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At least 343 records · Page 19Linked to original sources

PubMed2005

Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review.

BACKGROUND: Urinary tract infection (UTI) is one of the most common sources of infection in children under five. Prompt diagnosis and treatment is important to reduce the risk of renal scarring. Rapid, cost-effective, methods of UTI diagnosis are required as an alternative to culture. METHODS: We conducted a systematic review to determine the diagnostic accuracy of rapid tests for detecting UTI in children under five years of age. RESULTS: The evidence supports the use of dipstick positive for both leukocyte esterase and nitrite (pooled LR+ = 28.2, 95% CI: 17.3, 46.0) or microscopy positive for both pyuria and bacteriuria (pooled LR+ = 37.0, 95% CI: 11.0, 125.9) to rule in UTI. Similarly dipstick negative for both LE and nitrite (Pooled LR- = 0.20, 95% CI: 0.16, 0.26) or microscopy negative for both pyuria and bacteriuria (Pooled LR- = 0.11, 95% CI: 0.05, 0.23) can be used to rule out UTI. A test for glucose showed promise in potty-trained children. However, all studies were over 30 years old. Further evaluation of this test may be useful. CONCLUSION: Dipstick negative for both LE and nitrite or microscopic analysis negative for both pyuria and bacteriuria of a clean voided urine, bag, or nappy/pad specimen may reasonably be used to rule out UTI. These patients can then reasonably be excluded from further investigation, without the need for confirmatory culture. Similarly, combinations of positive tests could be used to rule in UTI, and trigger further investigation.

Child, Preschool↗

PubMed2002

Diagnostic value of various urine tests in the Jordanian population with urinary tract infection.

We compared the performance of leukocyte esterase and nitrite reductase dipstick tests with microscopic examination and uroculture in cases with clinically suspected urinary tract infection (UTI). We studied urine specimens from 504 Jordanian patients which were obtained by the mid-stream clean catch method and analyzed for bacteria. All samples were subjected to culture. Results of urine dipstick tests and pyuria (white blood cells (WBC)/high power field) were compared with urine culture for each sample. Significant bacteriuria was found in 117 cases (23.2%) with positivity of 59% and 68.5% for the presence of nitrite reductase and leukocyte esterase, respectively. Echerichia coli was the most common organism isolated. The dipstick leukocyte esterase and nitrite testing had a sensitivity of 68.5% and 59% for detecting bacteriuria in UTI cases and specificity of 73.5% and 78%, respectively. The positive predictive value of the tests was 44% and 60%, and the negative predictive value 88.5% and 86.2%, respectively. Microscopic WBC showed 86.5% specificity but low sensitivity. Urine dipstick results and pyuria significantly correlated with the results of urine culture but demonstrated more false-positive results, which ranged from 13.4-26.6%. The probability of growing a urinary pathogen correlated with urinary WBC counts and allowed prediction of the presence or absence of bacteriuria by counting urinary leukocytes. A combination of pyuria and urine dipstick testing appears to be a very useful marker for the diagnosis of UTI. Urine culture can be omitted if both tests are negative.

Carboxylic Ester Hydrolases↗

PubMed2002

Pilot study to assess the presence of Chlamydia trachomatis in urine from 18-30-year-old males using EIA/IF and PCR.

CONTEXT: To increase detection, urine samples from young males could be opportunistically tested for Chlamydia trachomatis. OBJECTIVE: To determine C. trachomatis prevalence in urine, optimum specimen and compare sensitivity/feasibility of routine use of different testing methods. DESIGN: Group A, 'sterile' pyuria samples June 1998-January 1999, tested by enzyme immunoassay (EIA) and, if reactive, by immunofluorescence (IF). Subsequently batch-tested by polymerase chain reaction (PCR). Group B, consecutive urine samples October 1998-January 1999; batch-tested by PCR. SETTING: Microbiology laboratory. SAMPLES: From males aged 18-30 years; group A = 71, group B = 83. MAIN OUTCOME MEASURES: Chlamydia trachomatis positive if EIA- and IF- or PCR-positive. RESULTS: Group A: 12 EIA/IF-positive; 9/12 and 15 EIA-negative samples PCR-positive. Group B: 11 PCR-positive; 8/11 showed 'sterile' pyuria. CONCLUSIONS: Opportunistic testing of urine from young men shows a significant number of C. trachomatis infections. 'Sterile' pyuria samples are optimal. EIA/IF are less sensitive than PCR but can be routinely performed and detect a significant proportion of cases.

