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PubMed2005

No association between elevated post-void residual volume and bacteriuria in residents of nursing homes.

OBJECTIVE: To evaluate the concept that increased post-void residual urine volume (PVR) is a risk factor for bacteriuria. DESIGN: Cross-sectional study. SETTING: Three nursing homes in Jönköping, southern Sweden. SUBJECTS: A total of 147 elderly residents in municipal nursing homes. MAIN OUTCOME VALUES: PVR volumes measured with a portable ultrasonic bladder scan, urine specimen, and questionnaire data on incontinence, immobility, impaired cognition, neurological diseases, and medications. RESULTS: Mean age was 86 years and 78% were women. The prevalence of a PVR for the four chosen cut-off values (30, 50, 100, and 150 ml) was 51%, 39%, 20%, and 7%, respectively. The prevalence of bacteriuria was 42%, 46% for women and 28% for men. Elevated PVR was not associated with bacteriuria, incontinence, immobility, impaired cognition or neurological disease (stroke, Parkinson's disease). CONCLUSION: Bacteriuria and elevated PVR are common among elderly residents in nursing homes. The study could not confirm that elevated PVR predisposes to bacteriuria in elderly residents in nursing homes.

Aged↗
PubMed1998

Incidence of urinary tract infection in patients without bacteriuria undergoing SWL: comparison of stone types.

Extracorporeal shockwave lithotripsy (SWL) currently is accepted as the preferred treatment for most renal and upper ureteral calculi. However, little is known about the infection risks of SWL. In this study, the incidence and severity of urinary tract infection in 117 patients with renal calculi undergoing SWL were evaluated and the stone characteristics of those with and without infection were compared. The patients were followed clinically and bacteriologically 1 and 14 days after the procedure. Bacteriuria was noted in six patients within 24 hours after SWL. No bacteriuria was noted 2 weeks later. Of these patients, three were symptomatic (including dysuria, burning, and fever >38 degrees C). No patient was hospitalized. We found no significant correlation between the occurrence of bacteriuria and the number or size of the stones (P > 0.05), nor was there any correlation between bacteriuria and the stone-free rate or the location of the calculi (P > 0.05). However, there was a significantly higher risk of urinary tract infection in patients with struvite stones than in those with other types of stones (17.3% v 2.1%). In patients with infection stones, prophylactic antimicrobial chemotherapy is necessary even if bacteriuria is not present before SWL.

Adult↗
PubMed1990

Bacteriuria in non-catheterized elderly patients in the first eight days of hospital stay.

One hundred and sixty-one non-catheterized consecutive acute geriatric admissions were screened for bacteriuria on the day following admission, both in the morning and in the afternoon and seven days later--morning and afternoon. The prevalence of bacteriuria was 29% on admission. A correlation between bacteriuria and leucocyturia was shown. The patients were admitted with a variety of medical illnesses but in no case was a diagnosis of urinary-tract infection made prior to admission. There was a significant relationship between incontinence and bacteriuria on admission; 12% of abacteriuric patients became bacteriuric between day 1 and day 7 following admission. Escherichia coli accounted for 51% of the isolates on admission to hospital. Bacteriuria was associated with increased mortality within 1 year following admission to hospital.

Acute Disease↗
PubMed1995

Prevalence of asymptomatic bacteriuria and associated host factors in women with diabetes mellitus. The Manitoba Diabetic Urinary Infection Study Group.

A prospective study was undertaken to determine the prevalence of significant asymptomatic bacteriuria in adult women with diabetes mellitus attending endocrinology clinics at two tertiary-care university-affiliated teaching hospitals. In addition, host factors of the patients were correlated with bacteriuria. The overall prevalence of bacteriuria was 7.9% (85 cases per 1,072 women). Absolute urinary leukocyte (white blood cell) counts were > or = 10/mm3 in 77.6% (66) of the 85 bacteriuric women vs. 23.7% (234) of the 987 nonbacteriuric women (P < .001). Bacteriuric women were significantly more likely than nonbacteriuric women to have non-insulin-dependent diabetes mellitus, longer duration of diabetes, neuropathy, and heart disease. Aboriginals had bacteriuria at a significantly higher prevalence rate than that among nonaboriginals (19.7% [15 of 76] vs. 7.0% [70 of 996], respectively; P < .0001), were more likely to have occult upper urinary tract infection (antibody-coated bacteria positivity: 53% [8 of 15] vs. 20% [10 of 50], respectively; P = .016), and had significantly lower urinary leukocyte counts, whether they were bacteriuric or not (P < .05). Multivariate analysis identified duration of diabetes and aboriginal origin as independent risk factors for the presence of bacteriuria.

