Asymptomatic Urinary Infection Research Articles

The Paradigm Shift to Non-Treatment of Asymptomatic Bacteriuria.

Asymptomatic bacteriuria, also called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract. The characterization and introduction of the quantitative urine culture in the 1950s first allowed the reliable recognition of asymptomatic bacteriuria. The observations that a substantial proportion of patients with chronic pyelonephritis at autopsy had no history of symptomatic urinary infection, and the high frequency of pyelonephritis observed in pregnant women with untreated asymptomatic bacteriuria, supported a conclusion that asymptomatic bacteriuria was harmful. Subsequent screening and long term follow-up programs for asymptomatic bacteriuria in schoolgirls and women reported an increased frequency of symptomatic urinary tract infection for subjects with asymptomatic bacteriuria, but no increased morbidity from renal failure or hypertension, or increased mortality. Treatment of asymptomatic bacteriuria did not decrease the frequency of symptomatic infection. Prospective, randomized, comparative trials enrolling premenopausal women, children, elderly populations, patients with long term catheters, and diabetic patients consistently report no benefits with antimicrobial treatment of asymptomatic bacteriuria, and some evidence of harm. Several studies have also reported that antimicrobial treatment of asymptomatic bacteriuria increases the short term risk of pyelonephritis. Current investigations are exploring the potential therapeutic intervention of establishing asymptomatic bacteriuria with an avirulent Escherichia coli strain to prevent symptomatic urinary tract infection for selected patients.

Efficacy and Safety of Botulinum Toxin A Intradetrusor Injections in Adults with Neurogenic Detrusor Overactivity/Neurogenic Overactive Bladder: A Systematic Review

Botulinum toxin A (BoNTA) is increasingly used for therapy of neurogenic detrusor overactivity (NDO) refractory to antimuscarinics or where patients are experiencing antimuscarinic-related side effects. The objective was to compare and critically discuss the reported efficacy and safety of BoNTA in adults with neurogenic bladder dysfunction. Studies published between January 1985 and July 2012 were identified in the MEDLINE (PubMed) and SCOPUS databases. A search for studies with onabotulinumtoxinA--the only formulation of BoNTA approved by the US FDA in adults with NDO--was performed. Exclusion criteria were urethral sphincter injection, no separate analysis between onabotulinumtoxinA and other formulations of BoNTA, mean follow-up ≤ 4 weeks and studies with ten or fewer patients. Clinical and urodynamic parameters for efficacy, adverse events (AEs) and tolerability were reviewed to offer recommendations for practice and future research. A total of 28 included studies revealed superior effects of onabotulinumtoxinA compared with placebo in achieving continence, reducing incontinence episodes, improving urodynamic parameters and health-related quality of life. The most frequently reported AEs were de novo intermittent catheterization, urinary retention and asymptomatic urinary infection. Limitations of this review are the inclusion of studies with the level-3 evidence (22/28 studies), the heterogenicity of outcome parameters and time points chosen for follow-up reported in the reviewed studies. OnabotulinumtoxinA therapy is effective, safe and well tolerated in adults with neurogenic bladder dysfunction. Further high-quality prospective trial data are required to determine the optimal dose, injection technique, long-term safety, favourable timing, indications for re-injections, and the impact of concomitant antimuscarinics on onabotulinumtoxinA therapy.

Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection: A large prospective study with long-term follow up using Plastibell

To evaluate the preventive effect of neonatal circumcision on urinary tract infection and the incidence of complications following neonatal circumcision using Plastibell. A prospective study was carried out between 2004 and 2008. During this period, there were 3000 neonatal circumcisions. All of the cases were examined for any complications 1 week later, and occurrence of meatal stenosis was followed up to 15 months of age. In this group, urine analysis and culture was successfully performed four times for 2000 circumcised infants at 1.5, 3, 9 and 15 months. In the control group of 3000 uncircumcised infants, 1000 cases accomplished urine analysis and culture at the same designated intervals. A positive urine culture was observed in none of the circumcised cases and in 20 (2%) uncircumcised cases after obtaining a suprapubic bladder aspiration sample. The latter 20 infants were circumcised and follow-up cultures were negative in 17 cases. The overall complication rate in the circumcised group was 1.6%. The difference in frequency of urinary tract infection between the two groups was statistically significant (P<0.0001). Neonatal circumcision has few complications and reduces the incidence of asymptomatic urinary infection. It may be considered as a preventative health measure.

