Prognostic value of semi-quantitative bacteruria counts in the diagnosis of group B streptococcus urinary tract infection: a 4-year retrospective study in adult patients

BMC Infectious Diseases

Glen C Ulett³  William H Benjamin²  Michael Steele⁵  Kimberly B Ulett⁴  Chee K Tan¹ 

[1] School of Medical Sciences, Centre for Medicine and Oral Health, Griffith University, Gold Coast Campus, Queensland, 4222, Australia;Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA;Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA;Present address: Royal Brisbane and Women’s Hospital Department of Medicine, Bowen Bridge Road, Herston, Queensland, 4029, Australia;Bond University, Gold Coast, Queensland, 4229, Australia

关键词: Uropathogen;    Urinalysis;    Asymptomatic bacteruria;    Streptococcus agalactiae;    Bacteruria;    Cystitis;    Urinary tract infection;   

Others  :  1159618
DOI  :  10.1186/1471-2334-12-273

 received in 2012-07-12, accepted in 2012-10-23,  发布年份 2012

【 摘 要 】

Background

Semi-quantitative bacteruria counts (s-QBC) are important in the diagnosis of urinary tract infection (UTI) due to most uropathogens. The prognostic value of s-QBC for diagnosis of UTI due to group B streptococcus (GBS) is unknown. In this study, we assessed the value of s-QBC for differentiating acute GBS UTI from asymptomatic bacteruria (ABU), independent of other potential prognostic indicators.

Methods

Medical record review and urinalysis (UA) values for 1593 patients who had urinary GBS isolated(10³ to ≥10⁵ CFU/ml) during a four-year period were analyzed using binary logistic regression to determine the predictive values of s-QBC, age, and gender for infection category (acute UTI, ABU) based on the clinical diagnosis.

Results

s-QBC alone had a strong predictive value for infection category but only for ABU. Multivariate logistic regression showed similar predictive power of s-QBC for infection category using age as a co-predictor, which was also independently associated with infection category. Typical s-QBC cut-off values that are commonly used in diagnostic settings had no significant power in predicting infection category. Among other UA measures, proteinuria and hematuria were significantly associated with acute infection.

Conclusions

Together, these data show that s-QBC is not useful in the differential diagnosis of GBS UTI. Among the patients in this study, age was an equally effective prognostic indicator compared to s-QBC for identifyinghigh- and low-risk patients for acute GBS UTI. Collectively, these findings indicate that age-based associations may be equally as useful as s-QBC for predicting infection category in the setting of adult patients with GBS-positive urine cultures.

