Reduction of bacteriuria and pyuria using cranberry juice.
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Aged↗
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Leukocyte esterase tests detect pyuria, not bacteriuria.
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Humans↗
[Urinary disorders in small girls and pyuria of genital origin].
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Anti-Bacterial Agents↗
Study of urinary tract infection in children in one health district.
OBJECTIVES: To determine the number of children who had urine specimens sent for culture, who had infections or sterile pyuria, and who were investigated further. To relate the laboratory findings to the results of imaging. DESIGN: One year survey of urine specimens submitted to a laboratory; review of previous and subsequent laboratory reports; review of the findings of imaging of the urinary tract. SETTING: Portsmouth and South East Hampshire health district. SUBJECTS: An estimated population of 89,086 children aged 12 years or under. MAIN OUTCOME MEASURES: Urine bacterial count and results of imaging. RESULTS: 12,551 urine specimens were submitted from 7450 children, 3138 boys and 4312 girls. 2238 children had infection or sterile pyuria at least once during the study (13.9/1000 boys, 37/1000 girls). 996 (45%) of the children with infection or sterile pyuria underwent some form of imaging. 128 children who had infection or sterile pyuria were already known to have urinary tract abnormalities and 114 children had newly identified abnormalities (1.0/1000 boys, 1.5/1000 girls). 50 (44%) of the children with newly detected abnormalities had no pyuria and 48 (42%) had bacterial counts below 10(8)/l. Eight children who had sterile pyuria on presentation were found to have abnormalities on imaging. CONCLUSIONS: Urinary tract infection is much commoner in children than is widely believed. Low bacterial counts, the absence of pyuria, or a finding of sterile pyuria should not be disregarded.
Age Distribution↗
Causes of the acute urethral syndrome in women.
To determine the cause of the acute urethral syndrome, we studied 59 women with dysuria and frequent urination without "significant bacteriuria" (defined as greater than or equal to 10(5) organisms per milliliter), 35 women with typical cystitis and 66 women with no symptoms of urinary-tract infection. Although none of the 59 women with urethral syndrome had greater than 3.4 x 10(4) bacteria per milliliter in either of two successive midstream urine specimens, samples of bladder urine obtained by suprapubic aspiration or catheterization from 24 women contained coliforms, and samples from three contained Staphylococcus saprophyticus; all but one of these 27 women also had pyuria. Of the 32 women with sterile bladder urine, 10 of 16 with pyuria and one of 16 without pyuria were infected with Chlamydia trachomatis (P = 0.002). Chlamydial infection was found in 11 of 42 women with urethral syndrome and pyuria, in three of 66 without symptoms, and in one of 35 with cystitis (P less than 0.01 when the group with urethral syndrome is compared with either of the other groups). Thus, 42 of 59 women with urethral syndrome had abnormal pyuria and 37 of these 42 were infected with coliforms, S. saprophyticus, or C. trachomatis, whereas few women without pyuria had demonstrable infection. Bacteriuria of greater than or equal to 10(5) per milliliter may be an insensitive diagnostic criterion when applied to symptomatic lower-urinary-tract infection.
Acute Disease↗
Suprapubic aspiration under ultrasound guidance in children with fever of undiagnosed cause.
OBJECTIVES: To assess the ease of use of suprapubic aspiration of urine under ultrasound guidance in babies with fever of uncertain cause and to assess the importance of bacterial counts and pyuria in relation to abnormalities of the urinary tract and the importance of pyuria in the absence of bacteriuria. DESIGN: Analysis of urine samples obtained by suprapubic aspiration in babies and children from July 1991 to June 1992. The clinical records of the children with bacteriuria and sterile pyuria were examined retrospectively. SETTING: Neonatal and paediatric wards of a district general hospital. SUBJECTS: 508 babies and children who had fever of uncertain cause or were seriously ill. RESULTS: No difficulties arose in the collection of 545 specimens. Bacteria were isolated from the specimens of 44 children, 24 of whom had abnormalities of the urinary tract. The bacterial count was < 10(8)/l in 18 of the children with bacteriuria, 10 of whom had abnormalities. No white cells were seen in 22 of the 46 bacteriuric specimens; nine of the children with no pyuria had vesicoureteric reflux. 439 of the 499 non-bacteriuric specimens showed no white cells. 60 children had pyuria without bacteriuria. CONCLUSIONS: The use of ultrasound guidance simplifies suprapubic aspiration of urine in babies. Low bacterial counts may be associated with abnormalities of the urinary tract. Laboratory techniques capable of detecting such counts reliably should be used. Pyuria is absent in half of babies and very young children with bacteriuria. It rarely occurs without bacteriuria, and if it does an explanation should be sought.
