Screening and treatment of bacteriuria in pregnancy and postpartum period

The paper gives an overview of today's knowledge of urinary tract infection in pregnancy and different treatment procedures. Three different studies of urinary tract infection (UTI) in pregnancy and the postpartum period are reported. Urinary screening of 1798 pregnant women showed a cumulative frequency of bacteriuria of 4.8%, recurrent infection in one-fifth of the cases, and pyelonephritis in 0.6%. Chlamydial infection was observed as a cause of dysuria in pregnancy. In the postpartum period bladder bacteriuria was demonstrated in 3.7%. The condition persisted in 27%, while short-course treatment had significant effect.Presented at the Zambon Symposium on Bacteriuria in Pregnancy, International Urogynecological Association Annual Meeting, Riva del Garda, Italy, September 13, 1989.     

The epidemiology of bacteriuria in pregnancy

Bacteriuria in pregnancy is now easily detected by various techniques adapted to the office setting. It is importtant to screen for bacteriuria in pregnancy because 3%–10% of pregnant women will be positive for occult infection. Up to 30% thus infected will subsequently develop pyelonephritis later in pregnancy, which in turn is associated with premature labor and delivery. This entity must be detected and treated as early as possible in pregnancy to prevent these adverse effects.Presented at the Zambon Symposium on Bacteriuria in Pregnancy, International Urogynecological Association Annual Meeting, Riva del Garda, Italy, September 13, 1989.Dedicated to the memory of Edward H. Kass, MD, PhD.     

Evaluation of 3 Methods of Bladder Irrigation to Treat Bacteriuria in Persons With Neurogenic Bladder

Abstract

Background/Objective: We conducted a randomized, double-blind comparison of twice daily bladder irrigation using 1 of 3 different solutions in community-residing persons with neurogenic bladder who used indwelling catheters to evaluate efficacy in treatment of bacteriuria.

Methods: Eighty-nine persons with bacteriuria were randomized to irrigate their bladders twice daily for 8 weeks with 30 mL of (a) sterile saline, (b) acetic acid, or (c) neomycin-polymyxin solution. Urinalysis, cultures, and antimicrobial susceptibility tests were performed at baseline and weeks 2, 4, and 8 to determine the extent to which each of the solutions affected numbers and types of bacteria, urinary pH, urinary leukocytes, and generation of antimicrobial-resistant organisms.

Results: Bladder irrigation was well tolerated with the exception of 3 participants who had bladder spasms. None of the 3 irrigants had a detectable effect on the degree of bacteriuria or pyuria in 52 persons who completed the study protocol. A significant increase in urinary pH occurred in all 3 groups. No significant development of resistance to oral antimicrobials beyond what was observed at baseline was detected.

Conclusions: Bladder irrigation was generally well tolerated for 8 weeks. No advantages were detected for neomycin-polymyxin or acetic acid over saline in terms of reducing the urinary bacterial load and inflammation. We cannot recommend bladder irrigation as a means of treatment for bacteriuria in persons with neurogenic bladder.     

An investigation of the effectiveness against bacteriuria of silver-coated catheters in short-term urinary catheter applications: A randomized controlled study

AimThe aim of this study was to investigate the effectiveness of antimicrobial-coated catheters against bacteriuria and urinary tract infection in patients who have urinary catheterization.MethodsTwenty eight and twenty six people similar in terms of demographic characteristics and primary and underlying diseases were randomly selected from patients undergoing short-time urinary catheterization in the intensive care unit. Silver-coated slicone foley catheters and normal slicone foley catheters were used for uninary catheterization in the first and second group of the patients respectively. Urine specimens were collected from patients at 2-day intervals and assessed in terms of bacteriuria.ResultsBacteriuria was found in 12 (46.2%) of the patients using normal catheters and 13 (46.4%) of those using silver-coated catheters throughout the monitoring period. No significant relationship was determined between use of different catheter types and bacteriuria (p = 0.98). The most common microorganism was identified as E. coli in the normal catheter group while microorganism other than E. coli was identified in the silver-coated catheter group. The prevalence of bacteriuria was statistically significantly higher in patients with a history of hospitalization in the previous 3 months (p = 0.028).ConclusionThe use of silver-coated silicone catheters was not shown to have a protective effect against bacteriuria in this study. Further well-designed studies with larger case numbers are now needed to confirm whether history of hospitalization, which emerged as a statistically significant factor in this study, increases the prevalence of catheter-related bacteriuria.     