Contributory Factors to Postoperative Spinal Fusion Complications for Children With Myelomeningocele

This is a retrospective review of all children with myelomeningocele (MMC) who were undergoing surgery for scoliosis at our institution. Our aim was to investigate possible correlations between poor nutritional indexes and/or positive urinary cultures before surgery to perioperative infection risk. Patients who have scoliosis secondary to MMC have been shown to have a high rate of infectious complications. Many children with MMC have been found to have asymptomatic urinary tact infections due to their neurogenic bladder. There is little literature on risk factors for and ways to prevent postoperative infections for these patients. We reviewed a comprehensive database for the outcome for spinal fusion surgeries of 59 patients with MMC treated at our institution over the past 45 years. Perioperative infections were correlated to preoperative nutritional status (measured by patient hematocrit [Hct]) and presence of active infection using Fisher Exact Probability Test. A total of 84 different spinal fusion operations for 59 patients were recorded. Patients presenting with poor preoperative nutrition (Hct<or=33) and positive preoperative urinary cultures demonstrated the highest risk for perioperative wound infection (P=0.001). Patients with preoperative poor nutrition without a positive urinary culture as well as those with adequate nutritional status but a preoperative positive urinary culture showed an increased risk of wound infection respectively (P=0.03) and (P=0.002). Positive urine cultures obtained before spinal surgery for children with MMC significantly increased the risk for perioperative wound (P=0.002). Urinary tract infections can be easily detected and treated. We believe urinary culture, protein deficiencies, or Hct<or=33, should be treated and corrected before surgery.

Prevalence and risk factors of urinary tract infections in type 2 diabetic women

Background: Diabetic patients are more susceptible to urinary tract infections (UTI) than non-diabetics .This study was carried out to determine the prevalence and risk factors of urinary tract infections in type 2 diabetic women in Tehran. Methods: This cross sectional study was designed to examine 511 non-pregnant type 2 diabetic women using consecutive sampling during September and March 2007. Subjects were selected from attendance of an Endocrine and Metabolism Institute of Iran University of Medical Sciences. Subjects were allocated in two symptomatic and non- symptomatic groups. Participants with symptoms of UTI and one positive urine culture were put in symptomatic group and those without symptoms of UTI with two positive urine cultures were assigned as non-symptomatic group. Asymptomatic UTI group was defined by the presence of more than 105 colony-forming units(CFU) per milliliter of one or two microorganisms in a culture of clean-voided midstream urine. Different related risk factors for developing UTI were investigated. Results: It was indicated that prevalence of symptomatic urinary tract infection was 6.2% and prevalence of asymptomatic urinary tract infection was 1.8%. In this study, age was the only variable among risk factors for UTI that showed significant association with urinary tract infection in diabetic women (p=0.049) There was no correlation between UTI and other risk factors. Conclusion: This study showed that the prevalence of urinary tract infections in type 2 diabetic women was lower than the previous studies. Age is a risk factor for UTI in diabetic patients .

Outcome of surgery for scoliosis in patients with myelomeningocele

Background Since the 1950s, patients with severe, progressive scoliosis have undergone spinal instrumentation to reduce the curvature and to provide more stability to the spinal fusion. Patients that have scoliosis secondary to myelomeningocele (MMC), have been shown to have an increased number of complications compared to patients with scoliosis due to other conditions. There is little literature on risk factors for and ways to prevent post operative complications for these patients. Many children have been found to have asymptomatic urinary tact infections due to their neurogenic bladder.

Editorial Comment

The authors investigate whether the use of a disposable needle guide results in a decreased incidence of infectious complications after transrectal prostate biopsy. Previous studies have focused on different antibiotic prophylaxis regimens and the use of enemas to reduce infectious complications. This appears to be the first study reporting the use of a disposable needle guide. One hundred ninety-eight patients were randomly assigned into 2 groups. Group 1 underwent a biopsy with a reusable needle guide that was disinfected with 3.2% glutaraldehyde solution between patients and group 2 underwent a biopsy with a disposable transrectal ultrasound probe needle guide. All patients had a negative urine and blood culture 2 days before the procedure. The patients also received ciprofloxacin 500 mg twice a day beginning the day before the biopsy and continued for 1 week after. The infectious complication rates were recorded as asymptomatic bacteriuria, high fever, and acute urinary infection. All 3 complication rates were found to be significantly lower in group 2.

