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Asymptomatic bacteriuria in schoolgirls. VI. The correlation between urinary and faecal Escherichia coli. Relation to the duration of the bacteriuria and the sampling technique.

The occurrence of the urinary strain in the anus, rectum and faeces was investigated in 27 girls with asymptomatic bacteriuria (ABU). In patients with bacteriuria of relatively short duration 46% of the faecal isolates were of the urinary strain as compared to only 18% in patients with bacteriuria of relatively long duration. In general the correlation between the urinary and faecal flora is striking at the time of establishment of ABU but diminishes with time. The diminished correlation may be due to two factors: firstly, the composition of the faecal flora changes with time. Secondly, the correlation may be obscured by complex changes in the properties of bacterial strains established in the urinary tract. Contamination by the infected urine did not seem to be a serious problem when the rectal mucosa was swabbed proximal to the anal canal.

Anal Canal

Asymptomatic bacteriuria in schoolgirls. VII. A follow-up study of the urinary tract in treated and untreated schoolgirls with asymptomatic bacteriuria.

The urinary tracts of 116 schoolgirls with asymptomatic bacteriuria detected at screening were investigated by excretory urography and micturition cystourethrography. Three years later the studies were repeated in 11 patients with scarred kidneys, 11 patients with unscarred kidneys plus reflux, and 14 untreated patients with radiologically normal urinary tracts. Exceptionally small scarred kidneys showed little growth. Unscarred kidneys with vesico-ureteral reflux exhibited normal growth, as did unscarred kidneys in untreated patients. The risk of kidney damage developing as a result of asymptomatic bacteriuria in a schoolgirl with a radiologically normal urinary tract seems to be small.

Adolescent

Asymptomatic bacteriuria in schoolgirls. II. Differences in escherichia coli causing asymptomatic bacteriuria.

Three hundred and forty-three E. coli strains isolated from the urine of patients with asymptomatic bacteriuria (ABU), symptomatic cystitis, or pyelonephritis were analysed with regard to O group distribution and sensitivity to the bactericidal effect of normal serum. Strains of O groups 1, 2, 4, 6, 7, 16, 18 and 75 were found in 31.3% in ABU, in 58.7% in cystitis and in 79.8% in pyelonephritis. Spontaneous agglutination was noted in 45.2% of ABU, 6.5% of cystitis and 1.7% of pyelonephritis strains. The strains from patients with ABU were significantly more sensitive to the bactericidal effect of normal serum than were those from patients with symptomatic urinary tract infection. In some patients with untreated ABU, changes in the characteristics of the urinary strains isolated were noted. The strains tended to become spontaneously agglutinating as well as more sensitive to the bactericidal activity of normal serum. The strains found in patients with ABU probably had an altered cell wall compared with those found in patients with symptomatic infections such that they produce fewer symptoms and possibly be less virulent.

ABO Blood-Group System

Polymicrobic bacteriuria: significant association with bacteremia.

Current clinical practice states that a urine culture yielding three or more isolates must be considered a contaminated specimen and discarded. The validity of this practice was tested by reviewing all patients at the West Haven Veterans Administration Hospital with positive blood cultures for 1 year to determine how many were associated with polymicrobic bacteriuria (two or more urine isolates each present at greater than 10(5) colonies/ml). During 1973 there were 18 patients who had bacteremia associated with a urinary tract infection in which the same organism with the identical antibiogram was found in both the blood and the urine of these 18 patients with monomicrobic bacteremia 11(61%) had polymicrobic bacteriuria, with a mean of an additional 1.75 urinary pathogens present in significant quantities. In these patients with polymicrobic bacteriuria, an indwelling bladder catheter was present for a mean period of 4.4 months before the episode of bacteremia. Only 5 of the 11 patients with polymicrobic bacteriuria had temporally associated urinary tract manipulation. Monomicrobic bacteriuria occurred in seven patients (39%). The mean indwelling bladder catheter time was 0.9 days, and urinary tract manipulation near the time of bacteremia occurred in all seven patients. Prospectively, nine other patients with polymicrobic bacteriuria were recultured by one of us to be certain that appropriate collection and transportation methods were used; the presence of polymicrobic bacteriuria was repeatedly demonstrated in 7(78%). This study illustrates the clinical importance of polymicrobic bacteriuria.

Aged

Bacteriuria in men infected with HIV-1 is related to their immune status (CD4+ cell count).

