Persistent Bacteriuria Research Articles

Bacteriuria in the puerperium: Risk factors, screening procedures, and treatment programs

Screening for bacteriuria by culture of voided midstream urine was done in 6803 puerperal women; significant growth was found in 8.1%. The urine was recollected by suprapubic aspiration and bacteriuria was confirmed in 52%, corresponding to an incidence of bladder bacteriuria of 3.7%. A history of past urinary tract infection, bacteriuria in pregnancy, operative delivery, epidural anesthesia, and bladder catheterization increased the risk of postpartum urinary tract infection. Only 21% of the women complained of dysuria; this symptom occurred significantly more often after operative delivery and in patients with previous urinary tract infection. Two hundred fifty-one women with bladder bacteriuria were subjected to different treatments by randomized allocation: 153 patients with amoxicillin-susceptible bacterias were selected for amoxicillin treatment of 1, 3, and 10 days' duration. The cure rates were 84%, 94%, and 98%, respectively; the single-dose therapy was significantly less effective than 10 days' treatment (p < 0.05). Forty-six women with amoxicillin-resistant bacterial infections received cephalexin or nitrofurantoin therapy of 7 days' duration; the cure rate was 91%. Fifty-two women served as control subjects and received no treatment. Ten weeks later 27% still had persistent bacteriuria in their suprapubic aspiration control specimens. All therapeutic regimens except the single-dose method showed a cure rate that was significantly higher than the spontaneous cure rate (p < 0.05). Multiparity seemed to be a predisposing factor for persistence of bacteriuria. The study indicates that puerperal patients with positive midstream urine specimens should not be automatically treated, but more thoroughly examined. In cases of confirmed bladder bacteriuria, treatment should be recommended; 3 days' therapy appears to be sufficient.

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.

Intermittent urethral catheterization in the elderly.

Thirty-five elderly patients receiving intermittent urethral catheterization in a Veterans Administration Hospital and attached nursing home care unit were prospectively studied for development of bacteriuria and/or urinary tract infection. Thirty-one of the 35 patients (88.6%) developed urinary tract colonization. The mean time from initiation of catheterization to development of colonization was 5.7 +/- 1.3 days. Persistent bacteriuria with one or several different microorganisms developed in 17 patients. The most common colonizing organisms were coagulase negative staphylococci, Klebsiella pneumoniae, and enterococcus. Four patients (11%) developed symptomatic urinary tract infection. Although urinary tract colonization was common in patients receiving intermittent urethral catheterization, especially in those with poor functional status, infection was uncommon. Based on these results, intermittent urethral catheterization appears to be a safe and effective method of bladder drainage in elderly male patients when performed with sterile techniques over short periods of time in the nursing home or hospital setting.

Bacteriuria Following Extracorporeal Shock Wave Lithotripsy of Infection Stones

Extracorporeal shock wave lithotripsy effectively pulverizes infected (struvite) renal calculi. However, after treatment minute residual fragments that may harbor bacteria and cause persistent bacteriuria remain in the renal collecting system for months. We investigated prospectively the incidence of persistent Proteus mirabilis bacteriuria after extracorporeal shock wave lithotripsy among 15 consecutive women with Proteus mirabilis urinary tract infections and struvite calculi. All patients received parenteral gentamicin for 3 to 8 days (mean 4.7 days) immediately before and after extracorporeal shock wave lithotripsy. Oral antimicrobials then were administered for 14 to 34 days (mean 25 days). Ten patients have maintained a sterile urine or experienced urinary reinfection by other organisms during 8 to 19 months (mean 13 months) of subsequent bacteriological surveillance. Of these 10 patients 9 had residual fragments. Five patients had Proteus mirabilis bacteriuria after 1 to 7 months of surveillance, including 3 with residual fragments. The mean stone size, methods and duration of renal drainage procedures, and duration of antimicrobial therapy were similar for the 2 patient groups. Proteus mirabilis was isolated from the cultures of only 3 of 11 retrievable stone fragments. In contrast to intact infected renal calculi, residual stone fragments after extracorporeal shock wave lithotripsy often are susceptible to sterilization with antimicrobials.

The treatment of asymptomatic bacteriuria in the elderly.

The treatment of asymptomatic bacteriuria in the elderly.