Adolescent↗

PubMed1991

[Prophylactic antibiotics after transurethral resection of prostate].

We studied whether or not prophylactic use of antibiotics following transurethral resection of prostate (TUR-P) was needed. The subjects were 152 patients preoperatively passing sterile urine who underwent TUR-P. They were divided into three groups: 35 with no use of antibiotics (no prophylaxis group), 70 with one day use of antibiotics (one day-prophylaxis group) and 47 with use of antibiotics until pyuria disappeared (long term-group). The three groups did not differ in their rates of fever episodes (greater than or equal to 38.0 degrees C) during the first two weeks nor in the time of disappearance of pyuria. The no prophylaxis group and the one day-group differed statistically in their cumulative rates of bacteriuria (greater than 10(4) CFU/ml) on the postoperative third day: 4 patients (11.4%) in the no prophylaxis group and none in the one day group (p less than 0.01). On the 90th day, however, no significant difference was found in that rate: 22 patients (62.9%) in the no prophylaxis group and 32 patients (45.7%) in the one day group, 70% of the bacteria isolated from urine during the follow up were Gram positive cocci. The time to the elimination of pyuria was not influenced by the use of antibiotics. Our study suggests that postoperative antibiotics for patients passing sterile urine is not necessary following TUR-P.

Aged↗

PubMed2001

Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women.

BACKGROUND: Recurrent urinary tract infections (UTIs) are a common outpatient problem, resulting in frequent office visits and often requiring the use of prophylactic antimicrobial agents. Patient-initiated treatment of recurrent UTIs may decrease antimicrobial use and improve patient convenience. OBJECTIVE: To determine the safety and feasibility of patient-initiated treatment of recurrent UTIs. DESIGN: Uncontrolled, prospective clinical trial. SETTING: University-based primary health care clinic. PARTICIPANTS: Women at least 18 years of age with a history of recurrent UTIs and no recent pregnancy, hypertension, diabetes, or renal disease. INTERVENTION: After self-diagnosing UTI on the basis of symptoms, participating women initiated therapy with ofloxacin or levofloxacin. MEASUREMENTS: Accuracy of self-diagnosis determined by evidence of a definite (culture-positive) or probable (sterile pyuria and no alternative diagnosis) UTI on pretherapy urinalysis and culture. Women with a self-diagnosis of UTI that was not microbiologically confirmed were evaluated for alternative diagnoses. Post-therapy interviews and urine cultures were used to assess clinical and microbiological cure rates, adverse events, and patient satisfaction. RESULTS: 88 of 172 women self-diagnosed a total of 172 UTIs. Laboratory evaluation showed a uropathogen in 144 cases (84%), sterile pyuria in 19 cases (11%), and no pyuria or bacteriuria in 9 cases (5%). Clinical and microbiological cures occurred in 92% and 96%, respectively, of culture-confirmed episodes. No serious adverse events occurred. CONCLUSION: Adherent women can accurately self-diagnose and self-treat recurrent UTIs.

Adult↗

PubMed2005

Colouterine fistulas in elderly women: a report of 2 cases.

