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A prospective study of asymptomatic bacteriuria in sexually active young women.
BACKGROUND: Asymptomatic bacteriuria is common in young women, but little is known about its pathogenesis, natural history, risk factors, and temporal association with symptomatic urinary tract infection. METHODS: We prospectively evaluated 796 sexually active, nonpregnant women from 18 through 40 years of age over a period of six months for the occurrence of asymptomatic bacteriuria (defined as at least 10(5) colony-forming units of urinary tract pathogens per milliliter). The women were patients at either a university student health center or a health maintenance organization. Periodic urine cultures were taken, daily diaries were kept, and regularly scheduled interviews were performed. Escherichia coli strains were tested for hemolysin, the papG genotype, and the ribosomal RNA type. RESULTS: The prevalence of asymptomatic bacteriuria (the proportion of urine cultures with bacteriuria in asymptomatic women) was 5 percent (95 percent confidence interval, 4 percent to 6 percent) among women in the university group and 6 percent (95 percent confidence interval, 5 percent to 8 percent) among women in the health-maintenance-organization group. Persistent asymptomatic bacteriuria with the same E. coli strain was rare. Symptomatic urinary tract infection developed within one week after 8 percent of occasions on which a culture showed asymptomatic bacteriuria, as compared with 1 percent of occasions when asymptomatic bacteriuria was not found (P<0.001). Asymptomatic bacteriuria was associated with the same risk factors as for symptomatic urinary tract infection, particularly the use of a diaphragm plus spermicide and sexual intercourse. CONCLUSIONS: Asymptomatic bacteriuria in young women is common but rarely persists. It is a strong predictor of subsequent symptomatic urinary tract infection.
Clinical practice. Acute uncomplicated urinary tract infection in women.
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Clinical significance of proteinuria.
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Office urine cultures in pediatric practice.
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Incidence of bacteremia and bacteriuria in patients with non-infection-related urinary stones undergoing extracorporeal shock wave lithotripsy.
In a prospective pilot study, 26 patients with non-infection-related renal or ureteric stones and sterile urine were examined for evidence of bacteriuria and bacteremia following extracorporeal shock wave lithotripsy (SWL). Blood samples were obtained for aerobic and anaerobic bacterial culture at the end of, and 1 hour after, the SWL procedure. Urine cultures were performed 24 hours before and after treatment. Bacteremia was recorded in 7.7% of the patients immediately after SWL but in no patient at 1 hour after treatment. None of the patients manifested significant bacteriuria or post-SWL fever. These findings support the contention that, provided the urine is sterile and a negative history of urosepsis is available, antibiotic prophylaxis is unnecessary in patients with non-infected renal stones submitted to SWL treatment.
Quantitative studies of urine cytology.
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Usefulness of macroscopic urinalysis as a screening procedure. A preliminary report.
The macroscopic examination (physicochemical testing) is a sufficient laboratory screening procedure for routine urinalyses when accurately assessed. Only in those patients for whom routine urine specimens are macroscopically positive or in symptomatic patients with or without known renal or urinary-tract disease should a microscopic examination be necessary. Results of this study of more than 900 consecutive routinely screened urine specimens indicate that there is less than a 3% diagnostic yield when the urine sediment is examined after a negative macroscopic examination.
Urine screening strategy employing dipstick analysis and selective culture: an evaluation.
A cost-effective urinalysis test strategy, employing screening dipstick analysis with sediment microscopy performed on urines positive for leukocyte esterase, nitrite, protein, or blood, is evaluated. Screening urine culture is done when greater than or equal to 5 WBC/HPF, greater than 10 bacteria/HPF, or yeasts are found on sediment microscopy. Predictive value, sensitivity, and specificity of the test strategy in predicting significant bacteriuria is compared with sediment microscopy, Gram staining of uncentrifuged urine and leukocyte chamber counting. Employment of the test protocol for routine urine specimens would decrease sediment microscopy by 49%, while effectively screening for significant bacteriuria with a sensitivity of 88.9% and predictive value of a negative result of 98.8%.
The detection of leukocyte esterase activity in urine with a new reagent strip.