Adolescent↗
PubMed1976

Significance of diuresis-provoked bacteriuria.

Of 52 clinically healthy, ambulant elderly subjects with urine that was sterile or contained less than 0.2 X 10(5) bacteria/ml before diureisi, 11 (21.2%) responded to oral water loading and intravenous treatment with furosemide with a bacterial excretion rate of greater than 2.4 X 10(5)/min. Subjects with bacteriuria had decreased blood pressure, rate of creatinine clearance, maximal level of urinary creatinine, and maximal urinary flow. Twenty-nine of the nonbacteriuric and eight of the subjects who developed bacteriuria after diuresis were retested one to two years later. No subject had received antibacterial agents in the interim. The infections of four of the original subjects who had developed bacteriuria had cleared up and showed functional improvement. The remaining four subjects who had developed bacteriuria during the first study and three subjects who had been nonbacteriuric during the first study had concentrations of bacteria ranging from 0.05 X 10(5) to 1.80 X 10(5)/ml before diuresis in the second study, and excreted increasing numbers of bacteria (from 0.12 X 10(5) to 9.0 X 10(5)/min) in response to the diuretic loading. Two of the subjects who were bacteriuric in both surveys were infected with different bacteria during the two studies. The data show the high frequency of occult bacteriuria in ostensibly healthy elderly patients that is revealed only by forced diuresis, the detectable functional deficits, the improvement after clearing of the infections, and the rapid turnover between infected and clear periods.

Aged↗
PubMed1992

Randomized trial of meatal care with silver sulfadiazine cream for the prevention of catheter-associated bacteriuria.

A randomized, controlled, prospective clinical trial involving 696 hospitalized patients was undertaken to determine the effectiveness of 1% silver sulfadiazine cream applied twice daily to the urethral meatus in preventing transurethral catheter-associated bacteriuria. The overall incidence of bacteriuria was 11.4% (38/332) in the treated group and 13.2% (48/364) in the untreated group (P = .56; odds ratio, 0.85; 95% confidence interval, 0.53-1.37). Cox proportional hazards analysis identified female sex, lack of antibiotic use, and a positive initial meatal culture (but not treatment randomization or lack of urinemeter use) as independent variables associated with an increased risk of bacteriuria. Survival curve analysis of subgroups stratified by sex and antibiotic use failed to detect an effect of silver sulfadiazine on the rate of bacteriuria. Meatal care with silver sulfadiazine cream did not prevent the development of catheter-associated bacteriuria in short-term catheterized patients.

Administration, Topical↗
PubMed1989

Bacteriuria in pregnancy. Frequency and risk of acquisition.

A total of 3,254 pregnant women attending two antenatal clinics in Göteborg, Sweden, were screened for bacteriuria. The coverage of the pregnant population in the areas served by the two clinics was estimated to be 88%. Of the women who were registered at the two clinics, 99% took part in at least one screening; 71% were screened during each of the three intervals. The high frequency of screening of the women made it possible to estimate the risk of acquiring bacteriuria during pregnancy. This risk increased with the duration of pregnancy from 0.8% of bacteriuric women in the 12th gestational week to 1.93% at the end of pregnancy. The risk of onset of bacteriuria was highest between the ninth and 17th gestational weeks. The 16th gestational week was the optimal time for a single screening for bacteriuria calculated as the number of bacteriuria-free gestational weeks gained by treatment.

Adult↗
PubMed1985

Bacteriuria in pregnancy.