Urinary tract infections in older people

Urinary tract infection is the most common bacterial infection in older populations. It is an important clinical problem across the full spectrum – from elderly persons who are well and living in the community to highly functionally impaired residents of long-term care facilities. Symptomatic urinary infection is a frequent cause of morbidity, and urinary infection is responsible for substantial antimicrobial use. This review summarizes current knowledge relevant to both asymptomatic and symptomatic urinary infection in older populations, and identifies unresolved issues for further study. The discussion is relevant to older individuals without indwelling urethral catheters, unless it is specifically stated that the older person with an indwelling catheter is being addressed.

IL-1beta, IL-6 and IL-8 levels in gyneco-obstetric infections.

During pregnancy cytokines and inflammatory mediators stimulate the expression of prostaglandin, the levels of which determine the onset of labor. The aim of this work was to study interleukin IL-1beta, IL-6 and IL-8 levels in the vaginal discharge, serum and urine of pregnant women with genitourinary infection before and after specific treatment. One hundred and fifty-one patients were studied during the second or third trimester of their pregnancy. The selected patients were: healthy or control group (n = 52), those with bacterial vaginosis (n = 47), those with vaginitis (n = 37), those with asymptomatic urinary infection (n = 15) and post-treatment. The level of cytokines was assayed by ELISA test. The Mann-Whitney U-test was used for statistical analysis. The IL-1beta levels in vaginal discharge were: control 103.5 +/- 24.2 pg/ml, bacterial vaginosis 1030 +/- 59.5, vaginitis 749.14 +/- 66.7l ( p < 0.0001), post-treatment 101.4 +/- 28.7. IL-6 values were similar in both control and infected groups, and there were no patients with chorioamnionitis. In vaginal discharge IL-6: control 14.2 +/- 3.9 pg/ml, bacterial vaginosis 13.2 +/- 3.8, vaginitis 13 +/- 4.2. IL-8 levels were: control 1643 +/- 130.3 pg/ml, bacterial vaginosis 2612.7 +/- 257.7, vaginitis 3437 +/- 460 (p < 0.0001), post-treatment 1693 +/- 126.6. In urine the results were: control 40.2 +/- 17 pg/ml, asymptomatic urinary infection 1200.7 +/- 375 (p < 0.0001). In patients with therapeutic success both IL-1beta and IL-8 returned to normal levels. Genitourinary infections induce a significant increase in IL-1beta and IL-8 levels in vaginal secretions, and IL-8 in urine as well. Both cytokines could be useful as evolutive markers of infection.

IL-1beta, IL-6 and IL-8 levels in gyneco-obstetric infections.

OBJECTIVE: During pregnancy cytokines and inflammatory mediators stimulate the expression of prostaglandin, the levels of which determine the onset of labor. The aim of this work was to study interleukin IL-1beta, IL-6 and IL-8 levels in the vaginal discharge, serum and urine of pregnant women with genitourinary infection before and after specific treatment. One hundred and fifty-one patients were studied during the second or third trimester of their pregnancy. METHODS: The selected patients were: healthy or control group (n = 52), those with bacterial vaginosis (n = 47), those with vaginitis (n = 37), those with asymptomatic urinary infection (n = 15) and post-treatment. The level of cytokines was assayed by ELISA test. The Mann-Whitney U-test was used for statistical analysis. RESULTS: The IL-1beta levels in vaginal discharge were: control 103.5 +/- 24.2 pg/ml, bacterial vaginosis 1030 +/- 59.5, vaginitis 749.14 +/- 66.7l ( p < 0.0001), post-treatment 101.4 +/- 28.7. IL-6 values were similar in both control and infected groups, and there were no patients with chorioamnionitis. In vaginal discharge IL-6: control 14.2 +/- 3.9 pg/ml, bacterial vaginosis 13.2 +/- 3.8, vaginitis 13 +/- 4.2. IL-8 levels were: control 1643 +/- 130.3 pg/ml, bacterial vaginosis 2612.7 +/- 257.7, vaginitis 3437 +/- 460 (p < 0.0001), post-treatment 1693 +/- 126.6. In urine the results were: control 40.2 +/- 17 pg/ml, asymptomatic urinary infection 1200.7 +/- 375 (p < 0.0001). In patients with therapeutic success both IL-1beta and IL-8 returned to normal levels. CONCLUSIONS: Genitourinary infections induce a significant increase in IL-1beta and IL-8 levels in vaginal secretions, and IL-8 in urine as well. Both cytokines could be useful as evolutive markers of infection.