Additional antibiotic use and preterm birth among bacteriuric and nonbacteriuric pregnant women

OBJECTIVES: To determine the magnitude of and factors associated with spousal abuse during pregnancy in women presenting to tertiary care hospitals in Karachi, Pakistan. METHODS: Five hundred women who delivered a live singleton baby were interviewed. Physical and/or emotional abuse during pregnancy (PEAP) was the primary outcome measure as determined by the World Health Organization's domestic violence module. Frequencies of different forms of abuse were measured and the relationship between PEAP and the risk factors was determined using multiple logistic regression. RESULTS: Of the women interviewed, 44% reported abuse during the index pregnancy; and of these, 43% experienced emotional abuse and 12.6% reported physical abuse. Factors independently associated with PEAP were number of living children (adjusted odds ratio [AOR] 1.34; CI, 1.08-1.65), interfamilial conflicts (AOR 3.03; CI, 1.85-4.96), husband's exposure to maternal abuse (AOR, 2.38; CI, 1.41-4.02), and husband's use of tobacco (AOR 1.59; CI, 1.05-2.42). Women who had adequate social support were less likely to be abused by their husbands (AOR 0.65; CI, 0.51-0.82). CONCLUSIONS: Almost half of the pregnant women interviewed were either physically or emotionally abused. Strong social support helps protect against abuse.     

Comparison of effectiveness of two urinary drainage systems in intensive care unit: a prospective,randomized clinical trial

Objective In a previous nonrandomized study we observed no difference in the rate of acquisition of bacteriuria between a complex closed drainage system (CCDS) and a two-chamber drainage system (TCDS) in ICU patients. To confirm this result we performed a statistically powerful study assessing the effectiveness of the CCDS and the TCDS in ICU patients.Design and setting Randomized, prospective, and controlled study in the medicosurgical intensive care unit (16 beds) in a teaching hospital.Patients and interventions We assigned 311 patients requiring indwelling urinary catheter for longer than 48 h to TCDS or CCDS to compare the rate of acquisition of bacteriuria.Measurements and results Patients did not receive prophylactic antibiotics during placement management or catheter withdrawal. Urine samples were obtained weekly for the duration of catheterization and within 24 h after catheter removal, and each time symptoms of urinary infection were suspected. There was no statistical difference in the rate of bacteriuria between the two groups: 8% with TCDS and 8.5% with CCDS. Rates of urinary tract infection were 12.1 episodes with TCDS and 12.8 episodes with CCDS per 1000 days of catheter.Conclusions This randomized study on the effectiveness of TCDS and CCDS in ICU patients confirms the findings of our previous study. No differences were noted between the two systems. The higher cost of CCDS is not justified for ICU patients.An erratum to this article can be found at     

Catheter-associated Urinary Tract Infections

Catheter-associated urinary tract infections (CAUTIs) are a major source of nosocomial infections and represent a significant burden in morbidity and costs. Although several different approaches to disease prevention are being investigated, the most effective methods of prevention are to avoid unnecessary catheterisations and to remove catheters as soon as possible. An optimal catheter material or coating is still awaited. The growing number of publications regarding implementation of reminder systems and infection control programs shows the importance of these measures, which can effectively decrease the rate of CAUTIs. Systemic antibiotic prophylaxis is not recommended for long-term indwelling catheterisation. Treatment of catheter-related asymptomatic bacteriuria should be avoided, as this may increase the rate of antibiotic resistance without eradicating the bacteria. Systemic antibiotic treatment is indicated only for symptomatic CAUTIs. Alternative methods of urinary drainage may be preferable to indwelling urethral catheterisation. Evidence-based catheter management and treatment of CAUTIs are mandatory.Patient summaryThis review summarises different management options for the prevention and treatment of catheter-associated urinary tract infections. Treatment for bacteria in catheterised urine in the absence of symptoms should be avoided, as this may increase the rate of antibiotic resistance without eradicating the bacteria. Systemic antibiotic treatment is indicated only for symptomatic infections. The most effective methods of prevention are to avoid unnecessary catheterisation and to remove catheters as soon as possible.     

贵阳市10039名无症状小儿泌尿系疾病普查结果分析

对贵阳市10039名无症状的中、小学生和托幼儿进行了蛋白尿、潜血和细菌尿的普查。先用尿试纸进行初筛;任一项阳性者再用试纸法进行复查,同时加用磺硫酸法进行蛋白定性及玻片法计数尿中红细胞;对第二次检查中任一项阳性者,进行体检及特殊检查、化验。结果查出阳性人数77人,阳性率为0.77%,其中急性肾炎及肾炎可疑者28例,占普查总数的0.28%,泌尿系感染共27例,占0.27%;另有无症状血尿、泌尿系结石等,提示在儿童中进行尿普查是有意义的。     

The screening of more than 2,000 schoolgirls for bacteriuria using an automated fluorescence microscopy system

Summary After initial evaluation of a manual fluorescence microscopy system on a variety of urines the method was automated and subsequently tested in a population survey of urinary tract infection in schoolgirls. This automated Bactoscan system allowed a rapid analysis of urine samples and with the introduction of modifications to the staining protocol it correctly eliminated 91% of samples as being not significantly infected.