Bacteriuria↗
Urine microscopy on a counting chamber for diagnosis of urinary infection.
Several quantitative methods of urine microscopic examination for bacteriuria and pyuria on a blood cell counting-chamber have been found reliable for the diagnosis of urinary tract infection (UTI). However, no one technique has become popular or widely used because of laborious procedures associated with the method. We investigated the usefulness of microscopic examination of uncentrifuged urine on disposable counting-chambers. A total of 89 urine samples were obtained from 53 children (24 male and 29 female). Urine samples were examined for bacteriuria and pyuria using a disposable counting chamber and its reliability was analyzed in predicting significant bacteriuria defined by routine urine culture. Significant bacteriuria was diagnosed in 23 of 89 urine samples by urine culture. Microscopic urine examination on disposable counting-chambers was very easy without the need to set up or wash chambers and provided immediate information. Urine bacterial concentration determined by the counting-chamber method was closely correlated to that determined by bacterial culture. The counting-chamber method identified bacteriuria correctly in 21 of 23 urine samples diagnosed as significant bacteriuria (sensitivity = 91%) and also gave a correct diagnosis of 64 of 66 urine samples with non-significant bacteriuria (specificity = 98%). Nineteen of the 23 urine samples with significant bacteriuria also had pyuria. The positive predictive value of concomitant bacteriuria and pyuria was 100%. When neither bacteriuria nor pyuria was found, the negative predictive value was 100%. It was concluded that urine microscopy using disposable counting chambers was very easy, inexpensive, quick and reliable and thus an extremely useful method for diagnosing UTI.
Adolescent↗
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↗
Home-voided urine specimens in women. Diagnostic agreement with clean-catch midstream specimens.
One hundred and fifty women who brought a home-voided urine sample to a general practitioner were asked at the same consultation to provide another sample under controlled conditions. Seventy-three women had lower urinary tract symptoms and 77 were asymptomatic. The two samples were analysed for pyuria (greater than or equal to 5 leucocytes/HPF) and bacteriuria (greater than or equal to 10(4) v. greater than or equal to 10(5) cfu/ml). The agreement when diagnosing pyuria and bacteriuria was estimated by Kappa (K). The home-voided sample was taken with adequate sampling technique by only 12% of women. Moreover, its bladder incubation time was twice that of the surgery sample (5.4 h v. 2.4 h). There was, however, no difference in the distribution of pyuria or bacteriuria between the paired samples. Agreement, which was high for the diagnosis of pyuria (K = 0.80), was significantly lower for the diagnosis of bacteriuria (K = 0.52, P less than 0.01). A home-voided sample seems sufficient in the diagnosis of the dysuria-pyuria syndrome in women.
Adolescent↗
Laboratory in the diagnosis and management of urinary tract infections.
The laboratory is essential in the diagnosis and management of UTIs. The presence of pyuria and bacteriuria, the two most important indicators of UTIs, are most accurately determined by standard techniques. In quantitating pyuria, the finding of greater than or equal to 10 leukocytes/mm3 of urine by either hemocytometry or direct microscopy correlates highly with symptomatic, culture-proven UTIs. The determination of bacteriuria by direct microscopy is inaccurate, particularly at lower levels of bacteriuria; thus, quantitative urine cultures remain the most accurate measure of bacteriuria. Significant bacteriuria, previously defined as greater than or equal to 10(5) CFU/ml of urine, has been redefined with the observation that as few as 10(2) CFU/ml can be associated with significant pyuria and symptoms suggestive of cystitis. The need for routine and posttreatment urine cultures in nonpregnant women with acute dysuria remains controversial, but current data suggest that they are usually unnecessary. Rapid diagnostic tests for detection of pyuria and bacteriuria are designed to increase efficiency and decrease cost in the diagnosis of UTI. Unfortunately, none of these techniques can quantitate pyuria or bacteriuria as accurately as the standard methods, but the level of accuracy offered by the standard methods is not always necessary in the care of patients with uncomplicated UTIs. These tests are particularly well suited for screening asymptomatic high-risk populations. Noninvasive localization techniques continue to be explored as possible alternatives to invasive localization procedures, but they remain largely research tools that are not readily available to the practicing clinician. Understanding the applicability and appropriate use of newer technologies in the evaluation of patients with UTIs and how these technologies complement the standard diagnostic techniques will lead to better, more efficient, and less costly patient care.
