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PubMed1985

Value of a screening urinalysis in pregnancy.

In order to assess the value of a screening urinalysis in the detection of urinary tract infection, the results of routine urinalyses from 1,062 obstetric patients were compared to subsequent culture results. A positive urine culture was predicted by pyuria, bacteriuria and a positive nitrite test; the predictive values were 23%, 21% and 87%, respectively. If all the parameters were negative, 96% of the cultures were negative. These findings suggest that in the interest of cost effectiveness, the urine can be cultured only when the screening urinalysis shows pyuria, bacteriuria or a positive nitrite test.

Bacteriuria↗

PubMed1970

Unsuspected urinary infection in general practice.

A SURVEY was undertaken to find the prevalence of asymptomatic bacteriuria in people in normal health who were patients of members of the North-west Faculty of the Royal College of General Practitioners. Midstream specimens were collected from 341 males and 456 females seen in visits to 19 practices in Lancashire and Cheshire. Three males and 45 females had > 10(5) bacteria/ml; three males and 26 females had > 50 pus cells/cu mm. Both significant bacteriuria and pyuria were found in three males and seven females. The percentage incidence varied in each practice from 0-24 per cent. About one third of the patients with significant bacteriuria or pyuria had urinary symptoms, but there were also 53 males and 104 females, who had urinary symptoms, whose urine was normal.The highest attendances were in those practices where the family doctor made the initial approach to the subjects.

Bacteriuria↗

PubMed1983

[Double-blind comparison of cefotetan and cefmetazole in complex urinary tract infections].

For the purpose of carrying out an objective evaluation of the clinical efficacy and safety of cefotetan (CTT), a new cephamycin-type injectable antibiotic, in the treatment of complicated urinary tract infections, cefmetazole (CMZ) was employed as the control drug in a comparative study performed by the double-blind method. CTT was administered in a dose of 0.5 g or 1 g, while CMZ was used in a dose of 1 g; both of these drugs were administered by intravenous drip infusion twice a day for 5 days. The total number of treated cases was 393; 105 patients in the CTT 1 g group, 97 patients in the CTT 2 g group, and 96 patients in the CMZ 2 g group. The judgment of the clinical effects of these 3 therapeutic regimens was carried out in accordance with the criteria for evaluation of clinical efficacy of antimicrobial agents on UTI (2nd edition). The results are as follows. With regard to the overall efficacy of the drug treatments, the calculated efficacy rates were 54.3% in the CTT 1 g group, 63.9% in the CTT 2 g group and 52.1% in the CMZ 2 g group. The differences between these efficacy rates were not statistically significant. Regarding the efficacy of the treatments in terms of the bacteriuria, the bacterial cultures were seen to become negative in 40% of the cases in the CTT 1 g group, 54.6% of the CTT 2 g group and 42.7% of the CMZ 2 g group. Again, there were no statistically significant differences between the groups. Concerning the efficacy of the drugs against pyuria, by combining the cases found to be normalized and those seen to show improvement, the improvement rates were calculated to be 41.9% for the CTT 1 g group, 37.1% for the CTT 2 g group, and 37.5% for the CMZ 2 g group. These pyuria improvement rates show no statistically significant differences, respectively. The incidences of occurrence of side effects and laboratory test abnormalities thought to be caused by the drug therapy were as follows; 1.5% and 5.3% in the CTT 1 g group, 1.5% and 3.1% in the CTT 2 g group and 0% and 6.9% in the CMZ 2 g group. There were no significant differences between the groups. Based on the above clinical results, it can be concluded that, in the treatment of complicated urinary tract infections, we can expect CTT to provide the same therapeutic efficacy as CMZ when its dosage is the same or even half thereof. In addition, the safety of CTT is equal to that of CMZ. Therefore, CTT is concluded to be a useful drug.

Adolescent↗

PubMed1983

[Comparative double-blind study of cefroxadine and cephalexin in the treatment of complicated urinary tract infection].