In a racially mixed community in Gisborne, New Zealand, the prevalence of asymptomatic (covert) bacteriuria of pregnancy was 9.6%. The prevalence in Maori women was 17.1% and in non-Maori women 4.7%. There was a higher prevalence of bacteriuria in the younger women. Escherichia coli was the infecting organism in 58 of the 72 women with bacteriuria. Twenty-five (44%) of the E. coli were resistant to ampicillin and amoxycillin. Fifty-eight (81%) of the women with bacteriuria also had pyuria. In 37 of the 44 women (84%) who received antimicrobial therapy, the infection was cured. Single dose therapy was just as effective as a course of treatment. In 14 of the 28 untreated women, the infection cleared spontaneously. Four of the 28 (14%) patients in the untreated bacteriuric group developed acute pyelonephritis. More patients with bacteriuria had anaemia and a low fetal birth-weight.

Adolescent↗
PubMed1992

Asymptomatic bacteriuria, urinary antibody, and survival in the institutionalized elderly.

OBJECTIVE: To compare clinical status of elderly institutionalized subjects with asymptomatic bacteriuria and normal urinary antibody to those with elevated urinary antibody to the major outer membrane of Escherichia coli. DESIGN: Retrospective review. SETTING: Long term facility for the elderly. PARTICIPANTS: Convenience sample of 63 elderly subjects, 26% of those resident in the institution, aged 78.8 +/- 8.4 years with urine specimens collected and stored in 1987. MAIN OUTCOME MEASURES: Differences in clinical or functional status, demographic features, and outcome during 3-years follow-up between bacteriuric subjects with normal and elevated urine antibody. RESULTS: Thirteen subjects had no bacteriuria, and 12 had infrequent, intermittent bacteriuria; 38 (60%) had persistent bacteriuria, including four with frequent, intermittent infections. In the persistently bacteriuric group, 18 (47%) had persistently elevated urine antibody. There was no significant differences between bacteriuric residents with normal vs elevated urine antibody in clinical or functional status, age, duration of residence, or infecting organisms. However, 11 of 20 in the cohort with normal urine antibody were alive at 3 years compared to 3 of 18 with elevated urine antibody (P = 0.014). CONCLUSIONS: Elderly institutionalized subjects with persistent bacteriuria and elevated urine antibody have decreased survival compared to those with normal urine antibody. No differences in underlying illness or clinical course to explain this survival difference were identified.

Aged↗
PubMed1975

Asymptomatic bacteriuria in schoolgirls. III. Relation between residual urine volume and recurrence.

Residual urine volume (RUV) has been measured in 70 schoolgirls with asymptomatic bacteriuria using 121I-hippuran. The mean volume of residual urine was 23.7 ml. More than 5 ml RUV, the highest value found in 14 girls without bacteriuria or a history of urinary tract infection, was found in 47% of the patients. The mean volume for residual urine in the control girls was 1-1 ml. Among the 44 girls cured for their bacteriuria be a bladder wash out test or antibiotic treatment, recurrence was significantly more common (p less than 0.001) in those greater than 5 ml in RUV (45/20, 75%) than in those with less than or equal to 5 ml (4/24, 17%). In 5 of 22 patients not treated, the bacteriuria disappeared spontaneously during a one year observation period. The RUV was less than 3 ml in 4 of these 5 girls. While the presence of residual urine per se may not be the primary event leading to bacteriuria, it may increase the risk of recurrences, by facilitating bacterial growth and impairing the wash out of bacteria from the bladder on micturition.

Adolescent↗
PubMed1989

The prevalence of bacteriuria among high risk neonates in Nigeria.

Among the 446 high risk neonates studied for significant bacteriuria and pyuria in the neonatal wards of the Obafemi Awolowo University teaching hospital Complex, Ile-Ife, 7.6% and 5.8% were positive for significant bacteriuria and pyuria respectively, while none of the 81 infants in the control group were positive. Males and females were similarly affected and there was no seasonal variation in the prevalence of pyuria or bacteriuria. It is noteworthy that 25 (96%) of the 26 pyuria neonates also had bacteriuria emphazising the significance of pyuria as a possible screening method for urinary tract infections in neonates. The clinical problems in the neonates studied included prematurity, low birthweight, neonatal jaundice, fever, CNS symptoms, ophthalmia neonatorum, prolonged rupture of the membranes (PROM), respiratory distress, septic cord/skin, diarrhoea, vomiting and feeding problems. Only prematurity and low birthweight were significantly associated with bacteriuria in the neonates studied. The organisms encountered in this study were Escherichia coli (58.4%), Klebsiella species (35.3%) and Proteus species (5.9%). Of the bacterial isolates, 67% were sensitive to Ampicillin and 97% to Gentamycin. The combination of these antibiotics was effective in all cases in the present study. The study has highlighted the need for routine urine culture in our high risk neonates.