Bacteriuria in Pregnancy

The urinary tract undergoes profound physiologic and anatomic changes during pregnancy that facilitate the development of symptomatic urinary tract infections in women with bacteriuria. While the adverse effects of asymptomatic bacteriuria on maternal and fetal health continue to be debated, it is clear that asymptomatic bacteriuria is the major risk factor for developing symptomatic urinary tract infection and that symptomatic infections are associated with significant maternal and fetal risks. Because the majority of symptomatic urinary tract infections develop in women with bacteriuria earlier in pregnancy, treatment of bacteriuria is undertaken to prevent symptomatic infections. All women should be screened at the first antenatal visit, which is reliably and inexpensively done with a dipstick culture. Short-course therapy is as effective as prolonged therapy and should be followed with a repeat culture to document clearing of the bacteriuria. Failure to eliminate bacteriuria with repeated therapy or recurrence with the same organism is indicative of renal parenchymal infection or a structural abnormality. All women with persistent bacteriuria or recurrent infection should have follow-up cultures and a complete urologic evaluation after delivery.

Effects of aerobic training on primary dysmenorrhea symptomatology in college females.

Abstract “Single-Dose Therapy for Cystitis in Women: A Comparison of Trimethoprim-Sulfamethoxazole, Amoxicillin, and Cyclacillin,” Thomas M. Hooton et al. We evaluated single-dose regimens of trimethoprim-sulfamethoxazole, amoxicillin, and cyclacillin as treatment for acute cystitis in 38 women. The trial was prematurely stopped because of frequent treatment failures. At two days after treatment, all 13 patients given trimethoprim-sulfamethoxazole were cured, while four (31%) of the 13 given amoxicillin and four (33%) of 12 given cyclacillin had persistent bacteriuria. At two weeks, 11 (85%) of 13 patients given trimethoprim-sulfamethoxazole, six (50%) of 12 given amoxicillin, and three (30%) of ten given cyclacillin were cured. One patient with positive results of antibody-coated bacteria testing who was treated with cyclacillin had signs and symptoms of acute pyelonephritis three days after treatment, and two patients treated with amoxicillin and one treated with trimethoprim-sulfamethoxazole converted ...

Single-Dose Therapy for Cystitis in Women

We evaluated single-dose regimens of trimethoprim-sulfamethoxazole, amoxicillin, and cyclacillin as treatment for acute cystitis in 38 women. The trial was prematurely stopped because of frequent treatment failures. At two days after treatment, all 13 patients given trimethoprim-sulfamethoxazole were cured, while four (31%) of 13 given amoxicillin and four (33%) of 12 given cyclacillin had persistent bacteriuria. At two weeks, 11 (85%) of 13 patients given trimethoprim-sulfamethoxazole, six (50%) of 12 given amoxicillin, and three (30%) of ten given cyclacillin were cured. One patient with positive results of antibody-coated bacteria testing who was treated with cyclacillin had signs and symptoms of acute pyelonephritis three days after treatment, and two patients treated with amoxicillin and one treated with trimethoprim-sulfamethoxazole converted antibody-coated bacteria test results from negative to positive after therapy. We conclude that single-dose treatment of cystitis in unselected women with cyclacillin and amoxicillin may result in low cure rates and that progression to acute pyelonephritis may occur following ineffective single-dose therapy.

The urine smell around patients with urinary incontinence. The production of ammonia in ordinary diapers and in diapers impregnated with copper acetate.

The foul smell of urine around patients with urine incontinence is thought to be due mainly to the production of ammonia from urea by bacterial ureases. The production of ammonia was thus measured by infrared spectrophotometry in control diapers and in test diapers impregnated with copper acetate (CA), after use by urine-incontinent patients with persistent bacteriuria. The CA-impregnated diapers produced significantly less ammonia than the control diapers. The CA-impregnated diapers were not bactericidal, however. The results are consistent with the hypothesis that the smell reduction of the CA-impregnated diapers is due to a bacteriostatic action or an inhibition of bacterial ureases by CA.

The Reversibility of Catheter-Associated Polypoid Cystitis

Cystoscopic and histologic evidence of polypoid cystitis was recorded in 20 hospitalized patients with indwelling urethral catheters followed by cystoscopy, biopsies and repeated urine samples before and after catheter removal. The majority of the lesions were located in the posterior wall or dome. The lesions disappeared after removal of the catheter in 13 of the 15 patients followed for up to 28 weeks despite persistent bacteriuria. Polypoid cystitis still remained 28 weeks after catheter removal in 1 patient. The lesion is important as a differential diagnosis to bladder tumor. The importance of adequate biopsies is emphasized.

