Quantitative definition of bacteriuria

Platt, Richard

doi:10.1016/0002-9343(83)90072-4

Cited by 95 publications

(36 citation statements)

References 41 publications

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“…However, since CNS grow relatively slowly in urine, it has been suggested that lower colony counts of 100 to 100,000 CFU/ml should be considered an appropriate range for significant bacteriuria due to these organisms (132,184,251,287). Some investigators suggest that CNS should be considered a urinary tract pathogen only when they are present in pure culture (107,108) or are associated with no more than one other species (123).…”

Section: Specimen Collection and Processingmentioning

confidence: 99%

Update on clinical significance of coagulase-negative staphylococci

1994

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The clinical significance of coagulase-negative Staphylococcus species (CNS) continues to increase as strategies in medical practice lead to more invasive procedures. Hospitalized patients that are immunocompromised and/or suffering from chronic diseases are the most vulnerable to infection. Since CNS are widespread on the human body and are capable of producing very large populations, distinguishing the etiologic agent(s) from contaminating flora is a serious challenge. For this reason, culture identification should proceed to the species and strain levels. A much stronger case can be made for the identification of a CNS etiologic agent if the same strain is repeatedly isolated from a series of specimens as opposed to the isolation of different strains of one or more species. Strain identity initially can be based on colony morphology, and then one or more molecular approaches can be used to gain information on the genotype. Many of the CNS species are commonly resistant to antibiotics that are being indicated for staphylococcal infections, with the exception of vancomycin. The widespread use of antibiotics in hospitals has provided a reservoir of antibiotic-resistant genes. The main focus on mechanisms of pathogenesis has been with foreign body infections and the role of specific adhesins and slime produced by Staphylococcus epidermidis. Slime can reduce the immune response and opsonophagocytosis, thereby interfering with host defense mechanisms. As we become more aware of the various strategies used by CNS, we will be in a better position to compromise their defense mechanisms and improve treatment.

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Section: Specimen Collection and Processingmentioning

confidence: 99%

Update on clinical significance of coagulase-negative staphylococci

1994

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“…are at 1.6 times greater risk of perinatal death (76). Pyelonephritis during pregnancy is the most frequent cause of hospitalization during this period and is associated with increased perinatal mortality, more frequent premature deliveries, and deficient development of the infant (35).…”

Section: :1mentioning

confidence: 99%

Detection of urinary tract infections by rapid methods

Pezzlo

1988

Clin Microbiol Rev

121

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A review of rapid urine screens for detection of bacteriuria and pyuria demonstrates a number of available alternatives to the culture method. Selection of one or more of these systems for routine use is dependent upon the laboratory and the patient population being tested. The laboratory approach to the diagnosis of urinary tract infection should consider the clinical diagnosis of the patient whenever possible. Keeping in mind that quantitative urine cultures alone cannot be used to detect infection in some patient populations unless lower colony counts are considered, a rapid screen may be a more practical approach. It has become accepted that 10(5) CFU/ml can no longer be used as the standard for all patient groups, that pyuria often is important in making the diagnosis of a urinary tract infection, and that most of the rapid screens are more sensitive than the culture method at 10(5) CFU/ml. Presently, no one approach can be recommended for all laboratories and all patient groups. However, each diagnostic laboratory should select one approach which is best for its situation. It is not practical, efficient, or cost effective to define a protocol for each possible clinical condition; however, all should be considered when developing a protocol. This protocol should be compatible with the patient population and communicated to the physicians. Use of a rapid screen should be beneficial to the patient, the physician, and the laboratory.

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“…For Gramnegative bacteriuria at Ն10 5 CFU/ml, RapidBac was highly sensitive at 99%. It is worth noting that most evaluations of other rapid test kits and diagnostic methods have used 10 4 or 10 5 CFU/ml as the cutoff for significant bacteriuria by culture, while we have chosen a more stringent but more clinically relevant cutoff of 10 3 CFU/ml (12,15,27,28). In most commercial laboratories, in order to detect 10 3 CFU/ml of bacteria, a 1:1,000 dilution of the urine sample is plated, and a positive result constitutes a single colony on the culture plate(s).…”

Section: Discussionmentioning

confidence: 99%

Performance of a New Rapid Immunoassay Test Kit for Point-of-Care Diagnosis of Significant Bacteriuria

et al. 2015

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dUrinary tract infections (UTIs) are frequently encountered in clinical practice and most commonly caused by Escherichia coli and other Gram-negative uropathogens. We tested RapidBac, a rapid immunoassay for bacteriuria developed by Silver Lake Research Corporation (SLRC), compared with standard bacterial culture using 966 clean-catch urine specimens submitted to a clinical microbiology laboratory in an urban academic medical center. RapidBac was performed in accordance with instructions, providing a positive or negative result in 20 min. RapidBac identified as positive 245/285 (sensitivity 86%) samples with significant bacteriuria, defined as the presence of a Gram-negative uropathogen or Staphylococcus saprophyticus at >10 3 CFU/ml. The sensitivities for Gram-negative bacteriuria at >10 4 CFU/ml and >10 5 CFU/ml were 96% and 99%, respectively. The specificity of the test, detecting the absence of significant bacteriuria, was 94%. The sensitivity and specificity of RapidBac were similar on samples from inpatient and outpatient settings, from male and female patients, and across age groups from 18 to 89 years old, although specificity was higher in men (100%) compared with that in women (92%). The RapidBac test for bacteriuria may be effective as an aid in the point-of-care diagnosis of UTIs especially in emergency and primary care settings. Bacterial urinary tract infections (UTIs) are a common clinical problem across the age spectrum in both genders (1). Women and girls are disproportionately affected by UTIs, with the lifetime risk estimated at Ͼ60% (2). In the United States, the overall annual cost of diagnosis and treatment of UTIs is considerable, estimated at $2.3 billion in 2010 (1). Gram-negative bacteria are the causative agents in up to 95% of uncomplicated UTIs in women, with Escherichia coli responsible for 70% to 90% (1).Diagnosis of UTI remains problematic in certain settings. The presence of uropathogenic bacteria in urine is the hallmark of UTI, and urine culture is the gold standard method for determination of clinically relevant bacteriuria. However, the 24-to 48-h delay in obtaining urine culture results has presented a longstanding need for more rapid diagnostic methods. Currently available rapid methods for detection of bacteriuria, including microscopy and test strips for detecting nitrite, have been shown to have poor sensitivity (3-5). A meta-analysis of 34 studies evaluating the accuracy of nitrite test strips across settings and populations found a mean sensitivity of 48% (using a definition of 10 5 CFU/ml for significant bacteriuria) (6). Microscopic urinalysis and urine Gram staining, two relatively laborious methods, have been shown by several studies to lack sensitivity below 10 5 CFU/ml and to have poor specificity (4,5,7,8). Guidelines for UTI from the Infectious Disease Society of America (IDSA) do not recommend urine culture for most cases of acute uncomplicated cystitis, the most common UTI presentation, and do not address laboratory methods for diagnosing UTI (9).An accurate ...

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Quantitative definition of bacteriuria

Cited by 95 publications

References 41 publications

Update on clinical significance of coagulase-negative staphylococci

Update on clinical significance of coagulase-negative staphylococci

Detection of urinary tract infections by rapid methods

Performance of a New Rapid Immunoassay Test Kit for Point-of-Care Diagnosis of Significant Bacteriuria

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