Relation between Pyelonephritis and Bacterial Counts in the Urine

MacDonald, Richard A.; Levitin, Howard; Mallory, G. Kenneth; Kass, Edward H.; Norton, Joanne C.

doi:10.1056/nejm195705162562001

Cited by 129 publications

(29 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The correlation between the white cell level in the urine and the degree of bacteriuria is closer than in previously reported studies (MacDonald et al, 1957;Jackson, Grieble, and Knudsen, 1958;Kass, 1957;and Rengarts, 1960) in which the general impression was that pyuria was not a reliable indication of urinary infection. We feel that this difference of opinion is due first to the use of the variable and relatively inaccurate method of the ordinary wet film technique, and secondly te the use of 5 or more cells per H.P.F.…”

Section: Results and Interpretationsupporting

confidence: 64%

Simplified quantitative methods for bacteriuria and pyuria

McGeachie

Kennedy

1963

Journal of Clinical Pathology

View full text Add to dashboard Cite

SYNOPSIS Although pyelonephritis is a common disease, it escapes clinical detection in an undesirably high proportion of patients. The present unsatisfactory diagnostic position would be much improved by widespread screening of patients by simple yet reasonably accurate methods. Bacterial counts by the pour-plate technique and estimates of the white cell excretion per hour or day, while undoubtedly of diagnostic value, are probably unsuitable for use on a wide scale. In an attempt to find more convenient procedures a simplified stroke-plate method of bacterial counting and a simplified quantitative white cell count method were devised and applied to over 1,000 mid-stream urine samples from 398 patients. Good correlation was obtained between the simpler stroke-plate method of bacterial counting and the more time-consuming pour-plate method. The quantitative white cell procedure was a much more sensitive index of pyuria than wet-film microscopy, and comparison with the bacterial count results showed that it gave a useful indication of urinary infection. It is suggested that a quantitative bacterial count should replace non-quantitative culture methods when urinary infection is suspected and that the quantitative white cell count should be performed as a routine part of the initial clinical and laboratory assessment of all patients, followed by a bacterial count if pyuria is revealed. Experience has shown that routine urine microscopy by a precise method leads to the detection of many cases of occult urinary infection.Estimates of the incidence of pyelonephritis on the basis of necropsy evidence have ranged from 6 18 % (Brod, 1956) to 20% (Rhoads, Billings, and O'Conor, 1952). Many of these cases are undiagnosed, probably because obvious symptoms of urinary tract inflammation, such as dysuria and frequency of micturition, are often absent or slight, particularly if the infection is chronic. Thus, Kleeman, Hewitt, and Guze (1960) report that out of 629 cases of significant pyelonephritis seen at necropsy in a five-year period, only 104 (16.6%) were diagnosed clinically, although they stress that retrospective study of the case records indicated that there was suggestive information in 70% of all cases.

show abstract

Section: Results and Interpretationsupporting

confidence: 64%

Simplified quantitative methods for bacteriuria and pyuria

McGeachie

Kennedy

1963

Journal of Clinical Pathology

View full text Add to dashboard Cite

show abstract

“…In contrast, bacteria added to sterile urine as contamination in clean-voided specimens usually are considerably fewer in number. In general, this hypothesis has been verified (4)(5)(6)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and exceptions clearly outlined (21), but agreement has not been universal (22,23). The choice of the number of bacteria as a dividing line between bacteriuria and contamination is based on statistical probabilities.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, increasing emphasis has been placed on significant bacteriuria determined by quantitative urine cultures as a criterion for active pyelonephritis (4). In some subjects in whom bacteriuria has been discovered for the first time by quantitative urine cultures, the diagnosis of pyelonephritis has then been established from the clinical and laboratory findings (5); but in other individuals with asymptomatic bacteriuria, the normal urinary sediment and pyelographic findings, and even postmortem microscopic examination of the kidneys, have not supported a clinical suspicion of silent pyelonephritis (5,6).…”

mentioning

confidence: 99%

Urinary Concentrating Ability in Pregnant Women With Asymptomatic Bacteriuria*

Kaitz¹

1961

J. Clin. Invest.

View full text Add to dashboard Cite

“…This cut-off point dates back to a few papers by Ed Kass in the 1950s who defined a level of bacterial count that would include most patients with true UTI without including too many without a true infection. In his initial publication, however, he acknowledged that the proposed cut-off would lead to a number of false negative diagnoses [6].…”

Section: Bacterial Culturesmentioning

confidence: 99%

“…A recent study that used different cut-off levels for bag samples (≥10 6 ) and catheter samples (≥10 3 ) found that there were 29% false negative bag cultures compared to the catheter samples [10]. Children with true infections can thus be missed both in clinical practice and in scientific studies.…”

Section: Bacterial Culturesmentioning

confidence: 99%

Difficulties in diagnosing urinary tract infections in small children

Tullus

2011

Pediatr Nephrol

View full text Add to dashboard Cite

Urinary tract infections (UTIs) in children appear to be simple and straightforward matters, but there is as yet no consensus on UTIs in this patient group, and it remains one of the most -if not the most -controversial fields in paediatric medicine. Controversy and the lack of consensus can be found in many areas, including the diagnosis and management of UTIs in paediatric patients. Consequently, children with a UTI are investigated and treated quite differently in different parts of the world and also within different parts of the same country. One factor contributing to the current situation is the unexpected difficulty in diagnosing a UTI in children. This difficulty has implications not only for clinical work but also for scientific studies. Substantial over-and under-diagnosing can result from practical difficulties in at least three areas, including problems with collecting urine samples, in interpreting bacterial numbers correctly, and in confusing infantile asymptomatic bacteriuria and a true symptomatic febrile UTI. In this review, these problems will be discussed in detail as well as the implications they have had on clinical practice and research on UTIs.

show abstract

Relation between Pyelonephritis and Bacterial Counts in the Urine

Cited by 129 publications

References 7 publications

Simplified quantitative methods for bacteriuria and pyuria

Simplified quantitative methods for bacteriuria and pyuria

Urinary Concentrating Ability in Pregnant Women With Asymptomatic Bacteriuria*

Difficulties in diagnosing urinary tract infections in small children

Contact Info

Product

Resources

About