An evaluation of the Ames Leukostix reagent strips for the detection of leukocyte esterase activity in urine was undertaken to determine the interlot precision and between reader reliability, to compare Leukostix and Chemstrip LN results, and to determine if the Ames Leukostix reagent strip provides an alternative to, or supplement for, the microscopic detection of leukocytes. A total of 412 urines were analyzed with the Ames and Bio-Dynamics reagent strips. The sensitivity and specificity of Leukostix results, relative to a quantitative chamber count, were 89.4% and 90.4%, respectively. Chemstrip LN provided essentially the same results with a sensitivity of 88.8% and specificity of 92.4%. The between-reader and between-lot reproducibility was excellent, with 99% of the results agreeing within half a color block of each other. The sensitivity of the sediment count relative to the chamber count was 68.9% and the specificity, 97.7%. Performance of the sediment count in addition to use of the reagent strip provided little additional information. On the basis of these results, the Ames Leukostix reagent strip is considered to be a suitable alternative to sediment microscopic examination for the detection of leukocytes in urine.
Reflux nephropathy and chronic atrophic pyelonephritis: a review.
Chronic atrophic pyelonephritis is associated with vesicoureteric reflux in infancy. Reflux disappears during childhood in 50% of cases. It is more commonly detected in infants (49%) and children (26%) with infection than in adults (4.4%). Severe reflux may persist in adults and is usually (94%) associated with scarring. Patients with end-stage renal failure due to pyelonephritis are much younger than patients with end-stage renal failure due to other causes. The incidence of reflux according to sex is equal in infancy, but after infancy both pyelonephritic scarring and reflux are far more common in females. Infection is the likely cause of progressive scarring in females. Hypertension is associated with chronic atrophic pyelonephritis. Proteinuria is the worst prognostic feature in patients with reflux nephropathy and pyelonephritic scarring. Intrarenal reflux determines the site of scarring. The role of surgical correction of vesicoureteric reflux remains uncertain, but meticulous control of infection appears to prevent progressive scarring.
Urinary tract infection caused by Staphylococcus saprophyticus.
This study was designed to determine whether Staphylococcus saprophyticus was an important cause of urinary tract infection (UTI), as has been reported by European, but not by American, investigators, S. saprophyticus was the second most common cause of UTI in young (mean age, 20 years), sexually active female outpatients without known preexisting kidney disease or preceding manipulation of the urinary tract. Most cases presented as acute cystitis, but frank pyelonephritis and UTI in pregnant females were observed. The organism was rarely found as a contaminant in urine cultures. When present in the mucocutaneous flora of the anal-urogenital area, the organism was significantly associated with UTI by the same organism. These results show that S. saprophyticus should be accepted as an important urinary tract pathogen of young female patients in the United States. A simple adequate laboratory identification may be based on resistance to novobiocin (disk diffusion test), absence of hemolysis and coagulase, and intense pigment production (65% of strains yellow, 35% white).
A review of the problem of urinary infection management and the evaluation of a potential new antibiotic.
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A patient with autosomal dominant polycystic kidney and liver disease presenting with urinary tract infection...'Unable to see the wood for the trees'.
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Histological phases of Bactrim-induced fixed drug eruption. The report of one case.
A case is described of a patient with Bactrim-induced fixed drug eruption (FDE). Histological studies were performed at 1 day and 5 days after the drug exposure. While the 5-day-old lesion showed changes classically recognized as FDE, the 1-day-old lesion showed changes typical of a hypersensitivity response: diffuse spongiosis, dermal edema and hemorrhage, neutrophilic polymorphonuclear leukocyte abscess formations, and large numbers of eosinophils. This report underscores the dynamic cellular changes that occur in the evolving FDE lesion.
An etiology of nephrotic syndrome in chronic interstitial nephritis (pyelonephritis); an electron microscopic study.
Renal tissues were studied using electron microscopy (EM) and immunofluorescence microscopy (IFM) from three patients who were found to have chronic interstitial nephritis (pyelonephritis) by light microscopy (LM). By LM, 90% of the glomeruli in two patients and all glomeruli in one patient were normal. By EM, glomerular capillaries in all patients revealed generalized fusion of epithelial foot processes. In two patients, IFM for immunoglobulins, third component of complement and fibrinogen were negative. These two patients received corticosteroids for 6 to 12 weeks. In one, proteinuria markedly decreased (from 17.9 to 1.1 gm) in four weeks and in the other follow-up studies of renal histology revealed normal glomeruli and partial restoration of foot processes by LM and EM respectively. Thus, this study offers evidence for lipoid nephrosis (or minimal lesion disease) as an etiology of nephrotic syndrome in chronic interstitial nephritis (pyelonephritis). The impaired renal function in these patients is attributed to tubulo-interstitial disease rather than glomerular pathology. It remains to be determined whether the two disparate pathological conditions have coexisted or chronic interstitial nephritis had led to the appearance of lipoid nephrosis through an unidentified mechanism.
Infections of the urinary tract.
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