Bacterial Infections↗
Staining of urinary leucocytes as an aid to the diagnosis of inflammation in the urinary tract.
Five hundred specimens of urine have been examined for pyuria and bacteriuria, the leucocytes being stained by the Sternheimer-Malbin method. Most urines contained either less than 1 or more than 10 leucocytes per cmm; a few specimens contained 1 to 10 cells per cmm, whatever their viable bacterial count. The presence of leucocytes in urine was usually related to the bacterial count, pyuria being commonest in urines showing ;significant bacteriuria'. However, urinary tract instrumentation caused pyuria in the absence of infection. Leucocytes with nuclei staining blue by the Sternheimer-Malbin technique were considered to be indicative of active inflammation, but the incidence of such cells appeared to be a reflection of the total leucocyte count of the specimen rather than of its viable bacterial count. In the majority of cases the diagnosis of infection can be made on the basis of the bacterial count and the degree of pyuria. The staining technique appears to have a limited use, restricted to the interpretation of cases in which the results of culture and conventional leucocyte counts are ambiguous.
Bacteriuria↗
A reassessment of the importance of "low-count" bacteriuria in young women with acute urinary symptoms.
OBJECTIVE: To determine whether a statistical association exists between "low-count" bacteriuria (> 10(2) to 10(4) colony-forming units/mL) and acute urinary symptoms in young women. DESIGN: Prospective, case-control study. SETTING: Gynecology clinic at a student health center. PATIENTS: Women with or without urinary or vaginal symptoms. MEASUREMENTS: History of urinary infections and sexual activity. Quantitative determination of bacteriuria and pyuria and bacterial species; urine leukocyte esterase test; specific gravity; creatinine levels; vaginal leukocytes; and in-vitro culture of urine. RESULTS: The frequency of recent sexual activity, pregnancies, and contraceptive practices was not statistically different between women with acute urinary symptoms and asymptomatic controls. Escherichia coli and Staphylococcus saprophyticus were the only microorganisms statistically associated with urinary symptoms and pyuria (P < 0.001). Low counts of these organisms were found in 10.2% of asymptomatic women. As the bacterial count increased, the association between these organisms and symptoms increased, and a step-wise increase occurred in the frequency and magnitude of pyuria, but the specific gravity and urine creatinine levels remained unchanged. Escherichia coli, even at low counts, grew well in the patients' own urine. Pyuria (> 20 leukocytes/mm3) was present in 19.6% of asymptomatic women and was associated with vaginal leukorrhea. CONCLUSIONS: "Low-count" bacteriuria was statistically more frequent among young women with urinary symptoms than among asymptomatic controls. The low counts could not be explained by dilution of the urine or failure of the bacteria to grow well in the patients' urine. These findings suggest that the infection was not established in the bladder urine and that "low-count" bacteriuria might be an early phase of urinary tract infection.
Acute Disease↗
[Study of the long-term administration of ofloxacin to the patients following transurethral resection of the prostate].
The present study was undertaken to evaluate the clinical efficacy of long-term administration of ofloxacin (OFLX) to the patients following transurethral resection of the prostate. The patients were randomly divided into two groups: A and B. All the patients were administered flomoxef (FMOX) intravenously for 3 days following transurethral resection of the prostate (TUR-P). In group A, 100 mg of OFLX twice daily was thereafter administered for 4 to 15 weeks to 22 patients until they showed an improvement in pyuria. In group B, which served as a control, neither OFLX nor any other antibiotics were administered to 26 patients until they showed an improvement in pyuria. No patients complained of urination trouble due to infection. At the same time, cultures of bacillus in the urine were also examined 4 days, 7 days and 2 weeks after TUR-P with these two groups. The mean days necessary for the improvement of pyuria were 64.9 +/- 20.5 in group A, 66.3 +/- 18.4 in group B. At 2 weeks after TUR-P, bacillus in the urine were negative in 19/22 patients in group A, and 14/26 in group B. Chi-square test showed significance for these two groups. Accordingly, OFLX was useful for bacillus in the urine, but OFLX was not so useful for shortening the continuance of pyuria of post TUR-P. No patients complained of nausea or any other complications during the study.