Bacteriuria↗
PubMed1977

Antimicrobial prophylaxis for catheter-associated bacteriuria.

We evaluated short-term systemic antimicrobial prophylaxis for catheter-associated bacteriuria in women undergoing elective gynecological operations in a prospective, controlled, double-masked study. Nine of 100 placebo-treated patients acquired bacteriuria during catheterization compared with 3 of 96 of the drug-treated group. However, at the time of hospital discharge, clean-voided urine specimens were positive as frequently in the drug-treated group (8 of 82 patients cultured) as in the placebo group (8 of 75 patients cultured). No difference in febrile morbidity due to bacteriuria was noted between the prophylaxis and placebo groups. The incidence of catheter-associated bacteriuria may be reduced by antimicrobial prophylaxis. However, because the protective effect is transient and is associated with the selection of resistant organisms, prophylaxis is not indicated for patients at low risk for acquired bacteriuria and in whom the sequelae of catheter-associated infections are infrequent.

Anti-Infective Agents↗
PubMed1989

Proteeae species bacteriuria accompanying Proteeae species groin skin carriage in geriatric outpatients.

There have been numerous reports of Proteeae species urinary tract infections among elderly individuals. To explore a possible urinary carrier source of Proteeae species in this population, the frequency of aerobic gram-negative bacillus (AGNB) bacteriuria at the greater than or equal to 10(2)/ml level was determined in 67 ambulatory elderly outpatients classified as to Proteeae group (Morganella, Proteus, Providencia) groin carriage by a set of two skin cultures obtained at least 1 week apart. None had urethral catheters, symptomatic infections, skin ulcers, or recent antibiotic therapy. We found AGNB bacteriuria in 12 of 15 carriers (80%) and in 21 of 52 noncarriers (40%) (P = 0.009). Proteeae species bacteriuria occurred in eight carriers (53.3%) and six noncarriers (11.5%) (P = 0.001). At the 10(2) to 10(4)/ml level, Proteeae species were isolated in urine specimens from seven carriers (46.7%) and four noncarriers (7.7%) (P = 0.001). There was concordance of species of skin and urine Proteeae isolates in six carriers. By contrast, non-Proteeae AGNB bacteriuria at any level was present in four Proteeae species carriers (26%) and 15 noncarriers (28.8%) (P greater than 0.05). There was a 36.7% frequency of Proteeae species bacteriuria in nursing home residents, in contrast to 8.1% among those living in private homes; this parallels the greater frequency of Proteeae species groin carriage among nursing home residents in the study population. Low-level urinary colonization with Proteeae species accompanying Proteeae species groin skin colonization in elderly individuals is a hitherto unrecognized finding. This may account for the greater frequency of Proteeae species urinary infections in this population.

Aged↗
PubMed1995

Significance of Salmonella typhi bacteriuria.

Bacteriuria due to Salmonella typhi usually occurs following recent typhoid fever or in chronic carrier states. Data from 18 patients with S. typhi bacteriuria, seen during 5 years, were analyzed. Fourteen patients had localized urinary tract infection due to S. typhi. Four others had bacteriuria, probably associated with typhoid fever. Localized abnormalities of the urinary tract and kidneys and also systemic diseases were found to predispose patients to S. typhi bacteriuria. Local abnormalities encountered included urolithiasis (n = 3), prostatic hypertrophy (n = 1), and tuberculosis (n = 1). One renal transplant recipient and another with lupus nephritis had S. typhi bacteriuria. One had associated strongyloidosis, and another was pregnant.

Bacteriuria↗
PubMed1980

Asymptomatic bacteriuria in healthy preterm babies.