To evaluate the efficacy, safety, and utility of cefroxadine (CXD) for the treatment of complicated urinary tract infections, a double blind study comparing CXD with cephalexin (CEX) was carried out. Patient received either 1,500 mg/day of CXD 3 times a day, or 2,000 mg/day of CEX 4 times a day for 5 days by oral route, and the following results were obtained. Of the 305 patients, clinical efficacies were evaluated in 220 cases (CXD 105 cases, CEX 115 cases) except that excluded or dropped out. Side effect was evaluated in 301 cases (CXD 150 cases, CEX 151 cases). There was no statistically significant difference in the back ground characteristics between the 2 groups. Overall clinical assessment by the committee according to the "Criteria for Evaluation of Clinical Efficacy of Antimicrobial Agents on Urinary Tract Infection" patients evaluated as better than "good" were 64 of 105 (61.0%) for CXD and 75 of 115 (65.2%) for CEX. The difference between the 2 groups was not statistically significant. In effect on pyuria, patients evaluated as better than "decreased" were 58 of 105 (55.2%) for CXD and 69 of 115 (60.0%) for CEX. The difference between the 2 groups was not statistically significant. In effect of bacteriuria, patients evaluated as better than "decreased" were 57 of 105 (54.3%) for CXD and 69 of 115 (60.0%) for CEX. The difference between the 2 groups was not statistically significant. Analyses were stratified according to classification by the type of infection, diagnosis, degree of pyuria before treatment, and bacterial count before treatment. There were no statistically significant differences between the 2 treatment groups as to any item. In evaluation by attending physician, patients evaluated as better than "good" were 81 of 140 (57.9%) for CXD, and 85 of 141 (60.3%) for CEX. Statistically significant difference was not observed between the 2 groups. In drug usefulness by attending physician, patients evaluated as better than "usefulness" were 106 of 140 (75.7%) for CXD, and 109 of 141 (77.3%) for CEX. The difference between the 2 groups was not statistically significant. In evaluation of the infections with sensitive species to both CXD and CEX by the committee according to "Criteria for Evaluation of Clinical Efficacy of Antimicrobial Agents on Urinary Tract Infections, overall clinical efficacies were evaluated in 102 (CXD 48 cases, CEX 54 cases) which were infected with sensitive species. There was no statistically significant difference in the back ground characteristics between the 2 treatment groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1984

[Clinical studies on recurrence of acute uncomplicated cystitis].

Recurrence rate and symptoms after chemotherapy against acute uncomplicated cystitis (AUC) were studied. Upon completion of a 7-day treatment with two regimens, one of CEX alone (Group C) and the other of a combination of CEX with Lysozyme (Neuzym) (Group L), at a dose of 1 g CEX daily, efficacy of the drugs was assessed according to the criteria established by the UTI Study Group. The forty one cases in Group C and 38 cases in Group L showing an excellent response were evaluated for recurrence. The rates of recurrence were 12.2% in Group C and 21.1% in Group L during the first 7 days after treatment. In recurrent cases, bacteriuria was seen in 84.6% (11/13), pyuria in 53.8% (7/13) and miction pain in 30.8% (4/13). Thus, bacteriuria and pyuria should be the items of the criteria for AUC recurrence.

Acute Disease↗

PubMed1984

[A study on non-sterile intermittent self-catheterization for voiding dysfunction following radical uterine or rectal carcinoma surgery].

To determine the effectiveness of non-sterile intermittent self-catheterization, a study was made of 35 patients who had radical surgery of the carcinoma of the uterus or rectum between January, 1978 and October, 1982. These cases were divided into 2 groups; (1) early instituted group of 27 patients who used self-catheterization within 3 months following surgical intervention; (2) late instituted group of 8 patients who received drug treatment for more than 3 months after surgical treatments and then used self-catheterization. After the introduction of self-catheterization, urinary tract infection was evaluated on the basis of the incidence of pyuria defined as more than 5 white blood cells per high magnification field. In 16 of the 35 patients, the incidence of pyuria ranged from 0 to 20 per cent. Regarding prognostic results in the first group the application of self-catheterization, 6 patients had a residual urine ratio ranging from 0 to 20 per cent and were able to void at will. Uroflometry was performed in 9 patients in the first group. In 8 of these patients, UP max values increased 3 months after self-catheterization as compared with those before self-catheterization although their values were still lower than normal. Non-sterile intermittent self-catheterization can shorten the stay in hospital and enable the patient to live a catheter-free life.

