Purple Urine Bag Syndrome: More Than Eyes Can See

Abstract

Background/Aims: Purple urine bag syndrome (PUBS) is an uncommon clinical entity characterized by purple urine discoloration in the setting of urinary tract infections. Pa-thophysiology of PUBS has been correlated to aberrant metabolism of tryptophan. Multiple predisposing factors have been recognized, namely: female gender, advanced age, constipation, institutionalization, long-term catheter-ization, dementia and chronic kidney disease. Herein, we present a comprehensive review of all PUBS cases reported in PubMed, focusing on the predisposing factors and the microorganisms related to PUBS. Methods: We performed a search in PubMed database for articles referring to PUBS, published in English, French, Spanish and German from January 1978 until November 2017. The literature recruitment strategy was based on several keywords and Medical Subject Heading combination such as “purple urine bag syndrome” or PUBS or “urine discoloration”. The finally selected articles were categorized into case reports/series (88 articles including 112 patients) and studies (10 articles including 134 patients). Demographical data as well as predisposing factors were recorded and further analyzed. Results: According to our findings, mean age of PUBS patients was 78.9 ± 12.3 years, 70.7% were female while 90.1% were suffering from constipation, 76.1% were in a bedridden situation, 45.1% were experiencing long-term catheterization, 42.8% had been diagnosed with dementia, 14.3% had recurrent urinary tract infections and 14.1% were chronic kidney disease patients. 91.3% of patients presenting with PUBS alkaline urine were observed while the most common microbe in urine cultures was E. coli. Conclusions: PUBS is considered benign process in the majority of catheterized patients. Clinicians should be aware of the syndrome that may indicate serious comorbidities.

Purple Urine Bag Syndrome in a Critically Ill Patient: Case Report

“…Indole is then absorbed and reaches the liver through the portal system where it's transformed into indoxyl sulfate. When excreted in the urine, it may come into contact with bacteria with indoxyl phosphatase and sulfatase activity such as Providencia species, Escherichia coli, Pseudomonas aeruginosa, Morganella, Klebsiella pneumoniae, and Proteus mirabilis [1,2,5]. The bacterial enzymes break down indoxyl sulfate to form indigo and indirubin pigments which interact with the material of the drainage system, especially PVC, as part of the reaction that gives off the purple color change [3].…”

“…PUBS can be worrisome for individuals unfamiliar with this finding [1,6]. It's usually considered a benign entity and normally disappears once infection has resolved [7]. However, there are few reports of associations with severe cases, probably owning to severity of infection rather than to the color change itself [6,8].…”

“…This depends on each individual case in order to detect UTIs which require treatment. It may act as a clinical sign suggesting an infection in certain patients, such as those with limited communication abilities due to situations like altered states of consciousness, dysphasia, or the critically ill [5]. Some authors recommend adequate urinary catheter care in patients without clinical UTI symptoms [4].…”

Une couleur inhabituelle

“…Les facteurs de risque sont l'âge avancé, le sexe féminin, la constipation, la démence, l'alitement prolongé, l'institutionnalisation, l'insuffisance rénale terminale, le sondage urinaire ou la néphrostomie au long cours, la déshydratation, les infections urinaires récurrentes, une bactériurie élevée et un pH urinaire alcalin [3]. Une infection urinaire, volontiers apyrétique, est quasi-systématiquement retrouvée [3].…”

“…Les facteurs de risque sont l'âge avancé, le sexe féminin, la constipation, la démence, l'alitement prolongé, l'institutionnalisation, l'insuffisance rénale terminale, le sondage urinaire ou la néphrostomie au long cours, la déshydratation, les infections urinaires récurrentes, une bactériurie élevée et un pH urinaire alcalin [3]. Une infection urinaire, volontiers apyrétique, est quasi-systématiquement retrouvée [3] . Les bactéries les plus fréquemment associées au syndrome de la poche à urine violette sont : Escherichia coli , Proteus mirabilis, Klebsiella pneumoniae, Enterococcus, Pseudomonas aeruginosa, Providencia stuartii , Morganella morganii , Enterobacter aerogenes , etc.…”