Diagnostic value and biological significance of antibody-coated bacteria in urine.

The incidence of antibody-coated bacteria (ACB) in the urinary sediments as an indication of the site of urinary tract infections (UTI) was investigated in 103 adult subjects with persistent bacteriuria by means of a direct immunofluorescence technique.ACB were found in 49 of 58 (84.5%) subjects with long-standing upper urinary tract obstruction and in 5 of 45 (11.1%) with lower UTI; this difference was statistically significant (X(2) = 51.79; P<0.001). The group with upper UTI was further subdivided according to renal function (patients with renal insufficiency had both bilateral obstruction and bilateral renal damage); 21 positive results were obtained in 27 (77.8%) patients with normal renal function, whereas 28 positive cases were observed among 31 (90.3%) patients with chronic renal insufficiency. Thus the degree of renal involvement also seemed to influence the outcome of the test. Within the group of lower UTI, a higher rate of ;false-positive' results was obtained in 14 patients with symptomatic long-standing infection (21.4%) than in 31 subjects with asymptomatic bacteriuria (6.4%). The three major immunoglobulin classes and the secretory component were studied in 42 cases. Of these, 29 were found to be positive for ACB. The constant presence of IgA and secretory component on the surface of ACB suggests that the secretory immune system plays an important role in UTI.

Urolithiasis after kidney transplantation--clinical and mineralogical aspects.

Urolithiasis is a rare complication following kidney transplantation. Experience with this complication in 6 of 426 transplantations performed from 1968 to 1979 is reviewed. The clinical symptoms are different from the disease in non-transplant patients. Three major predisposing causes for the development of calculi after kidney transplantation were found in our patients--urodynamic disorders following complications of the ureterovesical anastomosis, persistent bacteriuria and renal tubular acidosis and, less importantly, the presence of hypercalcemia and hypercalciuria as a result of secondary hyperparathyroidism. Crystal-optical and x-ray-diffraction studies contributed to the interpretation of the constituents and texture of the calculi and of the aetiological factors concerned.

Antibody-coated bacteria as an indicator of the site of urinary tract infection in renal transplant recipients receiving immunosuppressive agents

Distinguishing an infection in the upper urinary tract from one in the lower urinary tract is especially important in renal transplant patients. Although the presence of antibody-coated bacteria in the urine has been shown by others to be a reliable indication of an infection in the upper urinary tract, it was not known whether sufficient antibody to coat the bacteria would be produced in a renal transplant recipient undergoing immunosuppression. We used a fluorescent test for detecting antibody-coated bacteria in the urine to follow 80 renal transplant patients prospectively for six months. Antibody-coated bacteria were detected in specimens from four patients with a clinical picture compatible with, or histopathologic evidence of, pyelonephritis. The origin of bacteriuria in a fifth patient was indeterminate both clinically and by the fluorescent antibody test. Twenty-three other patients with bacteriuria without clinical or histopathologic evidence of pyelonephritis had negative tests for antibody-coated bacteria. One patient with pyelonephritis in her own end-stage kidney had persistent bacteriuria with a negative fluorescent antibody test. Her transplanted kidney, however, was not infected. A positive test for antibody-coated bacteria is judged useful in distinguishing an infection in the upper urinary tract from one in the lower urinary tract in the presence of immunosuppression; however, the small number of cases and the methods used do not allow us to draw a conclusion about the significance of a negative result in a population undergoing immunosuppression.

Unilateral medullary sponge kidney Cause of persistent bacteriuria

A patient with twenty years of persistent bacteriuria secondary to unilateral medullary sponge kidney, and in whom no antibiotic would sterilize the urine, was cured of her infection by nephrectomy in the presence of contralateral hydronephrosis. A review of the literature shows 23 cases of unilateral medullary sponge kidney in which nephrectomy or partial nephrectomy was apparently equally successful, although no bacteriologic follow-up data are given.

Bilateral nephrectomy prior to renal transplantation.