BACKGROUND: Colouterine fistula is a rare complication of diverticulitis. We report 2 cases of colouterine fistula in elderly women presenting with fever and pyuria and managed with an aggressive workup and surgical treatment. CASES: Two elderly women presented with persistent pyuria, abdominal pain and fever without a vaginal discharge. Imaging revealed diverticulitis and a fistula. One patient, 92 years of age, underwent hysterectomy, sigmoid resection and primary colorectal anastomosis. The second patient, aged 87, was treated with hysterectomy, sigmoid resection and diverting colostomy with delayed colostomy closure. CONCLUSION: Colouterine fistula may present with pyuria, fever and abdominal pain even in the absence of vaginal discharge. Patients who are elderly and fragile are more likely to be treated conservatively and inappropriately. We advocate surgical management, including resection of all involved tissue, early in the course of the disease. In elderly women, aggressive 1- or 2-stage procedures are highly successful and could save the patients' lives.

Aged, 80 and over↗

PubMed1994

Spermatic cord torsion in adults.

A five year retrospective review of 15 cases of spermatic cord torsion in male patients 18-years or older was performed. Eighty percent of patients were correctly diagnosed at time of initial presentation while 20% of patients were misdiagnosed as epididymitis. Fifty three percent of cases has history of similar previous attacks. The average delay prior to presentation was 7 hours. Absence of fever was the rule occurring in all patients. Leucocytosis and significant pyuria were commonly encountered occurring in 33% and 27% of patients respectively. Our orchidectomy rate was 20%. Our data suggest that while, in adult patients presenting with scrotal pain, the absence of pyuria make the diagnosis of epididymitis unlikely as a cause of the condition, the presence of significant pyuria even if associated with leucocytosis does not exclude spermatic cord torsion and further studies with Doppler examination and Radionuclide Scans are necessary to establish the diagnosis.

Adult↗

PubMedDate not supplied

Serum and urinary interleukin-6 (IL-6) levels as predicting factors of Kawasaki disease activity.

From January 1988 to Autumn 1991, 60 patients suffering from Kawasaki disease (KD) were recruited in this study. Their ages ranged from 4 months to 5 years. Diagnosis was based on the criteria revised in 1984 by the KD Research Committee in Japan. Of these, 12 cases developed coronary aneurysms. First, blood samples from 60 KD patients were taken on admission before aspirin and/or intravenous immunoglobulin (IVIG) treatment. Convalescent blood samples were taken 3 months after onset of disease. The control group included (1) 10 cases of viral infection with skin rash and fever (aged 5 months to 5 years) and (2) 10 age and sex matched normal children admitted for elective pediatric surgery such as inguinal hernia. Second, urinary samples were collected from 32 cases during the acute phase of KD. Of these, 10 cases had pyuria and/or proteinuria. The results showed that the serum IL-6 levels from KD patients during the first week of acute phase were significantly increased while undetectable in the convalescent sera and controls. There was also a statistical difference between the with and without coronary aneurysm groups during the first week (336.8 +/- 95.1 vs 125.5 +/- 56.5 pg/ml, P < 0.001). Urinary IL-6 levels were significantly elevated in KD patients with pyuria and/or proteinuria (156.6 +/- 77.7 pg/mg Cr) and undetectable in the group without pyuria and proteinuria and controls during the first week. There was no difference between with and without coronary aneurysm. These results suggest that serum IL-6 level is a useful factor for predicting formation of coronary aneurysm even within one week after onset of disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers↗

PubMed1992

The dipstick test in the diagnosis of UTI and the effect of pretreatment catheter exchange in catheter-associated UTI.

We examined the value of the dipstick test for detecting pyuria and bacteriuria in the diagnosis of urinary tract infection (UTI). The dipstick esterase test could be quickly assessed and could easily detect leukocyte esterase in the urine. This was well correlated with the conventional sedimentation method. The dipstick nitrate reduction method for detecting bacteriuria, however, was not well correlated with the urine culture method. These findings suggested that the dipstick esterase test was a useful method for detecting pyuria in the diagnosis of UTI, but not the dipstick nitrate reduction method. Catheter-associated UTI is the most difficult category of UTI to treat and control. One of the reasons for this is the formation of biofilm around the indwelling catheter. We attempted to evaluate the effect of catheter exchange just before treatment of catheter-associated UTI with either 300 or 600 mg/day of levofloxacin, one of the newer quinolones. However, we are unable to find any apparent effect on the drug's efficacy.

