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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    • "Semi-quantitative urinary cultures have been reported in several studies in which over half of symptomatic patients exhibited s-QBC values lower than the traditional cut-off of 105 CFU/ml often used for defining significant bacteruria [35,36]. Others have reported that a ≥102 CFU/ml s-QBC criterion may be superior to a ≥105 threshold [37,38]. "
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    ABSTRACT: Background Semi-quantitative bacteruria counts (s-QBC) are important in the diagnosis of urinary tract infection (UTI) due to most uropathogens. The prognostic value of s-QBC for diagnosis of UTI due to group B streptococcus (GBS) is unknown. In this study, we assessed the value of s-QBC for differentiating acute GBS UTI from asymptomatic bacteruria (ABU), independent of other potential prognostic indicators. Methods Medical record review and urinalysis (UA) values for 1593 patients who had urinary GBS isolated (103 to ≥105 CFU/ml) during a four-year period were analyzed using binary logistic regression to determine the predictive values of s-QBC, age, and gender for infection category (acute UTI, ABU) based on the clinical diagnosis. Results s-QBC alone had a strong predictive value for infection category but only for ABU. Multivariate logistic regression showed similar predictive power of s-QBC for infection category using age as a co-predictor, which was also independently associated with infection category. Typical s-QBC cut-off values that are commonly used in diagnostic settings had no significant power in predicting infection category. Among other UA measures, proteinuria and hematuria were significantly associated with acute infection. Conclusions Together, these data show that s-QBC is not useful in the differential diagnosis of GBS UTI. Among the patients in this study, age was an equally effective prognostic indicator compared to s-QBC for identifying high- and low-risk patients for acute GBS UTI. Collectively, these findings indicate that age-based associations may be equally as useful as s-QBC for predicting infection category in the setting of adult patients with GBS-positive urine cultures.
    Full-text · Article · Oct 2012 · BMC Infectious Diseases
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    • "La terminologie de syndrome urétral a été introduite par Gallagher et al. en 1965 [1] mais ce syndrome est toujours resté une entité mal définie, d'origine imprécise et de traitement difficile. En 2002, lors de son travail nosologique sur les troubles mictionnels et les douleurs pelvipérinéales, l'International Continence Society (ICS) a proposé l'appellation de syndrome douloureux urétral (urethral pain syndrome) [2] [3] en le définissant comme une douleur urétrale récurrente survenant habituellement lors de la miction, accompagnée d'une pollakiurie diurne et nocturne, en l'absence d'infection prouvée ou d'une autre pathologie évidente. "
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    ABSTRACT: Objective To describe the clinical features, pathogenesis and differential diagnosis of urethral pain syndrome.Material and methodsA review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either medical subject heading (MeSH) keywords (urethra, pain) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the “AND” operator. The literature search was conducted from 1990 to the present time.ResultsUrethral pain syndrome is defined as recurrent urethral pain usually occurring during micturition, but sometimes unrelated to micturition, accompanied by daytime frequency and nocturia, in the absence of documented infection or another clinically apparent disease. The cause of this syndrome is unclear, but it could correspond to an early form of interstitial cystitis/painful bladder syndrome. Urethral pain syndrome is a diagnosis of exclusion and, in a patient presenting with urethral pain and voiding disorders, various more common and more clearly defined organ or tissue diseases must be excluded by a urological and gynecological work-up (especially genital tract and urinary tract infection, urethral stricture, bladder tumor, urethral tumor, hyperactive bladder, low urinary tract or distal ureteric stones).Conclusion The cause of urethral pain syndrome is unclear. This syndrome remains a diagnosis of exclusion in patients with urethral pain and voiding disorders.
    Preview · Article · Nov 2010 · Progrès en Urologie
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    • "It is important to note that several studies were conducted before the introduction of standards for reporting diagnostic accuracy studies [37-41]. Spectrum bias is identified as a potential source of bias across certain studies, with studies including both complicated and uncomplicated patients [7,38] or failing to clearly report whether the study was focusing on complicated or uncomplicated UTI [26,40]. Partial verification bias is also noted in two studies whereby only a selected sample of patients' symptoms are verified by the reference test [24,41]. "
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    ABSTRACT: Acute urinary tract infections (UTI) are one of the most common bacterial infections among women presenting to primary care. However, there is a lack of consensus regarding the optimal reference standard threshold for diagnosing UTI. The objective of this systematic review is to determine the diagnostic accuracy of symptoms and signs in women presenting with suspected UTI, across three different reference standards (10(2) or 10(3) or 10(5) CFU/ml). We also examine the diagnostic value of individual symptoms and signs combined with dipstick test results in terms of clinical decision making. Searches were performed through PubMed (1966 to April 2010), EMBASE (1973 to April 2010), Cochrane library (1973 to April 2010), Google scholar and reference checking.Studies that assessed the diagnostic accuracy of symptoms and signs of an uncomplicated UTI using a urine culture from a clean-catch or catherised urine specimen as the reference standard, with a reference standard of at least ≥ 10(2) CFU/ml were included. Synthesised data from a high quality systematic review were used regarding dipstick results. Studies were combined using a bivariate random effects model. Sixteen studies incorporating 3,711 patients are included. The weighted prior probability of UTI varies across diagnostic threshold, 65.1% at ≥ 10(2) CFU/ml; 55.4% at ≥ 10(3) CFU/ml and 44.8% at ≥ 10(2) CFU/ml ≥ 10(5) CFU/ml. Six symptoms are identified as useful diagnostic symptoms when a threshold of ≥ 10(2) CFU/ml is the reference standard. Presence of dysuria (+LR 1.30 95% CI 1.20-1.41), frequency (+LR 1.10 95% CI 1.04-1.16), hematuria (+LR 1.72 95%CI 1.30-2.27), nocturia (+LR 1.30 95% CI 1.08-1.56) and urgency (+LR 1.22 95% CI 1.11-1.34) all increase the probability of UTI. The presence of vaginal discharge (+LR 0.65 95% CI 0.51-0.83) decreases the probability of UTI. Presence of hematuria has the highest diagnostic utility, raising the post-test probability of UTI to 75.8% at ≥ 10(2) CFU/ml and 67.4% at ≥ 10(3) CFU/ml. Probability of UTI increases to 93.3% and 90.1% at ≥ 10(2) CFU/ml and ≥ 10(3) CFU/ml respectively when presence of hematuria is combined with a positive dipstick result for nitrites. Subgroup analysis shows improved diagnostic accuracy using lower reference standards ≥ 10(2) CFU/ml and ≥ 10(3) CFU/ml. Individual symptoms and signs have a modest ability to raise the pretest-risk of UTI. Diagnostic accuracy improves considerably when combined with dipstick tests particularly tests for nitrites.
    Full-text · Article · Oct 2010 · BMC Family Practice
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