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PubMed1990

Detection of endotoxiuria in polycystic kidney disease patients by the use of the Limulus amebocyte lysate assay.

Urinary tract infections (UTI) due to gram-negative bacteria are a serious complication in patients with polycystic kidney disease (PKD). Endotoxin, a component of the cell wall of gram-negative bacteria, has been reported to be pro-cystogenic in experimental animals. Because endotoxin levels in urines (endotoxiuria) from PKD patients have not been reported, the Limulus amebocyte lysate (LAL) assay, which detects picogram quantities of endotoxin, was used to probe for this cyst-promoting chemical. Fifteen PKD patients (seven females, eight males), asymptomatic for UTI, were tested and compared with 10 female and 10 male controls. All urines were assessed for (1) evidence of aerobic bacteria by routine quantitative cultures, (2) bacteria and pyuria by microscopic examination of gram-stained urine, and (3) bacterial endotoxin by the LAL assay. LAL tests were positive in 73% (11/15) of PKD patients, but only 25% (5/20) of controls (P = 0.0058). There was no significant difference in test positivity between PKD females (71%) and males (75%). There was no correlation of age, degree of renal dysfunction, or urine osmolality with endotoxiuria. Routine quantitative cultures were negative for gram-negative bacteria in PKD patients and all controls (except one female), as were microscopic findings for intact bacteria and pyuria. Thus endotoxiuria, in the absence of classical signs, symptoms, and microbiological findings of UTI, raises the possibility that endotoxin is available intrarenally to promote cystogenesis even before a potential susceptibility of PKD patients to classical UTI is manifested. Sources of urinary endotoxin observed in PKD patients, such as cryptic intrarenal sites or leakage from the gastrointestinal (GI) tract, remain to be defined.

Adult↗

PubMed1999

How adequate are the new guidelines on clinical evaluation of bacteriological outcome in uncomplicated UTI?

While the Infectious Diseases Society of Americas guidelines for clinical trials of antibiotics have proven valuable for defining inclusion criteria in studies of urinary tract infections, they are far from perfect when it comes to defining outcome of treatment. This was obvious in a trial comparing a beta-lactam antibiotic and a fluoroquinolone for treatment of acute uncomplicated cystitis in women. Depending on how failure was defined in terms of bacterial count and pyuria, failure rates with one and the same regimen varied between 6 and 67% of patients treated with the beta-lactam. Another finding was that pyuria measured with microscopy of urine sediment was a highly unreliable technique. Systematic studies are needed to define the optimal criteria for measuring outcome in these infections.

Anti-Bacterial Agents↗

PubMed1990

Ureteric catheterization in the diagnosis of pyelonephritis--an experimental evaluation.

Experimental models of renal infections have been used to determine the accuracy with which the cellular and microbiologic components of ureteric and voided urine reflected the pathologic status of the kidney in pyelonephritis. In acute pyelonephritis, the composition of the ureteric urine reflected the pathologic status of the kidney, although in a few cases ureteric samples were either sterile or cell free. Animals with chronic pyelonephritis in which the lesions were either infected or sterile commonly had sterile ureteric urine. Pyuria, however, was demonstrable in both these situations. In subclinical pyelonephritis, ureteric samples from infected kidneys were variably culture positive, although pyuria was a common observation. Discriminate function analysis based on actual renal status and ureteric data gave an overall correct classification rate of 67% and demonstrated at least 80% agreement in four of the five classification groups.

Animals↗

PubMed2001

Factors causing variation in urinary N-nitrosamine levels in enterocystoplasties.

