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Antibody-Coated Bacteria in Urinary Tract infections
0022-504 7/82/1276--1249$02.00/C T:s::z JOURNAL OF lJ~o:;:_A)GY Copyright© 1982 by The T~li.Hia:ms
VVilkins Ce;.
INFECTIONS AND ANTIBIOTICS Limitations of the Direct Imm1.mofiuore§cence Te§t for Antibody-Coated Bacteria in Determining the Site of Urinary Tract Infections in Children 8.
MONTPLAISIR,
C.
COURTEAU,
B.
MARTINEAU
AND
M.
Departments of Microbiology and Immunology, and Pathology, Universite de Montreal and Hopital SainteJustine, Montreal, Canada
PELLETIER,
Canad. Med. Ass. J., 125: 993-996 (Nov. 1) 1981 The authors performed direct immunofluorescence of antibody-coated bacteria on 282 children with significant bacteriuria. False negative results were observed in 20 per cent of the cases (19 of 94). False positive results were found in 52 per cent of the specimens (19 of 188) and resulted from contamination with stool or vaginal secretions, which also were shown to be a source of antibody-coated bacteria. In addition, the presence of Fe receptors (receptors for the crystallizable fragment of the immunoglobulin molecule) from the surface of some strains of Staphylococcus aureus resulted in false positive results. The authors suggested that the test be done on urine collected by suprapubic puncture in children for best results. It also was recommended that conjugated anti-immunoglobulin G antiserum containing only F(ab)2, the antigen-binding fragments of the immunoglobulin G molecule, be used to prevent false positive results due to the presence of Fe receptors on the bacterial surface. W.J.C. 3 tables, 35 references
Antibody-Coated Bacteria in Urinary Tract Infections
V. L. THOMAS AND M. FORLAND, unvn·=,,,~,. of Medicine, San Antonio, University Texas Health Science Texas Kidney Int., 21: 1-7 (Jan.) 1982 In 1974 it was reported that a noninvasive fluorescent antitest was useful in establishing the anatomic site of infection in the urinary tract. The technique involves a simple and direct immunofluorescence procedure to detect coated bacteria in urine sediments I-'""''°,""" with tract infections. Al'.ltlDoav-co bacteria usually are found in urine from n~,n,,rnrn infections but not from patients with uncom1ah,ca1ced bladder infections. This review focuses on the efforts of the authors' hA~~,,A'"" and the work of other mvestlgators in evaluating the clinical application of the test for antibody-coated bacteria as a diagnostic determining the usefulness of the test in defining populations for epidemiologic and therapeutic studies, ascertaining the prognostic usefulness of the test in following the clinical course of the individmil patient with persistent or recurrent infections and defining the biological significance of antibody-coated bacteria in urine. The major clinical usefulness of a positive test for antibodycoated bacteria is the indication to the physician that the problem is more than a simple lower tract infection. Either kidney or prostatic involvement is present or an invasive bladder infection has occurred related to the presence of stones, malignancy, recent operation or hemorrhagic cystitis. A nega-
tive antibody-coated bacteria test in the absence of a clinical picture of acute pyelonephritis provides reasonable assurance that th.ere is no renal, or invasive bladder infection. The therapeutic guidelines predicated these findings suggest that the patient with a negative antibody-coated bacteria test will respond well to a short course of therapy, even for 1 to 3 days. The male patient with antibody-coated bacteria and recurrent infection appears to have the least likelihood of prompt relapse if therapy is prolonged for 6 to 12 weeks, probably because of chronic prostatic involvement. The limited studies available do not support maintaining treatment in women with antibody-coated bacteria >10 to 14 days because of the rapidity of recurrences after therapy. However, it is premature to set firm therapeutic guidelines and additional studies are necessary, particularly in a population with well defined, relapse infections. Clinical areas requiring further definition include the unexplained lack of correlation of antibody-coated bacteria with bladder washout studies in the pediatric population. Does age, duration of infection or the number of previous recurrences have a role in these discordant findings? Further correlations with the outcome of preg-nancy, as well as studies on the frequency, sequence of immunoglobulin appearance and significance of antit}o,iv--cc,a bacteria in the catheterized patient are necessary. Also, fundamental questions remain regarding antibody-coated bactflri,i. the u~,w'""""''"11ml!, of tract infection and host-organism interrelationships. Are the presence of immunoglobulins in the perineal area protective to the host and to the invading organism in the unique environment of the kidney? The persistence of renal infection after some years despite a sustained immunologic response, as strikingly demonstrated antibody-coated bacteria, continues to challenge investigators working in the area of host-organism interrelationships. G.P.M. 2 tables, 59 references
Single-Dose Amoxidllin Treatment of Urinary T-ract Infections
J. Ped<, 99: 989-992 (Dec.) 1981 TheoreticaJly, doses of antimicrobials are efficacious in the treatment of lower of the of prolonged Other include assured c.vH;i,mauc.so, low cost, decreased selection of resistant strnins and less side effects. Studies on treatment with single doses are few and the results are conflicting. The authors used a single dose of 50 mg./kg. amoxicillin in 18 girls (2.2 to 15.8 years with documented tive) lower urinary tract infection. An additional 17 girls ;-eceived 10 days of therapy (40 mg./kg. 3 times daily). Details of culture results are presented. Of the 18 children 14 (78 per cent) were cured with a single dose (4 failures and 3 recurrences). Of the 17 children who received treatment for 10 days 15 (88 per cent) were cured (2 failures and 2 recurrences). Single-dose therapy has been shown ineffective in adults with upper urinary tract infection and, hence, the treatment group was limited in this study. Resistant organisms were included
1249
~'=~=~·~-'"rn,~
VVilkins Ce;.
