-
Australian Journal of General Practice Apr 2021Recurrent urinary tract infections (rUTIs) and recurrent cystitis symptoms without infection occur commonly in women and present frequently in general practice.
BACKGROUND
Recurrent urinary tract infections (rUTIs) and recurrent cystitis symptoms without infection occur commonly in women and present frequently in general practice.
OBJECTIVE
The aim of this article is to provide a management approach to the assessment and treatment of recurrent cystitis symptoms in women with rUTIs as well as women who have negative urine cultures.
DISCUSSION
Five common clinical scenarios are discussed with different approaches to treatment: true rUTIs with positive urine cultures, women with variable urine cultures (some positive and some negative), women with negative urine cultures who have pyuria +/- haematuria, women with completely normal urine cultures and women with ongoing symptoms after a definite UTI. Red flags signalling the need for early referral to a urologist for further assessment are discussed. Both non-antibiotic and antibiotic-related strategies to treat women with rUTIs are available.
Topics: Anti-Bacterial Agents; Cystitis; Female; Humans; Recurrence; Urinalysis; Urinary Tract Infections
PubMed: 33786541
DOI: 10.31128/AJGP-11-20-5728 -
Infection Control and Hospital... Feb 2023Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance...
BACKGROUND
Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance of individual UA parameters and common thresholds for action are not well defined and may vary across different patient populations.
METHODS
In this retrospective cohort study, we included all encounters with UAs ordered 24 hours prior to a urine culture between 2015 and 2020 at 3 North Carolina hospitals. We evaluated the performance of relevant UA parameters as potential outcome predictors, including sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also combined 18 different UA criteria and used receiver operating curves to identify the 5 best-performing models for predicting significant bacteriuria (≥100,000 colony-forming units of bacteria/mL).
RESULTS
In 221,933 encounters during the 6-year study period, no single UA parameter had both high sensitivity and high specificity in predicting bacteriuria. Absence of leukocyte esterase and pyuria had a high NPV for significant bacteriuria. Combined UA parameters did not perform better than pyuria alone with regard to NPV. The high NPV ≥0.90 of pyuria was maintained among most patient subgroups except females aged ≥65 years and patients with indwelling catheters.
CONCLUSION
When used as a part of a diagnostic workup, UA parameters should be leveraged for their NPV instead of sensitivity. Because many laboratories and hospitals use reflex urine culture algorithms, their workflow should include clinical decision support and or education to target symptomatic patients and focus on populations where absence of pyuria has high NPV.
Topics: Female; Humans; Pyuria; Bacteriuria; Urinary Tract Infections; Retrospective Studies; Urinalysis; Reflex; Urine
PubMed: 36625063
DOI: 10.1017/ice.2022.315 -
Annals of the Royal College of Surgeons... Apr 2014The aim of this study was to review the published evidence on the pathogenesis and management of acute epididymitis (AE) in prepubertal boys after the authors... (Review)
Review
INTRODUCTION
The aim of this study was to review the published evidence on the pathogenesis and management of acute epididymitis (AE) in prepubertal boys after the authors encountered an unexpectedly large number of such cases in their institution.
METHODS
Using MEDLINE(®), a literature search was performed for articles in English with the words "pre-pubertal" OR "boys" OR "p(a)ediatric" OR "children" AND "epididymitis" OR "epididymo-orchitis".
RESULTS
The literature suggests that it is rare to find a bacterial infection or anatomical anomaly as a cause for AE in this population. A postviral infectious phenomenon is the most likely explanation. The management should be supportive and antibiotics reserved for those with pyuria or positive cultures. Urodynamic studies and renal tract ultrasonography have been advocated for those with recurrent epididymitis.
CONCLUSIONS
AE in prepubertal boys is more common than believed previously. A careful history for recent viral illnesses should be included. Antibiotics, urinary tract imaging and functional studies should be used in selected cases.
Topics: Acute Disease; Acute Pain; Analgesics; Bacterial Infections; Child; Epididymitis; Humans; Male; Scrotum; Watchful Waiting
PubMed: 24780779
DOI: 10.1308/003588414X13814021679311 -
Postgraduate Medical Journal Nov 1935
PubMed: 21312982
DOI: 10.1136/pgmj.11.121.395 -
The American Journal of Tropical... Jan 2013Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. The disease remains as an important public health problem in developing countries. Extrapulmonary TB... (Review)
Review
Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. The disease remains as an important public health problem in developing countries. Extrapulmonary TB became more common with the advent of infection with human immunodeficiency virus and by the increase in the number of organ transplantation, which also leads to immunosuppression of thousand of persons. Urogenital TB represents 27% of extrapulmonary cases. Renal involvement in TB can be part of a disseminated infection or a localized genitourinary disease. Renal involvement by TB infection is underdiagnosed in most health care centers. Most patients with renal TB have sterile pyuria, which can be accompanied by microscopic hematuria. The diagnosis of urinary tract TB is based on the finding of pyuria in the absence of common bacterial infection. The first choice drugs include isoniazide, rifampicin, pirazinamide, ethambutol, and streptomycin. Awareness of renal TB is urgently needed by physicians for suspecting this disease in patients with unexplained urinary tract abnormalities, mainly in those with any immunosuppression and those coming from TB-endemic areas.
