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PubMed1992

Urinary tract infection in acute spinal cord injury.

Preservation of renal function and prevention of recurrent urinary tract infections is the ultimate goal of any method of neurogenic bladder management in spinal cord injury patients. METHOD--The hospital courses of fifty such patients admitted to our Rehabilitation Department from August 1989 to August 1990 were studied according to age, gender, spinal cord injury level, method of bladder drainage on admission and upon discharge, type of urinary tract infections and results of bladder management were documented. RESULTS--Forty-five men and ten women were studied. Mean age of males was forty and females, forty-two. The commonest cause of injury was road traffic accident followed by accidents at work place. Fifty-three percent had cervical cord injuries, thirteen percent thoracolumbar and sixteen percent lumbo sacral injuries. Seventy-eight percent had an indwelling foley catheter upon admission. Upon discharge eighty-two percent of spinal cord injury patients were able to void with/without tapping and compression. There were a total of one hundred and forty-three urinary tract infections in our study group. All positive urine cultures had greater than or equal to 100,000 CFU/ml. The commonest organisms causing urinary tract infection were Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Proteus mirabilis. CONCLUSION--For bacteria to produce disease in the urinary tract, they must gain access and colonise the uroepithelium, induce inflammation and tissue damage. The indwelling catheter provides a direct access to the uroepithelium, making bacteriuria and subsequent infection inevitable. Impaired voiding and sensation in spinal cord injury patients provides an excellent reservoir for the multiplication of bacteria, tissue invasion and recurrent urinary tract infection. Hence current methods of neurogenic bladder management have to focus on attaining a catheter-free status as soon as possible; relevant antibiotic therapy and careful attention to individual urinary tract problems to reduce morbidity and improve on spinal cord injury patient's future. Although spinal cord injury patients are described, the material covered is applicable to any type of neurogenic bladder dysfunction.

Adult↗
PubMed2004

Criteria for urinary tract infection in the elderly: variables that challenge nursing assessment.

Urinary tract infections (UTIs) are common in the elderly, yet there is much disagreement in the literature regarding many aspects of this condition. To assist the nurse in developing optimum care strategies, UTI criteria in the elderly are discussed. Using the most recent knowledge to guide clinical assessment and intervention skills, the longterm care facility nurse and nurses who care for the elderly can influence positive outcomes in this challenging population.

Aged↗
PubMed1991

Clinical evaluation of cats with lower urinary tract disease.

In a prospective study, 141 cats with hematuria, dysuria, urethral obstruction, or combinations of these signs were evaluated by contemporary diagnostic methods and compared with 26 clinically normal cats (controls). Specific diagnosis was established in 45% (64/141) of cats affected with lower urinary tract disease (LUTD). Crystalline matrix plug-induced urethral obstruction was diagnosed in 21% (30/141) of affected cats, uroliths were identified in 21% (30/141) of affected cats, uroliths with concomitant bacterial urinary tract infection (UTI) were identified in less than 2% (2/141) of affected cats, and bacterial UTI alone was identified in less than 2% (2/141) of cats with LUTD. Viruses, mycoplasmas, and ureaplasmas were not isolated from urine samples collected from affected or control cats. Bovine herpesvirus 4 (BHV-4)-neutralizing antibodies were not detected in any serum sample obtained from cats with LUTD or from control cats. In contrast, BHV-4 antibodies were detected by an indirect immunofluorescent antibody (IFA) test in sera obtained from 31% (44/141) of cats with LUTD and 23% (6/26) of control cats. The prevalence of positive BHV-4 IFA test results in affected cats was not significantly different from that observed in control cats. Significant association was not apparent between positive BHV-4 IFA test results and clinical diagnosis, abnormal laboratory findings, or cat age. However, the number of male cats with BHV-4 IFA titer was significantly (P less than 0.02, chi 2 test) greater than that of female cats. Detection of BHV-4 antibodies in approximately 30% of affected and control cats indicates prior virus exposure. Further investigations are warranted to clarify the specific role of BHV-4 in cats with naturally acquired LUTD.

Animals↗
PubMed1990

Optimized urinary microscopy for assessment of bacteriuria in primary care.