OBJECTIVE: Reports from the United States that urinary tract infections (UTI) are more common in homosexual than in heterosexual men have not been confirmed in Europe. The occurrence of several UTI in men infected with HIV-1 has been recorded in The Netherlands. We therefore analysed the relationship between the presence of bacteriuria and the immune status (CD4+ cell count) in these HIV-1-infected patients. DESIGN: Urinary cultures were obtained prospectively for 2 years, during the first visit and every 6 months thereafter, when signs and symptoms of UTI occurred and when patients had fever of unknown origin. CD4+ cell counts were measured at the same time. SETTING: The study was performed at the University Hospital, Utrecht, The Netherlands. PATIENTS, PARTICIPANTS: One hundred and thirty HIV-1-infected men attended our hospital. Data from 98 were analysed. Eighty-nine (91%) of these men were either homo- or bisexual. MAIN OUTCOME MEASURES: Positive urinary culture. RESULTS: Group 1 (CD4+ cell count less than 200 x 10(6)/l) consisted of 47 patients; 30% had at least one period of bacteriuria, with 21 episodes. Group 2 (CD4+ cell count 200-500 x 10(6)/l) consisted of 27 patients; 11% had at least one period of bacteriuria, with five episodes. We did not find bacteriuria in the 24 patients in group 3 (CD4+ cell count greater than 500 x 10(6)/l). The rate of bacteriuria per patient-month, 4 (group 1) versus 2 (group 2), differed significantly (P less than 0.001). A significant relationship between CD4+ cell count and bacteriuria was found (P = 0.00003); no relationship, however, was found with anal intercourse, hospitalization, Karnofsky score, follow-up, or age. CONCLUSION: We conclude that men infected with HIV and presenting with a CD4+ cell count less than 200 x 10(6)/l are at increased risk for bacteriuria.

Adult

[Prevalence and treatment of bacteriuria in the geriatric population].

The aim of this study was to evaluate the prevalence of asymptomatic bacteriuria and its prognostic factors in a geriatric population living in a nursing home. Seventy-eight patients (68 females, 10 males) with a mean age of 82 +/- 6 years (range: 60-94) were studied. Once symptomatic infection is ruled out and the risk factors had been analyzed, a urine culture was performed in all cases. We then identified two different population groups: asymptomatic bacteriuria without risk factors (group A), and asymptomatic bacteriuria with risk factors (group B). Overall prevalence of asymptomatic bacteriuria was 38.5% (Group A: 23%, group B: 63%; p < 0.001). Considering all patients with bacteriuria, 50% of cases (15 out of 30 patients) had urine incontinence, 40% suffer from severe limitation of movements and 70% had a past history of pregnancy. The same figures for the population with negative urine culture were 12.5%, 14.5%, and 46% respectively (p < 0.01). In group B, 79% of cases had more than one RF, including all patients with the association of urine incontinence, movement limitation and diabetes. In group A, 93% of asymptomatic bacteriuria were due to E. coli with low adhesin expression (27%) whereas in group B, E. coli was isolated in 44% asymptomatic bacteriuria cases, with high adhesin expression (71.5%), other enteric gram-negative bacilli (31%), non-fermentative gram-negative bacilli (19%) and gram-positive cocci (6%). Group A patients were treated with a single dose of ciprofloxacin (500 mg) with elimination of bacteria in urine in 91% of cases (at one week) and 73% of cases (at one month).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Clinical evaluation of commercial reagent strips for detection of significant bacteriuria in dogs and cats.

The reagent strip technique of quantitative urine culture was a satisfactory screening test for the detection of significant bacteriuria in dogs and cats. The reagent strip technique was found to be of almost equal sensitivity as the calibrated loop technique in identifying significant bacteriuria. Significant bacteriuria was detected in 38 of 148 urine samples evaluated by the calibrated loop technique. Of these 38 urine samples, significant bacteriuria was detected in 35 by the commercial test. False-negative results were obtained with reagent strips in 1 urine sample which had significant bacteriuria by the calibrated loop technique. The other 2 samples had bacterial counts of suspicious significance (10,000/ml of urine) by the reagent strip technique. False-positive results were obtained with the reagent strip technique in 3 urine samples; however, all 3 urine samples had bacterial counts (10,000/ml of urine) of suspicious significance when evaluated by the calibrated loop technique. The reagent strip technique was not satisfactory for the examination of patients with gross hematuria. The nitrite test portion of the commercial test did not detect significant bacteriuria in all samples and, therefore, was not suitable as a screening test for significant bacteriuria in dogs and cats. The nitrite test may have been inhibited by ascorbic acid, a metabolite which normally may exist in the urine of these animals.

Animals

Bacteriuria in a population-based cohort of women.

