in about one-third of patients with fastidious bacteriuria. Bacteriuria due to fastidious bacteria occurs significantly more commonly in selected groups of pregnant women. U. urealyticum or G. vaginalis or both can be isolated, generally in relatively high numbers from more than 70% of pregnant women with renal disease and 20 to 30% of those with preeclampsia. In a prospective study in which urine was collected using an open ended catheter, ureaplasmas were isolated 3 times more frequently from women less than 25 years of age than from older women. Women with Ureaplasma bacteriuria at the first antenatal visit were 3 times more likely to develop preeclampsia than those without, but the mean birth weights of the infants born to the two groups of women were not significantly different. Further studies are required to determine the importance of these preliminary findings.

Age Factors↗
PubMed1993

Frequency and correlates of bacteriuria among children with neurogenic bladder.

Bacteriuria is a common clinical problem among children with neurogenic bladder due to meningomyelocele or traumatic spinal cord injury. To determine the frequency of bacteriuria among affected children at our institution, we obtained 257 urine specimens from 105 children being seen as outpatients for routine care over a 2-year study period. Specimens were obtained via catheterization. Almost half of these specimens (110/257 or 43%) yielded positive results when tested for urinary pathogens. To assess whether any characteristics of these children were related to the likelihood of bacteriuria, we analyzed further a subgroup of 46 children with normal renal ultrasonography from whom two to five specimens were obtained. There were no statistically significant associations between the likelihood of bacteriuria and the following characteristics: age, gender, socioeconomic status, level of spinal cord lesion, voiding technique, and use of prophylactic antibiotics. Children with neurogenic bladder are at high risk for bacteriuria. The pathogenesis of this bacteriuria, its part in deterioration of the urinary tract, and the possible means of its prevention in this special population all deserve further study.

Bacteriuria↗
PubMed2006

Bacteriuria, pyuria and bacteremia frequency following outpatient cystoscopy.

AIM: The assumed necessity of antimicrobial prophylaxis prior to cystoscopy is controversial. In this study, the rate of bacteriuria, pyuria and bacteremia in outpatients who underwent cystoscopy without antimicrobial prophylaxis is investigated prospectively. METHODS: The study included 75 patients who underwent cystoscopy for various indications and had sterile urine prior to intervention. A clean midstream urine sample was obtained 24 h before and 48 h after the procedure. Blood cultures were taken 1 h after cystoscopy. Patients were questioned for newly developed symptoms 48 h after cystoscopy. Blood cultures were taken again from patients who presented with fever. RESULTS: Six patients (8%) developed significant bacteriuria, and six patients (8%) developed pyuria without significant bacteriuria. Bacteremia was not determined in any of the patients. The association between presence of pyuria prior to the procedure and development of bacteriuria after the procedure was significant (P < 0.05). Four patients out of six who had bacteriuria were asymptomatic. In our study we found significant bacteriuria after cystoscopy in 8% of patients, and no bacteremia. CONCLUSIONS: Thus we conclude that cystoscopy is a safe and well-tolerated procedure. Antimicrobial prophylaxis should not be administrated unless specific indications are present.

Adolescent↗
PubMed1993

The source of organisms in the post-prostatectomy bacteriuria of patients with pre-operative sterile urine.

Ninety patients undergoing prostatectomy for benign prostatic hyperplasia (BPH) with sterile urine pre-operatively were prospectively studied for post-prostatectomy bacteriuria; 26 of 90 patients (29%) developed bacteriuria (18 of 64 after transurethral resection (TUR) and 8 of 26 after open prostatectomy), of whom 15 had pre-operative indwelling urethral catheters. The correlation of bacteriuria with several factors was studied, namely the presence of a histological inflammatory reaction within the prostatic adenoma, prostatic culture, intra-operative outgoing irrigation fluid culture, intra-operative blood culture and post-operative external meatal swab culture. The only significant correlation was between bacteriuria and meatal cultures. It was concluded that post-prostatectomy bacteriuria is probably caused by post-operative ascending infection along urethral catheters. There was not enough evidence to ascribe bacteriuria to pre-existing septic foci within the adenoma. Intra-operative contamination and infection from distant foci were also unlikely causes.

Aged↗