OBJECTIVE: To establish the presence or absence of any diurnal or long-term variation in N-nitrosamine levels (which might be important in the development of cancer in enterocystoplasties) in enterocystoplasty urine, and to assess other factors that might alter enterocystoplasty N-nitrosamine levels. Patients, subjects and methods Thirty-six patients with enterocystoplasties and six normal controls were assessed. Urine samples were collected every 4 h over a 24-h period and N-nitrosamine levels determined using a modification of the Pignatelli METHOD: An additional urine sample was assessed by microscopy, culture and sensitivity. In a subgroup of 16 patients with an enterocystoplasty, the urinary N-nitrosamine levels were re-measured at 3-monthly intervals. RESULTS: No diurnal or long-term variation in urinary N-nitrosamine levels was identified. The mean N-nitrosamine levels were significantly higher in the cystoplasty group than in the controls (1.7 vs 1.0 micromol/L; P = 0.008). Mean N-nitrosamine levels were also significantly higher in enterocystoplasty patients with sterile pyuria than in those with no pyuria (P = 0.01). Those taking prophylactic antibiotics had significantly lower mean N-nitrosamine levels than those not doing so (P = 0.05). Individuals with infected urine and those needing to intermittently catheterize had higher N-nitrosamine levels than their counterparts, but this difference was not significant. Conclusion There were no diurnal or long-term variations in urinary N-nitrosamine levels. Levels were consistently higher in patients with inflamed or infected cystoplasties, those using intermittent self-catheterization and those not taking antibiotic prophylaxis.

Adolescent↗

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↗

PubMed2001

Effects of the routine change of chronic indwelling Foley catheters in persons with spinal cord injury.

OBJECTIVE: To determine whether routine catheter changes have any effect on the urinary white blood cell count (WBC) and bacterial culture in asymptomatic individuals with spinal cord injury (SCI) who have indwelling Foley catheters. DESIGN: Prospective case series. SETTING: Urology and SCI outpatient departments of a rehabilitation center. SUBJECTS: Twelve asymptomatic individuals (male and female) with SCI who have chronic indwelling urethral Foley catheters that are changed routinely every month. MAIN OUTCOME MEASURES: Two sets of urinalysis and urinary culture and sensitivity from each individual, one set taken through the Foley catheter before the catheter change and another set after the catheter change. WBC, bacterial identity, and colony count were measured, and the corresponding data were compared. RESULTS: All subjects had pyuria and bacteriuria before and after the catheter change. Analysis of the data showed a statistically significant increase in WBC in the urine after the indwelling Foley catheter was changed (P = .0039). However, bacterial types and corresponding colony counts remained almost completely unchanged. CONCLUSIONS: Routine change of chronic indwelling Foley catheters in asymptomatic individuals with SCI causes a significant rise in the urinary WBC, without altering the bacterial identity or colony count. Pyuria and bacteriuria are prevalent among individuals with SCI (including those who are asymptomatic) with indwelling Foley catheters. This study suggests that urinalysis should be taken before a catheter change.

Bacteriological Techniques↗

PubMed1994

Laboratory evaluation of urinary tract infections in an ambulatory clinic.

A 4-month evaluation of ambulatory patients with a suspicion of a urinary tract infection was performed. Specific objectives included assessment of five urinary screening methods, reevaluation of the necessity of the phenylethyl alcohol plate (PEA), and cost-effectiveness of screening for low colony count bacteriuria. Urine samples were collected as midstream, clean-caught specimens. A total of 142 samples, 87 from 79 symptomatic patients and 55 negative controls, were evaluated. All urine specimens were cultured using a 0.01 mL loop and a 0.001 mL loop onto Columbia sheep blood agar, MacConkey agar, and PEA agar. Twenty-four specimens (17%) were sterile, 64 (45%) were contaminated, and 54 (38%) were infected. Five urine screening methods were performed. These tests and their associated sensitivity and specificity are as follows. The Chemstrip 9 (Behring, Inc., Somerville, NJ) for leukocyte esterase and nitrate, 67%, 98%; microscopic analysis on spun urine, 79%, 93%; methylene blue stain for pyuria, 60%, 99%; Gram stain for pyuria, 45%, 93%; Gram stain for bacteriuria, 65%, 75%; and the URISCREEN (Analytab Products, Plainview, NY), 92%, 89%. Inclusion of a PEA plate for isolation of gram-positive organisms provided no additional information. Routine culture of urine samples at 10(-2) mL increased the contamination rate by 19%.

Ambulatory Care↗

PubMedDate not supplied

Asymptomatic Chlamydia trachomatis urethritis in men.