Bacteriuria↗

PubMedDate not supplied

Prevalence of urinary tract infection during outpatient follow-up after renal transplantation.

Seven hundred and twenty-seven renal transplant patients are reviewed with respect to the occurrence of urinary tract infection (UTI) after renal transplantation. UTI was defined as the detection of both bacteriuria (10(5) CFU/ml) and pyuria (10 leukocytes/hpf). UTI developed in 11 of the inpatients (20.8%) and in 30 (4.2%) of the outpatients during a one-year period. Among outpatients, 12 had symptomatic infections, comprising seven with acute pyelonephritis and five with acute cystitis. Asymptomatic UTI was detected in 18 patients. In addition, asymptomatic bacteriuria without pyuria was observed in ten (1.4%) patients. UTI was more common in patients with diabetes, and underlying urinary tract complications were present in some patients. Administration of trimethoprim-sulfamethoxazole for about 4 months is suggested to reduce the frequency of UTI in the early period after renal transplantation.

Anti-Bacterial Agents↗

PubMed1998

Evaluation of urinary IL-1alpha and IL-1beta in gravid females and patients with bacterial cystitis and microscopic hematuria.

OBJECTIVES: to determine IL-1alpha and IL-1beta levels in patients with bacterial cystitis, microscopic hematuria, and gravid females relative to a control group of normal subjects. METHODS: enzyme immunoassays were used to measure concomitantly urinary IL-1alpha and IL-1beta in clean catch urine samples from normal subjects (n = 31) and study patients (n = 46). All normal subjects and patients underwent urinalysis, urine culture, and urine creatinine level determination. Since the IL-1alpha assay was developed for serum, the utility of the assay for urine specimens was unknown. The key parameters of urine collection, processing and sample storage for IL-1alpha were evaluated in detail. RESULTS: mean values +/- SEM (pg/mg) for IL-1alpha/ Cr and IL-1beta/Cr were control group (0.25 +/- 0.10 and 0.17 +/- 0.06), bacterial cystitis (9.97 +/- 1.15 and 42.45 +/- 1.86), and microscopic hematuria (2.81 +/- 0.65 and 2.82 +/- 0.70). Differences in cytokine levels between the control group and patients with either bacterial cystitis or microscopic hematuria were statistically significant for both IL-1alpha/Cr (P < 0.026; P < 0.007, respectively) and IL-1beta /Cr (P < 0.0004; P < 0.014, respectively). IL-1beta/Cr correlates better with pyuria than IL-1alpha/ Cr (P = 0.02 vs P = 0.44). In gravid females, only IL-1alpha was significantly elevated relative to non-pregnant females (IL-1beta elevation approached statistical significance). Gravid females with positive urine cultures could not be distinguished from those with negative cultures based on either interleukin (P > 0.05). CONCLUSIONS: Significant elevations of IL-1alpha and IL-1beta occur in patients with bacterial cystitis and microscopic hematuria. Correlation between pyuria and cytokine elevation was stronger for IL-1beta than for IL-1alpha. Changes in IL-1alpha may reflect changes in the bladder epithelium rather than in the inflammatory leukocytes. The ability of IL-1alpha and IL-1beta to serve as markers for bacterial cystitis in gravid females is diminished due to high basal levels during pregnancy.

Bacterial Infections↗

PubMed1985

Cystitis with ureteral reflux caused by ureaplasma urealyticum.

The authors present a case of a fifteen-year-old boy with urgency, suprapubic pain, hematuria, and pyuria with negative routine urine cultures. Cystoscopy revealed gross cystitis, and VCUG showed bilateral reflux and ureteral dilatation. Renal arteriograms, percutaneous renal biopsy, and bladder biopsy also were performed. After finding a positive culture for Ureaplasma, therapy with doxycycline rendered the patient asymptomatic and reflux improved on follow-up VCUG. Ureaplasma urealyticum should be considered in patients with symptomatic pyuria and negative routine cultures. Ureteral reflux, reversible with appropriate therapy, may be part of the infectious process.

