Rapid differentiation of cocci/mixed bacteria from rods in voided urine culture of women with uncomplicated urinary tract infections

Jung

et al. 2020

Urogenit Tract Infect

Purpose: Diagnosing urinary tract infections by urine culture is time-consuming during a Bacillus Calmette-Guérin treatment. Because the urine culture results take time to collect, patients are treated presumptively, or Bacillus Calmette-Guérin is discontinued before the results. This study evaluated the ability of the Sysmex UF-1000i system to examine the urine bacterial count and determine if it could be used to predict a positive culture. Materials and Methods: 180 patients who underwent transurethral resection for bladder tumors and received intravesical Bacillus Calmette-Guérin treatment between January 2017 and July 2018 were evaluated prospectively. For patients who received an intravesical Bacillus Calmette-Guérin treatment, urine flow cytometry, and urine cultures were assessed weekly during the treatment period. Results: During Bacillus Calmette-Guérin instillation, 44, 146, and 27 patients had bacteriuria, pyuria, and positive urine nitrite, respectively. Multivariate analysis indicated that the predictors associated with bacteriuria included the urine flow cytometry results of ＞100 bacteria/l (odds ratio, 22.73; p＜0.001) and positive urine nitrite (odds ratio, 5.67; p=0.012) at the time of sampling for positive urine culture. The area under the receiver operative characteristic curve for diagnosing bacteriuria by urine flow cytometry was 0.825. A urine flow cytometry cutoff value of ＞100 bacteria/l resulted in a sensitivity and specificity of 75% and 90.91%, respectively. Using the cutoff of ＞1,000 bacteria/l, the sensitivity and specificity were 50% and 94.85%, respectively. Conclusions: Rapid urinary tract infection diagnosis using Sysmex UF-1000i can be used to determine whether to treat an infection and to avoid unnecessary Bacillus Calmette-Guérin discontinuation and urine culture tests.

supporting

confidence: 60%

Performance of the Sysmex UF-1000i System in Screening for Significant Bacteriuria in Patients with Bladder Cancer Who Received Bacillus Calmette-Guérin Treatment

Jung

et al. 2020

Urogenit Tract Infect

Journal of Infection and Chemotherapy

“…For that, microscopy findings of urine sediment with or without Gram staining is recommended, not only to ensure diagnostic accuracy, but also to distinguish between those forms. In the future, flow cytometry may take the place of microscopy, because a system for discriminating between Gram-positive and negative bacteria has been developed and may be available soon for clinical use [32].…”

Section: Discussionmentioning

confidence: 99%

Second nationwide surveillance of bacterial pathogens in patients with acute uncomplicated cystitis conducted by Japanese Surveillance Committee from 2015 to 2016: antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus

Hayami

Takahashi

Ishikawa

et al. 2019

The Japanese Surveillance Committee conducted a second nationwide surveillance of antimicrobial susceptibility patterns of uropathogens responsible for acute uncomplicated cystitis (AUC) in premenopausal patients aged 16e40 years old at 31 hospitals throughout Japan from March 2015 to February 2016. In this study, the susceptibility of causative bacteria (Escherichia coli, Klebsiella pneumoniae, Staphylococcus saprophyticus) for various antimicrobial agents was investigated by isolation and culturing of organisms obtained from urine samples. In total, 324 strains were isolated from 361 patients, including E. coli (n ¼ 220, 67.9%), S. saprophyticus (n ¼ 36, 11.1%), and K. pneumoniae (n ¼ 7, 2.2%). The minimum inhibitory concentrations (MICs) of 20 antibacterial agents for these strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) manual. At least 93% of the E. coli isolates showed susceptibility to fluoroquinolones and cephalosporins, whereas 100% of the S. saprophyticus isolates showed susceptibility to fluoroquinolones and aminoglycosides. The proportions of fluoroquinoloneresistant and extended-spectrum b-lactamase (ESBL)-producing E. coli strains were 6.4% (13/220) and 4.1% (9/220), respectively. The antimicrobial susceptibility of K. pneumoniae was retained during the surveillance period, while no multidrug-resistant strains were identified. In summary, antimicrobial susceptibility results of our second nationwide surveillance did not differ significantly from those of the first surveillance. Especially the numbers of fluoroquinolone-resistant and ESBL-producing E. coli strains were not increased in premenopausal patients with AUC in Japan.

“…Thus, a different approach might be required. Two trials used different patterns of bacteria fluorescent light to predict bacterial morphologies and mixed flora correctly using UF1000i (Sysmex, Kobe, Japan) [ 23 , 24 ]. While Yang, Yang [ 24 ] concluded that results of laser flow cytometry predict growth of mixed flora, the results of Geerts, Jansz [ 23 ] showed underperformance in the category mixed flora.…”

Section: Discussionmentioning

confidence: 99%

“…Two trials used different patterns of bacteria fluorescent light to predict bacterial morphologies and mixed flora correctly using UF1000i (Sysmex, Kobe, Japan) [ 23 , 24 ]. While Yang, Yang [ 24 ] concluded that results of laser flow cytometry predict growth of mixed flora, the results of Geerts, Jansz [ 23 ] showed underperformance in the category mixed flora. Further studies are needed to clarify the results of this promising approach and give recommendations for the use in clinical practice which is of special use in the emergency setting where the contamination rate is often found to be high [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

The development and validation of different decision-making tools to predict urine culture growth out of urine flow cytometry parameter

et al. 2018

ObjectivePatients presenting with suspected urinary tract infection are common in every day emergency practice. Urine flow cytometry has replaced microscopic urine evaluation in many emergency departments, but interpretation of the results remains challenging. The aim of this study was to develop and validate tools that predict urine culture growth out of urine flow cytometry parameter.MethodsThis retrospective study included all adult patients that presented in a large emergency department between January and July 2017 with a suspected urinary tract infection and had a urine flow cytometry as well as a urine culture obtained. The objective was to identify urine flow cytometry parameters that reliably predict urine culture growth and mixed flora growth. The data set was split into a training (70%) and a validation set (30%) and different decision-making approaches were developed and validated.ResultsRelevant urine culture growth (respectively mixed flora growth) was found in 40.2% (7.2% respectively) of the 613 patients included. The number of leukocytes and bacteria in flow cytometry were highly associated with urine culture growth, but mixed flora growth could not be sufficiently predicted from the urine flow cytometry parameters. A decision tree, predictive value figures, a nomogram, and a cut-off table to predict urine culture growth from bacteria and leukocyte count were developed, validated and compared.ConclusionsUrine flow cytometry parameters are insufficient to predict mixed flora growth. However, the prediction of urine culture growth based on bacteria and leukocyte count is highly accurate and the developed tools should be used as part of the decision-making process of ordering a urine culture or starting an antibiotic therapy if a urogenital infection is suspected.