Asymptomatic bacteriuria in elderly humans is associated with increased levels of circulating TNF receptors and elevated numbers of neutrophils

Low-grade inflammatory activity is strongly associated with age-associated diseases such as atherosclerosis, dementia, type-2 diabetes, sarcopenia, and osteoporosis and predicts mortality risk in elderly populations. The aim of the current study was to investigate if asymptomatic bacteriuria in elderly humans was associated with inflammation. Midstream clean-catch urine culture was collected from consecutive, elderly patients at admission to a department of internal medicine due to functional disability. Forty patients (age 70-91 years) were selected and included in the current study; 20 subjects had positive urine culture and 20 sex- and age-matched subjects had negative urine culture. Inclusion criteria were temperature below 37.8 degrees C, no clinical signs of infection and no current antibiotic treatment. Patients with asymptomatic bacteriuria had significantly increased levels of circulating tumor necrosis factor receptors (sTNFR-I) and a higher number of neutrophils in the blood compared to the group without bacteriuria. Thus, the present study provides some support for the hypothesis that asymptomatic urinary infections are associated with low-grade immune activity in frail, elderly humans.

Cost-effectiveness of urinary dipsticks to screen asymptomatic catheter-associated urinary infections in an intensive care unit

To assess the cost-effectiveness of urinary dipsticks (UDs) to screen asymptomatic catheterized patients for quantitative urine. Prospective comparison of UD with quantitative urine culture (QUC) (reference technique) and cost-effectiveness analysis performed from the hospital's perspective. Medical intensive care unit (ICU) of the Besançon University Hospital (France). All consecutive, asymptomatic, catheterized patients. Urinary dipsticks (Multistix 8-SG) were analyzed by the reflectance spectrophotometric method (Clinitek 50). Sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of four combinations of the leukocyte (L) test pad and the nitrite (N) test pad were calculated: L and N, L or N, L alone and N alone. A micro-costing technique was used to determine the direct medical cost of each strategy. The calculated cost-effectiveness ratio was the incremental cost-effectiveness (ICE) ratio. Three hundred thirty-nine urine samples taken from 144 patients were analyzed. The incidence of asymptomatic catheter-associated urinary tract infections (CAUTIs) was 31.3% (> or =10(5) organisms/ml). The L or N combination was the best detector of asymptomatic CAUTI: Se=87.2%, Sp=61.6%, PPV=30.6% and NPV=96.1%. The cost of QUC strategy and UD strategy was EUR 21.5 and EUR 12.6 per test, respectively. The ICE ratio of QUCs was EUR 69.5 per case of detected CAUTI. The UD is a cost-effective test for screening asymptomatic catheterized patients for quantitative urine culture in a medical ICU.

Preeclampsia: from epidemiological observations to molecular mechanisms.

Preeclampsia is the main cause of maternal mortality and is associated with a five-fold increase in perinatal mortality in developing countries. In spite of this, the etiology of preeclampsia is unknown. The present article analyzes the contradictory results of the use of calcium supplementation in the prevention of preeclampsia, and tries to give an explanation of these results. The proposal of an integrative model to explain the clinical manifestations of preeclampsia is discussed. In this proposal we suggest that preeclampsia is caused by nutritional, environmental and genetic factors that lead to the creation of an imbalance between the free radicals nitric oxide, superoxide and peroxynitrate in the vascular endothelium. The adequate interpretation of this model would allow us to understand that the best way of preventing preeclampsia is the establishment of an adequate prenatal control system involving adequate antioxidant vitamin and mineral supplementation, adequate diagnosis and early treatment of asymptomatic urinary and vaginal infections. The role of infection in the genesis of preeclampsia needs to be studied in depth because it may involve a fundamental change in the prevention and treatment of preeclampsia.