Aged↗
[A study on the treatment duration of an antibacterial agent in complicated urinary tract infections. Utility and recurrence after 14-day treatment by fleroxacin].
In this study, fleroxacin (FLRX), a new quinolone derivative, was orally given at 300 mg once daily for 14 days to 102 patients with non-catheterized complicated urinary tract infections in order to determine the optimal treatment duration. We investigated its efficacy at day 5-7 and day 14, according to the criteria proposed by the Japanese UTI Committee, and also to the recurrence rate after the withdrawal. The results were as follows: 1. Overall clinical efficacy rates were 86% at day 5-7 and 84% at day 14. Both incidence of bacterial replacement in bacteriuria and normalization in pyuria were increased at day 14 as compared with those at day 5-7. 2. Bacteriological eradication rates were 91% at day 5-7 and 89% at day 14. 3. Clinical efficacy rates from physicians' evaluation were 86% at day 5-7 and 88% at day 14. 4. Incidence of side effects was 9.1%, and most of the cases were gastrointestinal symptoms which appeared within 4 days. Slight and transitory changes in laboratory findings were noted in 2.3% of evaluable cases. 5. With the occurrence of pyuria and bacteriuria as markers, the "no recurrence" rates were 63% at 1 week, 54% at 2 weeks, 61% at 3 weeks, 81% at 4-6 weeks after the withdrawal, and the "recurrence" rates were 4%, 4%, 6% and 5%, respectively. Remaining cases were judged as "reserved assessment". Generally, aggravation of bacteriuria was found but the aggravation of pyuria was observed in only few cases. 6. According to breakdown of cases with bacteriuria only, cure rate was 67% and recurrence rate was 33%. Re-infections were observed much more frequently than relapse based on the identification of infecting organisms. These results suggest that sufficient bacteriological eradication and clinical efficacy could be obtained by 14-day treatment of FLRX in non-catheterized complicated urinary tract infections. The efficacy of the treatment became evident around day 7. In approximately 30% of the cases in which eradication of the initial causative organisms was observed at day 14 reappearance of bacteriuria (greater than or equal to 10(3) CFU/ml) occurred after withdrawal of the antibiotic, but cases with pyuria were few, and the incidence of true recurrence was generally low. Onset of side effect after 5-day was not seen, hence FLRX seemed to be a safe agent.
Administration, Oral↗
Detection of Chlamydia trachomatis in general practice urine samples.
BACKGROUND: Chlamydia trachomatis is frequently overlooked as a cause of dysuria and urinary frequency in general practice patients. AIM: This study set out to determine the impact of performing chlamydial antigen detection on sterile pyuria samples from patients aged 16-65 years and which were submitted to a hospital microbiology laboratory by general practitioners in the Winchester health district for routine microbiological investigations. METHOD: Chlamydial antigen detection was performed by enzyme immunoassay and direct immunofluorescence. The cost of performing the test was estimated. In the first year of the study (1991) questionnaires were sent to general practitioners whose patients had a positive test result. RESULTS: A total of 1025 samples of sterile pyuria were received at the laboratory between January 1991 and March 1993. Chlamydial antigen was detected in 54 samples (5%); 22 men and 32 women aged between 16 and 57 years (mean 25 years). The detection rate was highest in the 16-20 years age group (22% of men had a positive sample and 7% of women). Completed questionnaires from 27 general practitioners revealed that 59% of their patients were referred to the genitourinary clinic for treatment and contact tracing. The others were treated by the general practitioner. The cost of the screening programme per cure in this population was estimated to be 246 pounds. CONCLUSION: C trachomatis is a significant pathogen which may go unrecognized and untreated. The cost, medically and financially, of screening for this pathogen and treating infected patients and contacts is likely to be less than ignoring it, particularly if screening is confined to the 16-30 years age group. General practitioners should consider the diagnosis of chlamydial infection in young adult patients with sterile pyuria, and microbiology laboratories should screen sterile pyuria samples for chlamydial antigen.
Adolescent↗
[Clinical studies on the need of prophylactic antibiotics during extracorporeal shock wave lithotripsy].