Adult↗

PubMedDate not supplied

Etiologic role of Mycoplasma hominis and Ureaplasma urealyticum in women with the acute urethral syndrome.

In an assessment of the possible etiologic role of Mycoplasma hominis and Ureaplasma urealyticum in the acute urethral syndrome (AUS) in women, 79 women with AUS, 35 women with acute bacterial cystitis, and 66 asymptomatic volunteers were studied. Evidence against an etiologic role for M. hominis in AUS included: (1) a similar prevalence of the organism among women with AUS (18%), women with cystitis (29%), and asymptomatic women (15%); (2) a lack of association of M. hominis with AUS cases for which no other infectious cause was found; (3) a lack of association of pyuria with cases of infection in which M. hominis was isolated; and (4) an absence of M. hominis from cultures of bladder urine obtained by suprapubic aspiration. A possible etiologic role for U. urealyticum in some cases of AUS was suggested by the association of counts of this organism of greater than or equal to 10(3)/ml with pyuria in women whose AUS had no other apparent etiology and by the isolation of the organism from suprapubic aspirates from four of 15 women with AUS of unknown etiology. Further studies, similar to those done in men with nongonococcal urethritis, are necessary for confirmation of the causative role of U. urealyticum in AUS.

Acute Disease↗

PubMed1982

Chlamydia trachomatis in cervicitis and urethritis in women.

In the Scandinavian countries today, Chlamydia trachomatis seems to be the most important cause of sexually transmitted diseases. Although C. trachomatis is most prevalent in symptomatic women and in persons visiting venereal disease clinics, the asymptomatic carrier rate, particularly in young women, appears to be surprisingly high. In addition to young age and level of sexual activity, the use of oral contraceptives and the presence of cervical ectopy are important risk factors for chlamydial infection. Chlamydial cervicitis often is characterized by a hypertrophic follicular appearance, with severe edema, erythema, friability, and endocervical mucopurulent discharge. On colposcopy, an atypical transformation zone is frequently observed. Papanicolaou smears taken from C. trachomatis culture-positive patients often reveal benign atypias and dyskaryotic changes. C. trachomatis, therefore, being a venereally transmitted intracellular organism, may well play a role in the development of cervical intraepithelial neoplasia (CIN). Future studies on patients with cytological atypias, therefore, also should include tests for C. trachomatis. Prospective studies are needed to determine the natural history and outcome of C. trachomatis-associated atypias and their behavior after adequate therapy. A large proportion of C. trachomatis-infected women also are culture-positive from the urethra. The demonstration that C. trachomatis is a common causative agent of acute urethral syndrome (also called abacterial urethritis, dysuria-pyuria syndrome) in women has been a valuable contribution. The diagnosis of pyuria in a patient with abacterial dysuria is of critical importance, since it suggests a chlamydial etiology and thus is a potentially treatable condition.

Adolescent↗

PubMed1981

[Contribution of intravenous urography to the etiological diagnosis of microscopic haematurias (author's transl)].

From a study of 216 patients with microscopic haematuria who were helped by technically complete intravenous urography (IU), the authors conclude that this investigations method is particularly valuable when haematuria is unaccompanied by proteinuria, pyuria or renal insufficiency. IU led to an etiological diagnosis in almost 50 p. cent of the patients revealing, among other causes, numerous calculi and a non-negligible number of tumours. Renal biopsy is very useful in cases with proteinuria but has few indications in isolated microscopic haematurias. The same applies to diagnostic angiography. Cystoscopy should be considered angiography. Cystoscopy should be considered when IU might be unable to detect small tumours of the bladder or, more generally, lesions of the vesical mucosa, particularly frequent in patients with pyuria.

Cystoscopy↗

PubMed1981

Urinary tract infections due to Staphylococcus saprophyticus biotype 3.

