Urine Specimen Collection with External Devices for Diagnosis of Bacteriuria in Elderly Incontinent Men

Abstract

We determined the validity of using external devices for urine specimen collection from 24 elderly incontinent men residing in a nursing home by collecting three sequential specimens, two with external devices and then one by catheterization. The positive predictive value of organisms isolated in quantitative counts of 2105 CFU/ml in external devices for bladder bacteriuria was 86% for either sterile or clean collecting devices and 93% for the same organism in two consecutive specimens. The negative predictive value for organisms present in quantitative counts of <105 CFU/ml was 90% for both sterile and clean devices and 86% when the organism was present in both specimens. Contamination in external collection devices was not influenced by whether the device was clean or sterile, circumcision of the resident, or duration of time between device application and specimen collection. These data suggest that urine specimens collected by ward nursing staff with external devices are reliable for the diagnosis of bacteriuria in this patient population.Incontinence is a common problem in elderly men residing in nursing homes (5, 10). Collection of valid clean-catch urine specimens for culture from such individuals is frequently difficult or impossible due to lack of voiding control or lack of cooperation. For many of these residents, incontinence is managed through the use of condom drainage and leg bags (10). When urine specimens for culture are required, specimens are sometimes collected from these external drainage devices (1). This method of specimen collection may lead to contamination with flora colonizing the glans penis, compromising the validity of such specimens (2). Thus, it has been suggested that only specimens collected by in-and-out catheter, an invasive method, may be valid for this population.Bacteriuria has a prevalence approaching 50% in elderly institutionalized men (6,8). Studies to clarify the pathogenesis, natural history, and therapeutic outcome of bacteriuria in this population require a reliable, noninvasive method for the collection of urine specimens. Recently, Ouslander et al. (9) examined the reliability of urine specimens collected with external devices and reported that specimens collected by a single study nurse using a standard protocol were valid for mnicrobiologic analysis. We report here our observations of the validity of such specimen collection where specimens were collected by the ward nursing staff. In addition, factors which might correlate with contamination and the presence of pyuria in specimens were examined.(This study was presented in part at the 26th Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, La., September 1986.) MATERIALS AND METHODS Patient population. The study subjects were 24 elderly men with incontinence who reside at the Deer Lodge Centre, Winnipeg, Manitoba. Fourteen of these had incontinence managed by chronic condom drainage. Characteristics of * Corresponding author. this study population have been previously described (8). T...

Asymptomatic bacteriuria: review and discussion of the IDSA guidelines

“…Thus, the quantitative count of ≥10 5 CFU/mL remains the appropriate microbiological criterion. In elderly men with voiding managed by external condom catheters, the requirement for a quantitative count ≥10 5 CFU/mL has been validated by comparison with results of concurrent catheterized specimens [11,12]. Lower quantitative counts in specimens collected from these men reflect colonizing periurethral organisms or contamination of the condom, tubing or leg bag.…”

Pyuria in Institutionalized Elderly Subjects

“…Microbiological and biochemical methods: Urine specimens were obtained by 'clean catch' technique at the first moming void. Patients who were unable to control bladder function and required condom drainage had the first urine voided and leg-bag collected after the application of a clean condom (7). Six individuals with chronic indwelling catheters had specimens collected by aspiration from the catheter port.…”

Urinary IgG and IgA Antibodies in Elderly Individuals with Bacteriuria

“…Urine specimens were collected at the time of first morning void using a clean catch technique, or using a freshly applied clean condom catheter [10]. Urine culture was performed using standard quantitative microbiological methods with identification of organ isms using the API 20E system.…”