Benign prostatic hyperplasia with PSA &gt; 10.0 ng/ml: Correlations between PSA density and pathological findings of the surgical specimen after open prostatectomy

— Thirty patients with benign prostatic hyperplasia and PSA levels &gt; 10.0 ng/ml were submitted to open prostatectomy after a precise evaluation with transrectal ultrasound and prostatic biopsies. In the surgical specimen 7 prostatic carcinoma (23%) were found incidentally. In the remaining 23 patients the presence of active histological prostatitis was correlated with the PSA and PSA density values but was not directly due to an asymptomatic urinary infection or indwelling catheter. PIN and other pathological findings were not found to be correlated with PSA values.

Urinary IgG and IgA Antibodies in Elderly Individuals with Bacteriuria

We studied the urinary IgG and IgA antibody in elderly subjects without bacteriuria, with asymptomatic bacteriuria and symptomatic urinary infection. Elderly individuals with asymptomatic bacteriuria had significantly elevated antibody levels relative to controls. When followed up to 12 months with persistent bacteriuria, antibody levels tended to persist but were variable. In elderly women with elevated urinary antibody titers, site of infection tended to be localized to the kidney, but antibody levels within the control range occurred as frequently as elevated antibody levels for renal infection. Subjects with invasive urinary infection had significantly elevated antibody levels at onset of symptoms, with levels increased or decreased when repeated 2-4 weeks later. Further studies to clarify the clinical significance of these observations are necessary.

Urinary nitrite in symptomatic and asymptomatic urinary infection.

The dipstrip test for urinary nitrite is fairly unreliable in symptomatic urinary infections and only 104 (52%) of 200 symptomatic children with urinary infection attending an emergency department had a positive result. The test yielded positive results, however, in 83 of 100 outpatients with largely asymptomatic urinary infection attending a follow up clinic because of known predisposition to urinary infection. This difference was highly significant. The finding of urinary nitrite is highly specific for urinary infection and only 1% of 300 uninfected urine specimens gave a positive result. After addition of a broth culture of Escherichia coli to sterile urine incubation at 37 degrees C for four to six hours was required before the nitrite test yielded positive results. This suggests that frequency of micturition in urinary infection reduces the reliability of the nitrite test. On the other hand, the use of overnight, first morning urine specimens may further improve the sensitivity. If nitrite testing is used for screening for urinary infection at home, however, patients should be warned not to rely on a negative result in the presence of symptoms of urinary infection.

Urinary infection in infants and preschool children. Five-year follow-up.

A group of 1,617 infants and 1,711 preschool children were studied for symptomatic and asymptomatic urinary infection and followed up for three to five years. Asymptomatic bacteriuria was found in 1.8% of female infants, 0.5% of male infants, 0.8% of preschool girls, and none of the preschool boys. Seventeen percent of the infants and 13% of the preschool children with urinary infection studied roentgenographically had upper tract damage; 46% of the infants and 9% of the preschool children had vesicoureteral reflux. Infants with normal urinary tracts and urinary infection with or without reflux tended to have recurrent infection, whereas the kidneys remained anatomically normal. The infants with high-risk lesions, such as obstructive uropathy and vesicoureteral junction ectopia and deformity, had substantial bacteriuria on screening culture.

Follow-up of 13 children after ureterosigmoidostomy.

Follow-up of 13 children who had had a ureterosigmoid anastomosis 3 1/2 to 10 years previously and whose initial urogram had been satisfactory, showed that growth was normal and that there was no serious metabolic disorder. In particular whole-body potassium did not differ significantly from normal values (as given by Langham, 1961). Asymptomatic urinary infection is the chief hazard in these cases but is difficult to diagnose and may lead to progressive dilatation of the ureters.

Dépistage des infections urinaires asymptomatique chez l'enfant et l'adolescent. Principe et méthode

Screening for asymptomatic urinary infections in children and adolescents. Principles and method The reasons for early detection of inapparent urinary infections in young girls are discussed. The technical methods of gaining midstream urine and of preparation of urinary cultures by the “Uricult” technique are described. Two consecutive positive samples from the same person, revealing the same germs, indicate the need for further urological evaluation and for appropriate treatment. Its effectiveness is evaluated by repeatet bacteriological follow-up examinations.

R factors in bacteria causing asymptomatic urinary infection in antenatal patients.

R factors in bacteria causing asymptomatic urinary infection in antenatal patients.