Adolescent↗

PubMed1986

Screening for urinary tract infection using Bac-T-Screen bacteriuria device.

The Bac-T-Screen was used to process 795 urine specimens. Tests for urine specimens took slightly more than two minutes. The Bac-T-Screen predicted with 99 per cent accuracy if a specimen was negative for bacteriuria or pyuria. Thus, approximately one half of all carefully collected urine specimens need no further laboratory culture. In addition, the Bac-T-Screen detected bacteriuria with a sensitivity of 96 per cent at the 10(5) CFU/ml level of probability. Pyuria (1 +) was detected with a sensitivity of 98 per cent. The Bac-T-Screen can be used in an office practice as well as in the clinical laboratory.

Bacteriuria↗

PubMed1990

Survey of genitourinary organisms in a population of sexually active adolescent males admitted to a chemical dependency unit.

Sixty-two males consecutively admitted to an adolescent chemical dependency unit for treatment over a one-year period were studied. When interviewed, all denied having urogenital symptoms. Forty-eight reported having had sexual intercourse. Of these 48, 34 were screened (urethral swab) for Neisseria gonorrhoeae, Chylamydia trachomatis, Ureaplasma urealyticum, and Gardnerella vaginalis. Eighteen of the 34 males who had complete screening were found to harbor one or more organisms: 3 had Chlamydia, 13 had Ureaplasma, and 11 had Gardnerella. In addition, 61 of the original 62 subjects were tested for serum antibodies to Treponema pallidum and for pyuria. No subjects were found to have syphilis. Pyuria was present in all subjects with Chlamydia but in only two with Ureaplasma or Gardnerella.

Adolescent↗

PubMed1977

Anaerobic bacteriuria in a male urologic outpatient population.

We screened 517 urine samples from male outpatients, many of whom had underlying urinary tract pathology, for anaerobic and aerobic bacteriuria. Of the 153 specimens containing greater than 10(5) bacteria per ml. 20% yielded anaerobes only and an additional 6% revealed mixed anaerobic and aerobic growth. Pyuria was found more frequently in samples containing anaerobic bacteriuria than in those containing no growth but not as frequently as when aerobic bacteria were present. The high counts of anaerobic bacteria in first-voided specimens compared to midstream and post-prostatic massage aliquots suggested a urethral source for most bacteria. However, suprapubic aspiration of bladder urine demonstrated the organism in 2 of 10 patients with high numbers of anaerobes and pyuria in voided samples.

Aerobiosis↗

PubMed1984

Measurement of urinary leukocyte esterase activity: a screening test for urinary tract infections.

We evaluated the efficacy of testing for the presence of esterase (an enzyme released only from leukocytes) in the urine as an indicator of the presence of pyuria. We hypothesized that a "dipstick" test for urinary leukocyte esterase activity would be a rapid and simple screening technique for detecting urinary tract infections (UTI). To test our hypothesis we collected fresh urine specimens from 203 patients (148 outpatients, 55 inpatients) with a suspected UTI. Each specimen was divided into three aliquots; one was used for reagent strip testing (for leukocyte esterase, nitrite, and blood), one for microscopy, and one for culture. Of the 203 specimens, 49 showed significant bacteriuria (greater than or equal to 10(5) organisms/mL). The leukocyte esterase test was 100% sensitive (0% false negatives) with a 76% specificity (24% false positives) in predicting significant bacteriuria. Although a positive nitrite reaction was more specific (99% specificity, 0.6% false positives), it was insensitive (27% sensitivity, 73% false negatives). The high sensitivity of reagent strip leukocyte esterase testing for pyuria makes it a valuable screening test that should lead to the elimination of many needless urine cultures and microscopic examinations.

Adult↗

PubMed2003

Early detection of kidney disease in community settings: the Kidney Early Evaluation Program (KEEP).