Ten men with asymptomatic urethritis due to Chlamydia trachomatis were identified through culture screening and were treated with ceftriaxone (1 g given intramuscularly). Seven of the eight men who were followed for at least 21 days before and after therapy remained asymptomatic but culture-positive. One originally asymptomatic man had onset of symptomatic non-gonococcal urethritis 18 days after his first positive culture. Among asymptomatic men with positive cultures, pyuria was present in urine specimens obtained at 17 of 18 visits, while the leukocyte count on the urethral gram stain was above normal at ten of 29 visits (P less than .01). Therefore, one may conclude that ceftriaxone (1 g given intramuscularly) was ineffective therapy for chlamydial urethritis; male urethral infection with C. trachomatis can remain asymptomatic for 21-45 days; and in this population pyuria detected by urinalysis correlates better with infection than does a urethral gram stain.

Ceftriaxone↗

PubMed2003

A prospective randomized trial of the LoFric hydrophilic coated catheter versus conventional plastic catheter for clean intermittent catheterization.

PURPOSE: We compared the incidence of hematuria, pyuria and clinical urinary tract infection in patients who performed intermittent self-catheterization using a hydrophilic coated LoFric (Astra Tech AB, Mölndal, Sweden) or standard plastic catheter. MATERIALS AND METHODS: A total of 62 male patients who performed intermittent self-catheterization to manage neurogenic bladder were randomized into 2 treatment groups at 3 American study sites. Outcome measures included urinary tract infection, microhematuria, pyuria and satisfaction rates. RESULTS: Of the 62 enrolled patients 49 completed the 12-month study. The withdrawal rate was not different in the 2 groups. At the end of the study there was statistically significantly less hematuria in the hydrophilic coated catheter group compared with controls. In addition, there was a significant decrease in the urinary tract infection rate from baseline in the hydrophilic coated catheter group but not in controls. CONCLUSIONS: Use of the hydrophilic coated catheter by patients on intermittent self-catheterization is associated with less hematuria and a significant decrease in the incidence of urinary tract infections. Therefore, it may be preferable for some patients, especially those with a history of difficult catheterization, urethral trauma or a high rate of urinary tract infection.

Adult↗

PubMed1986

Urinary tract and renal findings in acute Yersinia infections.

We studied 71 patients with acute Yersinia infection for the occurrence of pathologic urinary and renal findings. Transient proteinuria and/or microhematuria was found in 17 patients (24%) and slightly elevated serum creatinine in seven patients (10%). Renal biopsy was done in two patients and revealed mild mesangial glomerulonephritis in both cases. One of these patients had IgA glomerulonephritis and Reiter's syndrome. Pyuria occurred in 16 patients (23%) and was frequently associated with Reiter's syndrome. Seventy-three patients with acute intrinsic renal failure were studied for the occurrence of acute Yersinia infection by determining Yersinia antibodies by ELISA. One out of 13 patients with acute glomerulonephritis but none of 60 patients with acute tubulointerstitial renal disease had acute Yersinia infection. Acute Yersinia infection seems to be rarely an etiologic factor in acute intrinsic renal failure. Our results indicate that transient proteinuria, microhematuria, pyuria or impaired renal function are frequent findings in patients with acute Yersinia infections. However, glomerulonephritis seems to be a rather infrequent and mild complication of acute Yersinia infection.

Acute Disease↗

PubMed2004

Clinicopathological study of vesicoureteral reflux (VUR)-associated pyelonephritis in renal transplantation.

We retrospectively studied the occurrence of vesicoureteral reflux (VUR)-associated pyelonephritis using renal biopsies obtained from the transplanted kidneys, and correlated the histological changes with clinical parameters. Out of a total of 131 renal biopsies performed between 1990 and 2001 on renal transplant patients at the department of Urology of Nagasaki University Graduate School of Biomedical Sciences, 12 patients showed pyuria more than twice in a single year. Seven of these 12 patients were available for determining VUR by voiding cystourethrography (VCUG). Cystoureterography demonstrated VUR in three of seven studied patients with pyuria. A histopathological examination revealed dilatation of both proximal and distal tubules in renal biopsies of transplant patients with VUR, compared to renal biopsies of transplant patients without VUR, or non-transplanted patients with thin membrane disease. One of the patients with VUR showed advanced features of chronic pyelonephritis in four consecutive biopsies at different time points, suggesting a late stage of reflux nephropathy in the transplanted kidney. We conclude from our study that the occurrence of VUR-related pyelonephritis may be one of the important long-term complications in the survival of renal allografts.

Adult↗

PubMed1990

Bacteriological state of the urine in symptom-free adult males.

