Absence Of Bacteriuria Research Articles

Evaluation of diagnostic criteria for bacteriuria in acutely spinal cord injured patients undergoing intermittent catheterization.

To evaluate diagnostic criteria for bacteriuria in acutely spinal cord injured patients undergoing intermittent catheterization, we studied paired urine specimens obtained by suprapubic aspiration and intermittent catheterization. Culture of suprapubic aspirate was used to define presence or absence of bacteriuria. Fifty patients were studied for an average of 5 consecutive days; bacteriuria occurred within the study period in 47 (94%). Low-level bacteriuria was frequent; thus, the traditional diagnostic criterion, greater than or equal to 10(5) cfu/ml of midcatheter urine, had unacceptably low sensitivity (gram-positive organisms 0.45; gram-negative organisms 0.65) for bacteriuria documented by suprapubic aspiration. The best diagnostic criterion for gram-positive bacteriuria was between greater than or equal to 10(1) cfu/ml (sensitivity 0.91, specificity 0.86) and greater than or equal to 10(2) cfu/ml (sensitivity 0.85, specificity 0.93). For gram-negative bacteriuria, greater than or equal to 10(1) cfu/ml was optimal (sensitivity 0.96, specificity 0.96); a more practical criterion, greater than or equal to 10(2) cfu/ml, retained excellent sensitivity (0.91). Suprapubic or flank pain and/or tenderness occurred in five of 47 bacteriuric subjects; nonspecific symptoms, possibly associated with bacteriuria, were seen in an additional 28 subjects. We conclude that, in this unique population, a criterion of greater than or equal to 10(2) cfu/ml of midcatheter urine should be used for diagnosis of bacteriuria.

Reflux Uropathy

Although much remains to be learned, most pediatric nephrologists and urologists are now in comfortable agreement with the following assumptions: (1) Most reflux (primary reflux) is due to a congenital anatomic abnormality of the bladder trigone. (2) In many instances this anomaly improves with growth and development of the child so that the reflux may cease spontaneously. In low-grade (I-II) reflux with undilated ureters, approximately 75 to 85 per cent will stop refluxing. In higher grades (III-V) with dilated ureters, the cessation rate is in the range of only 25-30 per cent. (3) Although radiologic grading is helpful in predicting the likelihood of spontaneous cessation, it is possible to improve that predictability by cystoscopic evaluation of the size, configuration, and position of the ureteral orifice plus the length of the submucosal tunnel. (4) Reflux in combination with bacteriuria can and does lead to renal scarring. (5) Renal scarring probably does not occur in patients with primary reflux and normal voiding pressures in the absence of bacteriuria. (6) Renal growth may proceed normally despite sterile reflux. (7) A few refluxing patients, perhaps 10 per cent, will have bacteriuria despite continuous antimicrobials, and these "breakthrough" infections may cause renal scars. (8) Other patients prove either unwilling or unable to comply with continuous medications and are also vulnerable to scars. (9) A successful antireflux operation may not change the recurrence rate of urinary tract infections per se, but it almost eliminates the likelihood of pyelonephritic episodes and the necessity for further continuous antibiotics. Unfortunately, in patients with intermediate grades of reflux, it is not presently known whether an early surgical correction might be more effective in allowing normal renal growth, in avoiding renal scars, and in preventing eventual hypertension, which is present as a late complication in almost 20 per cent of the patients. The data to answer this important question should ultimately be forthcoming from the current International Collaborative Reflux Study.

The incidence of erythrocyte P1 antigen retention in children with urinary tract infection.

AbstractThe erythrocyte P, antigen was observed in 91.7, 70.6, 56.7 and 62.5%, respectively, of children with upper urinary tract infection, symptomatic and asymptomatic urinary tract infections and cases responsive to initial therapy in which the abnormal urinary findings disappeared with the administration of antibiotics given despite the absence of bacteriuria. These values were significantly high (P<0.001, 0.001, 0.01, 0.001, respectively) compared with healthy controls (29.0%).In cases where initial antibiotic therapy was effective despite no significant bacteriuria, the presence of Gal cd– 4 Gal receptor in large quantity on the surface of the mucosa of the urinary tract was suggested, just as in the typical case of urinary tract infection with bacteria in the urine.No significant difference was observed in the incidence of P1 antigen in the peripheral blood of sick children according to the clinical symptoms and urinary findings in typical cases of urinary tract infection and cases responsive to initial antibiotic therapy.

Urinary tract infections in male spinal cord injured patients. Part two: Diagnostic value of symptoms and of quantitative urinalysis.