We examined whether prophylactic antibiotics are necessary or not during the ESWL treatment for patients with urolithiasis. Twenty-eight patients with unilateral renal or ureteral stones composed of calcium oxalate, calcium phosphate or the mixed stones were treated with MPL 9000 between May 12 and September 30, 1992. Although 17 patients (60.7%) had complications of pyuria before treatment, none of the 28 patients had taken any prophylactic antibiotics during the treatment. To evaluate the clinical signs of infection, we examined the white blood cell count, in blood and urine sediment and serum C-reactive protein (CRP) value at the time of 1, 3 and 7 days after ESWL treatment, and body temperature and urine culture at the time immediately after the treatment in addition to the above-mentioned days, compared with the pre-treatment data. White blood cell count at one day after ESWL treatment was significantly elevated both in the patients with and without pyuria, while body temperature at the time immediately after the treatment was significantly elevated only in the patients with pyuria. Six of the 23 patients (26.1%) with preoperative sterile urine and who had urine culture immediately after ESWL, had bacteriuria. However, none of the 28 patients had any clinically significant infectious complications during ESWL treatment without any antibiotics therapy. We concluded that it is important to examine urine culture immediately after ESWL treatment for early protection from complication of urinary tract infection and that administration of prophylactic antibiotics is not necessary during ESWL treatment for patients with non-infection stones even concomitantly with pyuria.
Adult↗
Postoperative prophylaxis with norfloxacin in patients requiring bladder catheters.
The effect of once daily doses of 200 mg oral norfloxacin on the occurrence of catheter-associated bacteriuria (greater than 1000 CFU/ml) and pyuria was studied in 105 post-operative gynaecologic patients. Norfloxacin was given from the second day after surgery until catheter removal. Bacteriuria developed in 32 of 51 (63%) control patients compared to 8 of 54 (15%) patients receiving norfloxacin (p less than 0.001). Pyuria was present in 22 of 51 (43%) control subjects versus only 3 of 54 (5%) patients treated with norfloxacin (p less than 0.001). Bacteria isolated from control patients comprised species of Enterobacteriaceae (40%), Staphylococcus (35%), and Streptococcus (17%); seven isolates were resistant to multiple antibiotics reflecting their nosocomial origin. In contrast, strains isolated from norfloxacin-treated patients comprised non-fermenting gram-negative rods (79%, usually Alcaligenes or Acinetobacter spp.) and faecal streptococci (12%). It is concluded that once daily doses of 200 mg oral norfloxacin are effective in reducing the rate of catheter-associated bacteriuria and pyuria following reconstructive gynaecologic surgery.
Adult↗
Bacteriuria in children with neurogenic bladder treated with intermittent catheterization: natural history.
OBJECTIVE: To determine whether bacteriuria unassociated with symptoms in patients with neurogenic bladder will lead to symptomatic infection and/or deterioration of the upper urinary tract if left untreated, we examined whether bacteriuria persisted in bladder urine of children with neurogenic bladder treated with clean intermittent catheterization (CIC) and whether persistence of bacteria led to symptomatic infection or deterioration of the upper urinary tract. DESIGN: Weekly home visits were made during 6 months of surveillance of 14 children on the CIC regimen with a normal upper urinary tract and no reflux (as determined by renal ultrasonography, voiding cystourethrography, and serum creatinine measurement). During visits a sample of bladder urine was obtained by CIC, and signs and symptoms of urinary tract infection and all medications were recorded. RESULTS: Fourteen children were observed for 323 weeks. Cultures of 70% (172/244) of the urine samples collected were positive for organisms (> or = 10(4) colony-forming units per milliliter), 152 (88%) for the usual pathogens and 20 (12%) for commensal organisms. Bacteriuria was associated with pyuria two thirds of the time, regardless of bacterial species. Carriage of the same pathogen for 4 weeks or longer, with associated pyuria, was common during surveillance. Despite frequent episodes of bacteriuria with associated pyuria, there were only five symptomatic infections during the 323 patient-weeks. Children remained clinically well during the study period, and their upper urinary tract did not deteriorate. CONCLUSION: Bacteriuria persists for weeks in symptom-free children being treated with CIC for neurogenic bladder associated with a normal upper urinary tract. Before attempts are made to eradicate bacteriuria, treatment should be proved to be beneficial to this population.
Adolescent↗