【 授权许可】

   
2012 Tan et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Foxman B: Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002, 113(Suppl 1A):5S-13S.
• [2]Patton JP, Nash DB, Abrutyn E: Urinary tract infection: economic considerations. Med Clin North Am 1991, 75(2):495-513.
• [3]Andriole VT, Patterson TF: Epidemiology, natural history, and management of urinary tract infections in pregnancy. Med Clin North Am 1991, 75(2):359-373.
• [4]Barnett BJ, Stephens DS: Urinary tract infection: an overview. Am J Med Sci 1997, 314(4):245-249.
• [5]Hooton TM, Stamm WE: Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am 1997, 11(3):551-581.
• [6]Ronald A: The etiology of urinary tract infection: traditional and emerging pathogens. Dis Mon 2003, 49(2):71-82.
• [7]Ronald A: The etiology of urinary tract infection: traditional and emerging pathogens. Am J Med 2002, 113(Suppl 1A):14S-19S.
• [8]Turnidge J, Bell J, Biedenbach DJ, Jones RN: Pathogen occurrence and antimicrobial resistance trends among urinary tract infection isolates in the Asia-Western Pacific Region: report from the SENTRY Antimicrobial Surveillance Program, 1998–1999. Int J Antimicrob Agents 2002, 20(1):10-17.
• [9]Drekonja DM, Johnson JR: Urinary tract infections. Prim Care 2008, 35(2):345-367. vii
• [10]Munoz P, Coque T, Rodriguez Creixems M, de Quiros JC B, Moreno S, Bouza E: Group B Streptococcus: a cause of urinary tract infection in nonpregnant adults. Clin Infect Dis 1992, 14(2):492-496.
• [11]Moller M, Thomsen AC, Borch K, Dinesen K, Zdravkovic M: Rupture of fetal membranes and premature delivery associated with group B streptococci in urine of pregnant women. Lancet 1984, 2(8394):69-70.
• [12]McKenna DS, Matson S, Northern I: Maternal group B streptococcal (GBS) genital tract colonization at term in women who have asymptomatic GBS bacteriuria. Infect Dis Obstet Gynecol 2003, 11(4):203-207.
• [13]Ulett KB, Shuemaker JH, Benjamin WH Jr, Tan CK, Ulett GC: Group B streptococcus cystitis presenting in a diabetic patient with a massive abdominopelvic abscess: a case report. J Med Case Rep 2012, 6(1):237-240. BioMed Central Full Text
• [14]Ulett KB, Benjamin WH Jr, Zhuo F, Xiao M, Kong F, Gilbert GL, Schembri MA, Ulett GC: Diversity of group B streptococcus serotypes causing urinary tract infection in adults. J Clin Microbiol 2009, 47(7):2055-2060.
• [15]Baker CJ: Group B Streptococcal infections. In Streptococcal Infections Clinical aspects, microbiology, and molecular pathogenesis. Edited by Stevens DL, Kaplan EL. New York: Oxford University Press; 2000:222-237.
• [16]Edwards MS, Baker CJ: Group B streptococcal infections in elderly adults. Clin Infect Dis 2005, 41(6):839-847.
• [17]Muller AE, Oostvogel PM, Steegers EA, Dorr PJ: Morbidity related to maternal group B streptococcal infections. Acta Obstet Gynecol Scand 2006, 85(9):1027-1037.
• [18]De Mouy D, Fabre R, Cavallo JD: Community-acquired urinary tract infections in 15 to 65 years old female patients in France. Susceptibility of E. coli according to history: AFORCOPI-BIO network 2003. Med Mal Infect 2007, 37(9):594-598.
• [19]Persson KM, Grabe M, Kristiansen P, Forsgren A: Significance of group B streptococci in urine cultures from males and non-pregnant females. Scand J Infect Dis 1988, 20(1):47-53.
• [20]Persson K, Christensen KK, Christensen P, Forsgren A, Jorgensen C, Persson PH: Asymptomatic bacteriuria during pregnancy with special reference to group B streptococci. Scand J Infect Dis 1985, 17(2):195-199.
• [21]Persson K, Bjerre B, Elfstrom L, Polberger S, Forsgren A: Group B streptococci at delivery: high count in urine increases risk for neonatal colonization. Scand J Infect Dis 1986, 18(6):525-531.
• [22]Lin K, Fajardo K: Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2008, 149(1):W20-24.
• [23]Cormican M, Murphy AW, Vellinga A: Interpreting asymptomatic bacteriuria. BMJ 2011, 343:d4780.
• [24]Schnarr J, Smaill F: Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. Eur J Clin Invest 2008, 38(Suppl 2):50-57.
• [25]Hay AD, Fahey T: Clinical diagnosis of urinary tract infection. JAMA 2002, 288(10):1229. author reply 1230–1221
• [26]Kaufmann J, Modest GA: Clinical diagnosis of urinary tract infection. JAMA 2002, 288(10):1229-1230. author reply 1230–1221