BACKGROUND: Early identification of persons at risk for kidney disease provides an opportunity to prevent or delay its progression and decrease morbidity and mortality. Our hypothesis was that implementation of a targeted screening program in communities with high-risk populations would detect previously unidentified persons with or at high risk for chronic kidney disease (CKD) with a prevalence that exceeds that predicted for CKD in the general population. METHODS: Persons with hypertension or diabetes or a first-order relative with hypertension, diabetes, or kidney disease were screened for kidney disease risk factors. Blood pressure, blood glucose level, serum creatinine level, hemoglobin level, microalbuminuria, hematuria, pyuria, body mass index, and estimated glomerular filtration rate (EGFR) were evaluated. RESULTS: Six thousand seventy-one eligible persons were screened from August 2000 through December 2001: of these persons, 68% were women, 43% were African American, 36% were white, 10% were Hispanic, and 5% were Native American. Most reported high-school education or more (84%) and health insurance coverage (86%). Twenty-seven percent met the screening definitions for diabetes; 64%, for hypertension; 29%, for microalbuminuria; 8%, for anemia; 18%, for hematuria; 13%, for pyuria; 5%, for elevated serum creatinine level; 16%, for reduced EGFR; and 44%, for obesity. Among participants without a reported history of specified conditions, screening identified 82 participants (2%) with diabetes, 1,014 participants (35%) with hypertension, 277 participants (5%) with elevated serum creatinine levels, 839 participants (14%) with reduced EGFRs, and 1,712 participants (29%) with microalbuminuria. Thirty-five percent of participants with a history of diabetes had elevated serum glucose levels at screening (> or =180 mg/dL [10 mmol/L]), and 64% with a history of hypertension did not have blood pressure controlled to less than 140/90 mm Hg. Only 18% of participants with a history of diabetes and 31% with a reduced EGFR had blood pressure controlled to less than 130/80 mm Hg and less than 135/85 mm Hg, respectively. CONCLUSION: Targeted screening is effective in identifying persons with previously unidentified or poorly controlled kidney disease risk factors, as well as persons with a moderately decreased EGFR.

Adolescent↗

PubMed2006

The use of pharmacokinetically guided indinavir dose reductions in the management of indinavir-associated renal toxicity.

OBJECTIVES: Indinavir is associated with nephrotoxicity. Therapeutic drug monitoring of indinavir improves clinical outcome, but there is little data regarding therapeutic drug monitoring for patients with established indinavir-associated renal impairment. We prospectively studied the use of therapeutic drug monitoring in patients with virological success but established nephrotoxicity on an indinavir-containing regimen. METHODS: We measured indinavir C(trough)/C(2h), serum creatinine, pyuria, blood pressure (BP), weight and HIV RNA. The major endpoint of interest was the number of patients achieving a normal creatinine level 20 weeks following final indinavir dose adjustment. Primary analysis was by intention to treat (ITT). RESULTS: A total of 35 patients were enrolled; mean (SD) age 40.3 (5.8) years; mean (SD) BMI 21.5 (2.8) kg/m(2). At baseline 6/35 (17%) had a serum creatinine concentration within normal limits, but were offered enrolment because of previous nephrotoxicity (nephrolithiasis and/or abnormal serum creatinine), and a screening pharmacokinetic profile associated with increased nephrotoxicity risk. By ITT analysis 11/35 (31%) had normal creatinine at study end (P = 0.18). Of the 29 patients with abnormal creatinine at baseline, 7/29 (24.1%) had normal creatinine at study end (P = 0.016). Patients had a median (IQR) indinavir per dose adjustment over the study of 400 (400-800) mg. We observed improvements in estimated creatinine clearance, pyuria, resting BP and indinavir pharmacokinetic profile. HIV RNA control was maintained with continued immune recovery despite lower indinavir doses. CONCLUSIONS: Patients experiencing nephrotoxicity on an indinavir-containing regimen were safely maintained on indinavir by means of therapeutic drug monitoring. Parameters of renal function improved but did not return to baseline values, at least in the short-term.

Adult↗