A survey for bacteriuria was conducted in a community-wide, unselected population of women 16--69 years old. The overall prevalence of bacteriuria was 3.5%. The prevalence of bacteriuria increased with age with a linear trend, but with a significant nonlinear component as well. Bacteriuria was associated with parity after correction for the effects of age. Current symptoms of dysuria and a history of previous urinary tract infection were slightly but significantly more common in women with bacteriuria. The population described should serve as an adequate base for continuing studies of the possible consequences of bacteriuria.

Adolescent

Significant bacteriuria among the mentally retarded. Identification and antibiotic sensitivity of isolates.

A study was carried out to determine the prevalence of significant bacteriuria in a mentally retarded population. With 100,000 or more bacteria per ml. of urine used as a criterion for significant bacteriuria, 24 of 665 persons studied were considered to have significant bacteriuria for an overall prevalence rate of 3.6%. Seventeen of the 24 positive urine cultures were either from clean catch or catheter specimens. All patients undergoing catheterization were found to have significant bacteriuria. The individual prevalence rates of significant bacteriuria for males and females were 1.7 and 5.6 respectively. In females, an increasing prevalence of bacteriuria was found primarily in the 55-64 age group. The predominant bacteria isolated from bacteriuric patients were gram-negative bacilli, Escherichia coli, being isolated in 50% of all positive cultures. Antiobiotic sensitivity patterns of the isolates indicated a high degree of in vitro resistance to both ampicillin and cephalothin.

Adolescent

The association between Staphylococcus aureus bacteremia and bacteriuria.

The relationship between Staphylococcus aureus bacteremia and bacteriuria was studied over a five year period in three hospitals. In a Veterans Administration Hospital, 59 patients with Staph, aureus bacteremia had a urine culture within 48 hours of a positive blood culture. In 16 of 59 (27 per cent), greater than 10(5) Staph. aureus was recovered from the urine in pure culture. Six of these patients had apparent primary staphylococcal urinary tract infection. Clinical and laboratory parameters in the patients with staphylococcal bacteremia and bacteriuria were compared with those in 31 patients with staphylococcal bacteremia and sterile urine cultures. The two groups differed only in the more frequent occurrence of pyuria and proteinuria in the bacteriuric patients. In two other hospitals, staphylococcal bacteriuria occurred in 7 per cent of patients with Staph. aureus bacteremia and in 13 per cent of cases of staphylococcal endocarditis. Review of autopsy records for 33 patients who died within one month of their bacteremia failed to show a correlation between bacteriuria and the presence of renal abscess. Staphylococcal bacteriuria is a frequent and unexplained concomitant of Staph. aureus bactremia.

Abscess

Asymptomatic bacteriuria in pregnancy: antibody-coated bacteria, renal function, and intrauterine growth retardation.

Asymptomatic bacteriuria (greater than 100,000 microorganisms per milliliter) was found in 70 of 1,400 pregnant women without symptoms referable to the urinary tract (five per cent). With the fluorescent antibody (FA) tests, antibody-coated bacteria were demonstrated in specimens from 35 patients (50 per cent), indicating silent renal bacteriuria. Although confirmation by direct localization methods was not feasible in this group of patients, indirect evidence of renal function impairment associated with the presence of antibody-coated bacteria was suggested by results of the serum creatinine and creatinine clearance tests. The outcome of the pregnancy was compared for patients with bacteriuria (FA-negative or FA-positive tests). An association between the presence of asymptomatic renal bacteriuria and intrauterine growth retardation was noted. Thus, the patient with asymptomatic bacteriuria and a positive FA test is at greater risk of delivering an intrauterine growth-retarded infant.

Bacteriuria

Natural history of bacteriuria in schoolgirls. A long-term case-control study.

To define better the natural history of bacteriuria in females, we followed 60 schoolgirls with bacteriuria and 38 matched controls for periods ranging from nine to 18 years. Among the schoolgirls with bacteriuria (greater than or equal to 10(5) organisms per milliliter in two or more consecutive cultures), reflux was repaired in five, nephrectomy was performed in two, and reduced inulin clearance was noted in one subject with atrophic pyelonephritis. Serum creatinine was slightly higher in cases than in controls. Renal scars or caliectasis occurred in 16 cases but in none of the controls. Blood pressure was similar in both groups. Episodes of bacteriuria in cases and controls were, respectively: five or more episodes, 21.7 and 2.6 per cent; and episodes during pregnancy, 63.8 and 26.7 per cent. Seven children of the cases but none of the children of controls showed urinary-tract infections. Bacteriuria among schoolgirls defines a group at great risk of recurrent symptomatic infections and renal scars and at low risk of reduced renal function.

Acute Disease

Significance of diuresis-provoked bacteriuria.

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

Aged

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

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

Adolescent