Bilateral nephrectomy was performed in 53 patients on regular haemodialysis. The indications were pyelonephritis in 30, polycystic kidneys in 6, glomerulnephritis in 7, uncontrollable hypertension in 9 and horseshoe kidney in 1. In 87 per cent of cases the operation was carried out as a separate procedure prior to transplantation. The mortality was 9 per cent and the postoperative complications included hypotension, clotting of arteriovenous shunts, pneumonia and subphrenic abscess. As a result of our experience we have revised our indications for bilateral nephrectomy which now are pyelonephritis only when associated with persistent bacteriuria or ureteric reflux, polycystic kidneys and uncontrollable hypertension.

Self-Screening for Significant Bacteriuria

A self-administered dip-strip device was used to screen for urinary tract infection in female subjects. Fifty-two cases of significant persistent bacteriuria were detected among 2,250 subjects by simultaneous use of pourplate quantitative cultures. The dip-strip culture test had good reliability in detecting Gram-negative organisms. Repeated nitrite tests, performed on first-morning specimens and read by the patient, also had good reliability in detecting Gram-negative bacteria. No false-positive test occurred. The device is effective in screening out contaminants, thus decreasing the need for repeated testing.

Persistent bacteriuria following simple suprapubic prostatectomy.

Among 65 patients who underwent simple suprapubic prostatectomy, three consecutive quantitative estimations of clean voided midstream urine were carried out, i.e. before operation, on discharge from hostpital and six months or later after operations (late review), respectively, and some factors that will affect persistent significant bacteriuria were discussed. The results thus obtained were as follows. 1. Incidence of persistent significant bacteriuria at late review was 30.8% in patients with significant bacteriuria preoperatively and this figure was higher than 17.7% in patients without significant bacteriuria preoperatively. 2. Duration of postoperative indwelling urethral catheterization plays a less significant role than the presence of preoperative bacteriuria in the persistent significant bacteriuria on discharge and at late review. 3. Size of the enucleated prostate also showed no significant relationship to the persistent significant bacteriuria at late review.

SCREENING POTENTIAL RELATED TRANSPLANT DONORS FOR RENAL DISEASE

The families of two hundred potential renal-transplant recipients were studied for evidence of renal disease. Eighteen of the two hundred families had other members with familial renal disease (polycystic, medullary cystic, hereditary nephritis, Fabry's disease). Thirty of the one hundred and eighty-two remaining families had had at least one member die of renal disease or require a renal transplant, hæmodialysis, or nephrectomy. Thus, a total of 22% of the families of patients with renal failure had a history of renal failure in other members. 209 potential related donors were studied. 10.5% of the women and 5% of the men had persistent bacteriuria; 12 had hypertension and 47 had abnormal intravenous pyelograms, 41 of these had associated urinary abnormalities. 82 of 193 arteriograms were abnormal, and 17 of the abnormal arteriograms revealed other renal abnormalities. Medical contraindications ultimately excluded 40 relatives from donation. It is suggested that apparently healthy symptom-free relatives of patients with terminal renal failure will have an extremely high frequency of underlying renal disease. Such persons might comprise a suitable population for intensive screening for asymptomatic renal disease within the population. This group might also be a suitable study group for evaluating techniques for prevention of progressive renal disease.

High incidence of 'asymtomatic' urinary tract infection in infant schoolgirls.

Two thousand one hundred and sixty five Renfrewshire entrant schoolchildren were screened for bacteriuria and pyuria. The correlation between these two criteria of urinary tract infection was found to be very high. Two of 960 boys and 31 of 1205 girls were found to have persistent significant bacteriuria and pyuria. The method used is described and compared with other methods. Investigation, treatment and follow-up of the affected children is described.

Bacteriuria in diabetes mellitus.

One hundred and four diabetic patients with bacteriuria were followed for a mean period of 44 months. They were divided in two groups “cured” and “persistent” according to the results of treatment. Retinopathy and albuminuria as evidences of microangiopathy were present at the beginning of the study in a greater number of patients and in a greater degree in those with persistent bacteriuria than in those cured. At follow-up the number of patients with and the severity of retinopathy and albuminuria were higher in those with persistent bacteriuria although not statistically different. Microangiopathy usually antedated bacteriuria and may have contributed to its persistence, although the possibility that bacteriuria played a role in the progression of microangiopathy cannot be excluded. No significant deterioration in renal function became apparent in either group, suggesting that persistent bacteriuria had not obviously contributed, to the development of pyelonephritis or progressive renal damage.