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ACUTE INFECTIONS OF THE URINARY TRACT AND THE URETHRAL SYNDROME IN GENERAL PRACTICE.

British medical journal 04/1965; 1(5435):622-6. DOI: 10.1136/bmj.1.5435.622
Source: PubMed
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    ABSTRACT: Emergency physicians often encounter females presenting with symptoms suggestive of urinary tract infections (UTIs). The diagnostic accuracy of history, physical examination, and bedside laboratory tests for female UTIs in emergency departments (EDs) have not been quantitatively described. This was a systematic review to determine the utility of history and physical examination (H&P) and urinalysis in diagnosing uncomplicated female UTI in the ED. The medical literature was searched from January 1965 through October 2012 in PUBMED and EMBASE using the following criteria: Patients were females greater than 18 years of age in the ED suspected of having UTIs. Interventions were H&P and urinalysis used to diagnose a UTI. The comparator was UTI confirmed by a positive urine culture. The outcome was operating characteristics of the interventions in diagnosing a UTI. Study quality was assessed using Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Sensitivity, specificity, and likelihood ratios (LRs) were calculated using Meta-DiSc. Four studies (pooled n = 948) were included with UTI prevalence ranging from 40% to 60%. H&P variables all had positive LRs (+LR, range = 0.8 to 2.2) and negative LRs (-LR, range = 0.7 to 1.0) that are insufficient to significantly alter pretest probability of UTI. Only a positive nitrite reaction (+LR = 7.5 to 24.5) was useful to rule in a UTI. To rule out UTI, only a negative leukocyte esterase (LE; -LR = 0.2) or blood reaction on urine dipstick (-LR = 0.2) were significantly accurate. Increasing pyuria directly correlated with +LR, and moderate pyuria (urine white blood cells [uWBC] > 50 colony-forming units [CFUs]/ml) and moderate bacteruria were good predictors of UTI (+LR = 6.4 and 15.0, respectively). No single H&P finding can accurately rule in or rule out UTI in symptomatic women. Urinalysis with a positive nitrite or moderate pyuria and/or bacteruria are accurate predictors of a UTI. If the pretest probability of UTI is sufficiently low, a negative urinalysis can accurately rule out the diagnosis.
    Academic Emergency Medicine 07/2013; 20(7):631-45. · 1.76 Impact Factor
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    ABSTRACT: Se analizaron 90 parejas cuya mujer presentaba síntomas urinarios bajos crónicos y recurrentes, usualmente con urocultivos negativos y tratadas numerosas veces por mèdicos de diversas especialidades como ginecólogos, urólogos, internistas, infectólogos, sin poder “curar” a la paciente, quedando sintomática y con repercusiones en el área íntima, familiar, social y profesional. Estudiamos sistematicamente desde el punto de vista microbiológico a ambos integrantes de la pareja (Test de Pesquisa Microbiologica femenina y masculina), y realizamos la investigación de los posibles factores predisponentes que rodean a las pacientes portadoras de “infecciones” urinarias sintomáticas recurrentes, en su esfera ginecológica, en su esfera urológica y en sus hábitos en general. Se investigó profusamente el tema en Medline en los ultimos 20 años. Se hicieron recomendaciones finales que podrían modificar las pautas a seguir en lo concerniente a las mujeres con infecciones urinarias recurrentes.
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    ABSTRACT: Background The cause of acute uncomplicated cystitis is determined on the basis of cultures of voided midstream urine, but few data guide the interpretation of such results, especially when gram-positive bacteria grow. Methods Women from 18 to 49 years of age with symptoms of cystitis provided specimens of midstream urine, after which we collected urine by means of a urethral catheter for culture (catheter urine). We compared microbial species and colony counts in the paired specimens. The primary outcome was a comparison of positive predictive values and negative predictive values of organisms grown in midstream urine, with the presence or absence of the organism in catheter urine used as the reference. Results The analysis of 236 episodes of cystitis in 226 women yielded 202 paired specimens of midstream urine and catheter urine that could be evaluated. Cultures were positive for uropathogens in 142 catheter specimens (70%), 4 of which had more than one uropathogen, and in 157 midstream specimens (78%). The presence of Escherichia coli in midstream urine was highly predictive of bladder bacteriuria even at very low counts, with a positive predictive value of 10(2) colony-forming units (CFU) per milliliter of 93% (Spearman's r=0.944). In contrast, in midstream urine, enterococci (in 10% of cultures) and group B streptococci (in 12% of cultures) were not predictive of bladder bacteriuria at any colony count (Spearman's r=0.322 for enterococci and 0.272 for group B streptococci). Among 41 episodes in which enterococcus, group B streptococci, or both were found in midstream urine, E. coli grew from catheter urine cultures in 61%. Conclusions Cultures of voided midstream urine in healthy premenopausal women with acute uncomplicated cystitis accurately showed evidence of bladder E. coli but not of enterococci or group B streptococci, which are often isolated with E. coli but appear to rarely cause cystitis by themselves. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.).
    New England Journal of Medicine 11/2013; 369(20):1883-1891. · 51.66 Impact Factor

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