Mid-stream urine specimens from 120 symptom-free males aged between 15 and 60 years were examined for cells and bacteria. Only 3 specimens showed pyuria, all of which yielded fastidious organisms. No specimen yielded a pure growth of an aerobe. Fastidious organisms in pure or mixed growth were isolated from 26% of the specimens, none in a count greater than 10(8)/l and the majority in counts less than 10(7)/l. It was concluded that pure growths of aerobes in any count in patients with symptoms are indicative of infection. Fastidious organisms should be sought in the urine of patients with symptoms or pyuria before more intensive and expensive investigations are pursued.

Adolescent↗

PubMed1999

Detection of canine transitional cell carcinoma using a bladder tumor antigen urine dipstick test.

Canine transitional cell carcinoma (TCC) carries a poor prognosis in part due to late disease detection. The measurement of specific tumor markers shed in the urine may aid in sensitive, early disease detection and therefore improved prognosis. A 1-year prospective clinical trial was designed to assess the efficacy, sensitivity and specificity of the first generation Bard BTA test to diagnose TCC in dogs. This test is a qualitative, rapid, latex agglutination, dipstick test run on voided urine, which measures a glycoprotein antigen complex associated with bladder cancer in human patients. Sixty-five dogs were entered in the study: 20 TCC confirmed patients, 19 healthy controls and 26 urologic controls with a variety of conditions including urinary tract infection, crystalluria and proteinuria. Overall test sensitivity was 90% and specificity was 78%. False positive test results were noted in the presence of significant glucosuria (4+), proteinuria (4+), and pyuria or hematuria (> 30-40 WBC or RBC per hpf). Urine parameters that had no effect on efficacy included collection method (cystocentesis or free catch), pH, specific gravity, crystalluria, bilirubinuria, bacteriuria and casts. These data indicated that the Bard BTA test was sensitive for the detection of the bladder tumor-associated antigen complex in canine TCC. As evaluated, this test may serve as a useful adjunct to diagnosis, especially when cytology or biopsy is questionable or impractical. Furthermore, because of the high sensitivity of the test, it may be a practical screening test to rule out TCC in geriatric patients or patients with clinical signs related to the lower urinary tract, particularly before pyuria and hematuria develop which may interfere with test results.

Journal Article↗

PubMed2001

[A pediatric case of acute focal bacterial nephritis; comparison with the reports in Japanese child cases].

We report an 8-year-old boy with acute focal bacterial nephritis (AFBN). At the age of 3 months, he had a history of urinary tract infection and vesicoureteral reflux. He was admitted to our hospital because of high fever and costovertebral angle pain. Although acute pyelonephritis was suspected, neither pyuria nor cultures of blood and urine were positive. An initial ultrasonogram (US) of his kidneys was normal except for bilateral hydronephrosis. Two days later, however, a computed tomography (CT) revealed a poorly enhanced mass in the upper pole of the right kidney. Similar findings were also observed by US. Under the diagnosis of AFBN, he received antibiotics for 3 weeks. Voiding cystourethrogram showed both-sided vesicoureteral reflux and he underwent an operation. At present the mass of the kidney still remains, albeit its size tends to decrease. We suggest that an early examination of US or enhanced CT is necessary in cases with fever of unknown origin, considering the possibility of AFBN even if neither pyuria nor cultures of urine are positive.

Acute Disease↗

PubMed2002

[Faropenem 300 mg 3 times daily versus levofloxacin 100 mg 3 times daily in the treatment of urinary tract infections in patients with neurogenic bladder and/or benign prostatic hypertrophy].

Faropenem (FRPM) is an only penem antibiotics. Though it has been reported that FRPM had good efficacy (overall efficacy rate: 82.0%) against patients with complicated urinary tract infection, FRPM has not been frequently used for UTI patients. This multicenter clinical study was designed to compare FRPM 300 mg 3 times daily to Levofloxacin (LVFX), which is the standard treatment for patients with UTI, 100 mg 3 times daily for 7 days in the treatment of urinary tract infections in patients with neurogenic bladder and/or benign prostatic hypertrophy. A total of 60 patients with significant bacteriuria and pyuria were included in this study. Overall efficacy rate (excellent plus moderate) was achieved in 90.6% (29/32) of patients treated with FRPM versus 82.1% (23/28) of those treated with LVFX. The ratios of eliminated bacteriuria and cleared pyuria were 71.9% and 56.3% of patients treated with FRPM, and 64.3% and 75.0% of those treated with LVFX. These data were not significant difference. In conclusion, FRPM 300 mg 3 times daily is at least as effective as LVFX 100 mg 3 times daily in patients with complicated urinary tract infection.