Urine was cultured from 51 healthy preterm babies. If the initial bag specimen grew more than 50 000 organisms/ml, a second bag specimen was cultured. After two positive bag specimens a suprapubic urine was cultured. Significant bacteriuria was excluded on the basis of one or two bag specimens in 90% of the babies. Suprapubic urine was sterile in a further 11 babies. Four babies with positive bag specimens were unfortunately not completely investigated: 2 had mixed growths and 2 had pure growths of 100 000 organisms/ml. As we and others consider that bacteriuria can only be diagnosed on a suprapubic sample of urine the incidence of proved infection in our series was zero. If both the babies with a pure growth of 100 000 organisms/ml had true bacteriuria, the incidence would rise to 1.3%. In view of the difficulties in obtaining clean urine samples in preterm babies and as the incidence of bacteriuria is so low, we do not recommend that healthy preterm babies be screened for bacteriuria.

Bacteriuria↗
PubMed1989

Untreated asymptomatic bacteriuria in girls: II--Effect of phenoxymethylpenicillin and erythromycin given for intercurrent infections.

OBJECTIVE: To investigate the effects of phenoxymethylpenicillin and erythromycin on urinary isolates from patients with untreated asymptomatic bacteriuria. DESIGN: Retrospective study of subgroup of patients from cohort followed up till the end of 1986. SETTING: Outpatient clinic for children with urinary tract infections. PATIENTS: 51 Girls aged under 15 with untreated asymptomatic bacteriuria. INTERVENTIONS: Before 1982 intercurrent infections (mostly tonsillitis or otitis) were treated with phenoxymethylpenicillin; after 1982 erythromycin treatment was preferred. END POINTS: Change of bacterial strain in urinary tract and symptomatic recurrences of disease. MEASUREMENTS AND MAIN RESULTS: Bacteria identified by serotype and electrophoretic type and compared before and after antibiotic treatment. Bacteriuria eradicated and replaced by new strains in most patients treated with phenoxymethylpenicillin, leading to symptomatic recurrences in about 15%. Conversely, patients given erythromycin rarely showed change in bacteriuria and none suffered symptomatic recurrence. CONCLUSIONS: In girls with untreated asymptomatic bacteriuria the use of phenoxymethylpenicillin for intercurrent infections may lead to a change of urinary bacteria and leave them at substantial risk of acute pyelonephritis. With erythromycin this risk is small (2/20 courses in this series).

Adolescent↗
PubMedDate not supplied

Bacteremia resulting from prostatic surgery in patients with or without preoperative bacteriuria under perioperative antibiotic use.

We investigated the source of organisms detected in blood specimens obtained during and immediately following prostatic surgery under perioperative antibiotic use, as related to the results of cultures of preoperative urines and prostatic tissues. Ninety patients with benign prostatic hyperplasia were studied. The incidence of bacteremia was 28.9%: 53.7% in patients with preoperative bacteriuria and 8.2% in those without bacteriuria, a significant difference (p < 0.01). Of these bacteremic patients, 5, who had preoperative bacteriuria, developed septicemia. Bacteremia developed more frequently in patients with positive than in those with negative prostatic cultures; this difference was significant (p < 0.05). The species in 80.8% of the isolates from blood specimens were identical with those isolated from preoperative urines, and the species in 53.8% were identical with those from prostatic tissues. These results indicate that in patients with urogenital infection, especially bacteriuria, septicemia can result from prostatic surgery even under perioperative antibiotic use. The incidence of postoperative bacteriuria was approximately 20% in the preoperative nonbacteriuric patients regardless of the duration of chemoprophylaxis.

Aged↗
PubMed1991

A comparative study of pyuria and asymptomatic bacteriuria in school children.

Urine samples were collected from 1,000 school children aged between 4 and 15 years. Twenty-eight children had significant bacteriuria, while 32 had significant pyuria. Seventeen pupils had both significant bacteriuria and pyuria. The study shows that although there is a positive association between pyuria and bacteriuria, the absence of pus cells in urine samples cannot be taken as evidence of absence of bacteriuria, nor can the presence of pyuria alone be considered as an indication of infection. Escherichia coli is the commonest agent in school children with significant bacteriuria.

Adolescent↗