INFECTIONS AND ANTIBIOTICS Limitations of the Direct Imm1.mofiuore§cence Te§t for Antibody-Coated Bacteria in Determining the Site of Urinary Tract Infections in Children 8.
MONTPLAISIR,
C.
COURTEAU,
B.
MARTINEAU
AND
M.
Departments of Microbiology and Immunology, and Pathology, Universite de Montreal and Hopital SainteJustine, Montreal, Canada
PELLETIER,
Canad. Med. Ass. J., 125: 993-996 (Nov. 1) 1981 The authors performed direct immunofluorescence of antibody-coated bacteria on 282 children with significant bacteriuria. False negative results were observed in 20 per cent of the cases (19 of 94). False positive results were found in 52 per cent of the specimens (19 of 188) and resulted from contamination with stool or vaginal secretions, which also were shown to be a source of antibody-coated bacteria. In addition, the presence of Fe receptors (receptors for the crystallizable fragment of the immunoglobulin molecule) from the surface of some strains of Staphylococcus aureus resulted in false positive results. The authors suggested that the test be done on urine collected by suprapubic puncture in children for best results. It also was recommended that conjugated anti-immunoglobulin G antiserum containing only F(ab)2, the antigen-binding fragments of the immunoglobulin G molecule, be used to prevent false positive results due to the presence of Fe receptors on the bacterial surface. W.J.C. 3 tables, 35 references
Antibody-Coated Bacteria in Urinary Tract Infections
V. L. THOMAS AND M. FORLAND, unvn·=,,,~,. of Medicine, San Antonio, University Texas Health Science Texas Kidney Int., 21: 1-7 (Jan.) 1982 In 1974 it was reported that a noninvasive fluorescent antitest was useful in establishing the anatomic site of infection in the urinary tract. The technique involves a simple and direct immunofluorescence procedure to detect coated bacteria in urine sediments I-'""''°,""" with tract infections. Al'.ltlDoav-co bacteria usually are found in urine from n~,n,,rnrn infections but not from patients with uncom1ah,ca1ced bladder infections. This review focuses on the efforts of the authors' hA~~,,A'"" and the work of other mvestlgators in evaluating the clinical application of the test for antibody-coated bacteria as a diagnostic determining the usefulness of the test in defining populations for epidemiologic and therapeutic studies, ascertaining the prognostic usefulness of the test in following the clinical course of the individmil patient with persistent or recurrent infections and defining the biological significance of antibody-coated bacteria in urine. The major clinical usefulness of a positive test for antibodycoated bacteria is the indication to the physician that the problem is more than a simple lower tract infection. Either kidney or prostatic involvement is present or an invasive bladder infection has occurred related to the presence of stones, malignancy, recent operation or hemorrhagic cystitis. A nega-
tive antibody-coated bacteria test in the absence of a clinical picture of acute pyelonephritis provides reasonable assurance that th.ere is no renal, or invasive bladder infection. The therapeutic guidelines predicated these findings suggest that the patient with a negative antibody-coated bacteria test will respond well to a short course of therapy, even for 1 to 3 days. The male patient with antibody-coated bacteria and recurrent infection appears to have the least likelihood of prompt relapse if therapy is prolonged for 6 to 12 weeks, probably because of chronic prostatic involvement. The limited studies available do not support maintaining treatment in women with antibody-coated bacteria >10 to 14 days because of the rapidity of recurrences after therapy. However, it is premature to set firm therapeutic guidelines and additional studies are necessary, particularly in a population with well defined, relapse infections. Clinical areas requiring further definition include the unexplained lack of correlation of antibody-coated bacteria with bladder washout studies in the pediatric population. Does age, duration of infection or the number of previous recurrences have a role in these discordant findings? Further correlations with the outcome of preg-nancy, as well as studies on the frequency, sequence of immunoglobulin appearance and significance of antit}o,iv--cc,a bacteria in the catheterized patient are necessary. Also, fundamental questions remain regarding antibody-coated bactflri,i. the u~,w'""""''"11ml!, of tract infection and host-organism interrelationships. Are the presence of immunoglobulins in the perineal area protective to the host and to the invading organism in the unique environment of the kidney? The persistence of renal infection after some years despite a sustained immunologic response, as strikingly demonstrated antibody-coated bacteria, continues to challenge investigators working in the area of host-organism interrelationships. G.P.M. 2 tables, 59 references
Single-Dose Amoxidllin Treatment of Urinary T-ract Infections
J. Ped<, 99: 989-992 (Dec.) 1981 TheoreticaJly, doses of antimicrobials are efficacious in the treatment of lower of the of prolonged Other include assured c.vH;i,mauc.so, low cost, decreased selection of resistant strnins and less side effects. Studies on treatment with single doses are few and the results are conflicting. The authors used a single dose of 50 mg./kg. amoxicillin in 18 girls (2.2 to 15.8 years with documented tive) lower urinary tract infection. An additional 17 girls ;-eceived 10 days of therapy (40 mg./kg. 3 times daily). Details of culture results are presented. Of the 18 children 14 (78 per cent) were cured with a single dose (4 failures and 3 recurrences). Of the 17 children who received treatment for 10 days 15 (88 per cent) were cured (2 failures and 2 recurrences). Single-dose therapy has been shown ineffective in adults with upper urinary tract infection and, hence, the treatment group was limited in this study. Resistant organisms were included
1249
~'=~=~·~-'"rn,~