Adolescent↗

PubMed2003

[Prostate histopathology of NIH category IV prostatitis detected by sextant prostate needle biopsy from the patients with high prostatic specific antigen].

Asymptomatic prostatitis is classified as category IV in NIH classification of prostatitis syndrome (1999). No report concerning this category has been present. We investigated this category histopathologically and clinically, in order to clarify the histopathological distribution and its correlation to the clinical features, in this study. Among 785 patients who were suspected prostate cancer because of their high prostatic specific antigen (PSA) values and to have a sextant prostate needle biopsy was performed between January, 1996 and December, 2000, 88 patients (11.2%) were diagnosed as NIH category IV prostatitis (asymptomatic prostatitis). We observed all pathological specimens stained with Hematoxylin-Eosine, and classified them into subtypes according to the classification criteria for prostatitis defined by True et al. (1999). We also investigated the relationship between histopathological distribution and clinical features such as PSA values, PSA density, the incidence of pyuria or bacteriuria. In the histopathological study, grade distributions were 12.5% (11/88) in mild, 71.6% (63/88) in moderate, and 15.9% (14/88) in severe. Location distributions were 2.3% (2/88) in glandular, 68.2% (60/88) in periglandular, and 29.5% (26/88) in stromal. No relationship between these subtypes and clinical features was recognized statistically. However, 7 patients (7.95%) were diagnosed as prostate cancers, later. Pyuria was found in 29.1% (23/79). Bacteriuria was present in 14.3% (11/77). Isolated bacteria were 4 strains of Enterococcus faccalis, 2 strains of each of Pseudomonas aeruginosa and Staphylococcus aureus, and one strain of each of Escherichia coli, Klebsiella oxytoca, Enterobacter cloacae, Enterobacter aerogenes, Staphylococcus haemolyticus, and Staphylococcus epidermidis. Gram positive rod, and Candida sp. No relationship between these subtypes and bacterial species was recognized. These results indicated that the incidence of NIII category IV prostatits was not low without correlation to any clinical features. However, we should pay attention to the presence of prostate cancer, because a small number of the patients were diagnosed as prostate cancer, later.

Aged↗

PubMed1982

Effects of ten milligrams of ampicillin per day on urinary tract infections.

A total of 20 patients with symptomatic urinary tract infections (greater than 10(5) colony-forming units of Escherichia coli per ml of urine in addition to pyuria) received 10 mg of ampicillin and 2 liters of fluid daily for 3 days. After 2 days, 16 patients had culture-negative urine without pyuria. A total of 18 similar patients received only 2 liters of fluid for 3 days. On day 4, all had greater than 10(5) colony-forming units of E. coli per ml of urine and greater than 10(4) leukocytes per mm3 of urine.

Adolescent↗

PubMed1984

Single-dose amoxicillin therapy of acute uncomplicated urinary tract infections in women.

Of 210 women who were experiencing dysuria, frequent urination, pyuria, and significant bacteriuria and who were treated with a single 3-g dose of amoxicillin, 165 (79%) were cured of their original infections. Patients with infections that were negative by antibody-coated-bacteria assay were cured at a significantly higher rate than those with infections that were positive by antibody-coated-bacteria assay (90 versus 59%; P less than 0.001). Similarly, those with infections caused by amoxicillin-susceptible organisms were cured at a significantly higher rate than those with infections caused by resistant organisms (85 versus 50%; P less than 0.001). Of 27 patients who had infections caused by amoxicillin-susceptible organisms and who had relapses after single-dose therapy, 14 (52%) had relapses again after a conventional 10-day course of therapy, although all responded to a 6-week course. An additional 27 patients experiencing dysuria, frequent urination, and pyuria but who had a lower number of uropathogens in the urine (10(2) to 10(4.5)/ml of urine) were treated with single-dose therapy, with a 100% eradication of organisms and an 89% rate of symptomatic relief.

Acute Disease↗