Staphylococcus saprophyticus biotype 3 (Micrococcus subgroup 3 or M3) has usually been shown to be the second commonset cause of urinary tract infections in European women who are not in hospital. It generally causes pyuria and symptoms as severe as those caused by Escherichia coli. Unlike S. epidermidis it is seldom found as a contaminant in midstream urine specimens, and almost exclusively infects women in their reproductive years. However, S. saprophyticus is seldom differentiated from S. epidermidis in Canadian clinical laboratories. Urinary isolates of S. saprophyticus were presumptively differentiated from other coagulase-negative Micrococcaceae by their resistance to novobiocin as demonstrated by a simple disc susceptibility test that misidentified the infecting organism in only 3.4% of specimens. These novobiocin-resistant, coagulase-negative organisms caused similar proportions of the urinary tract infections in young women in York, England and Vancouver -- 6.6% and 6.9% respectively. In York these organisms were associated with significantly greater pyuria than novobiocin-sensitive organisms or bile-tolerant streptococci but not S. aureus or Enterobacteriaceae. In both communities novobiocin-sensitive, coagulase-negative Micrococcaceae were appreciably more resistant to penicillin than novobiocin-resistant organisms. Thus, differentiating S. saprophyticus from novobiocin-sensitive, coagulase-negative organisms provides information that is clinically useful, particularly for primary care practitioners working in the community or in outpatient clinics.

Adult↗

PubMed1981

An epidemiological study of urinary tract infections in Benghazi, Libya.

Two groups of patients comprised 100 males and 100 females were investigated. All patients were more than 15 years of age and presented to the medical outpatient department with urinary tract symptoms. Fifty six male and female patients had no significant bacteriuria despite symptoms similar to those observed in 144 bacteriuric patients. Pyuria was observed in both bacteriuric and non-bacteriuric patients. Escherichia coli was the most common pathogen isolated from clinical specimens and was followed by Proteus sp. and Staph epidermidis. Escherichia coli was the main cause of acute urinary tract infection in adult females, while Proteus sp. caused a significantly greater proportion of symptomatic infections in males. Streptococcus faecalis was isolated only from males, and irrespective of chemotherapy. Infections with Staph epidermidis resembled the coliform ones, especially in the nature and severity of symptoms and in the degree of pyuria. Although E. coli and Proteus sp. were more predominant in our patients a wider range of resistant bacteria was involved. This development of resistance to antibacterial agents may be due to the frequent prescription of these agents by the general practitioners in public health clinics, dispensing of antibiotics by private pharmacies to the general public without medical prescriptions, and the misusage of these antibiotics by the general population.

Adolescent↗

PubMed1995

The usage of Andrographis paniculata following Extracorporeal Shock Wave Lithotripsy (ESWL).

One hundred consecutive cases with renal stones less than 3 cm in size and normal renal function underwent ESWL from January to March 1994. Out of these, 50 were given Andrographis paniculata tablets (250 mg), 4 tablests tid, 25 were given cotrimoxazole 2 tablets bid and 25 received norfloxacin 200 mg bid, started immediately after ESWL and continued for 5 days. All tolerated the treatment well and none had complications. At one month follow-up, pre- and post-ESWL pyuria, hematuria and proteinuria among the Andrographis paniculata group were 84, 58, 72, 40, 52, 22 per cent; the cotrimoxazole group 88, 64, 84, 64, 56, 44 per cent and the norfloxacin group 92, 56, 72, 40 per cent and 56, 28 per cent respectively. The results showed that post ESWL pyuria and hematuria in patients receiving Andrographis peniculata were reduced to 0.69 and 0.55 time of pre ESWL value. We think that this herbal medicine is beneficial in the treatment of post ESWL urinary tract infection. Besides the herbal drug given to eighteen previously sulfa sensitized patients resulted in no allergic reaction.

Adult↗

PubMed1995

Diagnostic value of urine cytology and urine carcinoembryonic antigen (CEA) level in the distinction between bladder cancer and urinary tract infection.

In the retrospective investigation we estimated the CEA levels in urine and urine cytology in 293 patients with urinary bladder cancer (group I) and in 129 patients with urinary tract infection (group II). An increased CEA level was found in 212 cases of bladder cancer and in 109 cases of urinary infection. Neoplastic cells in urine sediment were identified in 254 cases in the first group, while in the second, multiple inflammatory cells and pyuria were diagnosed in 55 and 56 cases, respectively. The combined examination (increased CEA level and/or positive cytology of the urine sediment) allowed for the diagnosis of neoplastic disease in 270 patients in the first group and infection diseases in 123 patients in the second group. After surgical therapy an increased urine CEA level and neoplastic cells in the urine cytology were found in 1 case which was then confirmed histopathologically. In the group with urinary infection an increased CEA level in urine, after antiphlogistic therapy, was found in 5 cases, inflammatory cells in 12 cases, pyuria in 8 cases and suspect cells were found in 6 cases in the group with urinary infection. In specimens from these cases, after electroresection, bladder cancer was diagnosed in 2, and cystitis cystica type changes in 2 cases.