Topics: HIV Infections; Humans; Incidence; Tuberculosis, Renal
PubMed: 23303798
DOI: 10.4269/ajtmh.2013.12-0413 -
Journal of the National Medical... Oct 1986That a female patient with abdominal pain is often considered to have pelvic inflammatory disease until proven otherwise is ubiquitous in the medical literature. This... (Review)
Review
That a female patient with abdominal pain is often considered to have pelvic inflammatory disease until proven otherwise is ubiquitous in the medical literature. This view is dangerous and should be challenged because it has resulted in episodes of ruptured appendix, death from ruptured ectopic pregnancies, and serious morbidity from delayed diagnoses of such entities as diverticulitis and endometriosis. Proper diagnostic steps should be taken for all patients with abdominal pain of unclear etiology.This article reviews the pathogenesis of tubo-ovarian abscesses so as to separate and clearly identify fact from fiction. Diagnostic steps and management guidelines are discussed.
Topics: Abscess; Endometritis; Fallopian Tube Diseases; Female; Humans; Intrauterine Devices; Ovarian Diseases; Pyuria; Salpingitis; Uterine Cervicitis; Vaginitis
PubMed: 3537321
DOI: No ID Found -
BMC Pregnancy and Childbirth Apr 2020Asymptomatic bacteriuria (ASB) and sterile pyuria (SP) are complexities of UTI whose prevalence are not known in the northern sector of Ghana. Our aim was to determine...
BACKGROUND
Asymptomatic bacteriuria (ASB) and sterile pyuria (SP) are complexities of UTI whose prevalence are not known in the northern sector of Ghana. Our aim was to determine the occurrence of sterile pyuria and asymptomatic bacteriuria among pregnant women accessing antenatal care at a secondary and tertiary care hospitals in Tamale, northern Ghana.
METHODS
A cross sectional study was conducted by screening 530 pregnant women with no signs of acute urinary tract infection attending antenatal clinic for a period of 6 months. Midstream urine was collected for microscopy, quantitative urine culture and antibiotic susceptibility testing. Data analysis was carried out using the Statistical Package for Social Sciences version 20.
RESULTS
Asymptomatic bacteriuria was respectively 20 and 35.5% at Tamale Central and Tamale Teaching Hospital out of the 390 and 90 women screened. Sterile pyuria was found among 66% of the 50 women presenting at Tamale Central Hospital. More than 64% of isolates recovered from ASB patients were S. aureus and coagulase negative Staph. (CoNS). Escherichia coli was the dominant species among members of the enterobacteriaceae isolated. Highest susceptibility was recorded against gentamicin and amikacin while most resistance was to Ampicillin, cotrimoxazole, chloramphenicol and nitrofurantoin. Resistance to imipenem and vancomycin were 28.8 and 52%, with strains showing multiple drug resistance of between 81 and 92%.
CONCLUSION
The prevalence of asymptomatic bacteriuria is appreciably higher (20-35.5%) than documented rates in the southern sector of the country. The presence of sterile pyuria which may be an indication of asymptomatic renal impairment and most often overlooked in antenatal management is 66%. Empirical treatment of UTIs at the Tamale Central and Teaching Hospital without confirmation of susceptibility may result in treatment failure. It is necessary to screen and treat pregnant women for ASB and SP due to the complications associated with these conditions.
Topics: Adult; Anti-Bacterial Agents; Bacteriuria; Cross-Sectional Studies; Escherichia coli; Female; Ghana; Hospitals; Humans; Microbial Sensitivity Tests; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Prenatal Care; Prevalence; Pyuria; Staphylococcus aureus; Urinary Tract Infections; Young Adult
PubMed: 32321461
DOI: 10.1186/s12884-020-02936-6 -
The Journal of Small Animal Practice Apr 2022To determine the effect of urine-specific gravity (USG) on using microscopic evaluation of bacteriuria to predict urine culture results in dogs and cats.
OBJECTIVE
To determine the effect of urine-specific gravity (USG) on using microscopic evaluation of bacteriuria to predict urine culture results in dogs and cats.
MATERIALS AND METHODS
We performed a retrospective medical record review of canine and feline patients that had a urinalysis and urine culture performed simultaneously. The sensitivity, specificity, positive predictive value and negative predictive value of microscopic bacteriuria for predicting urine culture results were calculated, stratified by USG. Multivariable regression was performed to test the effect of USG, pyuria, haematuria and species on the agreement between microscopic bacteriuria and culture results.