Seventy paired samples of urine, obtained by collection of a clean voided specimen and by suprapubic aspiration (SPA) of the bladder, were obtained from 43 male SCI patients who were free of indwelling catheters. The relationship of the presence or absence of symptoms and the degree of pyuria (determined quantitatively using a haemocytometer) to the presence or absence of bacteriuria (SPA specimen) was determined. Symptoms were poorly predictive of bacteriuria with concordance seen only 40% of the time. Most bacteriuric episodes (37/51-72.5%) were asymptomatic. The quantity of WBC in voided urine accurately reflected that in SPA urine (r = 0.825), indicating that urodynamics in SCI patients who received sphincterotomies are different than in normal persons. Pyuria (greater than or equal to 10(4) WBC per cc urine) was an excellent predictor of UTI--37 of 38 (97.4%) had UTI. However, 40.6% of samples with WBC less than 10(4) were also culture positive. Overall, consideration of the presence or absence of pyuria in relation to the presence of bacteriuria provided a sensitivity of 74.0%, specificity of 95.9%, and predictive value of a positive test of 97.4%. The predictive value of a negative test (WBC less than 10(4), however, was only 59.4%. There was poor correlation between absolute bacterial and WBC count. The point of cutoff for bacterial count correlating with 10(4) WBC count was not statistically significant in these patients; this is possibly due to repeated bacterial contamination from anterior urethra. While symptom status was often misleading, the presence of greater than 10(4) WBC per cc of urine was highly predictive of the presence of bacteriuria in male SCI patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Urine lactic dehydrogenase--an aid in the management of patients with spinal cord injury.

Urine lactic dehydrogenase (LD) and urinary LD isoenzyme determinations were performed for 59 adult afebrile patients with spinal cord lesions. Twenty-eight were found to have a predominance of LD 1 and 2. Thirteen had positive urine cultures and 12 also had positive antibody coated bacteria (ACB). Twenty were found to have a predominance of LD 4 and 5, with a mean total urine LD activity of 175.7 mU/ml. Sixteen of this group had positive urine cultures and 12 also ACB positive. Eleven had no demonstrable LD isoenzyme with a mean total urine LD activity of 17.5 mU/ml. Eight had positive urine cultures and four were also ACB positive. Forty-six normal controls had a mean LD activity of 15.1 mU/ml. In the study population changes in U-LD occurred in the absence of bacteriuria most frequently in patients who were appliance-free or used catheterization. In the absence of bacteriuria bladder overdistention may contribute to changes in LD isoenzyme patterns.

Does low urinary sIgA predispose to urinary tract infection?

Median urinary secretory IgA (sIgA) (ELISA technique in unprocessed urine) was 1.36 mg/liter (range, 0.29 to 2.31) in healthy female controls at various times of the menstrual cycle. It was significantly lower in women with urinary tract infection (UTI) without antibody-coated bacteria. Such decrease was found both in women with acute UTI episodes (median, 0.16; range, 0.06 to 1.71) and in asymptomatic nonbacteriuric women with a history of UTI (median, 0.52; range, 0.05 to 2.13). In the latter women, sIgA in nasal secretions tended to be low, but salivary sIgA was unchanged. Urinary sIgA was elevated significantly in individuals with nephrostomy and antibody-coated bacteria (14.4 mg/liter, range, 3.6 to 20). The study showed that locally synthesized sIgA immunoglobulins were low in the urine of individuals with recurrent UTI independent of the presence or absence of bacteriuria at the time of the study. UTI per se did not interfere with sIgA secretion as shown by high sIgA in patients with upper UTI. Low urinary sIgA may represent one factor predisposing to recurrent UTI.

Urinary tract infection: correlation of pyuria, bacteriuria with urine culture

Three hundred cases were analysed to find out value of direct smear examination, pus cell count and their correlation with culture method for diagnosis of urinary tract infection in children. Of 132 specimens with significant pyuria in uncentrifuged urine, and 102 specimens with significant pyuria in centrifuged urine, 54(40.9%) and 42(41%) cases respectively showed absence of bacteriuria. There was no satisfactory correlation between pyuria and bacterial colony count. Gram stain smear examination of the centrifuged urine showed high correlation with bacterial count in urine cultures. This is a good method in the absence of microbiology laboratory for the diagnosis of urinary tract infection.

Study of pyelonephritis using renal biopsy material.

Introduction Pyelonephritis is defined as an inflammation of the pelvis and parenchyma of the kidney. Historically the inflammation has been considered to be the result of direct bacterial invasion. However, there is little definitive evidence that documents the presence of bacteria in the kidney of patients with this disease. The purpose of this investigation was to determine if kidney tissue, obtained by percutaneous or surgical biopsy, harbors bacteria in patients with pyelonephritis and to relate these findings to the presence or absence of bacteriuria. Method and Material Patients were included in this study on the basis of the clinical presence of renal disease, most frequently pyelonephritis. A. Bacteriologic. — Renal tissue was obtained from 63 patients by percutaneous biopsy in 58 and by a surgical procedure in 5. A urine culture was done on the day of, or day prior to, the biopsy in most instances. In the other patients