Carcinoembryonic Antigen↗

PubMed1996

Long-term stone recurrence rate after extracorporeal shock wave lithotripsy.

PURPOSE: We followed patients who were stone-free after extracorporeal shock wave lithotripsy (ESWL) to investigate the factors that contributed to recurrent calculi. MATERIALS AND METHODS: For longer than 5 years 903 patients without residual fragments 3 months after ESWL were enrolled in this study. Plain abdominal films and/or excretory urograms were evaluated every 6 months for recurrent stones on the side of ESWL. Patients who presented with colic pain or other complaints and who were suspected of having recurrent stones were also examined. Stone recurrence rates were calculated with the Kaplan-Meier method. We assessed the influence of patient age; size, location, composition and configuration of the original stones, and pyuria after ESWL on stone recurrence. RESULTS: Mean followup was 25 months and stones recurred in 183 of 903 renal units (20.3%). Kaplan-Meier recurrence rates were 6.7, 28.0 and 41.8% after 1, 3 and 5 years, respectively. There was a significant correlation between stone recurrence and multiple stones on one hand, and pyuria after ESWL on the other hand. Stones recurred most frequently in the lower calix. Recurrent stones were passed without intervention in 33 cases, while ESWL was repeated in 53. CONCLUSIONS: These data demonstrate the importance of long-term followup and the search for an effective prophylactic therapy to prevent recurrence.

Adolescent↗

PubMedDate not supplied

[Diagnostic yield of various urine tests in urinary tract infections].

OBJECTIVES: 1. To determine the value of pyuria and bacteriuria by high-power field (hpf) in centrifuged urine and of tests with reactive strips for determining leukocyte estearase activity and nitrites in the diagnosis of urinary tract infection (UTI). 2. To establish the ideal cut-off point for these tests. DESIGN: Comparative survey. SETTING: Second level health care unit of the Instituto Mexicano del Seguro Social. PATIENTS AND METHODS: A total of 105 patients were prospectively studied, with or without urinary symptoms, seen in the emergency ward. MEASUREMENTS: A clinical history and physical exploration was done in each patient. A urine sample was used for microscopic analysis for determining leukocytes and bacteria using hpf microscopy; the urine leukocytes count was assayed as well as leukocyte estearase and nitrites using reactive strips. All samples were subjected to urine culture. Urine samples were obtained using a Nelaton probe in 65% of the patients and the rest using the midstream urination technique. RESULTS: Forty patients (38%) were identified as UTI cases based on clinical and laboratory criteria (urine culture and leukocyte count). The best cut-off point for number of leukocytes was 8 per hpf and for bacteriuria it was 2+ per hpf and for leukocyte estearase it was 1+. The sensitivity, specificity and predictive values of the pyuria hpf, bacteriuria by hpf and leukocyte estearase by reactive strip were comparable. The nitrites had a lower sensitivity than the other tests (p < 0.05). The negative predictive value of the nitrites was less than the microscopic bacteriuria (74% vs 85%, p = 0.005). The combination of positive tests in leukocytes and bacteriuria increased the specificity and the positive predictive value (99% and 96% respectively) when compared to the individual tests. CONCLUSIONS: The diagnostic performance of leukocyte estearase by reactive strips was similar to the microscopy of leukocytes and bacteria but the nitrite test had a lower performance. The combination of the leukocytes and bacteriuria measured by hpf appears to be very useful in the diagnosis of UTI.

Adolescent↗

PubMed1996

Nephrolithiasis as a presenting feature of chronic sarcoidosis: a prospective study.