Microscopy of wet-stained urinary sediment as an indicator of bacteriuria was evaluated in 418 consecutive primary care visits in a small community. Delivery of morning urine was encouraged and contributed to bladder incubation times of 4 or more hours in 79% of the visits; the overall culture positivity was about 80%. Bacteria or leukocytes alone or together as minimal requirements were suboptimal microscopy criteria for bacteriuria, whereas a minimum of moderate amounts of bacteria or 5 leukocytes per high-power field (x400) as a cutoff point yielded the best diagnostic accuracy. Optimization of urinary sediment microscopy in this way resulted in a desirable high sensitivity (97%) and efficacy (86%) in acutely symptomatic patients, as well as reasonably high efficacy (79%) in other patients, independent of sex or bladder incubation time. The method's simplicity and speed recommend it for use in primary care, particularly in patients with acute symptoms of urinary tract infection.

Bacteriuria↗
PubMed1989

Urine screening for leucocytes and bacteria by dipstick and reflectance spectrophotometry.

In order to develop a rapid and reliable method for screening large numbers of urines for leucocytes and bacteria a dipstick method was used with colorimetric reading of colour changes with a reflectance spectrophotometer. One thousand consecutive urine specimens were tested by that method using a single dipstick for leucocyte esterase, nitrite, blood and protein in parallel with routine methods for enumeration of leucocytes by microscopy and quantitative culture for bacteria. Results of the four dipstick tests taken together had predictive values of 83.7% for a positive test for evidence of infection and 97.2% for a negative result. The false negative rate was 1%. Of the 191 urines with a significant bacteriuria (greater than 10(5) organisms/ml), 10 were false negatives by dipstick testing, representing 5% of all infected urines. Elimination of the need for culture on specimens that were negative by all four tests would reduce the workload by 36%.

Bacteriuria↗
PubMed1986

[Clinical studies on doxycycline in the treatment of nongonococcal urethritis by Chlamydia trachomatis].

Twenty-one nongonococcal urethritis patients by Chlamydia trachomatis infection were treated with doxycycline (DOXY, Vibramycin) 200 mg/day orally for 2 weeks. The age of these patients were ranged from 17 to 52. C. trachomatis was eradicated 8(89%) of 9 cases on 3rd day and never reisolated on 7th day after treatment. Ten (83%) of 12 patients on 7th day and any patients on 14th day were not suffered from symptoms after treatment. Urethral discharge was not seen macroscopically, 11 (92%) of 12 patients on 7th day and any patients on 14th day. According to the criteria for urethritis requiring at least 4 WBC per high power field in urethral smear and/or first voided urine, the overall clinical efficacy rate was 44% (4/9) on 3rd day, 83% (10/12) on 7th day and 100% (9/9) on 14th day. No side effects were recognized in any cases. In conclusion, DOXY was thought to be useful and safe drug in the treatment of nongonococcal urethritis by C. trachomatis.

Adolescent↗
PubMed1987

Diagnosis and treatment of acute urinary tract infections.

Acute urinary tract infections are a major health problem in adult women. This discussion presents a practical approach to their diagnosis and treatment that incorporates recent research developments and that is designed to minimize the cost and adverse effects of therapy while maintaining therapeutic efficacy.

Acute Disease↗
PubMed1988

Comparative leukocyte esterase-nitrite and BAC-T-SCREEN studies using single and multiple urine volumes.

The Chemstrip LN and BAC-T-SCREEN filtration systems were used to evaluate 980 urine specimens rapidly for the presence of microorganisms. Multiple volumes of individual specimens were also tested using the BAC-T-SCREEN to determine whether this procedure enhanced test performance. Ninety-nine specimens (10%) could not be processed because of interfering substances or clogging of the BAC-T-SCREEN. Analysis of the remaining 881 samples showed these test results for the Chemstrip LN system: sensitivity, 48%; specificity, 93%; positive predictive value (PPU), 88%; and negative predictive value (NPV), 71%. The BAC-T-SCREEN results using multiple urine volumes were (for 1 mL) sensitivity, 88%; specificity, 98%; PPV, 97%; NPV, 92%; for 2 mL, sensitivity, 94%; specificity, 96%; PPV, 94%; NPV, 96%; for 3 mL, sensitivity, 98%; specificity, 95%; PPV, 93%; NPV, 98%. Analyzing multiple urine volumes permitted detection of 92% of urine samples with colony-forming units of 10(4) or less. The BAC-T-SCREEN system proved superior to Chemstrip LN for detecting microorganisms in urine specimens, and analyzing multiple urine volumes enhanced test sensitivity.

Bacteriuria↗