• [27]Libbus MK: Review: specific combinations of symptoms effectively rule in the diagnosis of urinary tract infection based on history alone. Evid Based Nurs 2002, 5(4):119.
• [28]Gau JT, Shibeshi MR, Lu IJ, Rafique M, Heh V, Meyer D, Carlsen WR: Interexpert agreement on diagnosis of bacteriuria and urinary tract infection in hospitalized older adults. J Am Osteopath Assoc 2009, 109(4):220-226.
• [29]Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S: Does this woman have an acute uncomplicated urinary tract infection? JAMA 2002, 287(20):2701-2710.
• [30]Nicolle LE: Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis. Urol Clin North Am 2008, 35(1):1-12. v
• [31]Kass EH: Pyelonephritis and bacteriuria. A major problem in preventive medicine. Ann Intern Med 1962, 56:46-53.
• [32]Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE: Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis 1992, 15(1):S216-227.
• [33]Burd EM, Sue Kehl K: A Critical Appraisal of the Role of the Clinical Microbiology Laboratory in the Diagnosis of Urinary Tract Infections. J Clin Microbiol 2011, 49(9):S34-S38.
• [34]Walsh CA, Moore KH: Overactive bladder in women: does low-count bacteriuria matter? A review. Neurourol Urodyn 2011, 30(1):32-37.
• [35]Gallagher DJ, Montgomerie JZ, North JD: Acute Infections of the Urinary Tract and the Urethral Syndrome in General Practice. BMJ 1965, 1(5435):622-626.
• [36]Tapsall JW, Taylor PC, Bell SM, Smith DD: Relevance of “significant bacteriuria” to aetiology and diagnosis of urinary-tract infection. Lancet 1975, 2(7936):637-639.
• [37]Wilson ML, Gaido L: Laboratory diagnosis of urinary tract infections in adult patients. Clin Infect Dis 2004, 38(8):1150-1158.
• [38]Ribeiro RM, Rossi P, Guidi HG, Pinotti JA: Urinary tract infections in women. Int Urogynecol J Pelvic Floor Dysfunct 2002, 13(3):198-203.
• [39]Thomsen AC, Morup L, Hansen KB: Antibiotic elimination of group-B streptococci in urine in prevention of preterm labour. Lancet 1987, 1(8533):591-593.
• [40]Stamm WE, Running K, McKevitt M, Counts GW, Turck M, Holmes KK: Treatment of the acute urethral syndrome. N Engl J Med 1981, 304(16):956-958.
• [41]Hooton TM, Scholes D, Stapleton AE, Roberts PL, Winter C, Gupta K, Samadpour M, Stamm WE: A prospective study of asymptomatic bacteriuria in sexually active young women. N Engl J Med 2000, 343(14):992-997.
• [42]Nicolle LE: Asymptomatic bacteriuria: review and discussion of the IDSA guidelines. Int J Antimicrob Agents 2006, 28(Suppl 1):S42-48.
• [43]Raz R: Asymptomatic bacteriuria. Clinical significance and management. Int J Antimicrob Agents 2003, 22(2):45-47.
• [44]Juthani-Mehta M: Asymptomatic bacteriuria and urinary tract infection in older adults. Clin Geriatr Med 2007, 23(3):585-594. vii
• [45]Skoff TH, Farley MM, Petit S, Craig AS, Schaffner W, Gershman K, Harrison LH, Lynfield R, Mohle-Boetani J, Zansky S, et al.: Increasing burden of invasive group B streptococcal disease in nonpregnant adults, 1990–2007. Clin Infect Dis 2009, 49(1):85-92.
• [46]Renko M, Tapanainen P, Tossavainen P, Pokka T, Uhari M: Meta-analysis of the significance of asymptomatic bacteriuria in diabetes. Diabetes Care 2011, 34(1):230-235.
• [47]Kunin CM, White LV, Hua TH: A reassessment of the importance of “low-count” bacteriuria in young women with acute urinary symptoms. Ann Intern Med 1993, 119(6):454-460.
• [48]Roos V, Ulett GC, Schembri MA, Klemm P: The asymptomatic bacteriuria Escherichia coli strain 83972 outcompetes uropathogenic E. coli strains in human urine. Infect Immun 2006, 74(1):615-624.
• [49]Ulett GC, Webb RI, Ulett KB, Cui X, Benjamin WH, Crowley M, Schembri MA: Group B Streptococcus (GBS) urinary tract infection involves binding of GBS to bladder uroepithelium and potent but GBS-specific induction of interleukin 1alpha. J Infect Dis 2010, 201(6):866-870.
• [50]Kline KA, Schwartz DJ, Lewis WG, Hultgren SJ, Lewis AL: Immune activation and suppression by group B streptococcus in a murine model of urinary tract infection. Infect Immun 2011, 79(9):3588-3595.
• [51]Tan CK, Carey AJ, Cui X, Webb RI, Ipe D, Crowley M, Cripps AW, Benjamin WH Jr, Ulett KB, Schembri MA, et al.: Genome-Wide Mapping of Cystitis Due to Streptococcus agalactiae and Escherichia coli in Mice Identifies a Unique Bladder Transcriptome That Signifies Pathogen-Specific Antimicrobial Defense against Urinary Tract Infection. Infect Immun 2012, 80(9):3145-3160.