BACKGROUND AND AIM OF THE WORK: The presentation of sarcoidosis with renal stones has never been evaluated in a prospective study. DESIGN: We have studied 110 consecutive patients with histologically proven sarcoidosis, first seen in the years 1993-1994 in the Milan Sarcoid Clinic. Those who had renal stones preceding or suggesting the diagnosis of sarcoidosis, and those who had evidence of renal calculi at presentation, were studied up to 31 December 1995 with serial evaluation of calcaemia, calciuria and serum 1,25 (OH)2D3 and are the basis of this report. RESULTS: Four patients had had calculi a long time ago and probably unrelated to their sarcoidosis. Three patients had a previous history of recurrent colic with calculi. In one further patient the occurrence of calculi suggested the diagnosis. In three other patients pyuria or microscopic haematuria at the presentation of pulmonary sarcoidosis led to the diagnosis of asymptomatic calculi. All the above seven patients had features of chronic disease and required long term corticosteroid therapy. Four of them required lithotripsy or pyelotomy before starting steroid therapy. Another had further calculi during the follow-up, and an episode of hydronephrosis requiring lithotripsy, due to poor compliance to corticosteroid therapy. Another patient had a single stone during follow-up in spite of proper therapy. In all the others prednisone was useful to control the disease. Summing up the results of a previous similar but retrospective study from our clinic, we can describe the full spectrum of nephrolithiasis at presentation of sarcoidosis, as it appears from the examination of 729 consecutive patients seen over 17 years (1978-1994), with a further follow-up of at least one year (see Conclusions). CONCLUSIONS: 1. Renal stones may be the presentation of sarcoidosis in 3.6% of cases, but the etiology may go unrecognized for many years in most of them. 2. There are asymptomatic renal stones at presentation in a further 2.7%: pyuria or microscopic haematuria may suggest such an occurrence. 3. Renal calculi appear to be a marker of chronicity, with long term corticosteroid therapy required in most cases. 4. A diagnosis of sarcoidosis should always be considered when patients present with renal calculi of unknown origin.

Adult↗

PubMed1996

[Does renal mycobacteriosis exist?].

Urinary mycobacteriosis is rare although nontuberculous mycobacteria (NTM) are frequently isolated from the urine. 63 patients (pts) with NTM isolated from the urine were followed up 1 to 8 years; the most frequent complaint was low back discomfort (91% pts), while the leading laboratory findings were pyuria (72%) and microscopic hematuria (57%). Intermittent proteinuria was present in the minority (35%) showing nonnephrotic range. IVP revealed pathologic findings in 72% of the pts. During follow up none of the pts have had clinical or laboratory progression of the disease. Standard antituberculosis therapy has been applied in 22 pts, only 4 with satisfactory response. -Evidence of NTM does not exclude search for other possible causes of hematuria or pyuria; -renal mycobacteriosis, even if it does exist as an entity, is not as aggressive as tuberculosis; -standard treatment regimen for tuberculosis does not have positive effects in majority and susceptibility testing is necessary.

Humans↗

PubMed1998

Screening for urinary tract infection in children with cancer.

Neutropaenia and immunosuppression place children on treatment for malignancies at a high risk for infections. We undertook to determine the prevalence of urinary tract infection (UTI) in children on treatment for cancer at the Kenyatta National Teaching and Referral hospital. With the understanding that many laboratories in the rural areas of the country lack appropriate facilities for confirmation of UTI, it was also important to evaluate simple and inexpensive screening methods against a "gold standard" in this cross sectional study. One hundred and eighty six children between the ages of five and 14 years admitted in Kenyatta hospital with leukaemia or lymphoma were enrolled. Besides clinical evaluation, urinalysis and culture and sensitivity were performed on all the subjects. Urine culture was considered the "gold standard" for diagnosis for UTI. The prevalence of UTI was 8.1% (CI = 6.1, 10.1). Only five out of 15 patients were symptomatic. E. coli and klebsiella spp. were responsible for 93.4% of the infections. Presence of pyuria, defined as five or more pus cells per high power field, had a sensitivity of 80.0%, specificity of 97.1% and a positive predictive value of 70.6% while comparative values associated with a positive nitrite test were 60%, 97.7% and 96%. Other clinical and laboratory tests had low sensitivity. UTI is a relatively frequent infection in children on cancer treatment. Screening for pyuria is simple, inexpensive and an accurate method of diagnosing UTI in children on treatment for lymphohaematopoietic malignancies in situations where facilities for urine culture are unavailable.

Adolescent↗