Relevance of "Significant Bacteriuria" to Ætiology and Diagnosis of Urinary-Tract Infection

Overactive bladder in women: Does low‐count bacteriuria matter? A review

“…However, both groups responded similarly well to antimicrobial therapy and the authors concluded that, clinically, both groups appeared to have the same disease. 10 Other studies confirmed these findings, with bacteriuria >10 5 CFU/ml detected in only 50--60% of women presenting with symptoms of acute UTI 11,12 suggesting that among symptomatic women, bacterial counts <10 5 CFU/ml may indeed be clinically important.…”

“…It is notable that many of these studies involve delays (usually refrigerated) of 3 or 4 hr prior to microscopic examination, which may lead to inaccuracies in the quoted rates of pyuria. 10,18,19 Some authors have also raised the possibility that pyuria should not be mandatory in cases of symptomatic lowcount bacteriuria, as it is with higher counts. In a review of pyuria in 1983, Stamm 37 noted that 'further studies of the relation of pyuria to infection .…”

All dysuria is local

“…Although some authors recommend using 10 2 colonies on culture as the gold standard for cystitis in symptomatic women, 35 most antibiotic treatment studies and test evaluation studies still rely on 10 5 , as did we. In 2,068 patients in 10 treatment studies, 11,34,36–43 the average prevalence of bacterial infection was 67% (range 46% to 78%). This formed our base case assumption.…”

“…To avoid this documented spectrum bias, 46 we determined the sensitivity of urinalysis from studies limited to symptomatic ambulatory women 11,21,38,39,42–44,47 . To estimate the false positive rate, we calculated the conditional likelihood of pyuria and bacteriuria for each cause of dysuria 11,15,34,38–40,44,48–51 . The diagnostic gold standards were urine culture for cystitis, pelvic exam for candida vaginitis and herpes simplex, and STD cultures for gonorrhea and chlamydia.…”

“…Efficacy of antibiotics for patients with urethral syndrome, including “low‐count” bacteriuria, was based on treatment trials and studies of the urethral syndrome 15,29,34,36,38–40,44,64–67 . Finally, we assumed that women with nonbacterial urethritis and vaginitis would not respond to antibiotics.…”