RESULTS
A total of 481 dogs and 291 cats with paired urinalysis and urine culture results were included in the study. Microscopic bacteriuria had moderate sensitivity (76% in dogs, 64% in cats) and high specificity (97% in dogs, 96% in cats) for predicting urine culture bacterial growth. Samples with rod bacteria were more likely to have bacterial growth than those with cocci (OR=Infinity, 95% CI 4.8 - Infinity). As compared to isosthenuric+hyposthenuric samples (USG ≤1.012), agreement was lower in moderately concentrated (OR=0.44, 95% CI 0.19 to 0.91) samples. Absence of bacteriuria, pyuria and haematuria had a high negative predictive value for no bacterial growth (96%).
CLINICAL SIGNIFICANCE
Microscopic bacteriuria has a high specificity in predicting urine culture results, regardless of USG. The finding that microscopic bacteriuria has better agreement with urine culture results in isosthenuric+hyposthenuric urine argues against reflex culture in these samples, especially if pyuria and haematuria are also absent. Urine microscopy can aid clinicians in determining the likelihood of urine culture growth.
Topics: Animals; Bacteriuria; Cat Diseases; Cats; Dog Diseases; Dogs; Female; Hematuria; Male; Microscopy; Pyuria; Retrospective Studies; Specific Gravity; Urinalysis; Urinary Tract Infections; Urine
PubMed: 34897695
DOI: 10.1111/jsap.13456 -
Cureus Dec 2020Urinary tract infection (UTI) is the most commonly occurring serious bacterial infection in young infants. Uncircumcised male infants have a higher rate of UTI when...
Urinary tract infection (UTI) is the most commonly occurring serious bacterial infection in young infants. Uncircumcised male infants have a higher rate of UTI when compared with circumcised male infants and girls. A prostatic abscess is a very rare clinical variety of UTI, especially in neonates. We present the case of a 15-day-old male neonate who developed a rare variety of urosepsis. The baby was evaluated and found to have a prostatic abscess. Ultrasound of the abdomen showed an enlarged prostate gland with diffuse heterogeneous hypoechogenicity. Magnetic resonance imaging (MRI) of the pelvis showed an enlarged, lobulated prostate with T2 hyperintense signal and T1 hypointense signal and diffusion restriction. The post-contrast images in the pelvis-MRI also showed peripheral rim enhancement suggestive of a prostatic abscess. Urine culture showed growth of methicillin-resistant Staphylococcus aureus (MRSA). The baby was treated with intravenous vancomycin, and pus was drained through a transurethral approach. Phimosis can cause purulence in the prostate. Prostatic abscess usually has a good prognosis in neonates when diagnosed early and appropriate treatment was instituted.
PubMed: 33489549
DOI: 10.7759/cureus.12137 -
Boletin Medico Del Hospital Infantil de... 2023Urinary tract infection (UTI) is infants' most common serious bacterial infection. This study aimed to investigate the reliability of urianalysis (UA) to predict UTI, to... (Review)
Review
BACKGROUND
Urinary tract infection (UTI) is infants' most common serious bacterial infection. This study aimed to investigate the reliability of urianalysis (UA) to predict UTI, to specify the colony forming units (CFU)/ml threshold for diagnosis, and to identify variables that help suspect bacteremia in infants under 3 months with UTI.
METHODS
We reviewed clinical records of children under 3 months hospitalized for a fever without source and recorded age, sex, days of fever pre-consultation, temperature and severity at admission, discharge diagnoses, laboratory tests, and treatments. According to the discharge diagnosis, we divided them into UTIs (-) and (+) with or without bacteremia.
RESULTS
A total of 467 infants were admitted: 334 with UTI and 133 without UTI. In UTIs (+), the pyuria had a sensitivity of 95.8% and bacteria (+) 88.3%; specificity was high, especially for nitrites (96.2%) and bacteria (+) (92.5%). Positive predictive value (PPV) for nitrites was 95.9%, for bacteria 96.7%, and oyuria 92.5%. Escherichia coli was present in 83.8% of urine and 87% of blood cultures. UTIs with bacteremia had inflammatory urinalysis, urine culture > 100,000 CFU/ml, and higher percentage of C reactive protein (CRP) > 50 mg (p= 0.002); 94.6% of the urine culture had > 50,000 CFU.
CONCLUSIONS
The pyuria and bacteria (+) in urine obtained by catheterization predict UTI. The cut-off point for diagnosis was ≥ 50,000 CFU/ml. No variables to suspect bacteremia were identified in this study.
Topics: Child; Infant; Humans; Pyuria; Nitrites; Reproducibility of Results; Sensitivity and Specificity; Urinary Tract Infections; Urinalysis; Fever; Bacteremia
PubMed: 37963294
DOI: 10.24875/BMHIM.23000030